Discover the Best Diet for IBS: A Comprehensive Guide

Diet significantly influences the development and management of IBS, serving as a powerful tool in both understanding the condition's pathophysiology and managing its symptoms effectively. IBS patients often need to follow a specialized diet, incorporating specific supplements and additional food components.

Microbiome-targeted supplements, such as probiotics, can help prevent gut microbiome shifts associated with a low FODMAP diet. Research has shown that IBS patients on a low FODMAP diet experienced a reduction in Bifidobacterium species, which was counteracted by the daily use of a high-dose, multi-strain probiotic supplement.

Enzyme supplements, which help break down FODMAPs, can also enable individuals to consume more FODMAP-rich foods, diversify their diet, and potentially boost microbiome prebiotic exposure.

These enzymes are substrate-specific and should be applied to targeted foods in patients who have suspected reactions to those foods. For instance, α-galactosidase enzymes facilitate the intake of galacto-oligosaccharide-rich foods like legumes and nuts, while lactase helps increase dairy intake.

Creating a personalized diet chart for IBS involves a phased approach. Initially, high FODMAP foods are replaced with low FODMAP alternatives. The second phase introduces a gradual reintroduction of foods while carefully monitoring symptoms. Finally, the diet is customized to avoid any identified trigger foods, ensuring a sustainable and effective plan.

According to the UK National Institute for Health and Care Excellence (NICE) and the American College of Gastroenterology, exclusion diets recommended for IBS patients include:

• Low FODMAPs Diet: Reducing intake of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs).
• Gluten-Free Diet (GFD): Eliminating gluten from the diet.
• Lactose-Free Diet: Avoiding lactose-containing foods.
• Soluble Fibers: 25–35 g of total fiber intake per day, particularly for constipation-predominant IBS.

Detailed Diet Plan for IBS Management

This plan provides general guidelines. It's crucial to work with a registered dietitian or healthcare professional to personalize your diet based on your specific needs and tolerances.

• Cereals and Cereal Derivatives: Provide significant daily energy. Recommended intake is 6 servings per day (1 serving = 40-60 g of bread or 60-70 g of pasta or rice). Choose low-FODMAP options.
• Vegetables: Important sources of nutrients and bioactive compounds. Recommended intake is 3-5 servings per day (1 serving = 100-150 g). Focus on low-FODMAP vegetables.
• Fruits: Valuable sources of nutrients and bioactive compounds. Recommended intake is 2-3 servings per day (1 serving = 80 g). Choose low-FODMAP fruits.
• High-Protein Foods: Includes meat, fish, eggs, legumes, soy, nuts, and seeds. Recommended intake is 2-3 servings per day (1 serving = 100-125 g of meat, 125-150 g of fish, 60-80 g of eggs, 60-80 g of legumes, or 20-30 g of nuts and seeds). Be mindful of FODMAP content in legumes and certain nuts.
• Milk and Dairy Products: Provide many essential nutrients, including calcium. Recommended intake is 2-3 servings per day (1 serving = 200-250 mL of milk, 200-250 g of yogurt, 80-100 g of fresh cheese, or 30-50 g of hard cheese). Opt for lactose-free dairy or dairy alternatives.
• Fiber: Emphasize soluble fibers (e.g., psyllium). IBS patients trying probiotics are recommended to take supplements daily for at least 4 weeks, at the dose recommended by the manufacturer, to see if symptoms improve.
• Fats, Sweets, Spicy Foods, Caffeine, and Alcohol: Can trigger IBS symptoms and should be consumed in moderation. Total fat intake should be limited to no more than 50 g/day, with a preference for healthy fats like olive oil.

Healthy sweets, such as dark chocolate, should be consumed sparingly (e.g., 30 g per serving). Alcohol, caffeine, and spicy foods should be restricted if they trigger symptoms; otherwise, consume within safe limits. Fried and processed foods should be avoided entirely.

NICE's Traditional Dietary Advice for Managing IBS

• Regular Meals: Ensure regular meals and take your time eating, reducing fatty or spicy foods.
• Avoid Long Gaps: Don’t miss meals or leave long gaps between eating.
• Stay Hydrated: Drink at least 8 cups of fluids daily, prioritizing water and non-caffeinated drinks like herbal teas.
• Limit Caffeine: Restrict tea and coffee to no more than 3 cups per day.
• Reduce Alcohol and Fizzy Drinks: Cut down on alcoholic and carbonated beverages.
• Manage Fiber Intake: It might be beneficial to limit high-fiber foods such as wholemeal flour and breads, cereals high in bran, and whole grains like brown rice during the elimination phase of the low-FODMAP diet. Soluble fiber may be better tolerated.
• Control Resistant Starch: Reduce intake of resistant starch found in processed or recooked foods.
• Limit Fresh Fruit: Keep fresh fruit consumption to 3 portions per day, with each portion being about 80 grams. Choose low-FODMAP fruits.
• Avoid Sorbitol for Diarrhea: If you have diarrhea, avoid sorbitol, an artificial sweetener found in sugar-free sweets (including chewing gum) and some diabetic and slimming products.
• Combat Wind and Bloating: People experiencing wind and bloating may find it helpful to eat oats (like oat-based breakfast cereal or porridge) and linseeds (up to 1 tablespoon per day). Ensure these are prepared in a low-FODMAP way.

By making informed dietary choices, IBS patients can significantly improve their condition and promote optimal gut health. It is essential to work with a healthcare professional or registered dietitian to create a personalized plan.

References

1. Staudacher, Heidi M and Tuck, Caroline J (2023). How can I improve my gut health if I am on a special diet?. The Lancet Gastroenterology and Hepatology 8 (10) 877-10.
2. Tetali B, Suresh S. Management of irritable bowel syndrome: a narrative review. Transl Gastroenterol Hepatol. 2024 Mar 21;9:26.
3. Chey WD, Hashash JG, Manning L, Chang L. AGA Clinical Practice Update on the Role of Diet in Irritable Bowel Syndrome: Expert Review. Gastroenterology. 2022 May;162(6):1737-1745.e5.
4. Böhn L, Störsrud S, Liljebo T, Collin L, Lindfors P, Törnblom H, Simrén M. Diet low in FODMAPs reduces symptoms of irritable bowel syndrome as well as traditional dietary advice: a randomized controlled trial. Gastroenterology. 2015 Nov;149(6):1399-1407.e2.
5. Galica AN, Galica R, Dumitrașcu DL. Diet, fibers, and probiotics for irritable bowel syndrome. J Med Life. 2022 Feb;15(2):174-179.