Irritable bowel syndrome (IBS) is a chronic digestive disorder that waxes and wanes. Sometimes IBS symptoms are mild and manageable, and other times they flare up and become a bigger pain in the a*s than usual (pun intended).
A lot of people wonder what to eat during an IBS flare up, so today we’ll explore flare ups, foods to eat and foods to limit, and other non-food strategies that can help when the gut is particularly cranky.
What Is An IBS Flare Up?
An IBS flare up is a term people use to describe a noticeable worsening of symptoms that can last days, weeks, or months.
Symptoms that usually flare include abdominal pain, bloating, gas, and reflux in people prone to heartburn.
Whether diarrhea or constipation worsens depends on the subtype of IBS a person has: diarrhea-predominant IBS (IBS-D), constipation-predominant IBS (IBS-C) or mixed IBS (IBS-M – alternating constipation with diarrhea).
How long a flare up lasts is highly individual and can be influenced by the factors that triggered it. Therefore, donning your thinking cap and considering the causes of the flare up is a good place to start as you work to tame your symptoms.
Why Do IBS Flare Ups Happen?
Many diet and lifestyle factors shape IBS symptoms, so people need to look closely at which ones are likely culprits. Knowing what is triggering a flare up helps IBS sufferers determine the best strategies for managing.
Here are some questions to ask yourself if you’re going through a flare up:
- Did my diet change recently?
- Am I eating more of my trigger foods because I enjoy them?
- Did I start eating a new food? (Eg. adding protein bars or sugar-free candy to your usual diet)
- Am I eating different foods from usual? (Eg. due to travel or staying with relatives)?
- Am I eating seasonal foods that are tough on my system? (Eg. more ice cream or salads in the summer; more alcohol in December; etc.)
- Am I experiencing more stress or anxiety than usual?
- Was there a big change in my life recently?
- Has my sleep deteriorated?
- Am I less physically active than normal?
- Did I start a new medication or supplement recently? Did I stop or change the dose of a medication or supplement?
- *Always follow your doctor’s advice on taking medications and speak to your doctor or pharmacist before making any adjustments to medications.
Another question to consider is whether you’ve stopped doing the things you usually do to manage your symptoms. For example, is your activity level down compared to normal? Did you give up making oatmeal for breakfast in favour of a simple bowl of corn flakes? Did an old coffee habit creep back?
After you’ve done a bit of personal sleuthing and hit on some possible flare up triggers, the next step is, of course, to address them.
Take a gander at my blog: “11 Ways to Relieve IBS Symptoms Without the Low FODMAP Diet“, which reviews diet and non-diet strategies for addressing common IBS triggers.
When to talk to a doctor
If you haven’t identified a particular trigger at the root of your current flare up, it might be time to chat with a doctor.
Doctors exist to help us manage our health, so if you think you should talk to a doctor about your digestive symptoms, then listen to your gut and do so.
Your doctor can assess whether your symptoms are a flare or if another digestive condition is playing a role in your discomfort.
People with IBS who develop the following symptoms should definitely check in with a doctor:
- Blood in the stool.
- New onset of unexplained and significant fatigue.
- Unintentional weight loss.
- New onset of multiple liquid bowel movements daily.
What to eat during an IBS flare up
The answer to this question is pretty individual. What works for one person may not work for another depending on their unique triggers and other lifestyle factors.
If you know your food triggers, make sure to limit them or cut them out entirely during the flare up.
Replace trigger foods with non-triggering equivalent foods to continue getting enough nutrients. For example, if you’re able to eat a few apples a week but know you can’t handle them daily, temporarily cut them out and replace them with a fruit you know you can handle.
Once the flare up passes, resume eating the apples as you did prior to cutting them out, and monitor your symptoms.
People who have completed the low FODMAP diet, identified their FODMAP triggers and moved onto the personalization phase of the diet can temporarily revert back to low FODMAP (green light) serving sizes of foods they usually tolerate in moderate (yellow light) serving sizes.
For example, if a person knows that they can tolerate only small amounts (ie moderate / yellow light serving sizes) of garlic and onion, cutting them out during a flare up may help ease symptoms.
People who haven’t done much symptom monitoring and are unaware of their food triggers might feel a bit lost, so here are some commonly-tolerated foods to try during an IBS flare up:
- Lean animal proteins: chicken breast, extra lean ground meat or poultry, fish, eggs, lean and tender cuts of meat like pork tenderloin.
- Plant proteins: firm tofu, canned and rinsed chickpeas and lentils (no more than 1/4 cup at a sitting), nut and seed butters, peanuts, walnuts, hemp hearts.
- Grains: Oatmeal, sourdough bread, rice; plain crackers, rice cakes.
- Fruit: Bananas, blueberries, kiwi, cantaloupe, clementines with the white pith removed.
- Vegetables: potatoes, sweet potato, carrots, butternut squash, pumpkin, parsnip, zucchini, fresh tomato, green beans, canned beets.
- Cook or blenderize (think smoothies) baby lettuces like baby spinach and baby kale, which are more tender than their tougher “adult” versions.
- Dairy/Alternatives: lactose-free milk and yogurt if you have lactose-intolerance, if not then regular milk and plain yogurt should be fine for most people; old cheddar in small amounts; cottage cheese; unflavoured almond milk (fortified with calcium and vitamin D).
- Flavourings: fresh herbs finely minced, dried herbs, mild spices like cinnamon and ginger, smaller-than-usual portion sizes of sauces.
Of course, just because a food is listed as usually tolerated by people with IBS doesn’t guarantee your body will tolerate it. Listen to your body and limit foods you know trigger symptoms.
Example day of eating during an IBS flare up:
- Breakfast: Oatmeal with blueberries, hemp hearts, and a bit of milk (lactose-free if needed). Glass of water. Peppermint tea.
- Lunch: Salmon salad sandwich on sourdough bread (go easy on the mayo), small vegetable soup, 1 kiwi. Glass of water.
- Supper: Roast chicken, rice pilaf, roasted vegetables (carrots, parsnip). Glass of water.
- Snack 1: Peanut butter with plain crackers. Glass of water. Ginger tea.
- Snack 2: Plain yogurt with cut up banana. Glass of water.
Haven’t identified connections between your symptoms and your diet & lifestyle?
Get journalling!
Foods to limit during an IBS flare up
Many people with IBS report a handful of foods that are more likely to trigger symptoms so limiting these items may help.
Common IBS trigger foods to limit include:
- Spicy food, especially food with hot spices like jalapeno, hot sauce, hot curry.
- Greasy, fatty food like pizza, fast food, fried food, fatty meat like sausages, chicken drumsticks (with or without skin), ribs, food with creamy sauces.
- High sugar foods like cookies, desserts, candies, chocolate bars, ice cream, etc.
If your IBS flare up includes upper abdominal symptoms like stomach discomfort and reflux, temporarily limit the following tough-to-digest foods:
- Raw vegetables, including salads. Don’t cut out vegetables though! Just cook them soft via steaming, roasting/baking, or gently sauteeing (but not frying).
- Fruit and vegetable skins. Remove skins from fruits and vegetables where possible, like cucumber, zucchini, carrots, potatoes, and sweet potatoes.
- Raw nuts and seeds. Instead, eat pulverized nuts and seeds like peanut butter, almond butter, ground flax, almond meal, hemp hearts blenderized in smoothies; also, cooked or soaked chia seeds.
- Tough and/or stringy meat like tough steaks, pork chops, lamb, shrimp / lobster and shellfish.
What to drink during an IBS flare up
People going through a flare up need to be extra mindful about drinking enough fluids, with 8 cups (250ml) per day being a minimum. People should drink a minimum of 10 cups/day of fluid when they spend time outdoors in warm weather, are physically active, or have larger bodies.
What to drink?
- Water (shocking, right?).
- Most of the fluids people drink in a day should be water, which we all know hydrates the body without triggering symptoms.
- Tea.
- Soothing teas that are also low FODMAP include peppermint tea and ginger tea. Check the Monash FODMAP app for other low FODMAP tea ideas.
- Sports drinks.
- If multiple liquidy bowl movements are present, electrolytes in our blood (eg potassium and sodium) can become depleted which can lower blood pressure and leave a person feeling weak. Sports drinks contain electrolytes to help replenish losses in liquid stool. Sports drinks also contain sugar or artificial sweeteners that may aggravate gut symptoms further, so they should be consumed conservatively.
Of course, if you’re having so much diarrhea that you feel you need more than one sports drink a day, consider speaking with a doctor about your diarrhea.
Drinks to limit
The following drinks may worsen an IBS flare up:
- Fizzy / carbonated drinks (eg. pop, carbonated water).
- Gingerale. This is a contentious one because some people feel better drinking Gingerale; however, as a fizzy drink with high fructose corn syrup, Gingerale may worsen gut symptoms.
- Teas that are higher in FODMAPs: strong black tea, strong chai tea, chamomile tea, oolong tea.
- Coffee / espresso, even decaf.
- Specialty coffees like mochas, iced flavoured coffees, etc.
- Alcohol.
- Juice. Sugary drinks tend to worsen diarrhea, and most are higher in FODMAPs.
Other ways to manage an IBS flare up
An IBS flare up may not be about food. The IBS gut is sensitive to new or worsening stressors, declining mental health, less sleep, lower activity levels, and even hormone fluctuations related to menstruation.
Non-food interventions for managing an IBS flare up include behavioural strategies like gut-directed hypnotherapy, diaphragmatic breathing, yoga, over-the-counter medications, and supplements like peppermint oil.
Behavioural (non-food) strategies
A lot of these activities can improve a person’s emotional state which can in turn help take the edge off during a flare up.
- Gut-directed hypnotherapy, either done with a counsellor or an app like Nerva or Regulora
- Mindfulness meditation
- Deep breathing
- Yoga
- Gentle exercise like walking, biking or swimming, which helps with gas clearance.
- Prioritizing sleep
- Journalling
- Engaging in something that shifts the mind’s focus: reading a book, watching a movie, playing with a pet / child / grandchild, playing a sport
- Hot bath or shower
- Heating pad
Over-the-counter medications
There’s a time and place for over-the-counter medications (OTCs). Talk to your doctor or pharmacist about whether OTCs might be right for you, and read the labels carefully.
- Simethicone (brand name: Gas-X) – helps reduce flatulence.
- Loperamide (brand name: Imodium) – helps with diarrhea.
- PEG 3350 (brand names: RestoraLAX, Lax-A-Day) – helps with constipation.
- Hyoscine butylbromide (brand name: Buscopan) – helps relieve abdominal pain and cramps.
Supplements
Some supplements have been studied and found to improve IBS symptoms. Like with OTCs, read the labels carefully.
- Psyllium husk (eg. Metamucil) or partially-hydrolyzed guar gum (eg. Fibre4) – these fibre supplements should be started at a low dose and slowly increased over time to minimize side effects like flatulence.
- Peppermint oil (185-225mg enteric-coated tablet) can help when abdominal pain arises, or prevent pain when taken before eating.
- Iberogast helps with abdominal pain.
- Probiotics can take weeks to start working and are usually best at reducing mild abdominal pain.
Bottom Line
IBS flare ups are frustrating and sometimes distressing, but with a little personal assessment and a few tweaks to diet and lifestyle, people can overcome them. Tweaks a person can implement include resuming their usual symptom-management strategies (if they’ve fallen to the wayside), and addressing triggers that have recently popped up.
Additionally, IBS sufferers can take control by limiting personal food triggers as well as more common ones while embracing easy-to-digest foods and beverages. And since taming IBS requires a holistic approach, other tweaks one can make during a flare up include addressing stress and gut-brain health, prioritizing sleepy and physical activity, and turning to over-the-counter medications.
xoAndrea, RD
