Registered nutritionist and gut health specialist Marilia Chamon, who is the founder of Gutfulness, shares her expert dietary advice on coping with IBS
Irritable Bowel Syndrome (IBS) is a functional gut disorder that affects 1 in every 7 people, or 15% of the world population. Two out of three treatment-seekers are women.
IBS is characterised by chronic, relapsing symptoms including lower abdominal pain and discomfort, bloating, wind, and altered bowel habits – ranging from diarrhoea to constipation.
Most recently IBS has been considered a disorder of the gut-brain axis, meaning there is a miscommunication between the gut and the brain, resulting in increased gut sensitivity.
IBS is a complex condition to navigate as it requires a multifactorial approach for long-term symptom relief, including diet, lifestyle and sometimes supplementation.
One of the most frequently asked questions I get in my private practice is what to eat during an IBS flare-up – below are my top tips to get you out of the flare-up loop.
Consider eating at a low FODMAP diet
FODMAPs are short-chain carbohydrates that do not get absorbed in the small intestine.
When we eat them, they move slowly through the gut attracting water, and once they reach the large intestine, they are fermented by gut bacteria.
This fermentation process produces gas and happens in everyone, but because individuals with IBS have an altered communication between the gut and the brain, they have an abnormal response to the fermentation of FODMAPs, leading to symptoms of abdominal pain and discomfort.
FODMAPs can be found in some of the healthiest foods, fruits and vegetables such as legumes, garlic, onions, pears, avocado, cauliflower and wheat to name a few.
Reducing their intake for as little as 3 or 4 days can help minimise a flare-up.
Low FODMAP alternatives include potatoes, oats, carrots, bean sprouts, blueberries, kiwi and all animal proteins such as chicken and eggs.
The low FODMAP diet should not be followed indefinitely and without professional guidance as it can become very restrictive – working with a FODMAP trained nutritionist to identify personal triggers and work towards food reintroduction is advised.
Avoid gut irritants
Caffeine, fried and fatty foods, carbonated drinks, spicy food, and alcohol are known gut irritants and can perpetuate digestive symptoms – minimise your intake during a flare-up.
Drink herbal teas
Carminative herbs are rich in volatile oils that influence gut motility by increasing contractions, speeding up transit time and lowering the chances of gas to build up.
They relax the smooth muscle in the gastrointestinal tract, helping expel gas and reduce symptoms of bloating.
Peppermint has been extensively studied and is an amazing herb to help reduce muscle spasm.
Sipping on peppermint tea in between meals can help alleviate symptoms – if something stronger is needed, peppermint oil capsules have been tried and tested in randomised controlled trials, and were superior to placebo in improving IBS symptoms.
Watch out for hidden ingredients
Many processed foods contain high FODMAP ingredients such as agave syrup, inulin, chicory root, apple/pear juice concentrate, xylitol, isomalt, erythritol or fructooligosaccharides (FOS). Reading the ingredients list is essential to avoid flare-ups.
What about gluten and lactose?
Gluten has been blamed as a trigger for digestive symptoms and following a gluten-free diet became popular among individuals that suffer from IBS as a way to minimise symptoms.
However, a randomised, double-blind, placebo-controlled study found that fructans, a type of FODMAP found in wheat, were to blame for gastrointestinal symptoms in individuals with IBS, and not gluten per se.
Fructans can also be found in garlic, leek, onions, figs, plums and watermelon.
Lactose should be restricted if you have IBS and lactose intolerance; and even if that is the case, most people who malabsorp lactose are able to tolerate 12–15g of lactose per day (equivalent to approx. 250ml of regular milk) and possibly more if lactose intake is spread out.
The content of lactose varies widely in dairy products, low fat milk, skim milk, and yoghurt for example are all high in lactose while brie, feta and ricotta cheeses are all low.
How do I know if the low FODMAP diet is right for me?
Managing IBS symptoms requires a multifactorial approach and diet is just one aspect.
Evidence suggests that 20–40% of individuals with IBS will not achieve IBS symptom relief on the low FODMAP diet.
Many individuals feel that stress is their main trigger and modifying diet only is not enough. For such cases it is advised to consider experimenting with alternative therapies such as gut-directed hypnotherapy or stress management techniques such as yoga and meditation.
A randomised clinical trial compared short and long-term effects of gut-directed hypnotherapy to the low FODMAP diet and showed similar, durable effects for the relief of IBS symptoms.
If you are experiencing regular IBS flare ups and discomfort, and have ruled out any other medical condition, book a consultation with a Registered Nutritionist and gut health specialist to identify other possible causes of chronic symptoms such as Small Intestinal Bacterial Overgrowth (SIBO) or food intolerances.
About Marilia Chamon
Marilia Chamon is a London-based registered nutritionist and gut health specialist, and founder of Gutfulness Nutrition.
Marilia is a SIBO Approved Practitioner, who is certified in applying functional medicine in clinical practice from the world renowned institute For Functional Medicine, and has undergone extensive research and training on the pathophysiology of IBS.
She has also completed the Monash University ‘Low FODMAP Diet for IBS’ training course for health professionals.
Marilia came to nutritional therapy as a result of her own health journey having struggled with unexplained digestive symptoms for nearly a decade.
After an episode of food poisoning she developed a condition called Post-Infectious Irritable Bowel Syndrome (PI-IBS) which affects 1 in every 9 people who suffers an episode of gastroenteritis.