IBS 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
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.
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.
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.
No costs are involved and think of the money you will save!
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.
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
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.
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.
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.
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.
Following an exclusion diet
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.
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.
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.
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.
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.
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.
There are generally no safety problems with meditation unless you have a severe or long-standing mental health problem.
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.
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.
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.
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.
Probiotics can be found in certain yoghurts and probiotic drinks and can also be bought in capsule and tablet form.
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.
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.
These techniques are generally safe unless you have a severe or long-standing mental health problem.
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.
Taking soluble fibre
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.
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.
It is safe to gradually increase the amount of soluble fibre in your diet.
No extra costs are involved.