While the Eating for IBS diet can be one of the most successful ways to manage all IBS symptoms, there are some common pitfalls. I hear from a lot of people who make a tremendous effort to modify their diet for IBS, but who still have abdominal symptoms they feel certain are associated with their eating habits.
This can be exasperating (to say the least) because it may seem like there simply aren't any steps left to take. But - it's much more likely than not that there are still dietary triggers involved, they're just being overlooked.
I've found there are seven specific traps that ensnare people as they adjust their diet - the Seven Sneaky Sins of the IBS Diet.
IBS Diet Sneaky Sin #1 - Coffee (yes, decaf counts)
I've given up all coffee except for my morning cup of decaf. I have cramps every morning too, but just one cup of coffee - especially decaf! - wouldn't cause this, would it?
Yep - just one cup of coffee is all it takes to completely disrupt the gut of most people with IBS. Coffee is a very powerful GI tract irritant - and it's NOT the caffeine that's the culprit. Caffeine is a stimulant, so it can aggravate IBS as well, but this just means that regular coffee has a double whammy.
Decaffeinated coffee is still practically guaranteed to trigger abdominal spasms, diarrhea, and a very unpleasant sense of urgency. Why? Because all coffee beans, decaf included, contain an enzyme that irritates the entire digestive tract.
Interestingly, though coffee is known for its laxative effect and many folks with IBS-constipation use coffee for just this reason, the end result will actually be a worsening of IBS symptoms - including constipation. The abdominal cramping and GI irritation from coffee increases gut motility violently and artificially, which is likely to cause a rebound effect of greatly slowed or halted gut motility if you're constipation-prone. In other words, the short-term laxative gain from coffee is likely to actually exacerbate IBS-constipation in the long-run. If you have IBS, your colon contractions are by definition dysfunctional; using coffee to irritate your colon to the point of spasms every morning will simply cause more severe, and chronic, gut motility problems.
Coffee is also highly acidic, and acidic foods can aggravate IBS as well as upper GI disorders such as GERD. Adding insult to injury, drinking coffee first thing in the morning, on an empty stomach, offers absolutely no buffer for the acid, irritant, and stimulant effects of the beverage. In addition, mornings are routinely stressful for many people, as they're tired, rushed, and trying to get out of the house to school or work. Adding a deadly dietary trigger like coffee into a hectic morning schedule is virtually guaranteed to cause IBS problems.
If you've been drinking decaf, you can quit cold turkey without caffeine withdrawal, and you should see improvements in your IBS immediately. Your first morning without coffee will likely be your first morning without abdominal cramps. If you're used to coffee with caffeine, quitting can trigger caffeine withdrawal, and you may suffer headaches for up to two weeks. You can try to wean yourself onto a half-decaf, half-regular coffee habit, and then gradually eliminate coffee completely. This will help prevent the headaches but will also prolong the IBS symptoms, so you'll have to choose the lesser of the two evils.
If you love coffee (and this is often the underlying reason people continue to drink it - they likely know that it's affecting their IBS, but it's never easy to give up something delicious) there are several coffee substitutes on the market to try. Different brands and flavors are available made from roasted soybeans, or blends of herbs, nuts, fruits and grains. Most health food markets carry several options, and most of the ones I've tried have been delicious.
Chai, an Indian spiced-tea drink (decaf versions are available), is positively luscious when brewed with soy or rice milk, and has the same hearty quality that coffee offers. You can buy chai tea bags, loose leaf tea, or make sweet ginger chai tea from scratch with very little effort.
Or, you could try something completely different, and switch to a helpful herbal tea for your morning (and afternoon, and evening) beverage. Peppermint (best for abdominal pain and spasms), chamomile, fennel (terrific for bloating and gas), anise, and ginger are all digestion-friendly teas that will actively help - not hurt- IBS symptoms.
IBS Diet Sneaky Sin #2 - Yogurt (it's a safe dairy product for IBS...isn't it?)
I've eliminated most dairy from my diet, but I still have a daily cup of yogurt. I've heard that since yogurt is fermented, the lactose isn't a problem. It also contains live cultures which are supposed to help digestive problems. The thing is, I think the yogurt is bothering me. This doesn't really seem to make sense, so I'm still eating it. Should I stop?
Yes, you should stop eating yogurt, as well as all other dairy products that are still in your diet. All dairy is extremely likely to cause IBS symptoms to flare - from diarrhea and cramps to constipation, bloating, and gas. Dairy products, including yogurt and Lactaid milk, have casein, whey, and typically a very high amount of fat as well.
To make yogurt, the live organisms Lactobacillus bulgaricus and Streptococcus thermophilus are added to milk; the cultures turn the milk into yogurt by converting lactose (milk sugar) into lactic acid. Though this makes the lactose easier to digest, this is really only helpful for people who are lactose-intolerant; it's not necessarily of any use at all for people with IBS.
Most people with IBS are not lactose-intolerant, but they still have tremendous digestive problems from dairy. The milk proteins casein and whey (which are always in yogurt, as well as all other dairy products) are very difficult to digest. Trace amounts of these proteins, such as the casein used in some soy cheese products, are often (though not always) quite tolerable for IBS. The large amounts of casein and whey in dairy, on the other hand, are likely to trigger IBS symptoms.
Dairy products, including yogurt, are often very high in fat, particularly saturated fat. Saturated fats tend to be the most difficult for the body to digest, and saturated animal fats are the worst of all. All fats are GI tract stimulants and can trigger IBS attacks, so a low fat diet is crucial for keeping your digestion stable. This means that the fats you do eat should be heart-healthy and mono-unsaturated/poly-unsaturated. All high saturated fat foods should be avoided as much as possible. You'll easily obtain the small amounts of saturated fat your body needs from a low fat diet that incorporates natural plant sources such as olive oil, canola oil, nuts, and flax.
The live cultures in yogurt (also called probiotics) can be highly beneficial to IBS and digestive health in general. However, you don't have to eat dairy to get these benefits. You can choose soy or rice yogurt that contains live cultures or take probiotic supplements. Plus, you can use a prebiotic soluble fiber such as Tummy Fiber that will encourage the growth of probiotics in your gut by giving your healthy gastrointestinal bacteria a food source.
Even better, you can cook with both non-dairy yogurt and Tummy Fiber, so you're getting probiotics and prebiotics with every meal. (See the delicious Heather Cooks! smoothie recipe in the video below for a super fast and easy example.)
Using probiotics and prebiotics for IBS is an excellent idea, and likely to help reduce and prevent a wide range of symptoms, particularly bloating and gas. Fortunately, there's no need to upset your gut by eating dairy in order to obtain these benefits!
IBS Diet Sneaky Sin #3 - Alcohol (just one glass of wine is okay, right?)
I've given up most alcohol, but I still like to have a glass of wine or beer when I get home from work. Just one drink can't cause problems, can it?
Alcohol is a strong GI irritant (and a potential colon carcinogen). Just one drink can definitely trigger IBS attacks, especially if you drink on an empty stomach. The worst drinks are those that contain other triggers as well, such as carbonation (beer, champagne), coffee, dairy (pina coladas, creme liqueurs), or fruit juices that are high in fructose. However, even a plain glass of wine or shot of liquor can cause GI problems.
If you're unsure whether or not alcohol in small quantities bothers you, it's best to totally eliminate it along with other triggers and get your diet stabilized. At that point you can very carefully try (if you still want to) adding a little alcohol back in to see how it affects you. Your tolerance will likely be greater once you have gotten your gut under control; when that happens your GI tract is less likely to be continually hypersensitive, so there is reason to have hope for the future here.
However...you definitely don't want to assume that just one drink won't hurt you, so as a result you never take the step of completely eliminating all alcohol from your diet. By continuing to drink (especially on a daily basis) you'll simply keep suffering the consequences.
This is a very common pattern with the foods and drinks people really don't want to give up - a juicy steak, ice cream sundaes, or that favorite cocktail before dinner. This is just human nature and it's easy to understand. I definitely sympathize. But, it's always better to know for sure how your body reacts to a potential trigger. Please don't blindly assume that something isn't bothering you simply because you don't want it to. IBS doesn't often respond to wishful thinking.
As a general rule, unless you're 100% stable and have no IBS symptoms whatsoever when you drink (either immediately or the following day), it's a safe assumption that alcohol in all forms is likely to cause GI troubles for you. Does this mean that you can never drink any alcohol at all ever again? It might - but it also might not.
How you drink as well as what you drink could make quite a difference here. A single glass of wine enjoyed after a high soluble fiber meal or a dose of your Tummy Fiber may be very tolerable for you, especially on an occasional (instead of daily) basis. Judging by reader feedback on this topic, white wine may be safer for IBS than red, and beer seems to be particularly problematic.
Having a drink when you're feeling relaxed instead of harried can make a difference as well. On the other hand, a double martini on an empty stomach after a stressful day is practically guaranteed to cause trouble.
If you do decide to take a chance with alcohol, please make sure to have at least one glass of water for each alcoholic drink. Alcohol is very dehydrating, and becoming even slightly dehydrated can seriously impact constipation and bloating. Even better, follow up your booze with actively helpful drinks like Fennel or Peppermint Tummy Teas.
On a happy note, cooking with alcohol is usually very tolerable, as the alcohol evaporates and any carbonation will totally dissipate. You'll be left with all of the flavor but none of the risk!
IBS Diet Sneaky Sin #4 - Vitamin supplements (they're good for you, aren't they?)
I'd like to take a multi-vitamin and multi-mineral supplement just to be sure that I'm getting the nutrients I need. But every time I take my vitamin pills I feel worse, not better. What's going on?
Vitamin and mineral supplements in general often cause GI problems for people with IBS. Ask your local pharmacist about the most tolerable brands of vitamins in their store. GI upsets are very common with vitamins, and pharmacists are familiar with this request. Prenatal vitamins may be an option, as they are sometimes formulated specifically to help minimize the risk of GI side effects. You may be able to simply phone in a prescription request for these from your doctor - just explain why you need them. You may also want to ask your doctor about intraveneous vitamins or vitamin shots if you are unable to tolerate oral vitamins.
Liquid vitamins or powder caplets may also be more tolerable than pills. Another thing to consider is the fillers and additives in many vitamins; check the ingredients for lactose, artificial colors, and preservatives, as many people with IBS are sensitive to even small quantities of these substances. A health food store may have a wider variety of additive-free vitamins than a drug store.
It's often helpful to take two or three smaller-dose vitamin/mineral supplements each day instead of one large dose. This will not only reduce the risk of GI upsets, but will aid your body in absorbing the nutrients as well. If you can't find smaller-dose vitamins, try just breaking a regular pill in half. Never take vitamins pills on an empty stomach. Always take your vitamins after a high soluble fiber meal, and for an extra measure of digestive stability add in a dose of your Tummy Fiber as well.
(As a side note here, soluble fiber will not interfere with the absorption of vitamins/minerals any more than food would, so no worries. After all, most of the naturally occurring vitamins you're eating come from fruits and veggies, which also contain fiber.)
Vitamin C is particularly notorious for causing gas, abdominal cramps, and diarrhea. Vitamin C is ascorbic acid, and as the name implies, it's acidic. When it enters the alkaline environment of the lower intestinal tract it can create diarrhea and gas. In Germany, vitamin C is actually an approved laxative, so imagine what it will do to you if you have IBS. The recommended dose for Vitamin C is generally under 2,000 mg. daily. Over that, and you really risk the GI side effects. Unless your doctor has recommended otherwise, make sure your multivitamin does not exceed one hundred percent of the US RDA for Vitamin C.
Calcium, magnesium, and iron all require special consideration as well. Calcium can have a constipating effect, which can be helpful or hurtful depending on your symptoms. Magnesium can have a laxative effect, and this too can either aid or exacerbate IBS, depending on the individual. For many folks with IBS, it's best to make sure that your mineral supplement is not giving you a megadose of either one of these ingredients, but simply a balance of the two. Calcium carbonate contains just calcium and no magnesium, and is a good choice if you always tend towards diarrhea. If you're IBS-C (prone to constipation), try cal-mag instead, which contains magnesium. With either form of calcium, there should be Vitamin D included in the supplement as well for the best possible absorption. It's a good idea to take only 500 mg. of calcium per dose, as your body may not be able to absorb more than this all at once.
Iron can cause stomach upsets and be quite constipating, particularly if it's ferrous sulfate and not ferrous gluconate. Iron also blocks the absorption of calcium. If you aren't anemic or prone to anemia, you may well not need an iron supplement at all. If you do need to take an iron supplement and you're also taking calcium, have these supplements with different meals. Iron is best absorbed in the presence of Vitamin C. If you're trying to juggle all of these different supplements, it can be helpful to take your multivitamin with C and iron at one meal, and your calcium or calcium/magnesium combination with Vitamin D at another meal. Again, make sure these are high soluble fiber meals, or that you're adding in Tummy Fiber to the meal itself.
As a rule, it's always best to get your nutrition from as wide a variety of fresh fruits, vegetables, legumes, grains, and nuts as possible. There are many nutrients in whole foods that simply can't be extracted into pills. If you're struggling to add enough nutrition to your diet, check Eating for IBS for how to safely incorporate insoluble fiber foods into your meals, and for nutritious IBS-safe recipes. Until you're able to stabilize your IBS, you may not want to add in any vitamin/mineral supplement at all (unless medically necessary); this will eliminate the risk of the potential GI upsets from the supplements.
IBS Diet Sneaky Sin #5 - No insoluble fiber foods (they're IBS trigger foods, so you just don't eat them, right?)
Since most fruits, vegetables, and whole grains have a lot of insoluble fiber, and that's a big trigger for my IBS symptoms, I don't eat these foods at all anymore. Is that okay?
Nope, it's definitely not a good idea to simply avoid insoluble fiber foods altogether. Insoluble fiber is found in fresh fruits, vegetables, whole grains, legumes, and nuts, and you can tell at a glance that these are among the very healthiest foods in the world. If you don't eat them you're setting yourself up for serious long-term health problems.
However, if you have IBS, insoluble fiber is a huge potential trigger, and your colon simply can't handle it if you eat these foods with abandon. You can (and absolutely must) eat insoluble fiber foods, as often and as much as safely possible, but within the IBS dietary guidelines. Treat insoluble fiber foods with suitable caution, and you'll be able to enjoy a wide variety of them, in very healthy quantities, without problem.
The number one rule here is: Never eat insoluble fiber alone or on an empty stomach. Always eat it with a larger quantity of soluble fiber foods, and ideally with a dose of your soluble fiber supplement as well, and you will help keep your IBS stable.
The second rule to remember here is that while you should be having lots of fresh fruits and veggies every day, make sure you cook, peel, chop, seed, dice, and/or puree most or even all of them. Peeling and seeding fruits and veggies will remove the toughest insoluble fiber altogether. Chopping, cooking, and pureeing will mechanically break down the insoluble fiber in fruits, vegetables, beans, and nuts before you eat it, making it much less likely to provoke problems.
If you're just starting to re-incorporate insoluble fiber into your diet, one of the best ways to begin is to blend fresh fruits into smoothies with a bit of soy or rice milk, and a dose of Tummy Fiber for the extra safety of a high soluble fiber foundation. Use a base of bananas, mangoes,
and/or frozen peaches for more soluble fiber, and add just a handful of strawberries, blueberries, cherries, and/or pineapple. Blend the drink until totally smooth and you'll really minimize the insoluble fiber.
Blend cooked fresh veggies into soups or sauces, and serve over rice or noodles, again with some Tummy Fiber. This is an especially good way to incorporate greens, which are highly nutritious but also some of the most difficult insoluble fiber veggies for most IBS folks.
It's also helpful to make sure you're already eating as much of the healthiest soluble fiber foods as possible: root veggies (sweet potatoes, pumpkin, beets, rutabagas, carrots, etc.), mangoes, bananas, peeled apples and peeled pears, peeled peaches and apricots, and avocados.
See how do you do with brown rice, oatmeal, and barley. These tend to be the best tolerated whole grains for IBS. Try adding in small amounts of well-cooked and pureed beans or lentils as soup or dip additions to your diet. Take this process slowly, and you can actually significantly increase your tolerance of legumes.
Take this whole process slowly and gradually, and remember that if you've been totally avoiding insoluble fiber foods you're going to have to start eating them carefully, and giving your body time to adjust. You will increase your tolerance for these foods and digest them better the more you eat them, as long as you follow the guidelines.
IBS Diet Sneaky Sin #6 - Too low a dose of IBS soluble fiber supplements
I've been taking a teaspoon of a soluble fiber supplement every day for weeks now, and I really haven't noticed any improvement. Isn't soluble fiber supposed to make a big difference for IBS?
Yes, a soluble fiber supplement such as Tummy Fiber should be extremely helpful for IBS. Soluble fiber is key to preventing the abdominal spasms and bowel dysfunction of IBS, and this is just as true for supplements as it is for soluble fiber foods.
Remember, soluble fiber works by absorbing liquids in the digestive tract to form a stabilizing gel that relieves cramping and prevents both diarrhea and constipation.
However - in order for soluble fiber supplements to work, you have to take a high enough dose, and many people don't. It's particularly easy to take too little of a supplement that's in tablet form, as most soluble fiber pills and capsules have only 1/2 gram of fiber. In comparison, most powder supplements contain 2-4 grams of soluble fiber per dose.
Generally, you'll need to gradually work up to a soluble fiber supplement dosage of 12-15 grams per day. However, diarrhea may stabilize at a lower dose, while constipation may require a further gradual increase up to 25-30 grams per day.
Remember that different people have varying tolerances and adjustment periods to soluble fiber supplements; this means that it can take from several days to two weeks or longer for your body to adjust to the increased fiber intake. Your symptoms should NOT dramatically worsen during this introductory period, and you may well see immediate improvement, but if you don't notice any difference the first day or two have patience. Soluble fiber may be the single greatest aid for controlling IBS symptoms you'll ever find, so give it a fair chance.
Best of all, soluble fiber supplements can be taken daily forever with no harmful side effects or risk of addiction. In fact, they have health benefits far beyond managing IBS, as soluble fiber has been shown to lower LDL ("bad") blood cholesterol levels, reduce the risk of heart disease, and minimize colon cancer risks. Soluble fiber also slows the absorption of fats and carbohydrates into the bloodstream, which improves glycemic control and helps prevent the formation of free radicals. It also lowers insulin requirements.
The most common soluble fiber supplements are: Tummy Fiber, Equalactin, FiberChoice, Benefiber, Metamucil, Konsyl, Fybogel, Citrucel, and Fibercon. Most are widely available at health food stores, drug stores and pharmacies, and they don't require a prescription (they are not drugs, just dietary fiber). Tummy Fiber is Acacia Senegal, Metamucil and Fybogel contain psyllium, Citrucel contains methylcellulose, Equalactin and Fibercon contain calcium polycarbophil, Benefiber contains wheat dextrin, and FiberChoice contains inulin.
Most brands other than Tummy Fiber contain fillers, binders, sweeteners, citric acid, and other unnecessary added ingredients. Tummy Fiber is the only certified prebiotic organic soluble fiber supplement on the market, which is important if you are trying to avoid chemical pesticides and herbicides.
Be aware that the sugar-free versions of soluble fiber supplements can contain artificial sweeteners, which can trigger diarrhea, gas, and cramps. In addition, citric acid is often added to orange-flavored supplements, and this can cause acid reflux in susceptible people (though it doesn't typically bother IBS).
If you're at all prone to bloating or gas (and many folks with IBS are), please avoid both psyllium and inulin, which can seriously worsen these problems in people with IBS. For bloating and gas the best bet is a slowly fermenting prebiotic soluble fiber like
Tummy Fiber, which will encourage the growth of healthy gut flora and actively decrease bloating and gas.
Aside from the high rate of problems with psyllium and inulin, there is a great deal of individual variation here in how someone responds to any particular soluble fiber supplement. It is crucial that you start at a low dose and increase gradually, to give your gut time to adjust to the fiber increase.
When you take your fiber supplement can also make a huge difference. Typically, taking your fiber right before a meal will help buffer your gut's response to food, and keep your digestion stable.
Remember that if you have IBS, your gastrocolic reflex can go awry, and the normal stimulus of eating can cause a dramatic overreaction in your colon. Soluble fiber helps stabilize the gastrocolic reflex and keeps your gut calm. If you're having a lot of problems, divide your daily dose so that you can take your supplement before every meal. This can really work miracles!
To initially stabilize yourself, try taking one-half to one gram of a soluble fiber supplement first thing in the morning as soon as you awake, before meals, and again before bedtime. Gradually increase one dose by another gram every four to five days or so. Typically, taking your fiber right before a meal will help buffer your gut's response to food, and keep your digestion stable.
These supplements are also great to have on hand when you find yourself unexpectedly eating out, going too long between meals, or just feeling a little shaky. Taking a soluble fiber supplement with a glass of tepid water or IBS-friendly herbal tea will always give you extra protection against attacks in dicey situations.
So, please ignore the fact that soluble fiber supplements are sometimes marketed as laxatives - they are NOT. They will of course relieve and prevent constipation, but they are just as effective at treating diarrhea, and they will not compromise normal bowel function at all once your IBS is under control - they'll simply keep things normal. Soluble fiber will, in fact, work beautifully to keep your GI tract running smoothly, comfortably, and pain-free on a day-to-day basis.
IBS Diet Sneaky Sin #7 - Not drinking enough water (doesn't soda pop count?)
I drink water when I'm thirsty, and I have several glasses of soda pop each day, and I don't feel like I'm dehydrated. Shouldn't this mean that I'm getting enough water?
Fresh water is crucial for good health in all respects, but is especially important for keeping your digestive tract functioning properly. In particular, soluble fiber, which is the basis of the IBS diet, requires plenty of water in order to be effective. (Remember, soluble fiber works by absorbing liquids in the digestive tract to form a stabilizing gel that relieves and prevents both diarrhea and constipation.)
Together, fiber and water maintain gastrointestinal muscle tone, dilute toxic wastes in the GI tract, bind irritants, bring oxygen to the tissues, and help maintain the correct balance of intestinal flora. In general, the more water you drink the better, whether plain or as IBS-friendly herbal teas.
Please note that not just any liquid can substitute for fresh water, however. Beverages with caffeine - black or green tea, soda pop, coffee - can actually dehydrate you further, and this is on top of the fact that they also contain ingredients that are outright harmful to IBS. Coffee is such a strong GI irritant that it is a deadly sin in its own right, while black tea contains tannins that can trigger acid reflux in susceptible people. Decaffeinated black or green tea may be more tolerable.
Soda pop, however, is one of the worst possible beverages for IBS. It's sweetened with either high fructose corn syrup or artificial sweeteners, both of which are likely to cause GI upsets. Carbonation triggers bloating, gas, and even abdominal cramping. Most sodas are full of artificial colors and flavors, both of which can bother sensitive GI tracts. The caffeine in sodas is just the last in a long list of detrimental ingredients, and it's problematic both because it is a stimulant (and can upset the rhythmic contractions of the gut), and due to its dehydrating effect. Do your digestion a favor and get in the habit of drinking plain fresh water, or caffeine-free herbal teas such as peppermint, fennel, chamomile, and anise.
At a bare minimum, make sure you're drinking at least 64 fluid ounces (eight cups) of fresh water each and every day, and aim for at least twice that amount - particularly if you're prone to constipation. (Research has actually shown that a person can safely drink up to 10 liters of water a day.) You may find yourself constantly running to the bathroom as you initially increase your water intake, but your bladder should adjust and become comfortable with your new routine after a week or two.
Many Americans are actually chronically dehydrated without ever realizing it, and this is a huge exacerbating factor (and sometimes even the underlying cause) for constipation. If you're on the opposite end of the spectrum and prone to diarrhea, you're at risk of losing too much water from your body too rapidly, and this can then result in dehydration. So no matter what your IBS symptoms, and whether they're flaring or in remission, please drink up!
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