QUESTION: “What is the best way of eating to reduce IBS symptoms based on my intolerances (I have an egg and yeast intolerance and am borderline with wheat). I had a food intolerance blood test done a few months ago. I also don’t eat meat (I still eat seafood and fish). So that leaves me with much less variety to choose from. So, all in all you could say I’m a pescetarian who doesn’t eat meat, eggs, wheat, yeast products and avoid milk as well (other than cheese – it’s too good). Or maybe I’m almost a vegan.. who still eats fish? It’s all a little complicated in my head.”
DR. NEAL: Thank you for emailing your question. We can get so creative with our eating habits and designing our meal plans that some days it may seem we at like a vegan and on other days, like Saturdays and Sundays, like it’s Thanksgiving Day all over again. This is true even for the most restrictive of dieters.
Diagnosing a Food Intolerance
Unfortunately, blood tests for food intolerances aren’t always accurate. Probably the most accurate measure to test food intolerances is to avoid those foods you suspect are causing your symptoms and do that for at least a month.
Now, if these are true food allergies and you are at risk of experiencing anaphylaxis, don’t do any of what I’m about to recommend. Instead, discuss how best to proceed with your doctor.
But, if these are truly just food intolerances, meaning, you start experiencing some discomfort after consuming these foods, then you can slowly reintroduce them, one by one back into your diet. You would start by consuming a small amount of the suspected food. Write down the date you ate or drank that food, the time, and monitor yourself to see if any symptoms return. If the symptoms don’t return after a couple of days, you can try consuming a slightly larger portion of that same food. Again, keep detailed food logs and see if any symptoms return. If nothing happens after a couple of days, that food is probably not the source of your intolerance. You would then repeat this process with another item that you suspect causes you discomfort.
Is There an Optimal IBS Diet?
So, is there an optimal diet for IBS? Let me first explain what IBS is. IBS stands for Irritable Bowel Syndrome. Symptoms of IBS can range from excessive gas, bloating, cramping, and periods of diarrhea or constipation.
I should mention that even though the symptoms sound similar, IBS is different from other gastrointestinal diseases like Crohn’s disease and ulcerative colitis. We’re learning that there are lots of things that can help with IBS: managing stress, exercise, getting enough sleep, and of course… diet. And, there is a diet I recommend you discuss with your doctor: it’s something called the Low-FODMAP diet. This is a restrictive diet, so there are foods you will need to avoid.
But, it has been shown to be very helpful for most that suffer from IBS. And, luckily, the diet can be followed in the short-term and may not require you to follow this eating pattern for life. Plus, there are other IBS therapies, so if this doesn’t work, there are other options that you can discuss with your doctor. I have recommended the Low-FODMAP diet to many folks and they often experience relief in just a few days. The research seems to support this as well.
So, what the does “low-FODMAP” mean, anyway? I remember when I first heard the name, I was like, “You mean ‘low-FOODmap’, right? We’re talking about a map of foods you can eat?” Nope. FODMAP is an abbreviation for: Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. Basically, these are fancy names for different types of sugars found in foods. For those with IBS, these sugars need to be reduced or completely avoided.
This is because they are “fermentable” by the bacteria in the gut. For those that don’t suffer from IBS, these sugars don’t cause any problems. But for those that suffer from IBS, it can lead to all those uncomfortable symptoms like gas, bloating, abdominal pain and diarrhea. By avoiding foods that contain these fancy-sounding sugars (oligosaccharides, disaccharides, monosaccharides and polyols), you may start to feel better.
How Do I Know Which Foods are Low-FODMAP?
So, the next logical question is, “Where do I find foods that are low-FODMAP?” This is where it gets a little tricky. Because these sugars are common in many foods, the list is a bit long. I’ll list some of the foods to avoid here, but I encourage you to download a list of low- and high-FODMAP foods to keep with you.
Again, here are some general recommendations:
- Fruit: when it comes to fruit, try and avoid stone fruit. These are fruits that contain a pit, like plums, peaches, nectarines, cherries, and mangoes. Apples are a no-go as well.
- Vegetables: onions, leeks, mushrooms and cauliflower should be avoided. Most importantly, avoid beans.
- Grains: try and avoid anything with wheat in it. So, you may need to purchase gluten-free for the time being.
- Dairy: foods that are high in lactose will typically cause symptoms to get worse. So, it’s best to avoid milk, ice cream, and soft cheeses. Yogurt could trigger symptoms, too, so if you want to be really careful, avoid yogurt. But, there are some folks that do just fine after consuming a small amount of yogurt.
- Meat: try and avoid processed meat because sometimes one of the FODMAPs gets added in during processing. Also, some marinated meats can cause problems. Again, this is because the marinade itself may contain one of those sugars that can trigger symptoms.
- Nuts and seeds: seeds are usually safe, but pistachios and cashews tend to irritate.
- Sugars: and, lastly, high fructose corn syrup, honey, and sugar alcohols tend to make symptoms worse.
So, the trick is to try and avoid these foods for 2-6 weeks and see if your IBS symptoms improve. If they do, fantastic! Along with guidance from your doctor, you can then consider reintroducing some foods to see if any discomfort returns.
With time, you will have a much better idea of how your body responds to these foods.