The connection between food and irritable bowel syndrome (IBS) symptoms is well-established, with over 80% of IBS patients reporting food-related triggers. Managing these dietary triggers is key to effective IBS management.
It's important to remember that there's no one-size-fits-all diet for IBS; individual responses vary, making personalized dietary strategies crucial.
Common Dietary Approaches for IBS
According to the UK National Institute for Health and Care Excellence (NICE) and the American College of Gastroenterology, common 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.
- Lactose-Free Diet: Avoiding lactose-containing foods.
- Soluble Fiber: Increasing soluble fiber intake to 25–35 g per day, particularly for constipation-predominant IBS.
These diets help identify and eliminate potential triggers.
Cultural Considerations: Asian vs. Western Diets
Dietary triggers, symptoms, and habits can differ significantly between Asian and Western populations. For example, rice, a low-fiber, highly absorbed carbohydrate, is a staple in South Asian diets, influencing IBS symptoms differently than the higher-fiber Western diet.
Furthermore, Indian cuisine often features spicy curries, many of which are high in FODMAPs, posing unique challenges for IBS management in these populations (Rajole et al., 2022). Accurately calculating FODMAP content in complex Asian dishes can be difficult.
Creating a Personalized IBS Diet
Developing an ideal IBS diet typically involves several phases:
- Elimination: High-FODMAP foods are replaced with low-FODMAP alternatives.
- Reintroduction: Foods are gradually reintroduced while monitoring for symptom triggers.
- Personalization: The diet is tailored to avoid identified trigger foods for long-term management.
Specific Foods to Avoid or Limit
Certain foods containing fructose, gluten, histamine, and lactose should be avoided or consumed cautiously based on individual tolerance. These include:
- Gluten-containing grains: Bread, bakery products, biscuits, muesli, croissants, pasta, wheat flour, and barley recipes.
- Dairy products: Milk (cow and goat), ice cream, yogurt with lactose, fresh cheeses, butter, and cream.
Other Potential Triggers
- Sulfur-containing vegetables: Broccoli, Brussels sprouts, cabbage, and cauliflower.
- Spicy foods: Chili (with capsaicin), pepper, ginger, garlic, and cinnamon (Esmaillzadeh et al., 2013). Spicy food consumption has been linked to increased IBS risk (Esmaillzadeh et al., 2013).
- Insoluble fiber: Bran.
- Legumes: Chickpeas, lentils, red kidney beans, and baked beans.
- Certain vegetables: Avocado, cauliflower, mushrooms, and snow peas.
Eating Habits and IBS
Irregular, binge, or skipped meals can affect colonic motility in about 30% of IBS patients. Managing the duration of restrictive diets, providing alternative foods, and addressing potential nutrient deficiencies are crucial for IBS symptom management.
References
- Schnedl WJ, Michaelis S, Mangge H, Enko D. A personalized management approach in disorders of the irritable bowel syndrome spectrum. Clin Nutr ESPEN. 2023 Oct;57:96-105.
- Lacy, Brian E. PhD, MD, FACG1; Pimentel, Mark MD, FACG2; Brenner, Darren M. MD, FACG3; Chey, William D. MD, FACG4; Keefer, Laurie A. PhD5; Long, Millie D. MDMPH, FACG (GRADE Methodologist)6; Moshiree, Baha MD, MSc, FACG7. ACG Clinical Guideline: Management of Irritable Bowel Syndrome.
- Rajole S, Damle G, Madan DJ, Moitra P. Determination of FODMAP Contents of Traditional Indian Regional Recipes. Curr Dev Nutr. 2022 Jun 14;6(Suppl 1):530.
- Jung KW, Myung SJ. An Asian perspective on irritable bowel syndrome. Intest Res. 2023 Apr;21(2):189-195.
- Tetali B, Suresh S. Management of irritable bowel syndrome: a narrative review. Transl Gastroenterol Hepatol. 2024 Mar 21;9:26.
- Jayasinghe M, Karunanayake V, Mohtashim A, Caldera D, Mendis P, Prathiraja O, Rashidi F, Damianos JA. The Role of Diet in the Management of Irritable Bowel Syndrome: A Comprehensive Review. Cureus. 2024 Feb 15;16(2):e54244
- Cozma-Petruţ A, Loghin F, Miere D, Dumitraşcu DL. Diet in irritable bowel syndrome: What to recommend, not what to forbid to patients! World J Gastroenterol. 2017 Jun 7;23(21):3771-3783
- Esmaillzadeh A, Keshteli AH, Hajishafiee M, Feizi A, Feinle-Bisset C, Adibi P. Consumption of spicy foods and the prevalence of irritable bowel syndrome. World J Gastroenterol. 2013 Oct 14;19(38):6465-71.
- Prof. Dr. Nilüfer et al. Nutritional Approaches in Irritable Bowel Syndrome. (2023) In: Current Perspective At Specific Issues in Nutrition"
Dr. Pranav Shukla
MBBS, MD Anaesthesia
Disclaimer: This communication does not substitute advice of a medical/healthcare practitioner. Please consult your doctor/healthcare professional for any medical/healthcare advice. Although greatest possible care has been taken in preparation of this response, Dr Reddy's shall not be liable to any person for contents of the same. Images appearing herein are for illustration purposes only.
