Diet and IBS Factsheet

Diet and IBS- Factsheet authored by Nigel Denby, Registered Dietitian

A guide to how your diet and lifestyle may affect symptoms of IBS

Introduction

Irritable Bowel Syndrome (IBS) is a very common digestive condition that
causes spasm and pain in the intestines.

Food is moved through the intestines by rhythmic and regular contractions of the muscles in the walls of the intestine. Sometimes these contractions are interrupted which can cause painful spasms.

IBS is a combination of this pain and also irregular bowel habits. Though troublesome, IBS is not linked with or known to lead to any serious illness.

What causes IBS?

There is no single, recognised cause of IBS. It is still a mystery why the intestinal muscles behave in this way. However, both diet and stress have been related to IBS, and both can influence the way the gut works.

20–65% of people with IBS believe their symptoms are caused by food.

How common is IBS?

It is thought that as many as 30% of the population may suffer from the condition – so you are not alone.

Women are more likely to have the condition than men.

Symptoms of IBS

The most common symptoms of IBS are:
• Abdominal pain – often relieved by passing wind or by bowel movement
• Abdominal bloating
• Urgency
• The feeling of incomplete passing of stools
• Irregular bowel movements – either diarrhoea, constipation or a combination of both
• Stools may be small and hard like pellets or may be ribbon-like in appearance
• Stools may be covered in mucous
• Mucous may be passed on its own

BUT – blood in stools is not a symptom of IBS – if this occurs see your doctor as soon as possible.

Less common symptoms:
• Pain, bought on by bowel movements
• Headaches, sweating, flushing and dizziness
• Loss of appetite
• Nausea, vomiting or belching

You may not experience all of the symptoms listed above – it varies greatly between individuals.

Symptoms may last a few days or be present for weeks/months at a time. The pain may be slight or severe.

Unfortunately there is no cure for IBS. However making simple changes to your lifestyle can lessen the symptoms and keep IBS under control.

Eating a well balanced, varied diet is the cornerstone in helping to control symptoms of IBS.

Most people find the following helpful:
• Having small regular meals and snacks – they are easier for the digestive system to manage, rather
than large and/or infrequent meals
• Taking time to eat do nothing else whilst you are eating.
• Eating slowly and chew food well, take plenty of time to relax afterwards
• Ensure good posture when eating – sit upright at a table
• Drink plenty of fluids – 8 to10 cups per day
• Avoid foods which you think makes your IBS worse

Your symptoms may be improved by altering the fibre content of your diet.

Increasing fibre can be beneficial if your symptoms are hard stools and/or constipation. It is important to increase your fibre intake gradually to avoid excess bloating and wind.

If your symptoms are predominantly diarrhoea you may need to reduce your fibre intake, especially if you suffer from bloating.

Fibre and IBS

The table below shows a variety of foods to help you select the correct food to either increase or decrease your fibre intake.

Food Type	High fibre foods	Lower fibre foods
Bread	Wholemeal, granary, high fibre white, rye	White
Breakfast cereals	Weetabix, shredded wheat, branflakes, porridge, muesli	Cornflakes, rice krispies, sugar puffs, coco pops
Rice and Pasta	Brown/ wholewheat	White
Fruits and vegetables	Pulses, cabbage, peas, beans, sweetcorn, onion, fruit with skin and seeds	Root vegetables, fruit with skins and seeds removed
Biscuit and crackers	Wholegrain crispbread, cracker wheat, oat cakes, digestives, hobnobs	Crackerbread, cheddar biscuits, rich tea, marie, plain crackers.

Fibre in foods can also be divided into soluble and insoluble fibre. Most people agree that increasing insoluble fibre is not beneficial for IBS, however is it advisable to have a mix of both types of fibre in your diet.

Insoluble fibre is found in:
• Wholemeal/granary bread
• Breakfast cereals containing wheat and bran
• Brown rice and pasta
• Whole wheat crackers and crispbreads
Soluble fibre is more likely to be beneficial, and is found in:
• Oats and oat products (oat cakes & porridge)
• Fruits and vegetables
• Peas, beans, pulses and lentils

Other links with IBS

In some people, IBS can be made worse by a sensitivity to certain food(s) – most commonly:
• Rich and spicy foods
• Drinks and foods containing caffeine
• Onion and garlic
• Some salad foods e.g. cucumber

Caffeine is a gastric irritant and stimulates muscle contractions in the intestines. This is likely to make IBS worse. Try to avoid caffeine containing drinks (coffee, tea and cola) and foods (chocolate) for a period of two weeks to see if your symptoms improve.

It is important to note that other foods may cause IBS symptoms. If you feel certain foods make your IBS worse it is important to talk to your dietitian.

Some people find that their IBS symptoms get worse during periods of stress and anxiety.

Learning to relax can help reduce the symptoms.

It is virtually impossible to live a stress free life, however these are some suggestions to try and reduce stress:
• Take 10 minutes to yourself, everyday in a quiet place to relax and unwind
• Take regular gentle exercise e.g. walking, yoga, pilates
• Allow plenty of time for meals – avoid eating ‘on the go’
• Try using relaxation tapes or books – they can teach useful techniques

The latest research

Keeping the cells that line your intestines in tip top condition may help to improve symptoms of IBS.

Emerging science has shown that supplementary nucleotides nourish these cells and studies show these nutrients help reduce many of the symptoms of IBS, including abdominal pain, urgency, bloating and incomplete evacuation. The only supplement currently available on the market that includes nucleotides is called IntestAid®IB.

Recent research has looked at the effects of pro-biotic drinks in IBS. It is thought they restore the balance of bacteria in the bowel thereby reducing the symptoms of wind, pain and bloating. Different drinks have different strains of friendly bacteria so its worth trying different products if the first one doesn’t work

Treatment with guar gum has decreased symptoms in both constipation- and diarrhoea-predominant IBS and decreased abdominal pain. Guar gum is thought to have prebiotic properties – increasing the numbers of ‘good bacteria’ in the intestines. At present there are no specific recommendations and guar gum is not widely available in a form suitable to ‘treat’ IBS symptoms.

Some people with IBS have an increased sensitivity to sorbitol and fructose. Sorbitol is naturally present in fruit, and is particularly high in peaches, apple juice, pears and plums. Sorbitol is also manufactured and added to soft drinks, ‘diet’ products and ‘diabetic’ foods.
Sufferers frequently cite dairy products as a cause of their symptoms. This is a very difficult subject to investigate and so far, no reliable conclusions have been drawn.

Finally

Other things you could try:
• Try to do 30 minutes of exercise everyday. Gentle exercises like yoga and Pilates will help with relaxation.
• Keep a food and symptom diary to try and pin-point specific foods that are causing your symptoms
• If you find a specific food causes you problems try removing this from your diet for 2 weeks to see if your symptoms improve. Don’t exclude whole food groups without the advice of a dietitian.
• If you find that lots of foods are causing you problems talk to a dietitian who can trial an exclusion diet.
Do not attempt this alone.
• Some people with IBS have found that cognitive behaviour therapy, hypnotherapy and acupuncture have helped ease their symptoms. There is no scientific proof that these work for everyone. Speak to your doctor or a qualified Practitioner before embarking on these alternative forms of treatment.

About the author
Nigel Denby is a registered dietitian, author of ten successful nutrition books and a broadcaster on both television and radio in the UK and across Europe.

Nigel trained as a dietician at Glasgow Caledonian University, following an established career in the catering industry.

He is a qualified chef and previously owned his own restaurant. His dietetic career began as a Research Dietician at the Human Nutrition Research Centre in Newcastle upon Tyne. After a period working as a Community Dietician,

Nigel left the NHS to join Boots Health and Beauty Experience where he led the delivery and training of Nutrition and Weight Management services.

In 2003 Nigel set up his own nutrition consultancy, delivering a clinical service to
Hammersmith and QueenCharlotte’s Hospital Women’s Health Clinic and the International Eating Disorders Centre in Buckinghamshire as well as acting as Nutrition Consultant for the Childbase Children’s Nursery Group.

Nigel also runs his own Private practice in Harley Street specialising in Weight Management, PMS / Menopause, Irritable Bowel Syndrome and food intolerance. He is a member of the expert panel for the Nutrition and Health Show and consumer dietetic advisor for Complete Nutrition magazine.

In 2006 the Food Standards Agency DVD “Eatwell”featuring Nigel won a Silver Screen award at the US International Film and Video awards."

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Meal plan for constipation

Breakfast

Glass prune juice
Bowl porridge made with semi-skimmed, oat or soya milk
Slice of brown or granary toast with jam/honey/marmalade
Drink

Snack

Banana
Drink

Lunch

Bowl 3-bean or lentil soup with large chunk granary bread
Piece of fruit
Small bag peanuts and raisins
Drink

Snack

Piece of fruit
Pot of yogurt
Drink

Evening meal

Chicken casserole served with brown rice
2-3 servings of green vegetables and root vegetables
Drink

Tips: Have at least 8-10 cups of fluid – experiment with fruit and herbal teas – fennel, ginger and peppermint are renowned for easing digestive upsets. Add pulses, lentils and pearl barley to casseroles, soups and salads to boost their soluble fibre content.
 

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Meal plan for diarrhoea

Breakfast

Glass apple juice
Bowl cornflakes/rice krispies with semi-skimmed or soya milk
Slice of white toast with jam/honey/marmalade
Drink

Snack

Apple
Drink

Lunch

Pasta salad with chicken, tuna or cheese
Drink

Snack

Piece of fruit
Pot of yogurt
Drink

Evening meal

Steamed or grilled salmon fillet with couscous
2 servings of root vegetables
Drink

Tips: Have at least 8 cups of fluid, more if you suffer frequent or prolong bouts of diarrhoea. use decaffeinated versions of tea and coffee. Experiment with fruit and herbal teas – fennel, ginger and peppermint are renowned for easing digestive upsets. Avoid foods and drinks containing the artificial sweetener sorbitol.

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Meal plan for bloating

Breakfast

Probiotic mini-drink
Bowl of wholegrain cereal with semi-skimmed or soya milk.
Top with sliced fruit or dried fruit
Slice wholegrain or granary toast with jam / honey / marmalade
Drink

Snack

Piece of fruit
Drink

Lunch

Meat, fish, egg or vegetarian sandwich on granary bread
Piece of fruit
Probiotic yogurt
Drink

Snack

Cereal bar
Drink

Evening meal

Grilled pork chop with honey and mustard glaze
Mashed potato add a little wholegrain mustard if liked
2 servings of root vegetables
Drink

Tips: Avoid fizzy drinks – including sparkling water. Green leafy vegetables, onion, garlic, beans, lentils and other pulses are renowned gassy foods and best avoided.

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Meal plan for urgency

Breakfast

Glass cranberry juice
Bowl cornflakes/rice krispies with semi-skimmed or soya milk
Slice of white toast with jam/honey/marmalade
Drink

Snack

Melon chunks
Drink

Lunch

Jacket potato (leave the skin) with tuna, prawns or cheese
Drink

Snack

Apple or pear
Pot of yogurt
Drink
Evening meal
Poached white fish with buttered new potatoes
2 servings of root vegetables
Drink

Tips: Have at least 8 cups of fluid. If you cannot give up tea and coffee use decaffeinated versions. Experiment with fruit and herbal teas – fennel, ginger and peppermint are renowned for easing digestive upsets. Avoid foods and drinks containing the artificial sweetener sorbitol.

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Meal plan for incomplete evacuation

Breakfast

Bowl porridge made with semi-skimmed, oat or soya milk
Top with chopped prunes, dates or other dried fruit
Slice of brown or granary toast with jam/honey/marmalade
Drink

Snack

Banana
Drink

Lunch

Bowl 3-bean or lentil soup with large chunk granary bread
Piece of fruit
Small flapjack or oat-based cereal bar
Drink

Snack

2 tbsp dried fruit
Pot of yogurt
Drink

Evening meal

Chicken and pasta bake
Large side salad including a selection of different coloured salad vegetables
Drink

Tips: Taking regular exercise is particularly important in trying to stimulate regular contractions of the intestines

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