Diet and Irritable Bowel Syndrome (IBS)
Irritable Bowel Syndrome (IBS) is a common illness. It affects around 1 in 5 adults. The cause of IBS is not known, but stress, diet and lifestyle can increase symptoms. This leaflet explains some of the things you can do to help your IBS symptoms.
- Eat in a healthy way.
- Do more exercise.
- Have 6-8 drinks every day.
- Drink less caffeine.
- Cut down on fatty foods, if you get pain after meals.
- Do not eat spicy foods if you get pain after eating them.
- Drink less alcohol.
- If you are constipated, eat more high fibre foods.
- Linseeds can help.
- You could try taking probiotics.
- Do not have the artificial sweeteners found in chewing gums and sugar free sweets.
- Some people find that peppermint oil helps with pain or bloating.
- Try ways to help you cope with stress.
- Only when first line advice has been trialled, can the low FODMAP diet be considered.
Healthy eating habits
Have a balanced diet based on the ‘Eatwell Guide’.
Potatoes, bread, rice, pasta and other starchy carbohydrates
Choose wholegrain or higher fibre versions with less added fat, salt and sugar.
Oils and spreads
Choose unsaturated oils and use in small amounts
Daily and alternatives
Choose lower fat and lower sugar options
Beans, pulses, fish, eggs, meat and other proteins
Eat more beans and pulses, 2 portions of sustainably sourced fish per week, one of which is oily (e.g sardines, mackerel, salmon). Eat less red and processed meat.
Fruit and vegetables
Eat at least 5 portions of a variety of fruit and vegetables every day.
Some people find that peppermint oil, peppermint capsules or peppermint tea help bloating, pain or cramping.
Stress and anxiety
The gut is closely linked to the brain and symptoms can be worse in times of stress or anxiety.
Try ways to relax and manage stress. If you have a smart phone or tablet you can download mindfulness or meditation apps, or alternatively you can buy relaxation CDs. Some people find yoga, aromatherapy or massage helpful.
If stress or anxiety that are making you feel unwell, or you are feeling low in mood, you can consider speak to your GP.
Some people find psychotherapy, cognitive behavioural therapy, or hypnotherapy, can help with symptoms.
There are also some medicines that can help with symptoms. You can talk to your GP about this.
Healthy eating habits
- Have three regular meals each day.
- Do not miss meals or eat late at night.
- Take time to eat slowly in a calm place.
- Chew food well.
- Do not eat ‘on the run’ – try to sit down to eat.
Exercise and movement can help IBS symptoms, particularly constipation. It can also help you feel less stressed, which can make symptoms better. Try to take regular exercise, such as walking, cycling or swimming.
It is very important to drink enough. Fluid can help with constipation. It can make poo softer and easier to pass. If you have diarrhoea, you need to drink more so you don’t become dehydrated. Aim to drink at least 8 drinks each day (1.5-3L), especially water and other caffeine free still drinks.
If you drink fizzy drinks regularly, try drinking less of these.
For some people, caffeine can cause symptoms or make them worse. Caffeine is in food and drinks such as tea, coffee, energy drinks and chocolate.
Try to have no more than three caffeinated drinks per day. You could have herbal or fruit teas and decaffeinated tea and coffee instead.
Artificial sweeteners - Polyols
Sugar free chewing gum, sweets, mints, and specialist diabetic foods contain artificial sweeteners called polyols. These can cause diarrhoea and bloating.
Avoid foods with these in the ingredients list:
Lactose (this is the sugar found in milk)
If you notice that you have symptoms after having food or drink that contains milk, you may be lactose intolerant. You can ask your doctor to test for this. The test is called a lactase hydrogen breath test.
If this is not available, then you can try a low lactose diet.
If your symptoms are not better after 7 days, lactose is unlikely to be the cause. You should return to your usual diet. Lactose intolerance is more likely in those with Caribbean, South American, Asian or African ethnic backgrounds.
Sources of lactose include cow/sheep/goat milk and yoghurts made from these milks, whey, skimmed milk powder, and buttermilk. Soft cheeses and cottage cheese also contain lactose.
Cream, butter, Greek yoghurt, hard cheddar cheese, parmesan, mozzarella and Swiss cheese are much lower in lactose and may be tolerated.
You may also choose soya, almond, nut or oat milk as a milk alternative, however make sure you are choosing products that have added calcium.
Cutting down on fat may help IBS symptoms, especially if you experience tummy pain, indigestion or discomfort around meal times.
Fatty foods include fatty cuts of meat, cream, butter, fried foods, cakes, chocolate and pastries.
Choose lower fat dairy products and lean meats. Grill or steam food instead of frying or roasting in oil. It can be helpful to measure oil out when cooking using a spoon or spray.
Takeaways are high in fat, and food from pubs, cafés and restaurants can have more fat than food you make at home.
Probiotics contain bacteria that may help you. Some people with IBS have a different balance of bacteria (microflora) in the gut than the general population.
The scientific studies on probiotics on IBS symptoms show mixed results. Trying a probiotic is not harmful in IBS, so it is something which you may wish to try.
There are lots of different brands available, containing different strains of bacteria in different forms and doses. If you are considering trialling probiotics here are some general guidelines to follow:
- Take the probiotic daily and follow the manufacturer’s instructions.
- You need to try it for 4 weeks before you will know if it works for you.
- If your symptoms don’t get better try a different brand.
- There are strict rules about what products can be called probiotics.
- Make sure it says the word “probiotic” on the label.
- Look for products stating that the bacteria reaches your gut and it has been tested to remain active, alive or survive through your stomach and gut.
- It should not contain lactose or polyols, which could make symptoms worse.
- Alflorex, Symprove, Yakult and VSL#3 are examples of products that are suitable.
Chilli, cayenne pepper and paprika contain a compound called capsaicin. For some people, this can cause abdominal pain or reflux. If you do get symptoms after eating spicy food try avoiding it.
Capsaicin is found in chili, cayenne pepper and paprika. It can cause tummy pain or reflux in some people. If you get symptoms after eating spicy foods try not to eat foods that have chili, cayenne pepper or paprika in them.
If you have constipation, try to eat more high fibre foods. Start with making changes to one meal a day and build up slowly so you don’t make symptoms worse. Drink more too to help the fibre go through.
High fibre foods:
- Wholemeal/granary bread
- Wholemeal pasta
- Basmati and brown rice
- Potatoes with skins on
Studies show that eating a variety of these foods works best. Do not add wheat bran to food as this can make symptoms worse.
Kiwi fruit are very high in fibre, and don’t tend to cause wind or bloating. You could try having these more often. Prune juice can help with constipation but whole prunes can cause bloating. You can buy psyllium husk powder as a fibre supplement, which can increase bowel action but may lead to wind and bloating.
Linseeds (also known as flaxseeds)
Some studies have found that linseeds/flaxseeds may help constipation, pain, and bloating. If you have both constipation and diarrhoea, then you could try them. They do not make diarrhoea worse in most people.
- Start with 1 teaspoon daily and build up to 2 tablespoons daily over 3 weeks.
- Add to breakfast cereal, yogurt, soups and salads.
- Brown, golden, ground and whole linseeds or flaxseeds have all been shown to have an effect.
- Drink an extra cup of water (around 150mls) at the same time with each tablespoon of linseeds/ flax seeds you take.
- It can take 3 months before you see any benefits.
Alcohol can make symptoms worse like loose stools, abdominal pain and nausea. Try to drink no more than 14 units of alcohol per week. Spread your alcohol over at least three days. A good way to cut down is to have a few alcohol free days each week.
What is a unit?
Large glass of wine
Pint of cider
Pint of beer
Pub measure of 40% spirits (25ml)
Home measure of spirits
usually more than 2 units
The low FODMAP diet
What are FODMAPs?
The low FODMAP diet is typically trialled once all aspects of first line dietary advice have been explored and have been unsuccessful with improving your IBS symptoms.
Food is made up of many components, including proteins, fats and carbohydrates (including sugars). Some of the carbohydrates are referred to as FODMAPs.
FODMAPs do not get absorbed in your small intestine, and travel to your large intestine where there are billions of bacteria. The bacteria then ferment FODMAPs which can result in gas production and symptoms such as wind and bloating.
Furthermore, diarrhoea/an altered bowel habit can occur due to a process which results in an increase in water content within the large intestine, which results in stools becoming more loose/liquid. By reducing the intake of FODMAPs in your diet, it may improve your gut symptoms.
How strict do I need to be and for how long?
We would advise that you try to follow low FODMAP for 4-8 weeks as strictly as you can. It has been found that those who follow the diet more strictly experience a better symptom improvement.
Long term advice
The low FODMAP diet requires a strict effort for the length of time indicated above. Although it has proved to be effective for a lot of patients with IBS, is should not be trialled prior to commencing first line advice for the management of your IBS. Patients with IBS tend to over-restrict their diet to manage their IBS symptoms, which can lead to vitamin and mineral deficiencies and/or unintentional weight loss; therefore, the low FODMAP diet should not be followed without the support of a registered dietitian.
Your symptoms and what advice to try
The relevance of different treatments varies depending on what IBS symptoms you experience.
Managing your eating habits, physical activity, stress levels and fibre intake will help with the majority of symptoms experienced with IBS.
The IBS Network
Self-Help IBS Group
Mind your Head