Changing your diet is one of the most effective ways to manage irritable bowel syndrome. Learn how nutrition therapy for IBS can help manage your condition.
·November 6th, 2021
Nutrition therapy for IBS has shown good results for people living with irritable bowel syndrome (IBS).
Diet is a key part of managing the symptoms of IBS, yet there’s no one diet that’s perfect for everyone.
Symptom control is ultimately a matter of finding the right diet for you, but that’s not always easy.
Dietary approaches include elimination diets; low-gluten or gluten-free diets; low-FODMAP diets; and low-dairy or dairy-free diets.
A nutrition therapist or dietitian can guide you through the process of trial and error to help you feel better, faster.
Changing the way you eat can be one of the most effective ways to control the symptoms of irritable bowel syndrome, but nutrition therapy for IBS can be complicated; many people find they can’t figure out the best approach on their own. While there are several dietary approaches you can try, a nutritionist or dietitian can guide you through the process of finding the dietary changes that work best for you.
Diet as IBS therapy
Diet as a complementary therapy for IBS is a popular approach, and with good reason. Many people with IBS find that when they hit on the right foods to eat and foods to avoid, they feel better. Unfortunately, however, because there doesn’t seem to be just one cause for IBS, there’s no single solution that works for everyone.
Still, nutrition therapy for irritable bowel syndrome has some distinct advantages over other treatment methods:
It’s non-invasive. There is little risk of harmful side effects or complications.
It’s convenient. There are few appointments to keep, no procedures to schedule, and no visits to the pharmacy.
It has few contraindications.Outside of a few foods, it’s unlikely to interfere with medications or other treatments.
It doesn’t require any medical equipment or drugs. All you need is some education and planning.
It’s easy to manage. Dietary changes are easy to make. With support from a nutritionist or dietitian, you can test foods and reactions and develop a diet that works for your specific symptoms.
Before starting nutritional therapy for IBS
If you’re like most people with irritable bowel syndrome, your doctor has probably introduced you to nutritional therapy for IBS by recommending you take a close look at what you eat. The best way to do that is to have a plan before you start.
Here are a few steps you should take before undergoing a serious nutritional therapy plan:
Have a full allergy screen. Allergies can fade or emerge over time, so having an up-to-date view of possible allergens to avoid will be useful.
Discuss dietary restrictions with your doctor. If you have other conditions, be sure you’re aware of any foods you should be avoiding. Also ask about potential complications of your chronic conditions, such as vitamin or nutrient deficiencies.
Ask about GI testing. Ask your provider if you should be tested for gastrointestinal disorders, such as celiac disease or lactose intolerance. Although some GI conditions are rare, ruling them out can save time and aggravation.
Make a list of foods you eat regularly. If you’re eating a specific food for some sort of benefit, such as a nutrient you feel you need more of, share that with your nutritionist/dietician.
Track your physical activity. This will help to determine your overall energy needs. For example, if you’re exercising regularly or plan to begin an exercise regimen, your nutritionist/dietician will need to factor that into your plan.
Cut down on caffeine and alcohol. Caffeine has been shown to significantly increase the severity of IBS symptoms, and alcohol intake may irritate the gut. Any dietary approach will likely remove these from your diet, so starting now will give you a leg up and help you determine how much these substances may contribute to your symptoms.
Stick to a regular eating schedule. Avoid skipping meals, eating late at night, or rushing through food.
General dietary guidelines
For a long time, less fat and more fiber was seen as the best way to eat, and this remains, in a broad sense, good advice. Almost any diet, aside from very specialized ones, will generally be heavier on fiber than fat. However, people with IBS have more specific concerns.
An overview of current dietary approaches recommends increasing fiber consumption while avoiding wheat bran, limiting fat intake to current dietary guidelines, and avoiding processed foods, including foods high in refined sugar, as much as possible.
As you’ll see below, the interplay of different nutrients in what you eat often relies as much on your gut microbiota, your specific IBS symptoms, and your overall lifestyle as it does with a specific diet.
Following are a few diets people with IBS symptoms often try first to develop a sense of what works for them.
Typically, this is the first approach providers will suggest. There are two common elimination strategies:
Allergen elimination. The first step is often eliminating foods from your diet based on your allergen profile or foods known to be common allergens.
Phasing out of other potential allergens. If you don’t have any notable allergies, or if you’ve cut out the allergens and you still have symptoms, your provider will likely recommend phasing out common suspects to see if there’s an effect.
In a sense, all of the diets mentioned below are elimination diets, as they leave out certain food groups. Yet as everybody (and every body) is different and our bodies change over time, this is often the best place to start before moving on to a more specific approach.
Low-gluten or gluten-free diets
One of the more popular approaches in recent years has been the low-gluten or gluten-free diet. Gluten is a protein generally found in wheat products, such as flour and seitan. Gluten is what gives bread its chew.
A 2021 study found that for certain types of functional bowel disorders, particularly those involving diarrhea or bloating, limiting gluten eased symptoms, especially in the presence of other factors pointing towards a gluten intolerance.
For people without that intolerance, however, the overall effectiveness of a low-gluten or gluten-free diet is less clear, as there may be some overlap between IBS symptoms and gluten and FODMAP sensitivities.
FODMAP stands for “fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.” These are short-chain carbohydrates, made of ten sugars or less, that can be difficult for the body to break down and absorb. As they linger in the large intestine, they draw water into the gastrointestinal tract, often causing loose stools.
FODMAPs can also ferment as bacteria snack on them, turning into gas and producing discomfort.
FODMAPs are common in just about everything we eat: processed food, fruits and veggies, even dairy and meats. They’re so common, in fact, that many people who believe they have an intolerance for gluten may have a problem with the FODMAP fructan instead.
That said, while many patients responded to a low-FODMAP diet in a 2020 review of studies, not all did. In some studies, many of those who experienced improvement also underwent yoga or gut-directed hypnotherapy to reduce anxiety and depression.
If you are considering trying a low-FODMAP diet, we recommend you keep an open mind and don’t expect a cure-all.
Low-dairy or dairy-free diets
One notorious FODMAP that causes stomach distress is lactose. Most commonly found in dairy products, lactose is a sugar that can only be effectively digested by people with a high amount of the enzyme lactase. Without enough lactase, the sugar passes directly into your large intestine, where bacteria eat it, causing digestive symptoms.
Curiously, a 2020 study found that while a high number of IBS patients report symptoms after consuming dairy, there’s little objective evidence that dairy directly triggers an IBS attack. What’s more, lactase supplements didn’t change the frequency or intensity of attacks after participants ate dairy products.
That said, the mechanism matters less than the results, so if you think dairy might be causing problems for you, you can try eliminating it.
The importance of working with a nutritionist or dietitian for IBS
“It remains challenging to identify what combination of treatments may be best to ensure a personalized approach and overall higher response rates to IBS therapy.” – 2020 review study
Pinpointing a dietary cause for IBS is challenging for a number of reasons.
While you can certainly keep trying new diets or eliminating foods one at a time, chances are good that it will take a long time before you stumble onto changes that improve your symptoms.
In many cases, it takes multiple changes to bring about improvement in digestive issues. Some people may never find the right combination of therapies on their own.
Working with a nutritionist or dietitian to find the cause of your digestive issues can speed the process so you feel better, faster. A dietitian or nutrition therapist for IBS will take your entire history into account to get a full picture of your nutritional needs and potential sensitivities.
They can guide you through what’s in each food, how it might affect you, and whether it needs to be in your diet. They can help you develop a “bigger picture” of what you eat overall, how it reacts with other foods, and what changes you’ll need to make.
They also can point you to replacement foods and recipes so you don’t have to give up everything you love to eat.
Eventually, you and your nutritionist or dietitian will be able to fine tune your diet to keep your IBS in check while making sure you get the calories and nutrients you need.
For more information
To learn more about complementary and alternative medicine therapies to improve gut health, follow our blog. To find a nutritional therapist or dietitian near you, visit our provider directory today.