During my time with IBS I've been fortunate to meet many other people who have a passion for understanding the complexities of IBS. I'm very glad to have got to know Vesta Simkute, who is currently studying nutrition. She has written a series of blog posts regarding IBS trigger foods which can be found below. Her knowledge of diet and IBS is comprehensive and I'm sure you'll enjoy reading and digesting these.
You can see more of Vesta's work here https://uk.linkedin.com/in/vestasimkute
You can see more of Vesta's work here https://uk.linkedin.com/in/vestasimkute
Hopefully, by now you know that you are not alone in this, even if people around you may not understand how it feels to live with IBS, yet alone how to help manage it.
You have probably discovered what foods are triggering your IBS symptoms. In fact, nine out of 10 individuals report that certain foods generate symptoms and two thirds of them start restricting those foods to improve symptoms (1,2,3). It could all go wrong from here if there is no one to supervise your attempts to help yourself. Dietetic support is helpful because working alongside a professional provides you with the support and education you need. Otherwise, reliance on the web with the excess of information when you start googling, cannot only confuse you but give the wrong advice.
Professionals rely on scientific reviews, analyses and studies from authoritative bodies which is sometimes available for the general public, like you and me.
A recent review by British Dietetic Association (4) provides some interesting insights into the types of foods that could be triggering IBS symptoms and how to deal with it practically. It is available to the public but what often happens is that the length of the paper and the academic jargon can put you off reading journal articles. Fear not, we are in this together, so let’s dive into it!
Let’s start with the basics: intake of alcohol, caffeine, spicy foods and fatty food.
Why does alcohol trigger IBS symptoms?
Alcohol affects gastrointestinal motility, absorption and intestinal permeability(5).
Plain English: Alcohol can loosen the stools (resulting in diarrhoea in extreme cases). And so the nutritious food you have eaten previously could pass through without any benefit. Intestinal permeability is just a term to describe the passage of “foreign bodies” through the lining of the gut into the bloodstream. In other words, alcohol is thought to be an irritant to the gut and provoke your symptoms.
However, there is a ‘but’…
The evidence is very biased, based on people’s perceived affect. So, any recommendation in terms of alcohol intake should follow common sense for now. The review did not have any evidence from randomised controlled trials, the gold standard research studies in clinical research.
Things to keep in mind:
· Be drink aware – a small glass of wine (standard 13% wine is about 2 units) shouldn’t be detrimental to the way you feel.
· Be self-aware – it takes time to pin point what’s causing distress in you gut. Our diets are really complex and non-food factors also play a role in the way your gut feels.
What about caffeine?
"Caffeine increases gastric acid secretion and colonic motor activity in healthy subjects and coffee has also been found to rapidly increase rectosigmoid motor activity" (6).
Plain English: You probably used a cup of coffee/tea to power through that pile of work. Caffeine is a stimulant – we know that. So your stomach is affected in the same way and it produces more gastric acid, fluid in your stomach which helps with breaking down and digesting food. That’s good, right? Not necessarily. Having a sensitive stomach and gut you are more likely to have acid reflux which also happens to people who don’t even have issues with the gut – it’s normal. Caffeine is, also, a diuretic – you simply make more trips to the toilet after having that cuppa or an energy drink or raw cacao drink, for that matter – food and drink rich in caffeine.
Again, caffeine can upset your stomach but the evidence is rather biased. So, nothing is set in stone. It is down to you to see where your limit is.
Caffeine intakes up to 400mg/day appear to be safe to consume. That amount of caffeine is equal to 0.5l or 1 pint of black brewed coffee. You are safe with having a few cups of coffee/ day.
One thing to remember, coffee is also an appetite suppressant, and you might want to skip a meal because you’re not hungry. That’s perhaps not a wise idea, just try to have something light to eat anyway.
Any evidence to say that symptoms are triggered by spicy foods?
"Capsaicin the active ingredient in spicy food accelerates gastrointestinal transit via the transient receptor potential vanilloid-1 (TRPV) causing abdominal pain and burning sensations in healthy individuals(7)".
Plain English: Capsaicin, a chemical compound that makes food spicy, can upset the stomach of healthy, IBS symptom free people. Therefore, you should be extra cautious but that doesn’t mean that you should exclude spicy food if you enjoy it. The effects really depend on the dosage. The review could not conclude any cause and effect relationship and put it down to nutrition content of the meal – high FODMAP ingredients such as onions or garlic, for example.
What effect does fat have on symptoms?
"Fat stimulates the gastrocolic reflex and, when delivered directly into the duodenum, the response is prolonged and exaggerated in individuals with IBS. Moreover, fat affects small intestinal motility (8)".
Plain English: Gastrocolic reflex is the response to the food you have eaten and which is being digested in your stomach and small intestine.
Now, the recommendation to reduce fat intake is rather vague.
‘What does it mean for me personally?’, you might ask. First, fat should be minimum 20% of total food intake in females and 25% in males to maintain healthy body weight and ensuring optimal nutrient intakes (5). To say what that means for you personally is hard, since this is a relative value. Let me illustrate: if you are eating a 2000kcal diet – 400kcal (44g total) should come from fat. However, if you are trying to loose weight and your caloric intake is at 1, 700kcal than 340kcal (38g total) of fat would be your 20%. This ensures satisfying the needs of your body so your brain, your reproductive, hormonal and nervous systems are functioning well.
This post has turned out to be quite lengthy and I have only gone through half of the review which means two things: the end of this post and Part 2 will follow.
1. Hayes, P.A., Fraher, M.H. & Quigley, E.M. (2014) Irritable bowel syndrome: the role of food in pathogenesis and management. Journal of Gastroenterology and Hepatology. 10, pp. 164–174.
2. Lacy, B.E., Weiser, K. & De Lee, R. (2009) The treatment of irritable bowel syndrome. Therapeutic Advances in Gastroenterology. 2, pp.221– 238.
3. Monsbakken K, Vandvik P & Farup P (2006) Perceived food intolerance in subjects with irritable bowel syndrome– etiology, prevalence and consequences. European Journal of Clinical Nutrition. 60, pp.667–672.
4. IBS Dietetic Guideline Review Group on behalf of Gastroenterology Specialist Group of the British Dietetic Association (2016) British Dietetic Association systematic review of systematic reviews and evidence-based practice guidelines for the use of probiotics in the management of irritable bowel syndrome in adults (2016 update). Journal of Nutrition and Dietetics. 29(5), pp. 549- 575.
5. Bagyanszki, M., Krecsmarik, M., De Winter, B.Y. , De Man, J.G., Fekete, E., Pelckmans, P.A., Adriaensen, D., Kroese, A., Nassauw, L., Timmermans, J.P. (2010) Chronic alcohol consumption affects gastrointestinal motility and reduces the proportion of neuronal NOS- immunoreactive myenteric neurons in the murine jejunum. Anatomical Record. 293, pp. 1536–1542.
6. Rao, S.S.C., Welcher, K., Zimmerman, B., Stumbo, P. (1998) Is coffee a colonic stimulant? European Journal of Gastroenterology and Hepatology. 10, pp. 113–118.
7. Akbar A, Yiangou Y, Facer, P., Walters, J.R.F., Anand, P., Ghosh, S. (2008) Increased capsaicin receptor TRPV1-expressing sensory fibres in irritable bowel syndrome and their correlation with abdominal pain. Gut. 57, pp. 923–929.
8. Caldarella, M.P., Milano, A., Laterza, F., Sacco F, Balatsinou, C., Lapenna, D., Pierdomenico, S.D., Cuccurullo, F., Neri, M. (2005) Visceral sensitivity and symptoms in patients with constipation-or diarrhea-predominant irritable bowel syndrome (IBS): effect of a low-fat intraduodenal infusion. American Journal of Gastroenterology. 100, pp. 383–389.
9. FAO (2010) Fats and fatty acids in human nutrition: Report of an expert consultation [online]. Available from: http://www.fao.org/3/a-i1953e.pdf [Accessed on 10 January 2017]
You have probably discovered what foods are triggering your IBS symptoms. In fact, nine out of 10 individuals report that certain foods generate symptoms and two thirds of them start restricting those foods to improve symptoms (1,2,3). It could all go wrong from here if there is no one to supervise your attempts to help yourself. Dietetic support is helpful because working alongside a professional provides you with the support and education you need. Otherwise, reliance on the web with the excess of information when you start googling, cannot only confuse you but give the wrong advice.
Professionals rely on scientific reviews, analyses and studies from authoritative bodies which is sometimes available for the general public, like you and me.
A recent review by British Dietetic Association (4) provides some interesting insights into the types of foods that could be triggering IBS symptoms and how to deal with it practically. It is available to the public but what often happens is that the length of the paper and the academic jargon can put you off reading journal articles. Fear not, we are in this together, so let’s dive into it!
Let’s start with the basics: intake of alcohol, caffeine, spicy foods and fatty food.
Why does alcohol trigger IBS symptoms?
Alcohol affects gastrointestinal motility, absorption and intestinal permeability(5).
Plain English: Alcohol can loosen the stools (resulting in diarrhoea in extreme cases). And so the nutritious food you have eaten previously could pass through without any benefit. Intestinal permeability is just a term to describe the passage of “foreign bodies” through the lining of the gut into the bloodstream. In other words, alcohol is thought to be an irritant to the gut and provoke your symptoms.
However, there is a ‘but’…
The evidence is very biased, based on people’s perceived affect. So, any recommendation in terms of alcohol intake should follow common sense for now. The review did not have any evidence from randomised controlled trials, the gold standard research studies in clinical research.
Things to keep in mind:
· Be drink aware – a small glass of wine (standard 13% wine is about 2 units) shouldn’t be detrimental to the way you feel.
· Be self-aware – it takes time to pin point what’s causing distress in you gut. Our diets are really complex and non-food factors also play a role in the way your gut feels.
What about caffeine?
"Caffeine increases gastric acid secretion and colonic motor activity in healthy subjects and coffee has also been found to rapidly increase rectosigmoid motor activity" (6).
Plain English: You probably used a cup of coffee/tea to power through that pile of work. Caffeine is a stimulant – we know that. So your stomach is affected in the same way and it produces more gastric acid, fluid in your stomach which helps with breaking down and digesting food. That’s good, right? Not necessarily. Having a sensitive stomach and gut you are more likely to have acid reflux which also happens to people who don’t even have issues with the gut – it’s normal. Caffeine is, also, a diuretic – you simply make more trips to the toilet after having that cuppa or an energy drink or raw cacao drink, for that matter – food and drink rich in caffeine.
Again, caffeine can upset your stomach but the evidence is rather biased. So, nothing is set in stone. It is down to you to see where your limit is.
Caffeine intakes up to 400mg/day appear to be safe to consume. That amount of caffeine is equal to 0.5l or 1 pint of black brewed coffee. You are safe with having a few cups of coffee/ day.
One thing to remember, coffee is also an appetite suppressant, and you might want to skip a meal because you’re not hungry. That’s perhaps not a wise idea, just try to have something light to eat anyway.
Any evidence to say that symptoms are triggered by spicy foods?
"Capsaicin the active ingredient in spicy food accelerates gastrointestinal transit via the transient receptor potential vanilloid-1 (TRPV) causing abdominal pain and burning sensations in healthy individuals(7)".
Plain English: Capsaicin, a chemical compound that makes food spicy, can upset the stomach of healthy, IBS symptom free people. Therefore, you should be extra cautious but that doesn’t mean that you should exclude spicy food if you enjoy it. The effects really depend on the dosage. The review could not conclude any cause and effect relationship and put it down to nutrition content of the meal – high FODMAP ingredients such as onions or garlic, for example.
What effect does fat have on symptoms?
"Fat stimulates the gastrocolic reflex and, when delivered directly into the duodenum, the response is prolonged and exaggerated in individuals with IBS. Moreover, fat affects small intestinal motility (8)".
Plain English: Gastrocolic reflex is the response to the food you have eaten and which is being digested in your stomach and small intestine.
Now, the recommendation to reduce fat intake is rather vague.
‘What does it mean for me personally?’, you might ask. First, fat should be minimum 20% of total food intake in females and 25% in males to maintain healthy body weight and ensuring optimal nutrient intakes (5). To say what that means for you personally is hard, since this is a relative value. Let me illustrate: if you are eating a 2000kcal diet – 400kcal (44g total) should come from fat. However, if you are trying to loose weight and your caloric intake is at 1, 700kcal than 340kcal (38g total) of fat would be your 20%. This ensures satisfying the needs of your body so your brain, your reproductive, hormonal and nervous systems are functioning well.
This post has turned out to be quite lengthy and I have only gone through half of the review which means two things: the end of this post and Part 2 will follow.
1. Hayes, P.A., Fraher, M.H. & Quigley, E.M. (2014) Irritable bowel syndrome: the role of food in pathogenesis and management. Journal of Gastroenterology and Hepatology. 10, pp. 164–174.
2. Lacy, B.E., Weiser, K. & De Lee, R. (2009) The treatment of irritable bowel syndrome. Therapeutic Advances in Gastroenterology. 2, pp.221– 238.
3. Monsbakken K, Vandvik P & Farup P (2006) Perceived food intolerance in subjects with irritable bowel syndrome– etiology, prevalence and consequences. European Journal of Clinical Nutrition. 60, pp.667–672.
4. IBS Dietetic Guideline Review Group on behalf of Gastroenterology Specialist Group of the British Dietetic Association (2016) British Dietetic Association systematic review of systematic reviews and evidence-based practice guidelines for the use of probiotics in the management of irritable bowel syndrome in adults (2016 update). Journal of Nutrition and Dietetics. 29(5), pp. 549- 575.
5. Bagyanszki, M., Krecsmarik, M., De Winter, B.Y. , De Man, J.G., Fekete, E., Pelckmans, P.A., Adriaensen, D., Kroese, A., Nassauw, L., Timmermans, J.P. (2010) Chronic alcohol consumption affects gastrointestinal motility and reduces the proportion of neuronal NOS- immunoreactive myenteric neurons in the murine jejunum. Anatomical Record. 293, pp. 1536–1542.
6. Rao, S.S.C., Welcher, K., Zimmerman, B., Stumbo, P. (1998) Is coffee a colonic stimulant? European Journal of Gastroenterology and Hepatology. 10, pp. 113–118.
7. Akbar A, Yiangou Y, Facer, P., Walters, J.R.F., Anand, P., Ghosh, S. (2008) Increased capsaicin receptor TRPV1-expressing sensory fibres in irritable bowel syndrome and their correlation with abdominal pain. Gut. 57, pp. 923–929.
8. Caldarella, M.P., Milano, A., Laterza, F., Sacco F, Balatsinou, C., Lapenna, D., Pierdomenico, S.D., Cuccurullo, F., Neri, M. (2005) Visceral sensitivity and symptoms in patients with constipation-or diarrhea-predominant irritable bowel syndrome (IBS): effect of a low-fat intraduodenal infusion. American Journal of Gastroenterology. 100, pp. 383–389.
9. FAO (2010) Fats and fatty acids in human nutrition: Report of an expert consultation [online]. Available from: http://www.fao.org/3/a-i1953e.pdf [Accessed on 10 January 2017]
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