IBS Elimination Diet
I think most people living with IBS have tried to figure out which foods make us ill – and most of us find it very difficult.
Certain foods can trigger IBS, but it can also be triggered by stress, medications, travel, hormones and plenty of attacks seem to come out of the clear blue sky.
Besides, most people will eat a dozen or more different foods each day, so how can you pinpoint the offending food?
The answer is to use an IBS elimination or exclusion diet, methodically excluding foods from your diet for a period of time to see whether you feel better as a result.
Asking for Advice
It’s usually safe to try an IBS elimination diet for a few weeks, but if you have any additional medical conditions or you could be pregnant, please ask for advice from a doctor or registered dietitian first.
Eliminating foods for any length of time can cause deficiencies of vital vitamins or minerals – cutting out dairy could mean your calcium intake plummets, for example – so be aware that guidance from a professional is needed if you plan to avoid any major food group long-term.
Before trying a full-blown IBS elimination diet, it’s a good idea to cut out some foods which are either known to be IBS triggers for many people or are known to cause digestive problems even in healthy folk.
Most of these foods and drinks can be cut out without compromising a healthy diet, so they are a useful place to start.
Common culprits include:
- Carbonated (fizzy) drinks, including fizzy water, which can cause bloating
- Coffee and other drinks containing caffeine such as cola
- Artificial sweeteners such as sorbitol, sucralose, and aspartame – sorbitol, in particular, can have a laxative effect
- Dairy products, particularly cheese, if you have constipation and fried or fatty foods if you have diarrhea.
One Food or Many?
If you’ve tried avoiding the common culprits and your symptoms remain then it’s time to try a full IBS elimination diet.
The first thing you're probably wondering is, "What foods should I cut out?" Of course, if you knew exactly what foods to avoid with IBS you wouldn’t need the diet in the first place!
It’s also obvious that you can’t cut out oranges this week and apples next week and pears the week after that you’ll be on a diet forever. So you need a system.
The trick is to eliminate groups of foods that tend to affect the gut similarly. For example, you might try a dairy-free diet followed by a gluten-free diet and compare the results. You could cut out red meat (or even meat altogether) or avoid high-fat foods.
It can be tempting to cut out an extensive range of foods, particularly if your IBS is out of control and you’re suffering.
Unfortunately, this approach won’t be useful in the long-term; although you might feel better eating chicken and rice for a few days it’s not sustainable, and it doesn’t give you any insight into which foods might be making you ill.
I know it’s tough, but if you can manage a few months of controlled eating, you may well reap the benefits for years.
It’s vital that you maintain a record of your progress so you can check whether the diet is working.
Keep a food and symptom diary and remember to write down everything you eat and drink, whether it’s a whole meal, a few grapes or even a stick of chewing gum that might be giving you gas. I would also record anything you think might have upset your gut outside of the diet, getting up very early or a stressful day at work.
Remember too that it’s unlikely that something you eat is giving you IBS symptoms immediately. Diarrhea-predominant sufferers often have to run to the bathroom straight after a meal, but that’s because of the gastrocolic reflex – contractions in the colon due to stretching of the stomach – rather than the food you’ve just swallowed.
Rather than looking for immediate reactions, take an overall look at your symptoms. You could record how many times you used the bathroom in a day and how many minutes/hours of IBS pain you experienced, for example, and then compare the results over whole weeks.
It’s also a good idea to minimize any other factors that could affect your IBS during this time – you’re conducting a scientific experiment on yourself, and you need to keep the variables under control!
So try to eat your meals at regular times, drink roughly the same amount of liquid each day (preferably plain water) and either stop using supplements such as fiber supplements or carefully take the same amount each day. That way you can be confident that it is the dietary changes themselves that are influencing your symptoms.
A Question of Timing
The International Foundation for Functional Gastrointestinal Disorders (IFFGD) recommend that you eliminate each food or food group for 12 weeks, starting with any foods that you already suspect may cause you problems. If you’re not sure where to start, they suggest excluding fiber, chocolate, coffee or nuts.
If you are cutting out fiber, you need to know the difference between soluble and insoluble fiber. The IFFGD advise that it is often insoluble fiber that triggers IBS symptoms, so you could try removing:
- Cereal fibers like brown or wholemeal bread
- Breakfast cereals like bran flakes
- Cereal bars
Soluble fiber may be better for you and can be found in foods such as oats, barley, beans, chickpeas and root vegetables like carrots and potatoes.
Twelve weeks sounds like a long time to wait for a result, but the nature of IBS means that it can wax and wane naturally, so the diet needs to last a reasonable amount of time to be sure of its effect.
You may well find that you feel better after just a few weeks but don’t give up if you don’t see results immediately. IBS intestines are sensitive by their very nature and need time to adjust to their new circumstances.
If you don’t have any luck with the IFFGD plan, then you could move on to one of the three most common exclusion diets for IBS – dairy-free, gluten-free or low FODMAP.
IBS Elimination Diet Types
Foods such as milk, cream, cheese, yogurt and ice cream must be avoided on this diet. Look out for dairy products in desserts, sauces and spreads as well. Alternative foods include soy, rice or almond milk and vegan cheese substitutes – and remember that eggs are not a dairy food!
Excluding all dairy foods for any length of time may leave you at risk of developing a calcium deficiency so talk to a healthcare professional about calcium supplements if you need to follow this diet.
Gluten-Free or Wheat-Free
A gluten-free diet is not the same as a wheat-free diet. Gluten refers to the proteins that are found in wheat, oats, barley, and rye, but wheat is only found in, well, wheat! Be aware that both wheat and gluten can hide in all kinds of foods under names like modified starch, and bran.
A gluten-free diet has recently become very fashionable, which is both a blessing and a curse – it means that there are now lots more gluten-free foods available, but it also means people may think you’re just blindly following a trend rather than trying to treat your illness.
It has to be said that although gluten-free foods have come a long way in recent years, there are still some that are crumbly, dry and not very palatable, so shop around. You can also buy gluten-free flour to bake with at home and look for corn crispbreads, rice cakes and fruit and nut bars for snacks.
FODMAP stands for the rather less pronounceable “fermentable oligo-, di-, monosaccharides and polyols.”
These are carbohydrates that are poorly absorbed and can irritate the intestines. The low FODMAP diet is relatively new but has been researched in clinical trials and shown to benefit many IBS sufferers.
High FODMAP foods include those that contain fructose (some fruits, honey), lactose (dairy), fructans and galactan (wheat, beans onions) and polyols (fruits with pits or seeds).
WebMD suggests trying this diet for up to four weeks to see the effects. You’ll need a comprehensive list of low FODMAP foods (see the resources section at the end of this article) as unfortunately there’s no easy way to identify high FODMAP foods – apples and grapefruit are off limits, but bananas and blueberries are fine, for example.
After the initial four-week period you should try to introduce some of the high FODMAP foods to find out which you can tolerate as this diet is quite restrictive.
Tips From My Own Experience
When my IBS symptoms were at their absolute worst, I used an IBS elimination diet to identify that I felt much better when I avoided gluten.
I have to admit it was not the easiest thing I’ve ever done because eating habits can be tough to break, but it was worth it in the end.
Here are a few tips for you based on my search for some IBS-friendly foods.
Keep Meals Simple and to a Schedule
Many processed foods have a huge long list of ingredients these days, and they can be difficult to interpret – is “emulsifier” safe to eat? What about “protein concentrate, enzymes, and calcium phosphate?” (All those ingredients are from one slice of Kraft cheese, by the way!)
It’s far easier to cook basic meals with a minimum of a fuss than wade through 20 ingredients.
This also means you’ll be avoiding those dubious E numbers, additives and sweeteners. I would also advise drawing up a meal plan for at least the first week or two to prevent last minute panics when you can’t eat anything in the house.
I spent my early years as an IBS sufferer desperately hiding my illness, which meant I would end up eating alone or trying to turn down food and drink without seeming impolite.
It’s much, much easier to just say, “I’m sorry, but I can’t eat that, I’m testing a new IBS elimination diet for symptoms.” Then if you have to change your whole diet again in a few weeks’ time people will understand that too.
Having said that, if you find that family and friends say, “Just a little won’t hurt you” or try to tell you what you can and can’t eat as an IBSer, keep your explanations a bit more vague: “It’s a medical issue” is all they need to know.
Don’t Forget the Treats
I think any diet is doomed to failure if it’s too strict and an exclusion diet is no exception, especially if the new regime doesn’t seem to be helping or perhaps even makes symptoms worse, to begin with.
Don’t suddenly throw all your treats in the trash or you’ll be tempted to break the diet – find a few tasty treats you’re allowed and keep them in stock.
The Next Step
Once you’ve completed the IBS elimination diet you need to sit down with your food diary and analyze the foods that seem to affect you the most.
At first glance, it may look like all gluten makes you ill, for example, but you might find that you can tolerate white bread but not whole grain, oats but not wheat, or maybe it’s the overall level of fiber you eat per day that is key.
If the low FODMAP diet has helped, you might find that you only need to avoid high fructose (monosaccharides) foods, but you’re fine with oligo-saccharides like wheat. Take some time to refine your diet and test out a few theories.
It’s strongly recommended that you try reintroducing foods after a period of time, to check whether they do disagree with you and make sure you don’t spend the next 20 years on a needlessly strict eating plan.
With a bit of luck, you’ll end up with a personalized diet plan that lets you eat a healthy, tasty food while keeping your wayward bowel in check.