Diet for irritable bowel syndrome with diarrhea

Your IBS Sick Day Diet

Finding the right foods for managing IBS, especially when you’re having a sick day, is a lot like solving a mystery — piecing together clues and uncovering culprits. As you learn ways to ease symptoms like diarrhea and constipation, you’re likely to get overwhelmed by the long list of foods you shouldn’t eat. You want to know what you can eat when IBS symptoms strike so that you can stay well nourished.

Several studies have unearthed some clues — that following a low-FODMAP diet helps improve IBS symptoms and involves eliminating foods that are high in certain carbohydrates called FODMAPs, or fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.

However, the diet doesn’t offer specific dietary advice based on whether you’re having diarrhea or constipation, said Baharak Moshiree, MD, associate professor in the division of gastroenterology at the University of Miami Miller School of Medicine in Miami. Tweaking your diet based on specific sick day symptoms will help even more.

IBS Sick Day Diet: General Guidelines

Some people with IBS experience diarrhea and some experience constipation, while others cycle between both. It helps to have some strategies to turn to when your IBS symptoms act up.

Some diet changes will help regardless of which category you fall into. For one, start by eating small meals and make them low in fat. It’s better to grill foods using a light cooking spray than dousing your meal with oil, Dr. Moshiree advised. Red meat can also irritate the stomach, so it’s best to go for white meat.

Also, a high protein diet will help with both diarrhea and constipation, so choosing a piece of fish or chicken is better than a bowl of pasta. Because raw vegetables are more likely to cause gas and bloating, consider cooking your vegetables, Moshiree said.

It’s very important to know your own body and how it will react to different foods. Most people with IBS have a very hard time with dairy products, so eliminate them right off the bat.

You might also be sensitive to gluten, found in bread and baked goods made with wheat, rye, and barley. Moshiree tells her patients to do a two-week trial of eliminating gluten to see if symptoms improve. If they do, you probably need to follow a gluten-free diet, especially when your symptoms are acting up.

The same can be done for other food categories that are associated with IBS symptoms, such as foods with high fructose corn syrup, artificial sweeteners, and garlic and onions along with dairy. Once you know your trigger foods, you’ll know what you need to avoid when IBS is acting up.

Because gas and bloating is also an issue when you have constipation or diarrhea, pass on beans and other legumes and foods that contain insoluble fiber such as apples, grapes, and blueberries when you’re having symptoms.

Also remember to eliminate alcohol, which is known to provoke symptoms.

Diarrhea-Predominant IBS: What to Eat

When people are sick, they tend to turn to high-carbohydrate foods with sugars to feel better, but that’s not what you want to do when you have IBS, said Melissa Garrett, MD, gastroenterologist and assistant professor of medicine at Duke University Medical Center in Durham, N.C. That’s because many problems with IBS are from intolerance to some carbohydrates in foods.

Instead, try these meals when you’re having IBS-related diarrhea.

Breakfast:A bowl of oatmeal with cinnamon without sugar or artificial sweeteners.

Lunch: Grilled or baked fish or chicken and a baked sweet potato without butter.

Dinner: A spinach salad with lean protein such as grilled chicken (made without oil).

Snack: Protein shake or protein bar. Be sure to read the label and avoid products with high fructose corn syrup or artificial sweeteners because those ingredients alone can cause significant diarrhea.

Drinks: Moshiree tells her patients to hydrate with water or an electrolyte replacement drink like Hydralyte or Pedialyte when they have diarrhea.

Constipation-Predominant IBS: What to Eat

Figuring out what to eat when you’re constipated can be trickier, according to Dr. Garrett. Adding in some fruits and vegetables that are typically banned on a low FODMAP diet can help move your bowels, but they can also increase bloating. The key is to avoid gas-forming insoluble fiber. Choose stone fruits such as prunes and peaches over bananas and apples, she said.

Breakfast: Fresh peaches and prunes with peppermint tea or something with natural peppermint oil, which is a laxative, Dr. Garrett said.

Lunch: A fruit and vegetable salad with some lean protein such as fish and a little oil. If you don’t make it a heavy meal, it should help to relieve constipation, she said.

Dinner: Another light meal with a fruit, cooked vegetables or a salad with a little oil and vinegar, and lean protein such as fish or chicken.

Drinks: Water, tea, or coffee, which may act as a laxative.

IBS Sick Day: When Will You Feel Better?

How long symptoms last varies from person to person. As you work on your diet, remember to also work on lowering stress. Even when you’re eating perfectly, high stress may mean your symptoms will stick around, Moshiree said.

When you do start to feel better, Moshiree warns against rushing back to eating foods that you know make your symptoms worse; sample only in small amounts. That’s an individual thing you have to determine on your own.

If you eat a healthy diet and learn what to avoid when symptoms strike, you should be better able to manage your IBS.

Irritable Bowel Syndrome: Controlling Symptoms With Diet

How do I control irritable bowel syndrome with diet?

You can manage your irritable bowel syndrome (IBS) by limiting or eliminating foods that may bring on symptoms, particularly diarrhea, constipation, gas, and bloating. Make sure you don’t stop eating completely from any one food group without talking with a dietitian. You need to make sure you are still getting all the nutrients you need.

Tips for controlling symptoms

Here are some suggestions to get you started:

  • Try to eat meals at about the same time each day. Take time to eat.
  • Don’t skip meals or wait too long between meals.
  • Drink plenty of fluids. Be sure to drink water in addition to your other beverages. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
  • Limit or avoid caffeine, such as from coffee and tea.
  • Avoid alcohol and fizzy (carbonated) drinks.
  • Avoid foods that may cause gas and bloating. Vegetables such as artichokes, asparagus, broccoli, brussels sprouts, cabbage, cauliflower, cucumbers, green peppers, onions, peas, radishes, and raw potatoes may not be digested well by your body and can cause gas and bloating.
  • Limit your intake of fresh fruit and fruit juice. These are high in fructose. People who have IBS may not be able to digest fructose well. This can cause diarrhea, gas, and bloating.
  • Be careful eating some types of fiber. Fiber affects each person who has IBS in different ways.
    • If you have diarrhea, try limiting the amount of high-fiber foods you eat, especially if you have a lot of gas and bloating. This includes vegetables, fruits, whole-grain breads and pasta, high-fiber cereal, and brown rice.
    • If you have constipation, add fiber such as fruits, vegetables, beans, and whole grains in your diet each day and drink plenty of water.
  • Try the low-FODMAP diet. FODMAPs are carbohydrates that are in many types of foods. It stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. If you have digestive problems, these can make your symptoms worse. A low-FODMAP diet is when you stop eating high-FODMAP foods for about two months. Then you slowly add them back to your diet to see what foods cause digestion problems.

Avoiding foods that might be causing symptoms

Many people find that their irritable bowel syndrome (IBS) symptoms become worse after they eat. Sometimes certain foods make symptoms worse. Foods most commonly listed as causing symptoms include:

  • Cabbage.
  • Onions.
  • Peas and beans.
  • Hot spices.
  • Deep-fried and fried food.
  • Pizza.
  • Coffee.
  • Cream.
  • Smoked food.

Other types of food that can make IBS symptoms worse include:

  • A sugar found in milk, called lactose. Some people who have IBS also have lactose intolerance. This can make IBS symptoms worse when they eat or drink dairy.
  • A sugar found in vegetables and fruit, called fructose. In people who have IBS, fructose may not be digested as it should. This can cause diarrhea, gas, and bloating.
  • An artificial sweetener called sorbitol. If you have diarrhea, avoid sorbitol. It is found in sugar-free chewing gum, drinks, and other sugar-free sweets.

Keeping a food diary

Track what you eat, your emotions, activities, and your symptoms after eating. If you notice patterns of symptoms after eating certain foods, you can try removing those foods from your diet. The diary also can be a good way to record what is going on in your life. Stress plays a role in IBS. If you are aware that particular stresses bring on symptoms, you can try to reduce those stresses.

Fiber Types

There are two types of fiber: soluble and insoluble.

What type of fiber you should eat depends on what’s going on with you.

“Soluble fiber helps diarrhea by absorbing water and adding bulk to stools. Insoluble fiber, which is not digestible, may help with constipation but make diarrhea worse,” says dietitian Hilary Shaw.

Which is which? In fruits, vegetables, and whole grains, generally the outside, or skin, is insoluble. This is known as roughage. The soft inside is soluble.

Soluble fiber also helps to lower your cholesterol and control your blood sugar. Foods that have soluble fiber include:

  • Oats
  • Beans, peas, and other legumes
  • Sweet potatoes
  • Apples
  • Mangos
  • Plums
  • Berries
  • Peaches
  • Kiwi
  • Figs

These foods have insoluble fiber:

  • The skins of fruit
  • The skins of beans
  • Potato skin (especially when it’s crispy, but avoid french fries, which are high in fat)
  • Whole wheat, wheat bran, and whole-grain cereal products
  • Brown rice
  • Seeds
  • Broccoli
  • Spinach
  • Carrots
  • Cucumbers
  • Celery
  • Lettuce
  • Zucchini
  • Tomatoes

While you’ll likely have more options to add fiber to your diet when you make meals at home, there are easy ways to get it on the go. Davis recommends these choices:

For Breakfast:

  • Oatmeal
  • Oat bran muffin
  • Yogurt with granola

For Lunch or Dinner:

  • Have chili with beans topped with lettuce and tomato (add lettuce and tomato whenever possible).
  • Skip the white bread with your sandwich and choose a whole wheat bun, wrap, or pita instead.
  • Swap the meat for a bean patty.
  • Order a side salad, fruit, or small baked potato instead of fries.

Metamucil (Psyllium Fiber)

Metamucil is a natural fiber that can cure many bowel problems, including both constipation and diarrhea! It also has other health benefits such as lowering cholesterol and risk of colon cancer.

WHAT IS METAMUCIL?

Metamucil contains a special type of fiber called “psyllium”. Metamucil is the brand name of the product. You may also find generic brands of psyllium that are less expensive, but you may find that the brand name Metamucil works better for you.

Psyllium is a source of both soluble and insoluble fibre. Soluble fibre helps to soften stools. It will either form a gel-like material when added to water (such as psyllium fibre found Metamucil) or it will dissolve completely in water. Insoluble fibre does not dissolve in water. It moves through your digestive system largely intact so it helps to bulk up stools. Both kinds are important.

HOW DOES IT WORK?

The fiber works as a sponge. It absorbs the extra water and adds bulk to the stool. Think of your bowel as a tube of toothpaste: When there is not much toothpaste left in the tube, it is hard to squeeze out the toothpaste. However, when there is a lot of bulk and the tube is full, it is very easy to squeeze out the toothpaste.

If your stool is too hard, that same sponge-like fiber absorbs water up into the stool and softens it.

For these reasons, Metacucil can cure both constipation and diarrhea. It is like a miracle cure for all!

DON’T FORGET TO ADD WATER!

When taking Metamucil, you will need to remember to drink more fluids during the day as well. If you add too much fiber and bulk without adding enough water, this can make constipation worse.

Men may need to take in 10 cups of fluid per day. Woman may need to aim for 8 cups. (1 cup = 250ml)

HOW DO YOU TAKE METAMUCIL?

The most common form of Metamucil comes in a powder. You mix it in water and drink it. Metamucil also comes in a pill (capsule) form. The powder form is less expensive. For some people, the pill form is more convenient, but be prepared to be taking at least 6 to 12 (or more!) of the pills per day.

There is no “correct” dose of Metamucil to take. Everyone may need a different amount per day for desired effect. The trick is to start with a low dose, like 1 scoop per day (or 6 pills per day). Try this for 3 or 4 days in a row and see how things go. After 3 or 4 days at the low dose, if you are not having success with your bowel movements, then try increasing the dose a little higher, like to 1 scoop TWICE per day (or 6 pills TWICE per day). Then see how things go after 3 or 4 days more on that dose. You may have to adjust your dose further from there.

Again, everyone’s body is different and everyone will need a different amount for desired effect. Just keep adjusting your dose a little up (or down) every 3 to 4 days until you find the right amount that works for you.

WHAT NOT TO BUY!

Metamucil now comes in a different version that contains a fiber called INULIN, instead of psyillium. DO NOT BUY THE INULIN KIND.
It causes people to have lots of gas and cramping.

If you have gas, bloating, or a sensitive bowel, you may also be interested in learning about the FODMAP diet here.

Evidence-Based Management of Irritable Bowel Syndrome With Diarrhea

Irritable bowel syndrome (IBS), a complex disorder of the gastrointestinal tract, is characterized by abdominal pain associated with defecation or changes in stool form or frequency. IBS is associated with substantial burden, including direct medical costs and indirect costs. Direct costs associated with IBS in the United States have been estimated to exceed $1 billion. However, indirect costs, such as negative effect on quality of life (QOL) and work productivity, are difficult to quantify. There are 3 main subtypes: IBS with prominent diarrhea (IBS-D), IBS with constipation, and IBS with mixed symptoms of both constipation and diarrhea. A number of pharmacologic agents have been used to treat IBS-D despite lack of approval by the FDA for this indication. The pharmacologic agents that are indicated by the FDA for the treatment of IBS-D include alosetron, eluxadoline, and rifaximin. The negative impact of IBS-D symptoms on QOL reported by patients indicate there is an unmet need for therapies that effectively treat and manage the symptoms of this condition. Addressing gaps in treatment is an important priority.

Am J Manag Care. 2018;24:-S0 Irritable bowel syndrome (IBS) is a chronic, potentially disabling disorder of the gastrointestinal (GI) tract with a relapsing/remitting course in which abdominal pain is associated with defecation or changes in stool form or frequency.1-3
Diagnosis of IBS
The Rome IV criteria represent the current standard for diagnosing IBS. In 2016, the Rome III criteria were updated by a group of multinational experts in functional GI disorders.2,3 The most significant change from the Rome III criteria is the elimination of the term “discomfort” from the definition, as it is vague.3
The current diagnostic criteria for IBS include abdominal pain at least 1 day per week during the last 3 months that is associated with at least 2 of the following3:
Defecation
Change in stool frequency
Change in stool form (ie, appearance)
To receive a diagnosis of IBS, individuals must have symptoms meeting the diagnostic criteria for 3 months, with the onset of initial symptoms at least 6 months before diagnosis.3
The diagnosis of IBS should be based on a clinical evaluation of the patient, a physical examination, and laboratory tests (minimal) and, when clinically indicated, a colonoscopy or other appropriate tests.3 The clinical evaluation includes determining the presence of abdominal pain, assessing bowel and dietary habits, and the patient’s medical and surgical history.2,3
The presence of abdominal pain is required for a diagnosis of IBS. Pain usually occurs in the lower abdomen but can occur anywhere in the abdomen.3 The presence of disordered bowel habits is also required for a diagnosis of IBS.2 Disordered bowel habits include a history of constipation and/or diarrhea. The association of constipation and/or diarrhea with abdominal pain should be determined.3 Abdominal bloating is not required for a diagnosis of IBS but is often present and can support the diagnosis.2
Physical examination in patients with IBS usually reveals abdominal tenderness but rarely other abnormalities. Physical examination should include a digital rectal examination, particularly in patients with constipation. The presence of enlarged liver, spleen, or lymph nodes; ascites; or a mass suggests a condition other than IBS.2 A normal physical examination and the absence of warning signs (see Differential Diagnosis section below) in the patient’s history support using the Rome IV diagnostic criteria to confirm a diagnosis of IBS.2
Patients with IBS generally experience symptoms for extended periods before they receive a diagnosis. Individuals who have not yet been given a diagnosis of IBS may have an even greater burden of symptoms than those who have received a definitive diagnosis.4 There are several reasons for a delayed diagnosis of IBS. Not all individuals with IBS symptoms consult a physician about their symptoms; in the United States, 30% of individuals with symptoms of IBS do so, and of these, 80% have IBS with prominent diarrhea (IBS-D). Those who see a physician have symptoms similar to those who do not but have higher pain scores, more anxiety, and poorer quality of life (QOL).5
Although the Rome guidelines clearly define IBS, 72% of community providers (community nonexpert gastroenterologists, general internal medicine physicians, and nurse practitioners) consider IBS a diagnosis of exclusion, whereas just 8% of experts (IBS key opinion leaders) do. This shows a clear disconnect between academic guidelines and community practice. Those who believe IBS is a diagnosis of exclusion are more likely to order additional diagnostic tests than those who do not.6
Classification of IBS
IBS is classified into subtypes based on symptoms. Although subtyping is used to suggest treatment, it is thought that each subtype may include more than 1 disease entity, explaining the variable responses to treatment.2 The diagnostic criteria used to define the IBS subtypes are the predominant bowel habits based on stool form on days with at least 1 abnormal bowel movement.3
The Bristol Stool Form Scale (BSFS) is used to record stool consistency on days when patients are experiencing abnormal bowel habits and defines the following 7 types3:
Type 1: separate hard lumps, like nuts; hard to pass
Type 2: sausage-shaped but lumpy
Type 3: like a sausage but with cracks on the surface
Type 4: like a sausage or snake, smooth and soft
Type 5: soft blobs with clear-cut edges
Type 6: fluffy pieces with ragged edges, a mushy stool

Type 7: watery, no solid pieces, entirely liquid
To accurately classify the subtype of IBS based on bowel habit abnormalities using the BSFS, patients should not be taking any medications to treat their symptoms, including laxatives or antidiarrheal agents, during the period of evaluation. IBS subtyping is most accurate when patients experience abnormal bowel habits at least 4 days per month.3
The IBS subtypes comprise 3 classifications based on the predominant bowel disorder and include IBS-D, IBS with constipation (IBS-C), and IBS with mixed symptoms of constipation and diarrhea (IBS-M).3 Individuals with a diagnosis of IBS whose bowel habits cannot be classified as IBS-D, IBS-C, or IBS-M are considered to have unclassified IBS (IBS-U).3 Frequent changes in diet or medications or the inability to discontinue GI medications may interfere with accurate determination of IBS subtype.3
The IBS-D subtype is defined as follows: More than 25% of bowel movements using the BSFS are type 6 or 7, and less than 25% of bowel movements are type 1 or 2. Alternatively, for epidemiologic studies and in clinical practice, if the patient reports abnormal bowel movements that are usually diarrhea, the patient can be considered to have IBS-D.3 Experiencing bowel patterns with at least 3 different types of stool in a week also supports a diagnosis of IBS-D.3
The IBS-C subtype is defined as follows: More than 25% of bowel movements are type 1 or 2 using the BSFS, and less than 25% are type 6 or 7. Alternatively, for epidemiologic studies and in clinical practice, if the patient reports abnormal bowel movements that are usually constipated, the patient can be considered to have IBS-C.3
The IBS-M subtype is defined as follows: More than 25% of bowel movements using the BSFS are types 1 and 2, and more than 25% are types 6 and 7. Alternatively, for epidemiologic studies and in clinical practice, if the patient reports abnormal bowel movements that are usually both constipation and diarrhea, the patient can be considered to have IBS-M.3
Patients who have the IBS-U subtype meet the diagnostic requirement for IBS, but their bowel habits cannot be accurately categorized as IBS-D, IBS-C, or IBS-M.3
Differential Diagnosis
IBS is not a diagnosis of exclusion.2 However, IBS shares symptoms with other conditions that should be ruled out during diagnosis. Warning signs that suggest a diagnosis of a condition other than IBS are also known as “alarm” features or red flag symptoms. Alarm features include fever; weight loss; waking during the night as a result of GI symptoms; blood in the stool (including occult blood); family history of colon cancer or inflammatory bowel disease (IBD); recent use of antibiotics; newly onset, progressive symptoms; and onset of symptoms after age 50 years.7
A limited number of laboratory tests may be conducted to identify conditions other than IBS in patients,3 including a complete blood count. Thyroid tests may be appropriate for some patients.3 Stool tests for bacteria and parasites or their eggs may be warranted in areas where infectious causes of diarrhea are common.3
Bacteria that cause acute gastroenteritis, a known precipitant of IBS-D, produce cytolethal distending toxin B (CdtB). Circulating antibodies to CdtB (anti-CdtB) also cross-react with the intestinal protein vinculin. Titers of anti-CdtB and anti-vinculin are elevated in individuals with IBS-D compared with healthy individuals or those with celiac disease and can therefore be used as biomarkers for IBS-D.8 Celiac disease can also be distinguished via other serologic tests and confirmational duodenal biopsy.3
Serum C-reactive protein and fecal calprotectin can be used to rule out IBD in patients with typical IBS symptoms. However, the erythrocyte sedimentation rate and fecal lactoferrin are not useful for ruling out IBD in patients with IBS.9
Screening colonoscopy is warranted in patients 50 years or older, African Americans 45 years and older, patients who have a family history of colorectal cancer, those with persistent diarrhea that has not responded to empiric therapy, and those with alarm signs of other disorders.2 These recommendations are identical to the national recommendations for the general population.2
Epidemiology of IBS
In a meta-analysis of 10 studies (N = 52,790), the pooled prevalence of IBS in the United States was estimated to be 11.8% (95% CI, 7.4%-17.2%).1 IBS is reported more frequently in women than in men and in individuals aged 30 to 49 years compared with those 50 years and older.1 In another meta-analysis of 14 studies of patients with IBS, the prevalence of IBS-D was highest, accounting for 40.0% of the patient population (95% CI, 31.0%-48.0%); the prevalence of IBS-C was 35.0% (95% CI, 29.0%-41.0%); and the prevalence of IBS-M was 23.0% (95% CI, 15.0%-31.0%).1
Pathophysiology of IBS
IBS is a complex disorder with a pathophysiology3 that is not completely understood.10 Risk factors for IBS in susceptible individuals include a genetic predisposition to the condition, exposure to environmental factors, and psychosocial factors (eg, an abnormal stress response).3
The onset or exacerbation of IBS symptoms can be caused by previous gastroenteritis, food intolerances, chronic stress, diverticulitis, or surgery.3
IBS symptoms may be caused by altered intestinal permeability resulting from infections, inflammation, or changes in the gut microbiome, all of which can trigger a release of inflammatory mediators such as cytokines or chemokines. These inflammatory mediators could lead to changes in the central nervous system that result in new onset of anxiety and depression; this, in turn, can further exacerbate IBS symptoms in a feedback loop.2 About half of IBS cases originate in the gut rather than the brain, and psychological stress develops after IBS symptoms.2
IBS-like symptoms are known to persist in 10% to 20% of individuals who have had acute bacterial, protozoan, or viral gastroenteritis and can be associated with intestinal inflammation. More than 30% of individuals who have experienced gastroenteritis develop IBS-D, which is referred to as postinfectious IBS (PI-IBS).10 The pathophysiology of PI-IBS is thought to be different from that resulting from other causes.2 Viral gastroenteritis is less apt to lead to PI-IBS than bacterial enteritis or protozoan or helminthic infections.11

Clinical Burden and QOL Associated With IBS

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IBS Diet: The Foods You Can Eat

Many people with irritable bowel syndrome (IBS) feel unable to eat various foods because of the unpleasant way their bodies respond. While some foods may be problematic, there are still many foods that people with IBS can safely eat. Dining out may still be enjoyable and patients’ diets can consist of a wide range of foods.

If you have IBS, you may be able to minimize symptoms triggered by foods with a healthy, balanced diet of three meals and 2-3 snacks a day. It is important to ensure your diet is rich in fibre, low in fat, and includes lots of fruits and vegetables.

It is very important to note that IBS and diet is a very individual thing in that what works for one person with IBS might not work for someone else. However, over time, patients, dietitians, and doctors have identified some foods that seem to cause problems for a number of people. We encourage you to eat a wide variety of foods and some of these suggestions might work for you. However, if these suggestions cause a negative reaction, then you should avoid them.

IBS Diet Suggestions:

  • Eat all cooked vegetables, except perhaps cabbage, cauliflower, and broccoli – which might cause too much gas – however, if they are your favourite foods and they don’t cause problems for you, then go for them too.
  • Try fruits without the skins. Some people might have problems with melons, apples, and citrus fruits.
  • Some IBS patients benefit from increasing the fibre content of their diet. When it comes to fibre, increase this slowly and ensure a water intake of 1.5-2L/day.
  • Bran fibre may aggravate some symptoms of IBS so be alert for any negative reactions to this food.
  • Usually people with IBS can tolerate bread, pasta, rice, bagels, and crackers, in any variety including rye, whole wheat, white, gluten free, etc. Some find seeds challenging, but experiment to see if they bother you or not.
  • Dairy products only cause problems for people who are lactose intolerant, so enjoy these products freely. If you have lactose intolerance as well as IBS, you could try lactose-free products or a Lactaid® pill.
  • Enjoy all meat, chicken and fish.
  • Some people have problems with heavily spiced, sauced, or fried foods.
  • Try choosing these snack foods: pretzels, baked potato chips, rice cakes, frozen yogurt, low fat yogurt, and fruit.
  • Look for low-fat items to enrich your diet.
  • For the foods that are potential IBS symptom triggers for you, try introducing them back into your diet by having a small portion and choosing only one trigger food at a time.
  • A good trick for some people is to take 1-3 tsp or three capsules of a soluble fibre supplement before a potential trigger meal. The supplement may protect against developing symptoms. Be sure to go slowly when adding fibre to your diet.
  • Prepare foods by grilling, broiling, baking, or steaming with little to no oil. Try using a cooking spray in place of oil.

IBS Diet Tips While Away From Home

When it comes to eating out, try to choose foods that would be the most similar to what you would eat at home. Order sauces and dressings on the side, avoid fried food, ask for limited spices, avoid foods that are oil-heavy, have a small portion of dessert, and don’t overeat!

When you are at a party or a friend’s house, if possible, let the host know your food preferences and needs, but if you cannot, then stick with the food you know you are safe with and have only a small portion of a known trigger food. If you are still hungry, eat when you get home.

Although, IBS can be challenging when it comes to food, it is important to take the perspective that there are still many foods to enjoy. Most importantly, start with a balanced and regular diet and then try the foods discussed above. If you are still experiencing symptoms, keep a food-symptom diary to help rule out the trigger foods and point out your safe foods. Most importantly… Enjoy and Bon Appetit!

Low FODMAP Diet for IBS

For some individuals with IBS, a diet low in Fermentable Oligo-, Di-, and Mono-saccharides, And Polyols (low FODMAP) may reduce symptoms. The premise is that food fermenting in the gut leads to uncomfortable side effects that mimic or magnify IBS symptoms. Read more about the low FODMAP diet here.

Naomi Orzech, Dietitian, Life Screening Centers
Photo: .com
First published in the Inside Tract® newsletter issue 154 – March/April 2006

5 Winning Ways to Live a Normal Life with IBS

Whether you’ve recently received a diagnosis or have been struggling with the symptoms of IBS (Irritable Bowel Syndrome) for some time, these proven lifestyle tips from Weill Cornell Medicine will help you continue to pursue all of your travel, relationship, and career goals.

It’s true that IBS symptoms can have an impact on your day-to-day decisions; however, preparation is the key to successful management. Solid planning will eliminate the nervousness and fear that might be preventing you from participating in your favorite activities.

1. Take Your Comfort with You

You know best what makes you comfortable. Packing up those necessary items and having them on hand will encourage you to step out boldly. Keeping a backpack full and ready in your vehicle, under your desk, or waiting by the door will allow spontaneous participation in life’s surprises. Grab it and you are ready to go.

It might include:

  • A change of clothes
  • Baby wipes
  • Needed medications or remedies
  • Healthy snacks
  • Drinking water

2. Expect the Best

Planning activities that you enjoy or that are important to your goals is an empowering step toward proactively living with IBS diarrhea or constipation. Taking positive daily action improves your wellbeing, and incorporating regular exercise into your day helps regulate your bowels.

Make intentional eating choices such as:

  • Eating small meals several times per day to reduce bloating
  • Trying probiotics, kefir, or aloe vera juice to promote healthy digestion
  • Drinking plenty of water to counteract IBS constipation or diarrhea
  • Incorporating whole grains, including brown rice, whole wheat pasta, or grainy breads
  • Following a low FODMAP diet, which will help you identify foods likely to cause symptoms to flare up

3. Plan Around the Pitfalls

Plan ahead and know where restrooms will be available along your route and at your destination. If you are traveling, book or choose an aisle seat near the facilities, and learn how to ask the right questions in the local language.

Avoid your known dietary triggers when away from home, including:

  • Dairy products
  • Artificial sweeteners
  • Vegetables known to cause gas, such as broccoli, cauliflower, cabbage, and beans
  • Sugary, fried, or fatty foods
  • Alcohol, caffeine, or soda

4. Prioritize Your Goals

Use what you’ve learned about yourself to prioritize your scheduling. Schedule your most important commitments for those times of day you are most likely to feel your best. Have important meetings before lunch, avoid meetings centered around eating if possible, and have your safe snacks and comfort kit along for the ride.

A break between appointments allows you to rest, refresh, or even change if necessary. Knowing that break is there will reduce your anxiety and help you keep a relaxed flexibility in your schedule. Remember to save time and energy for those most important moments and don’t stress about the rest.

5. Have Strong Allies Beside You

Having a supportive friend, family member, or co-worker who understands your condition and your symptom management strategies is a huge help. Someone who can fetch your backpack, help you avoid dietary temptations, or will fill the gap for you during a short break can make all the difference when attending a major event or important meeting.

Your medical support team should also be a strong ally in living a full and normal life. At Weill Cornell Medicine we offer innovative treatments delivered by the best gastroenterologists doctors in NYC. Our expert understanding of your symptoms, treatment options, and goals will provide the support and compassion you need to live your best possible life.

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Study: Low FODMAP Diet Improves Quality of Life for IBS Patients

Living with a gut disorder such as irritable bowel syndrome can be difficult.

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While the physical symptoms can be a nightmare for patients, the emotional toll is often just as devastating. Patients with IBS show higher levels of depression and anxiety compared with people without the disorder, one recent study found.

University of Michigan researchers think they can offer a recipe for hope: the low FODMAP diet, an elimination diet that removes carbohydrates assumed to prompt IBS symptoms.

U-M gastroenterologists Shanti Eswaran, M.D., and William D. Chey, M.D., recently studied the effects of the low FODMAP diet on IBS patients’ health-related quality of life, anxiety and depression levels, work productivity and sleep quality.

Their findings, published in Clinical Gastroenterology and Hepatology, are promising.

“We found that patients on the low FODMAP diet were more than twice as likely to have improvement in their quality of life than those who were randomized to the usual dietary advice for IBS patients,” says Eswaran, who is also a clinical assistant professor in the department of internal medicine at Michigan Medicine.

Although Eswaran’s prior research has proved that IBS patients following the low FODMAP diet will see improvements in abdominal pain and bloating, she notes that those aren’t always the factors that motivate patients to seek medical help.

“Patients really come to see us when their symptoms impact what they are doing,” she says. “They will tell us, ‘I can’t work because of my symptoms, or I don’t feel comfortable going out shopping or on a road trip because of my symptoms.’

“It’s really when IBS starts to impact their quality of life and their goals that they really start to seek care.”

Dietary changes bring results

Eswaran and Chey conducted a prospective, single-center, single-blind trial of 84 adults with IBS and diarrhea.

SEE ALSO: Clinical Trial Demonstrates Success of Low FODMAP Diet

Participants were randomly split into two groups. One group was placed on a low FODMAP diet, and the other adhered to mNICE, a modified diet recommended by the National Institute for Health and Care Excellence (part of the Department of Health in the United Kingdom).

The mNICE diet, Eswaran says, is essentially a common-sense diet that encourages patients to avoid foods they think trigger their symptoms. It also advises them to eat smaller meals throughout the day (instead of two or three large meals) and avoid excess alcohol and caffeine.

The low FODMAP diet, which is a bit more complicated, excludes many sugars and other carbohydrates found in wheat, milk and other dairy products, certain fruits and vegetables, garlic, onions and sugar substitutes.

U-M researchers assessed IBS-related quality of life, psychosocial distress, work productivity and sleep quality at the beginning and end of a four-week period.

Ultimately, the group that followed the low FODMAP diet fared better. At four weeks, those patients had a larger mean increase in their IBS quality-of-life score than patients on the mNICE diet.

Likewise, their anxiety scores, based on the Hospital Anxiety and Depression Scale, decreased. And activity impairment, based on the Workplace Activity Impairment Questionnaire, was also significantly improved with the low FODMAP diet compared with mNICE.

Eswaran thinks improvements in key IBS symptoms such as pain and bloating are the main quality-of-life benefits of the low FODMAP diet.

Eswaran also hypothesized that IBS patients on the low FODMAP diet may have experienced less anxiety because their physical symptoms improved — which led them to feel better overall.

Dietitians key to adherence, wellness

While the study results are highly encouraging, Chey points out a few caveats that IBS patients should know before trying the low FODMAP diet.

SEE ALSO: An Evolving ‘Holistic’ Approach to Treat IBS

Most important: a dietitian’s help to navigate the complexities that the shift requires.

“The low FODMAP diet should be done in three phases,” says Chey. “There is a two- to six-week elimination phase that is followed by a reintroduction phase and then a maintenance phase.”

Chey, director of U-M’s GI Physiology Laboratory and director of the Digestive Disorders Nutrition & Lifestyle Program, says many gastroenterologists in the United States recommend dietary changes to their patients with conditions such as IBS.

But few, he notes, incorporate the services of a registered dietitian. That’s often due to limited resources or a lack of access to registered dietitians with adequate training in nutritional counseling for GI disorders.

“For this reason, we created a comprehensive low FODMAP educational website (myginutrition.com) and a training program for dietitians with an interest in caring for patients with digestive and liver disorders,” says Chey.

The training sessions, which he plans to hold annually, provide dietitians and other health care professionals with a foundation in the pathophysiology, diagnosis and medical management of common — as well as complex — gastrointestinal diseases and disorders. The course will also train enrollees to appropriately assess, implement and monitor a nutritional care plan.

New research planned

Eswaran plans to create a road map for effectively carrying out the phases of the low FODMAP diet. She then hopes to share a standard of best practices for implementing the diet with other medical institutions, gastroenterologists and health care providers.

More research, meanwhile, is underway.

“We’re doing a trial now looking at the reintroduction phase,” she says. “Our goal is to try and standardize the best approach to give dietitians an algorithm or a plan to reintroduce foods back into a patient’s diet. Right now, it’s pretty much trial and error.”

As a successful full-time blogger in London, Scarlett Dixon kept her irritable bowel syndrome (IBS) diagnosis a secret from anyone aside from her teachers and parents for five years. When she finally opened up about it, at age 19, with a post on her lifestyle blog, the reactions shocked her.

“My first post got more than 100,000 views, lovely comments, and lots of emails from people all over world sharing their story,” says Scarlett. “It’s become a community of people instead of just me against IBS.” Now 22, Scarlett says she’s glad she shared her story, since it’s helped her to realize she’s not alone. “A lot of women have digestive issues, even if it’s on an infrequent basis, and we don’t speak about it,” she says. “But it shouldn’t be taboo, and people shouldn’t have to suffer in silence.”

Scarlett Dixon

A Disorder in Disguise

Scarlett says she’s had problems with her stomach for as long as she can remember. “I was always having either diarrhea or constipation and was constantly worried about being near a toilet,” she says. “Being a teenager is hard enough without that on top of it.”

Her first major IBS flare-up happened at 8 years old, when she was sent home from school on her birthday. “I was in so much pain and crying,” she says. Yet it wasn’t until she was 14, following stressful exams, that she finally saw a doctor and got diagnosed.

According to the National Institutes of Health (NIH), IBS is what doctors call a “functional gastrointestinal disorder,” or a collection of symptoms—including pain in your gut and changes in your bowel movements—that signify your bowels aren’t working correctly despite a lack of damage due to a disease. The exact cause is unknown.

“I get bad stomach cramps and pain,” explains Scarlett. “It feels like something is stuck, like there’s a knife inside my stomach. It’s left me waking up in the middle of the night thinking I was dying because it was so painful.”

“It’s a shame I kept my IBS in the dark for so long.”

People sometimes confuse IBS with other gastrointestinal issues, like food poisoning, says Scarlett—but it’s much more serious. A really bad bout for Scarlett can last a few weeks, all day every day. Even when the pain does subside, a flare-up is still a downer. “It makes you feel really exhausted, and you don’t eat properly because you don’t feel like eating, and food can aggravate IBS,” she says. “And you’re not sleeping well. Sometimes it knocks me out and I have to go home and lay down with hot water bottle.”

Bloating—which Scarlett says feels like a giant basketball in her stomach—is another common, aggravating symptom. “Sometimes I look five months pregnant,” she says. “I have to have so many dress sizes in my wardrobe, because if I’m really bloated that way I don’t have to wear uncomfortable clothes.”

RELATED: 4 Women Share What It’s Like to Live with an ‘Invisible’ Disease

Dating with IBS

Scarlett remembers her high school boyfriend once making a joke in passing along the lines of, “girls don’t fart or go to the toilet.” All of her friends were laughing, and it seemed like an innocent enough comment.

“I thought if that’s what he thinks, if he only knew I had these problems with my stomach,” says Scarlett. “It’s not ladylike. I’m sure he didn’t mean it in a negative way. But there’s a stigma attached, especially for girls, and boys play on that. You’re at that age when you’re embarrassed about a lot of things, and you don’t want to have to talk about your body and how it’s not functioning right.”

In fact, according to the NIH, although an estimated 10 to 15 percent of U.S. adults have IBS, only 5 to 7 percent actually get diagnosed. And perhaps more surprising, it’s actually more common in younger than people than those over 45.

“Sometimes I look five months pregnant.”

Scarlett recalls a holiday vacation she took with that same high school boyfriend and his parents in Europe. For a week, they shared a small house with a very un-private bathroom. “There was a hole in the wall,” she says. “Everyone could hear everything that went on in that bathroom and probably see as well. I immediately felt conscious and awkward. I had a really bad week with my stomach, and I’m not sure whether he noticed or not. I just remember being in so much pain, feeling like I had to shroud my condition in secrecy. It ruined the whole week for me.”

Scarlett says she always chooses first date spots where it would be easy to discreetly escape to the restroom. “It would be very difficult for me to go on a first date in a quiet, intimate environment, like a guy cooking dinner at his house,” she says. So her dates have always been in a restaurant. “You can always excuse yourself, plus there’s lots of distractions,” she says. “Not all the focus is on you.”

RELATED: This Is What It’s Like to Date When You Have an ‘Invisible’ Disease

Opening Up

Scarlett’s current boyfriend, David, is the first partner she’s opened up to about her IBS—and it was by accident. When they first met, she told him about her blog, forgetting about her posts on IBS. David read them all that night and immediately texted to tell her he was there to talk, and that he had a friend with IBS. “I don’t know that I would have otherwise shared all of that with a guy I was dating,” she says.

Later, on one of their first dates, David told her that his stomach was a bit dodgy because of something he’d eaten. “I remember thinking, ‘What am I worried about? Everyone has stomach issues from time to time. It’s not something I have to hide,'” she says. “From then on, I just didn’t feel so nervous about it.”

Since then, Scarlett says she’s been able to talk to David about everything. “I never had to explain,” she says. “He knows that sometimes I have to say I can’t eat this or that. There can be this perception that you’re being fussy or you’re trying to be trendy on a diet. But he’ll call ahead and tell the restaurant or pull the waiter aside and explain for me. It really takes the pressure off that there’s someone with you on your side.”

Scarlett Dixon

Finding a Treatment That Worked

Over the years, Scarlett says her doctors prescribed her “every one” of the medications available to treat IBS, and none of them provided any relief. At one point, says Scarlett, a doctor prescribed her low-dose antidepressants to help with the pain (depression has also been linked with IBS). “Obviously they’re a serious med, and that caused a whole other host of issues,” she says. “Like, I couldn’t wake up. I’d sleep 16 hours a day. I had no energy, and I gained a lot of weight.”

By age 21, Scarlett says IBS made it so she couldn’t function in daily life. “I was waking up every night in agony, ringing the doctors saying there must be something seriously wrong with me, telling my mum, ‘I don’t think I can go to university anymore,'” she says. “I thought, ‘This is not how want to live life as a 21-year-old.'”

That pain finally forced her to commit to making the change. “Before I never really gave myself the time to understand why it was happening and if I could change it,” she says.

Scarlett took the York test, a mail-order test that looks for IgG antibodies, markers of a food intolerance. Not all people with IBS have a food allergy or intolerance, according to the American Academy Allergy, Asthma, and Immunulogy, and some experts say the IgG test isn’t the most accurate diagnostic tool. But for Scarlett, it worked. She cut eggs and dairy, as well as almost all processed foods and chocolate, out of her diet. “I did so much research,” she says. “I kept a food diary every day for three months. It was a commitment. I needed to stick with it, because changes weren’t going to happen overnight.”

She also got a colonoscopy, and doctors discovered her colon was double the average woman’s. “My doctor told me mine is extra loopy and twisty, so it’s harder to push food through,” she says. (IBS is about twice as common as women as it is in men, perhaps in part because women’s colons are longer than men’s, according to the the NIH.)

Within three months of her new diet, Scarlett not only felt better, she’d lost about 40 pounds. “It was surprising because it wasn’t intended,” says Scarlett. “But it showed me what I was doing to my body with what I was eating before. It’s helped me to make healthier choices.”

“Everyone could hear everything that went on in that bathroom and probably see as well.”

Another condition often linked to IBS is anxiety—which Scarlett says still plagues her, though she’s working on it. “I’d worry about my stomach flaring up, and my stomach would flare up because I was worrying,” she says. She’s found cognitive behavioral therapy, which helps change the way you think about things, helpful. “It teaches you how you respond to those thoughts,” she says, “It’s been really helpful, because I’m a natural worrier. I like to be in control. But with IBS you don’t have control.”

Although Scarlett says she’s still not IBS-free, she’s found a lot of relief from her symptoms. “It doesn’t plague or control me,” she says. “That’s my health sore. Some people have really bad period pains or migraines. For me it’s IBS.”

RELATED: 4 Women Share What It’s Like to Have Colon Cancer

Tips and Tricks for Other Women with IBS

In addition to talking to a nutritionist with doctor, Scarlett recommends keeping a food diary so you can watch out for foods that trigger symptoms. “If I’ve eaten a food that’s a trigger, I’ll feel it within a few hours,” she says.

Scarlett says that a lot of people tell her that life must not be worth living without cheese or chocolate. “Before, I’d have a family-size chocolate bar every night,” she says. “I really loved it.” But she’s learned not to miss these foods. “I like way I feel without them, so I never really miss them,” she says.

When her IBS does flare up, Scarlett says making time for self-care helps her still feel sexy. “You want to feel glamorous, but it’s hard when you’re feeling crap inside,” she says. “When I’m feeling like that, it helps to experiment with makeup. It’s also nice to have a couple go-to outfits you can still wear and feel good in. It’s all about learning to live with it and not wallowing in fact of how you feel.”

While it hasn’t been easy, Scarlett says IBS has changed her life in many ways for the better. “I was always on so many diets because I wanted to lose weight,” she says. “But I’d do it for two weeks thinking I’d be my dream size, and it’s not how it works. As a byproduct of changing my diet, I have to go for healthier options and stick with them. It teaches you to respect your body.”

Colleen de Bellefonds Colleen de Bellefonds is an American freelance journalist living in Paris, France, with her husband and dog, Mochi.

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