IBS Triggers, Low FODMAP Diet, and Eating Disorders: A Complete Guide to Managing IBS Symptoms

Jessie (00:00): Hi everybody. Welcome to a new season of IBS Nutrition Podcast. Today, we are going to talk about something really important in GI health, and we have one of the most amazing speakers when it comes to eating disorders and GI disorders, or a combination of eating disorder, disordered eating in GI disorder, because it’s something we see a lot. Today is also National Registered Dietician Nutritionist Day. So Beth, Rosen, welcome and happy RDN Day to you.

Beth (00:34): Thanks, Jesse. Happy RDN day to you.

Jessie (00:37): Thank you. Now, Beth Rosen, as many of you in the GI field notes, she is a weight inclusive registered dietician specialized in GI disorder, nutrition and disordered eating. With over 30 years of experience, she has helped clients manage conditions such as IBS, SIBO, reflux, and gastroparesis. She also educates health professionals via webinars, national and international conferences and peer supervision. Beth is a registered dietician medical education lead for OG Health, a whole person GI health company, and a co-founder of the EDGI training project and co-author of Comprehensive Medical Nutrition Therapy for Co-occurring GI and Eating Disorder. Her upcoming book for patients, Gut Girls, which is a practical guide for managing IBS is out March 31st, 2026. You can learn more about that at bethrosenrd.com. All of this information will be in the show notes, so don’t worry. Hi, Beth. That was a handful to introduce you.

(01:52)It is amazing for you to join us today.

Beth (01:55): Well, thank you for the introduction, and I’m looking forward to this conversation.

Jessie (02:00): Yes. And for those of you who are listening today, we are going to tackle a few topics, five topics. IBS triggers. We’ll talk about different types of triggers when it comes to IBS, whether food trigger or lifestyle trigger. Number two, the nuances of the LOFOMAT diet. Number three, GI care without a side of diet culture. And then number four is the intersection of GI and eating disorder. And number five, Beth will share her IBS story with you. So Beth’s IBS journey started 16 years ago when she got an infection, a GI infection. So what she had was post-infectious IBS. She’s going to share with you her story of getting the diagnosis and also how she found out about her triggers. So be sure to stay until she share her stories. Now, let’s go ahead and dive into our first topic, IBS triggers. And I love that it’s actually laid out in your book, but I want to hear from you, Beth, what are some IBS triggers that patients can learn more about?

Beth (03:09): So I think patients always blame food, at least the ones that come to us. The first line of blame is always the food. And then there’s elimination on top of elimination, on top of elimination. And usually when they get to us, they’re on maybe a handful of foods that they eat. So food gets blamed, but there’s really a three-pronged list of IBS triggers. In the book, I call it the triumvirate. So food can be one. The other one is anxiety or stress. And the third one is poor sleep habits or change in your circadian rhythm. So that might not seem like a big one, but just think about the recent time change in the US, flying across time zones, working shift work where you’re working in the evenings and going to sleep during the day. All of that can also impact the gut. And then there’s this other one that we sort of talked about offline.

(04:03)And then there’s the unknown that we don’t know. And not just you and I, Jesse, that don’t know, but it’s probably known across most people with IBS that you can know what your triggers are and still have IBS symptoms because it is a chronic disease and there is no cure. So there’s still chances of having flares without knowing what’s triggering the flare.

Jessie (04:25): Absolutely. But the key is really to one, understanding your own triggers. Whether it is food related or like what you said, lifestyle and gut brain access related so that you don’t have that anxiety of, I have no idea what is going on. Most of the time, let’s put it that way.

Beth (04:43): Correct. Yeah. And you could have more than one trigger. It could be more than just food. It could be more than just stress. Absolutely. Everybody’s different. And that’s what makes IBS so interesting is that it’s so individualized and everybody’s … If you had a hundred people in the room who had IBS and asked them what their triggers were, they’ll all be different.

Jessie (05:02): Yeah. I love that. Absolutely. And also why IBS is so complicated when it comes to treatments, right? Because everybody have different symptoms, triggers, treatment needs to be individualized. Now, let’s talk about food triggers because our second topic is the nuances of the LOFORMAP diet. LOFOMAP is the first line recommendation when it comes to IBS management, when it comes to dietary management for IBS. However, it’s not the most straightforward, and I’m going to let you take away from here.

Beth (05:36): Yeah. So in the work I do, I do come with a bias for looking for folks who have eating disorders and disordered eating behaviors, because I see so much of it in my practice. So when it comes to the first line of a dietary intervention for IBS, yes, it is low FODMAP, but it’s not for everyone. So I just want to put that out there, that not everyone is a candidate. And if we had more time, I’d go into who is a candidate, but it’s in my book. So if you want to look it up, you can. But the low FODMAP diet is a three phase diet where the first phase, the elimination phase, is meant to be a diagnostic tool. It’s short term. You remove or you reduce the fermentable carbohydrates that are most commonly impacting GI symptoms, and you do that for a total of two weeks at max six weeks.

(06:23)And if you notice a marked difference, then you move on to the reintroduction phase. Then that means there is a high FODMAP food that’s probably bothering you, and the reintroduction phase is to figure out which one it is. If you go through the elimination phase and you see no difference, then that’s a pretty good indication that food is not one of your triggers, or at least high FODMAP foods aren’t doing it. And we’ll talk about that other one that we were talking about offline that starts with a G that might also be a trigger for symptoms. But then once you move to the reintroduction phase and you reintroduce all the foods and define your triggers, the third phase is the personalization phase. And that phase really allows you to liberalize your diet as much as possible because now you’re eating all low FODMAP foods plus all high FODMAP foods that you can tolerate.

(07:10)And it really could help you to lower the anxiety around food because now you know what your triggers are. So either you avoid them or you eat them and know what the consequences, and typically it’s temporary. So if that happens, it’s temporary. So that’s the low FODMAP diet in a very small nutshell.

Jessie (07:30): Absolutely. And it’s not just a one-page handout that most people get from their doctor offices. And that’s where we see patients get into trouble cutting out more and more foods because initially when they cut out certain high format food, they might have some symptom relief and they think that, okay, this diet is helping me. And then when symptoms do come back, which like you said earlier, it’s multifactorial. It’s not just one thing causing symptoms. It can be multiple things. And when symptoms do come back, when they’re already on a low form of diet, they cut out more food and people lead to cutting out more and more food. And that is sometimes what we see as disordered eating behavior in the GI space.

Beth (08:11): I just wanted to speak to the nuances of that. I just spoke about the diet as this boilerplate diet. And in fact, research shows that it’s done best with the help of a GI registered dietician who’s skilled in this because it can be nuanced, meaning that some foods can be added to the list or removed from the list depending on what information you come with about your health. And so it can be personalized at the elimination phase as well.

Jessie (08:40): Yes. And I love that. And you talked about this in your book as well, right? The FODMAP Gentle Diet and the cherry picking FODMAP diets. And for folks who are listening, read the book, learn more about it because it’s not one size fits all and you don’t have to cut out everything. And like you said, working with a GI trained dietician, we are looking at what you’re eating, what you’re reacting to. We may tell you to just remove one to two groups instead of removing every FODMAP group. And sometimes that’s enough for most people. And when we do the reintroductions, I want to put it out there too, so people are not cutting out all the foods. You don’t have to be fully low FAMAP to do the reintroductions. When we’re watching for symptoms, it is okay as long as your symptoms are in baseline to do the reintroductions when you are eating some forms of FODMAPs. And so for anyone listening, don’t go cut out more and more food.

Beth (09:29): I’m with you on that one.

Jessie (09:31): Yeah, absolutely. Okay. Now let’s talk about GI care with a side of diet culture. I think people are not aware that GI and eating disorder are closely related sometimes.

Beth (09:45): Yeah. So the research shows that up to 98% of folks with eating disorders have GI disorders. So if you are working with people that have GI disorders, chances are they also have disordered eating or eating disorder, or a majority of them do. Not to say that everyone does, but a lot of people do. And that’s typically related to patterns of undereating, malnutrition that can impact the microbiome and signaling in the body. And they will typically come for help with the GI issues without being aware that the eating disorder or the disordered eating behaviors has caused this or triggered it. So working with folks with GI disorders, it’s important that we consider what they might be hearing from diet culture. And what I mean by diet culture is at a very basic level, the belief is that weight is synonymous with health and that’s just not the case.

(10:39)There are people in all size bodies that get all diseases, including IBS, including diabetes, including cancer, right? Not one disease out there only impacts people in larger bodies. So when we come from a weight inclusive approach, we’re not dealing with the weight specifically. We’re dealing with the person and their symptoms and looking to treat and manage the symptoms. So that’s what I mean when I say I do GI care without a side of diet culture, not focusing on weight loss and weight loss in many cases. And a lot of the trends right now with like the protein maxing and the fiber maxing and the intermittent fasting, a lot of that can impact how the gut’s working. So sometimes we’re removing those roadblocks to get to a place where maybe some of the behaviors that are happening are impacting the gut more than the IBS itself.

Jessie (11:27): I love that you are talking about this because we are seeing, right? I think the last two years we saw a lot of intermittent fasting and really impacted their gut motility depending on what meal they’re cutting and most of the time is breakfast. And we know breakfast is so important for gut motility. And these days, we are seeing a lot more fiber maxing. We have somebody who ate over a hundred grams of fiber a day, and he came to us complaining of bloating and gas and discomfort. And guess what is causing it is that fiber amount that they are eating is way over the recommended range of 25 to 38 grams of fiber per day. So for folks who are listening more is not always better, know your body, understand your limits.

Beth (12:09): Correct. And I also think that people also need to know that there’s a difference in types of fiber that impact your gut in different ways. So something like soluble fiber, which dissolves in water and creates a gel, helps to lubricate stool, helps to keep it moist and moving. Whereas the insight of fiber is a little bit rougher, think roughage, and that pushes things faster, but it can also dry out if you don’t have enough fluid and if you don’t have enough of the soidal fiber. So it’s a delicate blend of both and a balance. And that’s, again, where a registered dietician can come in and help explain that. And some people do need to reduce their fiber in order to feel better. And that’s something that you don’t hear on social media.

Jessie (12:50): Absolutely. And usually people only get the message that they need more and more and more, but be careful, there is a limit. And I love you talking about different types of fiber. Yeah, absolutely. Okay. Well, let’s go to the next topic. And we kind of covered a little bit, the intersection of GI eating disorder. What are some red flags that you want, one, providers to know so that they can watch for when they’re working with patients? We have a lot of providers that listens to our podcast, but maybe two, also for audience, for our audience to know these may be red flags that you have eating disorder or disordered eating behavior.

Beth (13:33): Yeah. On the provider side, and remind me to talk about the patient side because I might forget, but on the provider side, I think it’s important to assess everybody’s relationship with food. While there’s no validated tool for assessing whether or not somebody with a GI disorder has an eating disorder, because there’s lots of eating disorder assessment tools, but they don’t account for pain and discomfort due to GI disorder. So you can glean some of the questions from those tools, but it will not measure whether or not somebody has a definitive eating disorder, and that’s not our job as dieticians. That’s a therapist’s job. But what you can ask for is information about a relationship with food. How does food make you feel? Are you in a good relationship with food? Are you afraid of food? Does it hurt you? Are you a dieter? Because a lot of things that are common in our culture are actually disordered eating behaviors, right?

(14:29)Like we said, skipping meals and putting protein in everything. This is not how food was meant today. We’re supposed to have adequacy and variety and all those things. And when you miss meals, you don’t necessarily get that. But asking patients about the relationship of food and also asking if they participate in any behaviors that helps them to manage their weight or if they have a preoccupation towards thinking about wanting to be thin or smaller, right? All of these things can be red flags if the answer is yes. But on the patient side, analyzing really how you’re eating and where you’re getting your information from, right? So social media, Reddit, Instagram, Google, YouTube, unless you’re watching someone who has a degree and is presenting you with data and isn’t trying to sell you something, right? You may not be getting the real information you need about what foods are best for your body, right?

(15:36)So things like hearing about seed oils or meal skipping, just as you said earlier, Jesse, about meal skipping, like our GI system is a series of muscles. And if we don’t work them out, they don’t work. So if we don’t turn them on in the morning, they’re not going to be ready to be turned on in the afternoon. They’re going to be sluggish because they didn’t get energy in the morning. So we know that starting our engines up in the morning gets our metabolism going, gets our GI system going, all that. But also for patients, asking yourself the hard question, how often are you thinking about food? Is it more than 20% of the day? How often are you worried about your body size and shape? Is that important? And if you’re concerned about these things, certainly reaching out to an eating disorder informed therapist would be really helpful.

Jessie (16:28): Absolutely. I love that. And I think what you talked about for providers too, that’s good information for patients to know to watch, do I have any of those behaviors that is mentioned here? And sometimes people don’t realize that they have a tendency or they get very influenced by diet culture. They’re very worried about their body image and it can be a vicious cycle. They’re worried about that. They restrict eating, they get gut symptoms, they restrict eating even further, and that cycle just doesn’t break in. It can be very difficult. And to help with that cycle, what is a dream medical team to help somebody who has GI disorders, eating disorders combination?

Beth (17:12): Okay. The dream medical team is everybody’s eating disorder informed. Everybody is trauma informed because eating disorders don’t end up in a bubble. They come from somewhere, right? And certainly weight stigma plays a role, trauma can play a role. So a medical doctor, a dietician, a licensed therapist, you could have a GI therapist on the side just for the gut brain piece, right? Sometimes you need a pelvic floor physical therapist because if there’s muscles related to this, if things have gone out ofway, who else would I add to that? I don’t know. I think Family and support is great. Yes, that’s a great one. And family support or support. It doesn’t have to be family, but peer support. Yes. Okay. So we have the same list.

Jessie (18:24): Very similar. But of course, ED informs and body inclusivity while working with somebody who has eating disorder. So love that. I love that.

Jessie (18:37): Okay. Now we are down to the most juicy parts of this conversation. And Beth, I’ve known you for years and I know you have certain food triggers. And can you tell us your GI story?

Beth (18:51): Yeah, it’s lots of fun. In 2010, I got C. Diff, which is a GI infection. After spending two nights in the hospital, not for me, but for my child who had to be in the hospital for pneumonia and I ended up getting sick. And it was so bad that I ended up in the ER and they just gave me fluids and sent me on my way with a referral to a GI doctor. That GI doctor had me do an endoscopy, did not take any biopsies. The doctor had told me to go off gluten and to go off dairy. And then I had the endoscopy, which as we know, you don’t go off gluten before you have an endoscopy because you need to rule out celiac disease and you need to have biopsies in order to rule out cellulitis. So you didn’t do either. And when I woke up, they gave me toast with butter and I was like, “What are you doing?” And so I lost trust in this doctor because he gave me wheat and dairy at the same time.

(19:48)And so the issue with that doctor was that he had the perfect opportunity to diagnose me or rule out certain diseases and he didn’t do it. I ended up leaving that doctor, going to another doctor. She did a colonoscopy, didn’t see anything, of course, because that’s part of IBS is that it’s functional. So my GI system will look beautiful, but it won’t work right. And that’s the difference. It’s not structural. She didn’t see ulcers, she didn’t see stricturing or narrowing. She didn’t see blockages or twists or anything, but it wasn’t working right. And then for the next year, she proceeded to have me come back every six months. I would tell her about my six weeks, really. She would tell me to come back every six weeks. And then I would tell her my symptoms and she’d say, “Well, you have IBS and deal with it.

(20:34)” And that was really it. So I left her and I went to another … It’s a lot. I went to another GI doctor and that GI doctor ended up sending me for a breath test and I ended up having SIBO and I also had lactose intolerance. So I got diagnosed with both of those. Then they had me go for a blood test and my TTGIGA, which is one of the immune markers that’s relevant to celiac disease or celiac disease was elevated, but because I never had the endoscopy with biopsy, I don’t know if it’s celiac or not. And that physician told me that it was called non-celiac wheat sensitivity. So here’s this disease state where you might have the same physical reactions or digestive reactions as you would if you had celiac disease, but it wasn’t doing damage to the small intestine. This is what I was told.

(21:31)I didn’t believe them. Went home, had a big bowl of pasta, and for a couple of days I was not in a good way. So after that, that was probably late 2011, early 2012. And then from then on, I just went gluten-free because maybe there was something there. But I ended up switching doctors from that practice and landed with my now physician who I’ve had for 14 years. And he was the first doctor to say to me, “It’s IBS, it’s a chronic disease. You’re never getting better and we’re going to look for tools to help you with your symptoms.” And I cried right in his office. I was like, nobody has said this to me. I didn’t know that this was forever. I didn’t know that there were some things that could be done on the medical side. I knew there was nothing on the nutrition side other than the low FODMAP diet, which to me was relatively new.

(22:31)And so I did do that on my own, only because I’m a dietician. So I did do it on my own. And I did find some food triggers, so that helped. My doctor did help with some over the counter meds. And so since then, I’ve been doing pretty well with managing my IBS. But what I want to say is that I know what my triggers are. I know which foods bother me. I know if I, for some reason, because this rarely happens, that if I don’t have more than six hours of sleep, I will not feel well the next day. And my reaction is to always blame food, but then I have to remember, oh, you only slept five and a half hours and that’s what it was. And then just get through that day. The only thing that really sticks out to me from that diagnosis that’s sort of the missing piece for me is that gluten sensitivity because I did the low FODMAP diet, I reintroduced or attempted to reintroduce fructans and I can have garlic, I can’t have onion, I can do onion and I can do beans with enzyme helps.

(23:37)And I do that because I want to liberalize my diet, but I cannot do bread. I cannot do wheat. Even I can’t do sourdough. And it’s a different reaction than what I get from other froctans, right? So instead of lasting just a couple of hours to overnight and then being better in the morning, it can last a week. And it’s not just GI discomfort. It is GI discomfort, but it’s also fatigue and sometimes like body aches. So it’s different. It’s a little

Jessie (24:11): Different. I love you bring this up. When patients are working with us, that’s something we watch for too. How long do symptoms last? What symptoms are they showing up as? Because with FOMAP reintroduction, symptom lasts one to two days. Once they’re out of your body, they do not cause any more symptoms. Then when it’s a gluten or immune reaction, symptoms can last for a bit longer. In what we see, symptoms last two to four weeks or one to four weeks in patients and sometimes some cases are more complex. It can last for two months if a patient’s have a very sensitive gut. It really varies how reaction shows up. And also it varies when reaction shows up as well. I think you know it as a dietician. Some people have immediate reactions. Some people have delayed reaction.

Beth (24:57): The longest case we have- And myself, if I forget my enzyme use with lactose or with beans, at the four hour mark from when I ate it, symptoms begin. And it’s like clockwork. All of a sudden I’ll not feel well and I’ll be like, “Why don’t I feel well?” And then I’ll look back at my head and go, “Oh my goodness, it’s been four hours and I forgot my enzymes.” But with wheat, it’s almost immediate and it’s not immediate. I won’t say it’s immediate. It’s a couple of hours and then it just doesn’t stop. Whereas if it’s onion, it’s immediate and it stops in a couple of hours. If it’s dairy, it takes four hours and then it stops by the end of the night. When I go to sleep, it gets better.

Jessie (25:41): Okay. I love that you’re sharing this because I think this is the confusing part, right? People think they know how to reintroduce food, but when in reality you don’t know how to catch the symptoms that might be presenting to yourself and different food presents with different symptoms. And going back to weeds, I think some of the cases we see usually is the two-day delay. Sometimes actually the longest case we see is a seven-day delay of symptoms. Symptoms didn’t start until seven days later when they do a gluten reintroduction. Now, I want to go back a little bit to your story and kind of give

(26:17)Our audience a little bit of statistics. So post-infectious IBS is one type of IBS that happens after patients get a gastroenteritis. It can be from foodborne units, it can be from flu, it can be from bacteria, it can be anything that causes inflammation or infection in your GI tract. A lot of the times people get better from football illnesses, but 20%, about 20% of patients who have GI infections may experience long-term GI symptoms. And that’s what we call post-infectious IBS. And then let’s also talk about gluten intolerance too that you mentioned. Non-celiar wheat sensitivity is the name that the world caused this condition. In the US, we call it non-celiac gluten sensitivity. We don’t fully understand what part of weeds or gluten that are impacting people, but we know how to test for it by using food that are not FODMAP containing. And there are a lot of research out there, especially research coming from Australia that talks about people who are self-claiming to be gluten intolerant may actually not be gluten intolerance.

(27:30)They might be fruiten intolerance. One subset might be more frutin intolerance, which is a FOTMAP group. And then another subset may have a gut brain access disorder or gut brain disorder causing them to have symptoms or placebo effects when they eat gluten. So these are things to consider too. For listeners here, do not put yourself on a diet if you don’t know how to identify symptoms because research have found that most people who are claiming to be gluten intolerance are not actually gluten intolerance. They might be fog intolerance or they might have something else going on. But there are also research that suggests that patients with non-celiac gluten sensitivity may have a different genetic markers that put them at higher risk of having a reaction to gluten. And there are certain research that shows thickening in the colon and maybe potential changes in the esophagus in certain non-celian wheat sensitive patients.

(28:25)And we need a lot more research in this area. And I think one of the things, Beth, you can tell, maybe talk about your gluten incident, right? And then also, how did you know what caused your symptoms?

Beth (28:41): It’s such a rookie mistake. I shouldn’t have made it, but I was at a conference, Digestive Disease Week, and I stopped in a store to get some snack bars because I didn’t have anything in my hotel room and walking over to the conference center needed some things. And I did not put on my reading glasses. I was just looking for the bolded word wheat in something to make sure that it didn’t have wheat in it. And I bought these snack bars with some almond butter in them and they were delicious. And a little later that day, I was not feeling well and I’m not one to love going to a public restroom to move my bowels, but I did not have a choice. And urgency kicked in. And a few times in the course of the afternoon, I was running back to the bathroom, did not know where it was coming from, did not realize it was the bar.

(29:29)And when I got home, I had taken the bars out of my bag and I was just reading the ingredients. I don’t know why I looked at the ingredients again, and I saw that it had a barley as the first ingredient, and barley has gluten in it, but it’s not wheat. It’s not one of the top eight allergens or nine allergens that they typically bold on the food label as a warning in the US. So that was, again, a rookie mistake. You need to look for wheat, rye, and barley when it comes to gluten and ingredients that derive from those when you’re worried about gluten. So as much as the research that’s out there might say that I’m not wheat sensitive or gluten sensitive, I beg to differ because I glutened myself and I didn’t realize I did it. I bought them with the understanding that they were totally safe for me.

(30:22)So it wasn’t like I went into it with any anxiety to eat this product. In fact, I enjoyed it and it didn’t taste like wheat because it was made from barley. So there is a texture of flavor to wheat that if you don’t eat it and it ends up in your food, you sort of can taste it, but I didn’t have that experience. And so that’s one of the things that happened to me, that doesn’t mean that happens to everybody, but it does show that I know my body best and I will continue to be gluten-free. And I’ve continued to reintroduce gluten over the course of the year since 2011, and I have not had a successful reintroduction to date.

Jessie (31:01): Right. And you reintroduce it with low farmat fruits, right? So that’s how we differentiate whether a person has gluten intolerance or a FODMAP or fruitin intolerance because I used a really good sourdough bread with a seven year starter, like a really good sourdough bread and it was delicious, but it did not love me back.

Jessie (31:20): Right, right. Now for listeners out here, as you are listening to our conversation, please do not self-diagnose with gluten intolerance. It’s a very difficult life to live gluten-free. You have to be very aware of what you are putting in your body all the time because not all ingredients will label themselves as gluten or as wheat, like Beth’s situation here, even as a dietician should gluten herself by accident. Okay. Well, thank you so much for sharing your story with us. I think this brings us to the end of our podcast. Beth, do you have any words? Maybe one for our patients that are listening.

Beth (31:58): Just know that you know your body best. And when you speak with your healthcare providers, advocate for yourself about your symptoms and your experience with food and symptoms so that they can understand your entire story.

Jessie (32:13): Yes. Advocate for yourself. Even Beth went to four different GIs. Am I counting it right?

Beth (32:19): I did. I did.

Jessie (32:21): Yeah.

Beth (32:21): But now I have the best one.

Jessie (32:23): Right. And don’t be afraid to go get a second opinion or third or fourth opinion. Find somebody that will listen to you that will work with you as a team. All right. Thank you so much, Beth. It’s such an honor to have you. And for those of you listening, remember, if you want to learn more about managing IBS, gut goals from Beth Rosen. It’s out March 31st, 2026. Thank you again.

Beth (32:48): Thank you.