Author: Dr. Stephen Wangen is the award winning author of two books on solving digestive disorders, and a nationally recognized speaker on IBS. He has been on ABC, NBC, and Fox as well as public radio. He was recently named one of Seattle’s Top Doctors by Seattle Magazine.
Many different foods can trigger IBS symptoms. Knowing what causes yours can help you relieve your symptoms. There are many different diets to choose from and what might work for some people might not work for others.
Many Dietary Approaches to Treating IBS
If you’ve done much reading about IBS diets, then you’ve seen all kinds of advice that might leave you wondering if you can ever eat again without triggering your symptoms. There is advice urging you to increase fiber if you’re constipated, increase fiber if you have diarrhea, cut back on sugar, drink more water, avoid lactose, avoid dairy, avoid bread, avoid red meat, cut back on yeast, reduce spicy foods, cut back on carbonated drinks and artificial sweeteners, eliminate chocolate, eliminate caffeine, eliminate alcohol, eat smaller meals, and so on and so forth.
The problem with this approach is that different foods trigger IBS in different people, and many foods can potentially trigger IBS symptoms. Therefore, the best diet for you may not be the best one for someone else.
Certainly, some people have been helped by one of the recommendations above, but many people have not. The diet that helps one person can actually make another sicker. For some patients, diet is not the issue at all. But one thing is clear, there is no single right diet for IBS.
You can find many different approaches to the IBS diet, and we have addressed some of the more popular ones here.
The BRAT Diet
The BRAT diet has been around for a long time. BRAT stands for bananas, rice, applesauce, and toast. The idea is fairly simple. You eat food that is very basic in an effort to minimize any impact on your digestive tract.
Limiting your diet in this way may or may not give you some temporary symptom relief, but it’s not a long-term cure for IBS. Plus, maintaining this diet is next to impossible and it is very low in nutritional value.
Low Fodmaps Diet
A popular IBS diet is the low fodmaps diet. This diet advocates that you avoid eating foods high in fermentable oligo-, di-, mono-saccharides and polyols. These are short chain carbohydrates that are present in many foods. Avoiding these foods will not cure your IBS, but it may provide some symptom relief.
Foods high in fodmaps include:
- Fructose (in excess) found in certain fruits, honey, and high fructose corn syrup
- Lactose: milk and milk products
- Fructans: wheat, onions, garlic
- Galactans: beans, lentils, legumes
- Polyols: often founds in fruits in the form of sorbitol and mannitol found in peaches, nectarines, mushrooms and sometimes added as artificial sweeteners
In our experience, if you are having trouble digesting these foods, it is most likely a byproduct of another problem. Most of our patients are able to eat these foods again once they get to the source of the problem and heal their digestive tract.
Food Elimination Diet
Elimination diets are also popular, but what should you eliminate? Nothing? Everything? Gluten? Lactose? Soy? GMOs? Fats? Oils? Processed foods? Fodmaps? Dairy? Sugar? Coffee? Alcohol?
The list is endless. There may be something you need to eliminate, but when your digestive tract feels lousy, it often feels like you need to avoid everything.
So where do you start? What do you need to focus on long-term in order to heal and what can you eventually add back into your diet? These are complex issues.
Ideally, to create an optimal IBS diet, all you’d have to do is avoid a certain food or food group to discover whether it was triggering your IBS. Unfortunately, this is easier said than done. It takes a great deal of time, persistence, and education to properly construct a diet that will adequately treat IBS.
The purpose of an elimination diet is to identify whether or not specific food groups trigger your IBS symptoms. Essentially, during an elimination diet, you stop eating the foods you normally eat until your symptoms improve. If you feel better after you’ve eliminated a food or stopped eating altogether, then you might strongly suspect your diet is involved. You may have gone on a fast or a cleansing diet, or simply avoided food for a day or two and discovered your IBS was much better. Of course, eventually you have to eat, and the trick is figuring out exactly what you can eat.
If, when you reintroduce a food, your symptoms return, then it’s likely that the food or one of its ingredients that is an IBS trigger for you. It sounds simple enough, but it can be a very slow process and very time consuming. And even after going through this process, you may still not see a pattern, or you may still be confused about which foods are causing your problems. There are many reasons for this.
There are many anti-inflammatory diets out there. They tell you certain foods cause inflammation and certain foods do not cause inflammation. What we’ve learned is there is no one food that is guaranteed to cause inflammation.
Your immune system must be triggered for you to have an inflammatory reaction. We’ve seen that any food has the potential to cause inflammation, depending on the patient. At the IBS Treatment Center, we help our patients determine the proper anti-inflammatory diet for them.
We do not use a generic approach to this topic; no two patients get the same advice when it comes to an anti-inflammatory diet.
Raw Food Diet
Some people try to avoid processed foods and go on a raw food diet. In theory, this sounds like it might be a good idea because raw foods are generally very high in nutritional value. However, there are other things to consider about a raw food diet.
When you have IBS, your digestive system is compromised, and you don’t digest food well. Raw food may have a lot more nutrients than processed food, but it is also a lot harder to digest.
Do you have trouble digesting a salad, or an apple, or nuts? Those are raw foods. You need help healing your digestive system before you can tolerate raw foods
This diet is exceptionally popular right now, and there is good scientific evidence that some people have real, measurable reactions to a specific protein in gluten grains. Others have reactions to other components of gluten grains, but not specifically gluten.
Unfortunately, due to its current popularity, there is a misconception that the gluten-free diet is inherently healthy and a good idea for everyone. That’s just not true.
A gluten-free diet can be a healthy diet, but just cutting out gluten, without attention to ensuring proper nutrition, can cause problems.
Some IBS sufferers do find eliminating gluten helps soothe or even prevent symptoms. But we have seen “false positives,” where patients seem to react to gluten, but actually need to address a different medical issue entirely. Once that issue is addressed, the formerly “gluten-intolerant” patient can eat gluten again without problems.
This complexity is best addressed by working with an expert doctor who has the tools and experience to help you decide if this diet is the right choice for your health.
If your doctor does recommend a gluten-free diet, here is what you can expect:
- Most bread products, cakes, pastas, and other starchy, bready foods will be off-limits since they’re normally made with wheat flour, which contains gluten.
- Almost everything with soy sauce is a no go
- Most beers are out
However, gluten-free shoppers have a multitude of specialty alternatives today. It is possible to replace wheat flour with other flours made from rice, corn, quinoa, flax, or even nuts and beans, there is gluten-free soy sauce, and even gluten-free beers.
Since high-fat foods are difficult to digest, some people with IBS find eating a low-fat diet helps with their symptoms.
However, while a low-fat diet is helpful for some people, it doesn’t help everyone. In fact, for some people, it can actually be unhelpful.
If your doctor recommends a low-fat diet, here’s what you can expect:
- Less frying and more baking, steaming and broiling
- Trim more fat from meats before cooking, and choose leaner cuts in general (loin versus roast, breast versus thigh, etc.)
- Look for low-fat or fat-free dairy products and bakery items
On the opposite end of the continuum from the low-fat diet is the paleo diet, which has gained enormous popularity in recent years.
Unfortunately, despite its celebrity status among foodies, this diet is not likely to be the best solution for people with IBS. The diet is based on what cavemen ate, back before the invention of agriculture. Paleo foods are therefore less refined and can be more challenging to digest, which in some cases can make things worse.
If you are advised by your doctor to try the paleo diet, here’s what you can expect:
- Primarily unprocessed meats, eggs, fruits, and vegetables
- Avoid processed foods, sweeteners, dairy, and grains
Again, we don’t recommend trying the paleo diet before working with a doctor who has the tools and experience to help you decide if this diet is the right choice for your health.
Low-Glycemic Index Diet
The Low-Glycemic Index Diet, or Slow-Carb Diet, is designed to reduce fluctuations in blood sugar and thereby reduce food cravings. This diet prioritizes foods that are high-fiber or high-fat, both of which slow down digestion.
Unfortunately, while this diet does help some people, it’s generally unhelpful and may even worsen symptoms for people with IBS. The higher fiber and fat content of this diet can put additional strain on the digestive system.
Bacteria and Diet
You have 100 trillion bacteria in your digestive tract. They like you, but only if you like them. How does that work?
A recent study noted that the types of foods that you eat change the types of bacteria you have in your gut. We shouldn’t be too surprised by this, but it seems we are just beginning to appreciate what is really going on down there.
The environment in our gut is its own ecosystem. It’s not unlike any other ecosystem. It’s has a natural state that took millions of years to develop, and like any ecosystem, our actions can dramatically change it. The most obvious things that impact our personal little ecosystem are the things that we ingest.
The healthier that you eat, the happier your bacteria will be. Eat bad stuff and you’ll feed your enemies. It’s as simple as that.
Which IBS Diet is Right for You?
You can find many different types of IBS diets on the internet and in books, far more than we can list here. There simply is no one-size-fits-all IBS diet that works for everyone, and there never will be.
We cannot recommend any single one of the diets because we treat each of our patients individually. Using our careful detective process, we determine the proper diet for each of our unique patients.
I cannot count all of the times that patients have told me, “I feel great when I eat really well and avoid all of the things that are bad for me. But I can’t eat that way all the time. No one can expect me to do that! I want to have a life!”
Why not? Why can’t we eat that way all the time? Is it peer pressure? Is it advertising? Is it cultural history? Are those foods addictive? Is it in our genes?
There are plenty of excuses, but we seem to equate having a full life with eating sweets, drinking alcohol, and enjoying the pleasures of rich food. And the worse we feel the more we seem to want to do those things.
Why do we equate being healthy with being cheated out of something? It shouldn’t have to be that way. You can choose to be healthy, and you won’t be alone. Many of us are already doing it, and we welcome you.
A doctor who is an expert in IBS has the tools and experience to help you determine the best choices for your health. At the IBS Treatment Center, we work individually with patients to identify their unique dietary needs. And we’ve cured more than 80% of our patients with this individualized care.