IBS sufferers don’t always need elaborate diets to ease their digestive distress. It’s remarkable how much symptoms can improve when a person minimizes common IBS triggers and adopts a healthy lifestyle. In this blog, we’ll explore 11 ways to relieve IBS symptoms without relying on the low FODMAP diet.
1. Eat healthy
Why eat healthy? This is a bit of a rhetorical question, but I can’t resist touching on a few notable reasons. Healthy eating….
- Provides adequate nutrients to fuel your body and support biological processes
- Minimizes inflammation via antioxidants and other phytochemicals
- Nourishes your gut microbiota so they in turn support your health
- Reduces the risk of diseases like diabetes, heart disease, dementia, and cancer
- Supports physical and mental well-being
Healthy eating principles
There are many different ways to eat healthy, but evidence-based guidelines generally point to a few major principles:
- Eat mostly whole foods
- Eat mostly plant foods
- Include lots of variety in your diet
- Eat fatty fish like salmon, trout, and herring (or seeds and walnuts)
- Stay hydrated with water
- Keep portions and frequency of “junk food” to a minimum
Healthy plate model for lunch and supper
Early in my career I discovered the power of the healthy plate model. Much more than Canada’s Food Guide, the healthy plate model gave my patients a practical guide for how to structure healthy, balanced meals. When Health Canada replaced the rainbow food guide with the healthy plate model, this geeky dietitian did a fist pump.
The healthy plate model divides the plate according to food type. Half the plate contains veggies and/or fruit, 1/4 contains whole grains, and 1/4 contains healthy protein.
For “mixed dishes” like casseroles, pastas, etc, think in terms of proportions: aim for 50% veg/fruit + 25% whole grains + 25% healthy proteins.
EXAMPLES:
Breakfast
- Oatmeal (whole grain) with hemp hearts and peanut butter (proteins), topped with berries (fruit).
- Small veggie omelet (protein, vegetables) accompanied by a slice of whole wheat toast (whole grain) lightly smeared with peanut butter and topped with sliced banana (fruit).
Lunch
- Teriyaki stir fry: brown rice (whole grain) with tempeh or chicken (protein) and lots of stir fried veggies (vegetables).
- Chickpea quinoa salad: Quinoa (whole grain) with chickpeas (protein) and veggies (vegetables).
Supper
- Spaghetti: whole grain pasta (whole grain) with ground chicken (protein), tomato sauce with vegetables (vegetable) and a side salad (to tip the balance of the meal towards vegetables).
- Mild veggie chili (protein and vegetables) with whole grain bun (whole grains).
Portions
A lot of people ask how much they should eat. The answer to this is so individual and depends on body size, activity level, age, health conditions and health goals.
For general health recommendations, a good rule of thumb is: let your body guide you.
This means eating mindfully and being aware of your hunger and fullness cues. One handy tool that can teach you to listen to your body is the hunger/fullness scale.
By eating around hunger level of 3-4, you may avoid being so hungry that you overeat. By finishing at a fullness level of 7-8, you avoid eating more than your body needs.
Room for “junk food”
Yes, there is room for “junk food” in a healthy diet.
Junk food is ultra-processed and/or high in saturated fat, trans fats, sugar, or sodium. Think baked goods, candy, chips, fried foods, chips, Goldfish crackers (sorry parents), sugary drinks, processed meats, and yes, even my beloved chocolate (cue gentle sobbing).
While these foods certainly won’t win any health awards, they can promote well-being and heighten the pleasure of social activities, so we don’t need to eliminate them altogether. There’s room for a little ‘junk food’ in any healthy diet, just stick with small portions and infrequency consumption.
There’s an inverse dose response with junk food – the more you eat, the less healthy your diet becomes. So stick to modest portions and limit the frequency.
2. Eat every 3-5 hours
When you eat and how much you eat influences your gut motility which in turn influences your IBS symptoms.
Having breakfast in the morning allows your to capitalize on your gastrocolic reflex, which is stronger in the morning. The gastrocolic reflex triggers intestinal motility when food enters the stomach. This causes the stool in your colon to inch closer to your rectum and spark the urge to defecate.
This might sound scary to folks with IBS-D, but isn’t it better to have a loose bowel movement at your home base after breakfast than at work after lunch?
If you eat every 3-5 hours, it’s likely that your meal size won’t be gargantuan, which is important because large meals tend to trigger bloating, gas and abdominal pain. So it’s no surprise that avoiding large meals is a common recommendation for people with IBS.
Grazing on food doesn’t trigger the gastrocolic reflex in the same way that a decent sized meal does.
Grazing also inhibits the migrating motor complex, which is a wave of movement in the stomach and intestines that occurs about 1-4 hours after eating. These waves keep the intestinal contents moving along at a healthy pace.
3. Chew well
Digestion starts in the mouth. By chewing well, your food is broken down into little particles that make it easier for your salivary amylase (an enzyme in your saliva) to start breaking down carbohydrates. This means there’s less digestive work for your small intestine and you’ll transfer fewer undigested carbs to the large intestine where they would otherwise ferment.
Chewing well has the added advantage of slowing your eating pace, which gives you time to more carefully listen to your body’s fullness cues.
4. Eat fibre, but not excessive amounts
If your diet generally follows the aforementioned healthy eating principles, you shouldn’t have to worry about getting enough fibre.
Some people go overboard with fibre, often in an attempt to relieve constipation. But this can backfire and cause bloating, gas and abdominal pain. In fact, most of the major clinical guidelines on IBS management advise avoiding excessive fibre, especially wheat bran.
At this point, I could drone on about the different types of fibre, but I’m not going to for the sake of keeping things simple right now.
General guidelines for getting enough fibre:
- Eat whole grains every day in modest portions (ie. 1/4 of your plate). Examples: oats, brown rice, quinoa, buckwheat, whole grain pasta / breads / crackers.
- Eat 2-3 servings/day of fruit. 1 serving = 1 medium fruit (eg. banana or apple) or two small fruit (eg. clementines, kiwi) or 1/2 cup (eg. berries, cut up fruit).
- Eat 4+ servings/day of vegetables. 1 serving = 1/2 cup cooked or 1 cup raw. Fill half your plate at supper and lunch with veggies.
- Eat nuts and/or seeds daily, up to 1/4 cup per day.
- Include plant-based proteins in your diet, like chickpeas, lentils and other legumes, tofu, tempeh.
- With fibre must come water to help keep stool from drying out. Drink a minimum of 8 cups of fluid per day, mostly water, and see the fluid section below for details.
Avoid these fibre pitfalls:
- Limit foods high in wheat bran, like cereal, muffins, granola bars, etc. Regular wheat bran consumption can lead to bloating and gas for some IBS sufferers.
- Be wary of products advertised as having “added fibre” or “extra fibre”. Food manufacturers sometimes add processed fibres like inulin to foods (eg. cereals, granolas, snack bars, etc) to boost the fibre and cash in on the marketing. Inulin can definitely cause bloating in susceptible people.
- Don’t increase your fibre intake too fast as this can trigger bloating, gas and pain. Ease into fibre by adding a healthy fibre food to a meal or snack every week. Here’s an example:
- week 1: add fruit to breakfast every day
- week 2: add an extra serving of vegetables to supper every day
- week 3: add nuts or seeds to a meal or snack several times a week, and so on.
5. Drink enough fluids
I know – everyone’s heard this tip before, but it begs repeating because I see a lot of people skipping their fluids – especially those with busy jobs and/or busy families.
As I mentioned above, fluid helps reduce the risk of stool drying out and becoming difficult to pass.
So how much fluid constitutes “enough fluid”? Well believe it or not, the jury’s still out on this one.
But a good rule of thumb is 8-10 cups (2000 – 2500ml) per day for women and 10-12 cups (2500-3000ml) per day for men. People should drink more when they’re physically active or when spending time in hot weather.
One way to check if you’re getting enough fluid is by the colour of your urine. Dark yellow urine means the body needs more fluids. Light yellow urine suggests the body is probably getting enough.
All beverages, including coffee, contribute to fluid intake. The healthiest fluid is, of course, water. You knew that. Fluids to limit include juices, pop, other sugar-sweetened beverages, alcohol and energy drinks.
6. Keep greasy / high fat foods to a minimum
By greasy / high fat food, I’m talking about pizza, fried foods, fast food, creamy sauces, and desserts.
Research has found that fat slows the movement of gas in the small intestine. This leads to distension (bloating) and abdominal cramping in people with IBS on account of the gut hypersensitivity that accompanies this condition.
At the risk of sounding like a broken record… if you’re following general healthy eating principles then you’ve already tackled this strategy.
If you find greasy foods trigger symptoms but you really want to indulge, consider doing so at home where you can endure symptoms more comfortably than in public.
I would never eat my whipping-cream based homemade ice cream (which is amazing!) and then head out for a social gathering. No no. I enjoy my bonkers fatty ice cream during quiet nights at home in case I’m hit by a gas attack.
7. Enjoy sweets in small, infrequent portions
There are a few reasons why sweets – candy, chocolate, sugary drinks, baked goods – may contribute to your gastrointestinal symptoms.
First, some people with IBS may be carrying genes that prevent their bodies from making enough sucrase isomaltase. This enzyme is responsible for breaking sucrose (ie sugar) down into fructose and glucose. Undigested sucrose can draw water into the intestine which triggers symptoms.
Studies have found that reducing sugar in the diet improves overall IBS symptoms as well as non-gastrointestinal symptoms like fatigue and joint pain.
Second, fructose in large quantities is universally malabsorbed – meaning everyone struggles to absorb it when consumed in large amounts – like in sweets. But for people who are particularly sensitive to fructose, even smaller amounts can wreak havoc on the gut by drawing water into the intestine and accelerating gut motility.
Commercially-made sweets and sugary drinks are often made with high fructose corn syrup – a type of sugar that’s high in fructose.
Sweets belong in the “junk food” file (along with fatty/greasy foods), so enjoy them in small, infrequent amounts.
8. Limit other common gut irritants
IBS sufferers commonly attribute symptoms to alcohol, caffeine and spicy food. One way these irritants induce symptoms is by altering gut motility.
Research has found that in 1/3 of the general population, caffeine stimulates colonic movement within 4-30 minutes of consumption. This is why some people find a coffee in the morning helps with bowel regularity.
However, for people with IBS-D, being prone to coffee-stimulated bowel movements can be pretty unpleasant so it’s best to steer clear.
Similarly, binge drinking (4+ drinks) can accelerate gut motility and cause diarrhea the morning after. In addition to diarrhea, some research has even found that alcohol temporarily damages intestinal villi and increases intestinal permeability. Thankfully though, our guts heal pretty quickly (usually within 24-48 hours).
Chilis, such as jalapenos and red hot chili peppers, also speed up gut transit time in people with IBS-D and can trigger abdominal pain as well.
Of course, if you listen to your body and feel these common gut irritants don’t contribute to your symptoms, then by all means enjoy them. But still, go easy on the alcohol.
9. Be physically active
I doubt I need to tell you that physical activity is good for your health. But did you know it’s also good for your gut?
A team of researchers investigating IBS and exercise found that IBS symptoms improved in people who moderately increased their physical activity for 12 weeks. In a follow up study 5 years later, the same researchers found that participants from the original study who maintained higher physical activity levels also maintained better symptom control.
One possible way that physical activity improves IBS symptoms is by promoting gas transport in the gut. When gas builds up in the gut it can cause bloating, distension and abdominal pain. Exercise helps alleviate gas retention, thereby improving digestive symptoms.
So before you put yourself on the low FODMAP diet, make sure your activity levels are up to snuff. This means engaging in at least 150 minutes per week of moderate intensity physical activity, with activity most days of the week.
Great ways to be physically active:
- Brisk walk
- Hiking in nature (my personal favourite)
- Bike riding
- Swimming
- Playing sports like tennis, soccer, hockey, pickleball, etc
- Exercise classes or cardio machines at the gym
10. Get a good night’s sleep
As I write this I’m fighting the urge to take a nap. This isn’t surprising though, as people with IBS tend to be more prone to sleep disturbance and report fatigue as their most common non-gut symptom. Why that is – we don’t really know yet. But research has found that a bad night’s sleep can set IBS sufferers up for worse symptoms, particularly abdominal pain, the next day.
So what can you do to improve your sleep? An important first step is addressing your sleep hygiene.
Sleep hygiene involves setting yourself up for the best sleep possible. It includes avoiding screens during the 30-60 minutes before bedtime, following relaxing pre-sleep routines, and keeping your bedroom cool and dark.
Read more about sleep hygiene at Sleep on It Canada and the Sleep Foundation.
11. Manage your stress
Stress alters gut function in numerous ways and plays a leading role in IBS symptoms. Stress reduces pain thresholds, meaning it takes less pain than usual for you to feel IBS’s classic cramping. Stress also slows motility in the small intestine and accelerates motility in the colon, which is bad news for our IBS-D & M friends.
There are a variety of was to manage stress, but research suggests a few specific techniques can help improve IBS symptoms:
- Mindfulness meditation
- Learn about mindfulness meditation
- Deep breathing
- Learn diaphragmatic breathing
- Yoga
- Cognitive behavioural therapy
- Learn more about cognitive behavioural therapy for IBS
The above strategies are often referred to as “healthy gut habits” and lay the foundation for relieving IBS symptoms.
If you think you could do better in any of these areas, I suggest you get to work on them before initiating the low FODMAP diet.
Wondering how closely you’re following these healthy gut habits? As a Monash FODMAP trained dietitian, I assess peoples’ diets and lifestyles and provide individualized advice to help them feel better.
As always, drop me a line in the comments section if you have any questions.
xoAndrea, RD
