Gut Health and Diet A guide to how your diet and lifestyle may affect symptoms of IBS Factsheet authored by Nigel Denby, Registered Dietitian
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. Diet and IBS Page 2 of 10
Diet and IBS 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 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 Breakfast cereals Wholemeal, granary, high fibre white, rye Weetabix, shredded wheat, branflakes, porridge, muesli White 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. Diet and IBS Page 3 of 10
Fibre and IBS (continued) 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 s 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 Diet and IBS Page 4 of 10
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." Diet and IBS Page 5 of 10
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 Banana Lunch Bowl 3-bean or lentil soup with large chunk granary bread Small bag peanuts and raisins Pot of yogurt Evening meal Chicken casserole served with brown rice 2-3 servings of green vegetables and root vegetables 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. Your notes: Diet and IBS Page 6 of 10
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 Apple Lunch Pasta salad with chicken, tuna or cheese Pot of yogurt Evening meal Steamed or grilled salmon fillet with couscous 2 servings of root vegetables 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. Your notes: Diet and IBS Page 7 of 10
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 Lunch Meat, fish, egg or vegetarian sandwich on granary bread Probiotic yogurt Cereal bar Evening meal Grilled pork chop with honey and mustard glaze Mashed potato add a little wholegrain mustard if liked 2 servings of root vegetables Tips: Avoid fizzy drinks including sparkling water. Green leafy vegetables, onion, garlic, beans, lentils and other pulses are renowned gassy foods and best avoided. Your notes: Diet and IBS Page 8 of 10
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 Melon chunks Lunch Jacket potato (leave the skin) with tuna, prawns or cheese Apple or pear Pot of yogurt Evening meal Poached white fish with buttered new potatoes 2 servings of root vegetables 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. Your notes: Diet and IBS Page 9 of 10
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 Banana Lunch Bowl 3-bean or lentil soup with large chunk granary bread Small flapjack or oat-based cereal bar 2 tbsp dried fruit Pot of yogurt Evening meal Chicken and pasta bake Large side salad including a selection of different coloured salad vegetables Tips: Taking regular exercise is particularly important in trying to stimulate regular contractions of the intestines Your notes: Diet and IBS Page 10 of 10