Eating for IBS: How to Choose the Best Diet for You
Food and IBS can be a love-hate relationship. Or, if your symptoms are particularly bad, it’s mostly just hate-hate. But you’ll be glad to know that foods can heal as well as harm and figuring out which is which is key to getting your IBS symptoms under control and giving your body the space to heal. If you’re new to the world of gut-healing diets for IBS, unsure of what you should be eating for IBS and don’t yet know your polyols from your paleo, then this is the blog for you!
Here is a summary of what we are going to cover:
> The five principles of a gut-healing diet & eating for IBS
> Why ‘bio-individuality’ is where we always start
> Considerations for the most common IBS diets
As with everything IBS related, I’m sure you aren’t surprised that there is no ‘one-size-fits-all’ diet. Last week we talked about testing for the most common root causes of IBS and how there are four main tests that we often use with our clients to guide which dietary options we consider. We also covered off why it is very likely that you have more than one of the five common root causes which, again will guide the type of diet we consider.
Dialling in your diet to help you with symptom management quickly is an art, and something that takes a little time, trial and error, but brings the most amount of relief to our clients in the short term. For this reason, we like to get there quickly and have lots of great recipe options available so you don’t get stuck for ideas preparing new meals that don’t cause you symptoms. I thought sharing some of our reasoning around dietary choices would be helpful for those who are suffering and don’t know where to start. Especially now that we know your IBS is very likely completely treatable and does NOT have to be ruining your life (check out THIS POST for a refresh on why that is).
The five principles of a gut healing diet & eating for IBS
An effective IBS healing diet needs to incorporate the following five things:
#1 SHORT-TERM and focussed on gut healing. Gut-healing diets are not a life sentence. They need to be tailored and targeted for your specific underlying root causes and current symptoms. Most of our clients are on a gut-healing diet for 3-6 months. But those with more severe gut dysfunction might need to stay on some variety of gut-healing diet for up to 12 months, always with the end goal of transitioning them back to a real, whole, nutrient-dense way of eating.
#2 Anti-inflammatory. Gut issues are strongly associated with inflammation so we are always looking to incorporate foods that are anti-inflammatory such as omega-3 fats found in oily fish and walnuts, plus antioxidants and minerals found in dark coloured fruits and veggies like broccoli, beetroot, blueberries and green leafy veggies. We also like to include anti-inflammatory spices like turmeric and ginger.
#3 Doesn’t exacerbate symptoms. There are lots of really healthy and unhealthy foods out there that cause people symptoms. The types of foods that can cause issues are inflammatory foods like processed and packaged goods; gluten and gliadin-containing grains; casein, whey and lactose in dairy and anti-nutrients such as saponins, phytic acid, oxalates, tannins and lectins to name a few. These are often found in grains, legumes, nuts and beans. This basically means that your gut-healing diet needs to be tailored to your symptoms and the foods that work best for your body. We like to use food sensitivity testing, plus elimination-style diets to help with figuring this out.
#4 Starves off any overgrowths or infections. If testing identifies SIBO or a gut infection as a root cause for your IBS then there are specific dietary requirements that you need to follow to help starve off these pathogens. Most feed primarily off carbohydrates so there will be some degree of carbohydrate restriction included as a part of your healing diet.
#5 Has enough variety (+ nutrient-density) to ensure you aren’t going to develop any nutritional deficiencies and encourages diversity of the microbiome. This is massive! We want to make sure that you have enough variety in the foods that you eat, especially with carbohydrate sources such as fruits and vegetables, so that you get as many of the vitamins, minerals and protein, fats and carbohydrates from your diet that your body needs. We also want to make sure that you are eating lots of variety so we can encourage greater diversity in the beneficial bacteria of your microbiome.
So where do we start?
We like to start with an over-arching principle: BIO-INDIVIDUALITY - which basically means that one person’s food can be another person’s poison. An example of this that we see almost weekly is eggs. They are an exceptionally healthy food, yet so many of our clients don’t tolerate them - what works for one person, won’t work for everyone. So with bio-individuality in mind, we consider your health history, test results and what you know has or has not worked for you in the past with your diet. Then we move onto figuring out the best dietary protocol for YOU, usually starting with one of the most common gut-healing diets listed below...
The most common IBS diets
When it comes to eating for IBS, there are a few gut-healing diets that we like to start with, then make modifications to, to suit our clients. They all focus on limiting processed and packaged foods, as well as certain carbohydrates. Why? Because carbohydrates are what feeds SIBO and gut infections, and they are the things that we eat that contribute most to a dysbiosis and leaky gut. Unfortunately, lots of the carbs that are removed can be healthy foods like fruits and vegetables, which is why we only use gut-healing diets for a short period of time and for a really specific reason - addressing the root causes of your IBS. The most common IBS diets we use are:
Specific Carbohydrate Diet (SCD)
SCD was founded in the 1950’s by Dr Sidney Valentine Haas who worked with coeliac disease and inflammatory bowel disease (IBD) sufferers. It was later developed further by Elaine Gottschall, whose daughter put her ulcerative colitis (UC) into remission using SCD.
This diet focuses on removing grains, sugar and starch, as well as all processed foods which damage the intestinal lining. We commonly start with SCD for our clients who have a moderate SIBO overgrowth, IBD (UC and Crohn's disease), Coeliac disease (yes, going gluten free is not enough for healing a gut damaged by coeliac disease) and acute diarrheal disease.
The types of foods that you would need to avoid on SCD include: processed and packaged foods, grains, processed meats, canned or processed fruits and vegetables, most dairy and legumes, starches and starchy vegetables, herbs and spices that contain caking agents and most sweeteners.
What are you left with? Unprocessed meat, poultry, fish and eggs, most fresh fruits and non-starchy vegetables, limited dairy, nuts and seeds, some legumes, all natural herbs and spices, animal fats and olive or coconut oil, raw honey as your sweetener and water or weak tea and coffee to drink. You are also allowed dry wine and some spirits in small amounts.
Gut and Psychology Syndrome (GAPS)
The GAPS diet was developed by Dr Natasha Campbell-McBride, and is largely based on SCD, with a few modifications for those with intestinal and neurological issues.
We use GAPS the least, however for clients who have gut issues that coexist with mood/brain disorders such as Autism, ADHD, depression, anxiety, bipolar, schizophrenia or narcolepsy for example, then GAPS was designed for you.
The types of foods you will need to avoid on GAPS are similar to SCD: processed and packaged foods which includes processed meats and dairy, grains, starchy vegetables, sugar and any foods that contain sugar, starchy beans, legumes and peas, and all lactose and alcohol.
The types of foods you are left with include: Unprocessed meat, poultry, fish and eggs, most fresh fruits and non-starchy vegetables, nuts and seeds, some beans and pulses, all natural herbs and spices, raw honey as your sweetener, animal fats and olive oil. Drinks can include water, freshly pressed juices, meat stocks, weak tea and coffee.
Low FODMAP Diet (LFD)
The LFD was developed by researchers at The Monash University in Australia. The premise of this diet is reducing certain sugars (short-chain carbohydrates), called FODMAPS - fermentable Oligo-saccharides, Di-saccharides, Mono-saccharides and Polyols. These sugars can be poorly absorbed in the small intestine and fermented by bacteria or archaea to produce gas and bloating.
A low FODMAP diet is great for correcting dysbiosis, mild SIBO (for those who tolerate grains, starch, fibre and sucrose), underweight clients, vegans and vegetarians, and as a transitionary diet from more restrictive diets once food tolerances have increased.
The types of food you need to avoid on a low FODMAP diet include: high fructose fruits, honey and sweeteners, lactose found in dairy products, sugar polyols such as mannitol and sorbitol found in some fruits, vegetables and sweeteners, fructans found in gluten containing grains and some vegetables such as onion and garlic, and galacto-oligosaccharides (GOS) found in some legumes.
Because this diet is focussed on sugars in foods, rather than whole food groups, it can be tricky to navigate. Adding to the complexity is the fact that many restrictions are based on the amount, rather than simply a ‘yes or no’ to that food. For example, 1/8 of an avocado is ok, but ½ an avocado is not. Clients generally need to carry around an allowable foods list for a while or access the low FODMAP app on their phone as they get used to the diet.
Foods you can consume include: Unprocessed meat, poultry, fish and eggs, animal fats and plant-based oils, some fruits, vegetables, grains, nuts, seeds, beans and pulses, low-lactose dairy, all natural herbs and spices, and sugar or maple syrup as your sweetener. Drinks can include water, limited freshly pressed juices, meat stocks, weak tea and coffee, and some alcohol.
SIBO Specific Food Guide
The SIBO Specific Food Guide was developed by Dr Allison Siebecker in response to working with complex SIBO clients. It is a combination of the SCD and Low FODMAP diets. It is more restrictive and works really well for a very compromised gut and severe IBS symptoms.
We use this diet for those who have severe SIBO (limited foods tolerated) or those who get inadequate relief from other, less restrictive diets.
This diet can be tricky to explain, but put simply, you must avoid: SCD illegal and high FODMAP vegetables, fruits, beans, legumes, nuts, seeds and dairy, processed meats, and all sweeteners, excluding stevia and some low FODMAP honey varieties (which can be tricky to find in Australia). You also need to avoid most juices, alcohol and strong tea or coffee. Similar to the LFD, portions are important, so it is easiest to carry around an allowable foods list for a while as you get used to this diet.
Foods you can eat include: SCD legal and low FODMAP vegetables, fruits, beans, legumes, nuts, seeds and dairy, unprocessed meat, poultry, fish and eggs, stevia and some low FODMAP honey varieties, all natural herbs and spices (not including powdered onion and garlic), animal fats and plant-based oils. You can drink water, limited freshly pressed juices, meat stocks, weak tea and coffee, and some alcohol.
Paleo Autoimmune Protocol (AIP)
Paleo AIP is by far the most restrictive diet because it is designed to help heal a leaky gut and dysbiosis that have resulted in systemic inflammation and an autoimmune condition. It was developed by Dr Loren Cordain and Robb Wolf, then modified further by Sarah Ballantyne. There is a big focus with AIP on including the highest quality, most nutrient-dense foods available, such as wild caught-fish, organic produce and free-range meats.
AIP is great for anyone who has gut issues and an autoimmune condition. We have also started to use AIP with highly symptomatic SIBO or gut infection sufferers due to the link between these as root causes for autoimmunity - most common among those whose initial trigger was an acute case of gastroenteritis.
Foods to avoid are: all processed foods, grains, nuts, beans, legumes, seeds, eggs, dairy, nightshades (specific vegetables, fruit and spices), food chemicals and NSAID medications.
Foods that are allowed include: fruits, roots, vegetables, meats, fats, offal, herbs, spices, occasional sweeteners like dates, honey and maple syrup, fermented foods and some pantry items such as apple cider vinegar, coconut products, arrowroot starch and tea.
The idea of a paleolithic diet can be traced back to a 1975 book by gastroenterologist Walter Voegtlin. It has had a few re-vamps, and was popularised again in Dr Loren Cordain’s 2002 book, The Paleo Diet. A paleo-style diet is a great place to start with eliminating foods that generally cause digestive issues, and focussing on real, whole and nutrient-dense food sources that give you the nutrition you need and help diversify your microbiome.
We usually start clients on a modified paleo diet. It works especially well for those who have only mild digestive symptoms, a very mild leaky gut or dysbiosis, and those who are new to restrictive, gut healing diets.
The paleo diet restricts processed foods, grains, beans, legumes and dairy. These foods are sources of carbohydrate that can cause digestive issues by damaging the gut or fuelling bad pathogens. All other foods are allowed.
Food sensitivities can be a root cause or trigger for IBS symptoms, so they must be layered over the top of the gut healing diet that a client chooses. An example of this might be a client who has mild SIBO and is following a low FODMAP diet, but their food sensitivity testing identifies a reaction to the proteins in eggs, pineapple and almonds. These three foods would also need to be avoided for 3 to 6 months, depending on the level of reaction identified on their food sensitivity test. Read this blog post if you want to know more about food sensitivity testing and leaky gut.
Key themes among each of the eating for IBS diets
By now, I am guessing you can see some key themes amongst these diets. Limiting different carbohydrates, and allowing all unprocessed meat, poultry and fish, animal fats and healthy plant-based or animal-derived oils are the common recommendations. This means that most of these diets are, you guessed it, lowering your carbohydrate intake, whilst still maintaining lots of protein and healthy fats. As clinicians, we work hard to make sure that when you are on a gut-healing diet that you have adequate carbohydrate intake to ensure a balance of macronutrients (protein, fats and carbs), and access to all the vitamins and minerals they offer.
Carbohydrates in the form of fruits and vegetables are essential to the diversity of your microbiome, which is why we do not recommend removing them completely. Ever. We commonly see that severely limiting or completely removing carbohydrates can lead to issues with hormones and the thyroid for those who have gut issues. And this usually looks like weight gain, issues with hair, skin and nails or fatigue, layered over the top of digestive issues. Not a great combination.
So now we know where to get started with choosing a gut-healing diet that is right for you, and the root causes of your IBS. The next and final step for this IBS blog series will be about other factors we need to consider when healing - rest, exercise, stress reduction and supplementation, which we will be covering in great detail next week. We find that once you figure out the right diet and have a good selection of recipes to cook from, that the process of healing the root causes of your IBS is so much more manageable.
It’s also really motivating because most symptoms go away for a period of time when you nail the right diet. Just enough time to treat, heal and move on with life, symptom-free. We hope you can easily use the content of this blog as a part of your IBS healing journey.
If you want to learn more about IBS diets, or how we can help you with your healing, please head to the Work With Us page to learn more about how we work online with clients in many countries to test for and treat the various root causes of IBS symptoms and other GI conditions.