IBS is a common condition affecting up to 20% of the population. Although there is no sinister underlying disease process it can cause a multitude of symptoms including abdominal pain, bloating and altered bowel habit. Some patients have particularly severe symptoms leading to a significant impact on quality of life.
Diet plays an important role in IBS and below we discuss ways in which you can altered your diet to improve symptoms. There is no single diet that will help all patients with IBS, advice is usually tailored to your symptoms and triggers.
Routine, Routine, Routine…
We all generally function better when we have a set routine and your bowels are no different – especially when you have IBS.
It’s important to eat your meals at approximately the same time each day – this includes weekends!
Slowing down is also important. Many of us have busy schedules and often meal times are rushed. This tends to cause more stress on the bowel and aggravates IBS symptoms. Take enough time with meals, chew properly and don’t rush.
Maintaining good hydration levels is important with IBS – ensure you are drinking at least 2 litres per day of mainly water (unless you have any other medical condition which requires you to restrict your fluid intake).
In patients that are constipated the fluid works with fibre in the diet to help relieve constipation. In individuals who have diarrhoea predominant IBS the fluid intake is important in recouping the fluid loss through loose motions.
Caffeine should be limited to no more than 2-3 cups of tea / coffee per day. This is due to caffeine stimulating bowel movements which can worsen symptoms. Furthermore, alcohol and carbonated drinks should also be minimised as both can worsen symptoms of diarrhoea. Low sugar drinks and those with added sweetener should also be avoided as they contain sorbitol which can lead to bloating and diarrhoea.
Probiotics are now readily available and can come in the form of capsules, drinks and yoghurts. They help to replace the “bad” bacteria in our bowels with “good” bacteria. Some studies have shown an improvement in IBS symptoms (abdominal pain and bloating) when using probiotics, however they do not seem to work for everyone.
The consensus is to try a particular probiotic for at least 4 weeks to assess response.
Not all fibre is equal
We are often told that having fibre is an important aspect of our diet but in patients with IBS it can exacerbate symptoms.
There are two main types of fibre – soluble and insoluble.
In patients with diarrhoea predominant IBS it is advisable to reduce insoluble fibre. This type of fibre does not easily dissolve in water and is found in whole-wheat bread, brown rice, and cereals. It adds more bulk to the stools which can make bloating and diarrhoea symptoms worse.
Soluble fibre is found in oats, barley, fruit and vegetables. It dissolves in water and forms a soft gel which can help aid the passage of stool. Increasing soluble fibre can help relieve symptoms in patients with constipation predominant IBS.
What are FODMAPs?
FODMAP stands for fermentable oligo-saccharides, di-saccharides, mono-saccharides and polyols.
These are essentially carbohydrates that are not well digested and enter the large bowel. Once there they draw in water in the large bowel and are fermented by gut bacteria leading to production of excess gases. This in turn can cause bloating and abdominal pain.
Having a low FODMAP diet has been shown to improve IBS symptoms in up to 80 % of patients. Examples of foods that are high in FODMAPs are numerous, including apples, pears, sweeteners, milk, cheese and cabbage. It is important to attempt a low FODMAP diet in conjunction with your doctor and a dietician.
For more information or a comprehensive consultation with a bespoke management plan please contact us at the GP Clinic London.