Post festive indulgence Looking at Irritable Bowel Syndrome and Diet recommendations

Irritable Bowel Syndrome, (IBS), is very common and can be really debilitating and can be much worse following festive indulgence.  Gut symptoms vary, but typically include abdominal pain, bloating, wind, nausea, diarrhoea and/or constipation. For some, the symptoms can be so severe that it stops or curtails every day and social activity.

 It is very important to have IBS confirmed as the diagnosis by your doctor, ruling out other possibilities, such as coeliac disease and Inflammatory Bowel Disease, e.g. Crohn’s Disease.  If you are considering a gluten-free diet, because you suspect wheat upsets you, talk to your GP about a coeliac blood test.  For this to be valid, you must eat gluten, (wheat), for 6 weeks before the test.  Too many people start long term gluten-free diets without being tested, yet coeliac disease presents with similar gut symptoms to IBS. If you are not tested, you will not rule out coeliac disease and you could miss essential treatment and monitoring for this condition.

Also, if you experience gut symptoms with any of the following please consult your doctor

• Unintentional and unexplained weight loss

• bleeding when you pass your stools or poo

• a family history of bowel or ovarian cancer

• a change in bowel habit to looser and/or more frequent stools persisting for more than six weeks in a person aged over 60 years.

What can I do to help my IBS?

• Three regular meals a day. Smaller meals may be better. Avoid late night eating, or skipping meals.

• Cut down fatty processed foods like chips, pizza, cakes and biscuits.

• Limit fruit to three (about 80g) portions a day

• Reduce fizzy drinks

• Keep a food and symptom diary to identify patterns and see if changes help. Make only one change at a time, so that you can tell what helped.

What other changes are worth trying? 

If you have the following symptoms these changes may help for

Wind/Bloating

Avoid gas-producing foods, such as sprouts, broccoli, cauliflower, beans, pulses, sugar-free mints and chewing gum.

You may find it helpful to eat oats (such as oat‑based breakfast cereal or porridge) and linseeds (up to one tablespoon per day). 

Constipation

Ensure a good fluid intake of 2 litres a day, (8 mugs/glasses).

Increase fibre gradually, with wholegrain and more fruit and vegetables. Oats and linseeds are particularly helpful with softer stools.

Try 1-2 tablespoons of linseeds with your breakfast cereal, soup, or yoghurt.

Avoid extra wheat bran. This can make things worse.

Diarrhoea

Ensure a good fluid intake of 2 litres a day, (8 mugs/glasses).

Limit fruit juice to a small glass daily.

Limit caffeine from coffee, tea and cola drinks to maximum three a day.

Choose white and lower fibre varieties of breakfast cereal and bread.

Avoid sugar-free sweets, mints, gum and drinks containing sorbitol, mannitol and xylitol. 

What about Probiotics?

If the actions above don't resolve your symptoms adequately, you may find probiotics helpful.  There are many types and you should try them for about a month before seeing if they work. You may need to try more than one strain/brand.

Still not working?

Speak to your GP about referral to a dietitian.  They may suggest a diet to reduce fermentable carbohydrates, (the Low FODMAP diet).  FODMAPs, (Fermentable, Oligo-, Di-, Mono-saccharides and PolyolS), are short chain carbohydrates, (e.g. fructans, galacto-oligosaccharides, polyols, fructose and lactose), that are poorly absorbed in the small intestine. With all the information on Low FODMAPS on the internet, you may be tempted to try this yourself.  However, it is not an easy diet and the first phase of cutting down FODMAPS for 6-8 weeks is only part of the treatment.  The second phase, and really important part, is to systematically test for toleration of the foods avoided.  The Low FODMAP approach is complex and, if both phases are not carried out, your food choice may be more restricted than needed.  It is recommended that you follow this approach under a dietitian's care.  It is important to avoid any unnecessary diet restrictions and potentially unwanted nutritional consequences, such as low calcium intake or weight loss which may compromise your recovery.

By Sue Luscombe RD, Specialist Dietician, Vitality360 

References and further reading

1, British Dietetic Association Foodfacts on Irritable bowel Syndrome.  Available at https://www.bda.uk.com/foodfacts/IBSfoodfacts.pdf (accessed December 2019)

2. National Institute for Health and Clinical Excellence (2008) CG61 Irritable bowel syndrome in adults: Diagnosis and management of irritable bowel syndrome in primary care. Updated Feb 2015 Available at http://www.nice.org.uk/guidance/cg61 (accessed December 2019)

3.  Lomer, M, McKenzie,Y et al (2010) The Dietetic Management of Irritable Bowel Syndrome in Adults, BDA Gastroenterology Group Clinical Guideline Birmingham: BDA