IBS
Click HereIBS and diet
It is always important to eat a healthy diet with enough vitamins and minerals, fruit, vegetables and whole grains. But people with IBS may need to limit their intake of certain foods (see below).
The National Institute for Health and Clinical Excellence (NICE) suggests that people with IBS should have regular meals, drink plenty of fluid (e.g. 8 cups of non-caffeine based fluid per day) and eat a wide variety of foods. However, NICE also notes that people with IBS often find they have to take care about the kind of dietary fibre they eat, and be aware that lactose (milk and dairy foods) can cause IBS in some people. NICE agrees that probiotics, prebiotics and water soluble dietary fibre are potentially beneficial.
People with IBS will benefit from the following dietary tips:
- Avoid foods that irritate the colon (like bits of seed or nut – as in granary bread or some muesli, string in vegetables like runner beans or celery, or even bran) and eat foods that soothe and regulate it.
- Eat frequent small meals rather than big ones, and reduce your intake of tea and coffee, alcohol and soft drinks.
- Eat fruit but if this seems to be upsetting (fruit acids can make some IBS symptoms worse) then limit this.
- Adding soluble fibre to your diet seems to help bloating and diarrhoea as well as constipation. Soluble fibre can be found in oats and linseed. Eat a tablespoon of each daily in porridge or muesli. Ispaghula powder, a plant-based soluble fibre made from certain seeds, is available from pharmacies and healthfood shops.
- Consider limiting resistant starches (often found in processed or recooked foods), which can be difficult for people with IBS to digest.
- Sorbitol is an artificial sweetener found in some sugar-free sweets, fizzy drinks and diet products. If you get diarrhoea, avoid products containing sorbitol, as it may worsen your symptoms.
Organising lifestyle for IBS
As well as a healthy diet, a regular daily routine and managing stress are the best ways of improving IBS symptoms. If anxiety or stress plays a part in your IBS, try exercising and getting more good-quality sleep. Learning a relaxation technique could be helpful too. Keeping an IBS diary may help you to spot foods, activities or causes of stress that trigger your symptoms. Once you know what the triggers are, you can do something about them.
Self care options
Cutting down on alcohol and stopping smoking
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Summary
IBS sufferers already have a sensitive stomach and intestines, and tobacco can over-stimulate and irritate them. Some people find tobacco smoke triggers IBS symptoms. Inhaling tobacco smoke can cause reflux and heartburn, as well as bloating, burping and gassiness.
Moderate drinking means no more than two drinks a day for men and one drink a day for women. A unit of alcohol is half a pint of ordinary strength beer, lager or cider or a small pub measure (25 ml) of spirits or a standard pub measure (50 ml) of fortified wine such as sherry or port (20% alcohol by volume). A small (125ml) glass of basic wine is 1 and a 1/2 units.
Evidence
There have been some studies to see if alcohol and smoking are linked to IBS. It seems that there may be a link. Smoking tobacco and drinking large amounts of alcohol can certainly worsen indigestion, heartburn and reflux.
Safety
Cutting down on smoking and alcohol is safe, but if you are cutting down from heavy use, there can be side effects including loss of appetite and difficulty sleeping. There are unlikely to be side effects if you are cutting down a moderate alcohol intake but if you are a very heavy drinker, it is better to get help with cutting down.
Cost
No costs are involved and think of the money you will save!
Further information
For more information, see the NHS information sensible drinking.
If you are giving up or cutting down on smoking you can order a Quit Kit from SmokefreeNHS. You can also phone the NHS Free Smoking Helpline on 0800 022 4332.
View the evidence
Influence of alcohol consumption on IBS and dyspepsia.
Halder SL, Locke GR 3rd, Schleck CD, Zinsmeister AR, Talley NJ. Neurogastroenterol Motil. 2006 Nov;18(11):1001-8.
Survey of nearly 5000 people in the UK. Drinking 7 or more drinks a week was linked to dyspepsia and abdominal pain and, in some women, it was linked to IBS.
Link to Abstract
NICE Guidance (systematic review conducted).: Irritable bowel syndrome in adults: Diagnosis and management of irritable bowel syndrome in primary care.
National Collaborating Centre for Nursing and Supportive Care. NICE clinical guideline 61, National Institute for Health and Clinical Excellence, Issue date: February 2008
NICE recommendation: cutting down on alcohol. Smoking not specifically addressed.
Link to Abstract
Systematic review and meta-analysis of the prevalence of irritable bowel syndrome in individuals with dyspepsia.
Ford AC, Marwaha A, Lim A, Moayyedi P. Clin Gastroenterol Hepatol. 2010 May;8(5):401-9. Epub 2009 Jul 23.
Systematic review of 19 trials (involving over 18,000 people) showed that people with dyspepsia (indigestion) are 8 times more likely to have IBS.
Link to Abstract
Dyspepsia in general practice: incidence, risk factors, comorbidity and mortality.
Wallander MA, Johansson S, Ruigómez A, García Rodríguez LA, Jones R. Fam Pract. 2007 Oct;24(5):403-11. Epub 2007 Aug 28.
Study in the UK comparing nearly 7000 people with and over 11000 people without dyspepsia. Showed that people who smoked were more likely to suffer from dyspepsia.
Link to Abstract
Exercise
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Summary
You don’t have to use the gym to exercise; even 30 minutes brisk walking every day is enough to make a useful difference to your overall health and well-being. Being active does more than keep you fit. It makes your heart and lungs work better, tones your muscles, and strengthens your bones and joints. It also stimulates blood flow to your brain and internal organs and boosts your immune system. It helps protect you against osteoporosis, triggers brain chemicals that lift your mood and can generate a glowing sensation of well-being. It has been shown to improve all sorts of health problems.
Exercise can include aerobics such as stepping and walking; strengthening exercises such as lifting weights or using resistance machines; and stretching for flexibility. Other types of exercise are tai chi, qigong and yoga
Evidence
Research shows that keeping active is generally helpful to health. Moderate exercise such as walking may help with IBS symptoms. But very vigorous exercise may make some symptoms, particularly diarrhoea, worse.
Safety
If you’re not used to being active, start off slowly and build up gradually, doing a bit more every other day. If you feel worse, cut back, and increase your activity more slowly. If you think it isn’t helping or that you’re getting worse in any way, check with your doctor. Anyone with severe osteoporosis, arthritis, acute back pain or recent injuries should first get advice about exercise from a doctor or physiotherapist.
Cost
You can exercise at home for nothing, remember walking and gardening are both forms of exercise. There will probably be a small cost, if you join an organised programme.
Further information
Natural England is one of several organisations that organise walking schemes designed to help people improve their health. Walk4Life Programme has about 600 local groups, and around 40,000 people take part in short local walks every week. Find out about Green Gyms where volunteers take on voluntary projects outdoors. Many local councils organise Health Walks for people who want to get active in company.
Check your local leisure centre for exercise classes. See also the Classes section for more information.
View the evidence
Irritable bowel syndrome in adults: Diagnosis and management of irritable bowel syndrome in primary care.
National Collaborating Centre for Nursing and Supportive Care. NICE clinical guideline 61, National Institute for Health and Clinical Excellence, Issue date: February 2008
NICE recommendation: All sedentary people should receive brief advice and counselling to encourage physical activity. Note: NICE guidance mentions moderate physical activity (e.g. brisk walking) may improve gut transit time but if you tend to get an irritable bowel, vigorous physical activity (e.g. running) can sometimes make you feel like you need the loo.
Link to Abstract
Physical activity improves symptoms in irritable bowel syndrome: a randomized controlled trial.
Johannesson E, Simrén M, Strid H, Bajor A, Sadik R. Am J Gastroenterol. 2011 May;106(5):915-22. Epub 2011 Jan 4.
Randomised controlled trial involving 102 people with IBS. People were either helped by a physiotherapist to increase their physical activity or told to maintain their normal lifestyle for 12 weeks. IBS symptoms in people in the physical activity group improved than in the normal lifestyle group.
Link to Abstract
The effects of exercise upon symptoms and quality of life in patients diagnosed with irritable bowel syndrome: a randomised controlled trial.
Daley AJ, Grimmett C, Roberts L, Wilson S, Fatek M, Roalfe A, Singh S. Int J Sports Med. 2008 Sep;29(9):778-82. Epub 2008 May 6.
Randomised controlled trial involving 56 people with IBS who were allocated to either an exercise consultation intervention or usual care for 12 weeks. No differences in quality of life scores were seen but symptoms of constipation improved in people in the exercise group.
Link to Abstract
Following an exclusion diet
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Summary
Keeping a food diary should help you to find out whether certain foods make your symptoms worse. Each day write down changes in what you eat score your main symptoms out of 10 (10 being worst). As the effects of food might be felt some time after you’ve eaten them you will need to do this over a few weeks to spot trends.
Evidence
Some research suggests that cutting out certain foods from your diet might help. In the studies that have been carried out, people with IBS have tried cutting out a wide range of different foods.
Safety
It can be quite difficult to exclude certain foods and still have a balanced diet. If you want to make big changes to what you eat, it is a good idea to see a dietician or nutritionist. They can help you make sure you are still eating a healthy diet and getting all the nutrients you need.
Cost
Eating a healthy diet and excluding some foods need not cost you anything. But if you consult a professional there will be a charge, unless there is a dietician service provided by your GP’s practice.
View the evidence
Irritable bowel syndrome in adults: Diagnosis and management of irritable bowel syndrome in primary care.
National Institute for Health and Clinical Excellence, National Collaborating Centre for Nursing and Supportive Care. NICE clinical guideline 61, Issue date: February 2008
Reviewed 16 studies including 2 randomised controlled trials. In most studies, specific foods were excluded and then reintroduced and mixed results were found. The guidance states that: Wheat, resistant starch, caffeine, fructose, sorbitol, alcohol and fizzy drinks have…been reported to commonly affect symptoms.
Link to Abstract
Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized placebo-controlled evidence.
Shepherd SJ, Parker FC, Muir JG, Gibson PR. Clin Gastroenterol Hepatol. 2008 Jul;6(7):765-71. Epub 2008 May 5.
Randomised controlled trial in which 25 people with IBS were given a diet low in fructose and fructans. People were then given fructose, fructans or glucose. Symptoms appeared worse when people received fructose or fructans compared with glucose.
Link to Abstract
Meditation
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Summary
Meditation is a state of mind, not a religion, though it features in most major religions, especially Eastern ones. Meditation seems to harmonise the activity between the two sides of the frontal brain, and encourages a ‘relaxation response’. The relaxation response happens when the body and mind do the opposite of what they do when you feel stressed. In meditation the body is relaxed while the mind is alert. You don’t need an experienced teacher or a spiritual faith in order to take up meditation. You can learn the basics from a book or a podcast. Meditation is easily accessible, and it is remarkably effective, both for rapid stress reduction and as a way of promoting long-term health.
Evidence
A small study of people with IBS who learnt meditation, then practised at home, showed that their symptoms improved after about three months. More recently, research has shown that mindfulness meditation may be a promising treatment for IBS symptoms, but further research is needed to confirm this.
Safety
There are generally no safety problems with meditation unless you have a severe or long-standing mental health problem.
Cost
Meditation involves certain (simple) techniques that can be easily practised at home. There are many online resources, books and audio aids available and some people find it useful to join a class initially.
View the evidence
Internet-delivered exposure and mindfulness based therapy for irritable bowel syndrome–a randomized controlled trial.
Ljatsson B, Falk L et al. Behav Res Ther. 2010 Jun;48(6):531-9. Epub 2010 Mar 16.
Randomised controlled trial involving 86 people who were allocated to the internet therapy or to an an online discussion forum. Symptoms of people in the internet therapy group reduced but in the discussion group they increased.
Link to Abstract
Mindfulness training reduces the severity of irritable bowel syndrome in women: results of a randomized controlled trial.
Gaylord SA, Palsson OS, Garland EL, Faurot KR, Coble RS, Mann JD, Frey W, Leniek K, Whitehead WE. Am J Gastroenterol. 2011 Sep;106(9):1678-88. doi: 10.1038/ajg.2011.184. Epub 2011 Jun 21.
Randomised controlled trial involving 75 women with IBS who took part in a mindfulness group or a support group for 8 weeks. Symptoms in women in the mindfulness group improved more than symptoms in women in the support group.
Link to Abstract
The effects of relaxation response meditation on the symptoms of irritable bowel syndrome: results of a controlled treatment study.
Keefer L, Blanchard EB. Behav Res Ther. 2001 Jul;39(7):801-11.
Small trial in which 16 adults were randomized to either a six week meditation (taught then practiced at home twice a day for 15mins) or wait list control group. 13 people completed the trial. Meditation appeared better than no mediation in improving IBS symptoms (wind, bloating and diarrhoea) after 3 months.
Link to Abstract
Probiotics
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Summary
We live in harmony with bacteria on our skin, and in our gut and urinary tract. Too many of the wrong sort may make us ill, but too few may make us more prone to illness. Probiotics are bacteria that occur naturally in the gut, or which are found naturally in certain foods (eg cider vinegar, miso, yogurt), or added to foods for particular benefits when eaten. Many kinds of probiotics and mixtures have been researched in clinical trials for IBS. They generally (but not always) show a modest reduction of symptoms including pain, wind, bloating and stool frequency.
Evidence
Many different types of probiotics have been studied in people with IBS. Some studies report that symptoms such as pain, wind, bloating and stool frequency improved. The size of effect is only small though and not all studies found effects.
Safety
Probiotics are generally safe and well tolerated. Avoid if you are allergic or hypersensitive to probiotics or lactose or milk (where these are the vehicle). Although probiotics seem to be helpful and safe for people with IBS, the type and best dose is still not clear.
Cost
Probiotics can be found in certain yoghurts and probiotic drinks and can also be bought in capsule and tablet form.
View the evidence
Alternative medical therapies for dyspepsia: a systematic review of randomized controlled trials.
Cash B, Schoenfeld P.
In: Johnson DA, Katz PO, Castell DO, eds. Dyspepsia. Philadelphia, Pa: American College of Physicians-American Society of Internal Medicine; 2001:159-175.
Efficacy of probiotics in irritable bowel syndrome: a meta-analysis of randomized controlled trials.
Nikfar S, Rahimi R, Rahimi F, Derakhshani S, Abdollahi M. Diseases of the Colon and Rectum 2008; 51(12): 1775-1780, doi:10.1007/s10350-008-9335-z
Probiotics may improve irritable bowel syndrome symptoms compared to placebo.
Link to Abstract
A systematic review and meta-analysis: probiotics in the treatment of irritable bowel syndrome.
Hoveyda N, Heneghan C, Mahtani KR, Perera R, Roberts N, Glasziou P. BMC Gastroenterology 2009; 9(15)
Systematic review of 14 randomised controlled trials involving 1,125 people. The authors concluded that probiotics may alleviate some symptoms of irritable bowel syndrome after several weeks of treatment.
Link to Abstract
The efficacy of probiotics in the treatment of irritable bowel syndrome: a systematic review.
Moayyedi P, Ford AC, Talley NJ, Cremonini F, Foxx-Orenstein AE, Brandt LJ, Quigley EM. Gut. 2010 Mar;59(3):325-32. Epub 2008 Dec 17.
Systematic review of 19 randomised controlled trials in 1650 people. Probiotics were shown to be beneficial in IBS but the size of the effect and which bacterial culture is most helpful are uncertain.
Link to Abstract
Irritable bowel syndrome in adults: Diagnosis and management of irritable bowel syndrome in primary care.
NICE Guidance (systematic review conducted).
National Collaborating Centre for Nursing and Supportive Care, NICE clinical guideline 61, National Institute for Health and Clinical Excellence, Issue date: February 2008
Systematic review of 11 trials. The conclusions were that probiotics may be useful in the management of IBS but this depends on the dose and specific bacterial strain.
Link to Abstract
Efficacy of probiotics in irritable bowel syndrome: a meta-analysis of randomized controlled trials.
Nikfar S, Rahimi R, Rahimi F, Derakhshani S, Abdollahi M. Diseases of the Colon and Rectum 2008; 51(12): 1775-1780, doi:10.1007/s10350-008-9335-z
Systematic review of probiotics, reporting some benefit.
Link to Abstract
Meta-analysis of probiotics for the treatment of irritable bowel syndrome.
McFarland LV, Dublin S. World J Gastroenterol. 2008 May 7;14(17):2650-61.
Systematic review of probiotics, reporting some benefit.
Link to Abstract
The utility of probiotics in the treatment of irritable bowel syndrome: a systematic review.
Brenner DM, Moeller MJ, Chey WD, Schoenfeld PS. Am J Gastroenterol. 2009 Apr;104(4):1033-49; quiz 1050. Epub 2009 Mar 10.
Systematic review of probiotics, reporting some benefit.
Link to Abstract
Effectiveness of probiotics in the treatment of irritable bowel syndrome.
Wilhelm SM, Brubaker CM, Varcak EA, Kale-Pradhan PB. Pharmacotherapy. 2008 Apr;28(4):496-505.
Systematic review of probiotics, reporting some benefit.
Link to Abstract
Relaxation techniques
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Summary
Many people who feel depressed say they get tense and have problems sleeping. Relaxation skills can help with this. This technique teaches you to notice muscular tension and learn to relax your muscles to release the tension. Progressive relaxation works by tensing and relaxing various muscle groups in your body, starting from your feet and working your way up. At each level, try to notice how it feels when your muscles are tense, and how it feels when you let go and relax. Gradually you will get used to the feeling of relaxation and learn how to make it happen at will. As with most relaxation methods, you need to start by finding a quiet, relaxing place to practise. Put yourself in a comfortable position, whether standing, sitting or lying, and start by allowing your out-breath to get softer, longer and deeper.
Evidence
Research shows that using relaxation or stress management techniques may help with some IBS symptoms. Studies have not yet proved that these techniques ease IBS pain.
Safety
These techniques are generally safe unless you have a severe or long-standing mental health problem.
Cost
Once you have learned the relaxation techniques, there are no costs. There are many books and audio aids available and some people find it useful to join a class initially.
View the evidence
Psychological treatments for the management of irritable bowel syndrome.
Zijdenbos IL, de Wit NJ, van der Heijden GJ, Rubin G, Quartero AO.
Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD006442.
Cochrane systematic review including 10 trials of stress management or relaxation therapy. Relaxation or stress management was found to be ‘better than usual care or waiting list for improving symptoms, abdominal pain and quality of life at 2 months’.
Link to Abstract
Effect of autogenic training on general improvement in patients with irritable bowel syndrome: a randomized controlled trial.
Shinozaki M, Kanazawa M, Kano M, Endo Y, Nakaya N, Hongo M, Fukudo S. Appl Psychophysiol Biofeedback. 2010 Sep;35(3):189-98.
Small randomised controlled trial (21 people) in which people received autogenic training or had discussions on diet and lifestyle. Autogenic training seemed to help with some aspects.
Link to Abstract
Functional relaxation as complementary therapy in irritable bowel syndrome: a randomized, controlled clinical trial.
Lahmann C, Röhricht F, Sauer N, Noll-Hussong M, Ronel J, Henrich G, von Arnim A, Loew T. J Altern Complement Med. 2010 Jan;16(1):47-52.
Randomised controlled trial involving 80 people with IBS who either took part in functional relaxation sessions or received treatment as usual plus two counseling interviews for 5 weeks. The results suggested that the relaxation training may be helpful.
Link to Abstract
Taking soluble fibre
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Summary
Taken with fluids, soluble fibre can relieve diarrhoea as well as constipation. But insoluble fibre, such as bran, is not effective for IBS and may make some people’s symptoms worse.
Evidence
Research has shown that certain types of fibre are better than others in easing IBS symptoms. Insoluble fibre (found in wheat bran and the skins, husks and peels of foods such as nuts, raw vegetables and brown rice) is less likely to help. Soluble fibre is much more beneficial. This is found in foods such as oats, oat bran, barley, quinoa and in ispaghula powder.
Safety
It is safe to gradually increase the amount of soluble fibre in your diet.
Cost
No extra costs are involved.
View the evidence
High-fiber diet supplementation in patients with irritable bowel syndrome (IBS): a multicenter, randomized, open trial comparison between wheat bran diet and partially hydrolyzed guar gum (PHGG).
Parisi GC, Zilli M, Miani MP, Carrara M, Bottona E, Verdianelli G, Battaglia G, Desideri S, Faedo A, Marzolino C, Tonon A, Ermani M, Leandro G. Dig Dis Sci. 2002. Aug;47(8):1697-704.
Link to Abstract
Irritable bowel syndrome: can nutrient manipulation help?
Cabre, E. Curr Opin Clin Nutr Metab Care. 2010 Sep;13(5):581-7.
Link to Abstract
Irritable bowel syndrome in adults: Diagnosis and management of irritable bowel syndrome in primary care.
National Institute for Health and Clinical Excellence, NICE Guidance (systematic review conducted). National Collaborating Centre for Nursing and Supportive Care, NICE clinical guideline 61, National Institute for Health and Clinical Excellence, Issue date: February 2008
Based on a systematic review of the evidence published up to 2005 (20 studies). The results were that people reported overall improvements even though pain and bowel habits did not appear to change. The conclusions were that ‘People with IBS should be discouraged from eating insoluble fibre (for example, bran). If an increase in dietary fibre is advised, it should be soluble fibre such as ispaghula powder or foods high in soluble fibre (for example oats).‘
Link to Abstract
Bulking agents, antispasmodics and antidepressants for the treatment of irritable bowel syndrome.
Ruepert L, Quartero AO, de Wit NJ, van der Heijden GJ, Rubin G, Muris JWM. Cochrane Database of Systematic Reviews 2011, Issue 8. Art. No.: CD003460. DOI: 10.1002/14651858.CD003460.pub3.
Cochrane systematic review of 12 trials published up to 2005. Concluded that there was no evidence that fibre supplements are helpful in IBS.
Link to Abstract
Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta‐analysis.
Ford A C, Talley N J, Spiegel B M, Foxx‐Orenstein A E, Schiller L, Quigley E M, Moayyedi P. BMJ.2008;337:a2313.
Systematic review of 9 trials (591 people) that concluded that Ispaghula husks, a type of fibre supplement, are more effective than placebo for treating irritable bowel syndrome.
Link to Abstract
The role of psyllium fibre supplementation in treating irritable bowel syndrome.
Chouinard LE. Can J Diet Pract Res. 2011 Spring;72(1):e107-14.
Systematic review of 12 trials of psyllium, a fibre supplement. The results of the trials were conflicting so it was not possible to state whether psyllium is helpful in IBS.
Link to Abstract