What to Eat with IBS: Navigating Diets and Finding Relief

Jessie Wong 00:00:00 Welcome to the IBS Nutrition Podcast, your go to source for navigating the complex diagnosis of irritable bowel syndrome. Here, we dive deep into IBS and discover the power of diet and lifestyle to find freedom from your IBS symptoms. I’m your host, Jesse Wong, Fodmap dietitian and a gut expert. For years, I suffered from debilitating gut symptoms that kept me out of work, feeling constant discomfort in my body and anxious around food. Today, I’m in control of my IBS. Able to eat the food I love again, travel whenever I want and spend quality time with loved ones. It is my mission to help you do the same and transform the way you live with IBS. Let’s get started. Hi everyone! Welcome back to another episode of IBS Nutrition Podcast. I’m here today with my amazing co-host Brooke Keenan, who is also our lead team IBS IPS dietician here. Okay. And of course, I am Jesse Weiland, registered dietitian and an IBS expert for anybody who is new to our podcast. And today we are talking about a very interesting topic that everybody asks us about, and that is what to eat for IBS.

Jessie Wong 00:01:11 Brooke, what do you think of this topic today?

Brooke Keenan 00:01:14 This topic is near and dear to my heart. Let’s talk about this all day long.

Jessie Wong 00:01:22 Absolutely. And this is, of course, what we help our clients with, right? Identifying their food triggers and helping them eat what they can eat without causing symptoms. Now, what you eat for IBS can be really tricky because there are many diets out there, and it can be really confusing for patients to find the right diet for them without too much restriction. And that’s one of the problem we see is that there’s just so much information, not enough to write guidance. And oftentimes a lot of the diets are really restrictive. They don’t yield long term results, and they cause the patients to fail or just have, disordered eating behavior because they become so afraid of food. Now we just went to the biggest digestive health conference in D.C. and that was amazing and mind blowing and really affirms us that there is only one diet out there for IBS that we should recommend as a starting place.

Jessie Wong 00:02:23 Do you want to tell us more? Well, we went to so many sessions there.

Brooke Keenan 00:02:27 Yeah, we went to a lot. So first, you know, we see people that are have been suffering for a while. I do think the first step would be doing higher fiber, making sure you’re drinking water. Sometimes fat can be a trigger. So once you’ve done all that and it hasn’t really helped. The next step would be doing the low Fodmap diet with a dietitian to help guide you. Because it can be complicated, it can be overwhelming. We see a lot of people that have been on it way too long and are then, you know, have maybe more symptoms because of that. So we’re actually working on liberalizing their diet as much as we can. But definitely the low Fodmap diet has the most research behind it of any diet for IBS for sure.

Jessie Wong 00:03:17 Absolutely. And I love that you talked about increasing fiber, increasing fluids, and maybe working on some of the lifestyle approaches first before trialing and elimination diets, because elimination diets, again, what we know as dietitians is that it’s not benign because it can cause more problems down the road.

Jessie Wong 00:03:35 And when you’re restricting huge food groups like FODMAPs or even gluten or, you know, some of the other diets out there like Sibo, Candida diets or specific carbohydrate diets, they are extremely restrictive and oftentimes not necessary. And when you restrict so much food in your diet, it can actually cause a shift in your gut microbiome. And that’s the last thing we want to happen. Now when it comes to the low Fodmap diet, it is what we primarily use in our practice when we see it being applicable. Can you tell us a bit more about what the low Fodmap diet is and how it is used?

Brooke Keenan 00:04:15 If the low Fodmap diet is a good fit for them, we will start with having them cut out the majority of high Fodmap foods in their diet. and focusing on and trying to make it as easy as possible providing recipes so you don’t necessarily have to think of all the things you’re cutting out, but look at the recipes and just start there. So then it feels like you’re just following some new recipes, not necessarily cutting, you know, everything you used to love out.

Brooke Keenan 00:04:44 but focusing on some great grocery lists and low Fodmap fruits, low Fodmap vegetables, some lower Fodmap grains. And then we really try and keep you on that restrictive phase for no more than six weeks before we start adding in the FODMAPs one at a time, to see if there are any that you react to. And and this is where our dietitian can also be really helpful because sometimes people can get away. There’s a three day diet trial, and I have a lot of clients who can tolerate, you know, day one and day two, but then they get to the day three amount and they really can’t. So then you know that you just might have to be mindful of those Fodmap groups when you’re eating. But in general you should be okay to just have a little.

Jessie Wong 00:05:26 I love what you just said and let me bring it back. So with the low Fodmap diets, there are three phases and that’s often not communicated to the patient when they are recommended a diet from a physician. Or maybe they found it on the internet.

Jessie Wong 00:05:40 Now with the first phase is elimination reducing the Fodmap intake in your diet? It’s not in no format diet, so you don’t have to be 100%. You can still have some higher Fodmap foods, but maybe at a lower quantity level. So it’s called a low Fodmap phase. That’s phase number one. Usually we want the patient to be on it for 2 to 6 weeks, as we are helping them to make sure they are actually doing it properly. And then the second phase is reintroducing FODMAPs grouped by groups. So there are six primary groups of fault maps. And we actually in our practice we break it down into 12 groups for challenge purpose so that we can really help you identify which group you don’t tolerate and what your tolerance level is at. And like you said earlier, right. We do the challenge. Each group of default map and Fodmap subgroups, we do a three day challenge. to identify a person’s our clients tolerance level. And oftentimes, you know, our clients will be able to tolerate everything most of the time.

Jessie Wong 00:06:40 Or if there’s something they don’t tolerate, it may be the bigger amount on day three that they may not tolerate. So we always start with a very small amount on day one and a moderate dose on day two, and a full serving on day three. And we monitor symptoms and monitor their bowel habits to see if anything changes. And then at the end of all of the challenges, that’s when we expand the diet based on what you tolerate and what you don’t tolerate. Now for everybody starting out, if you need help, if you want the grocery list that Brooke was talking about, we have a free resource for you. And that is our Low-fodmap Starter guide. It comes with our grocery list and education information on what the low Fodmap diet is. Basically what we were just talking about. We also have a vegan protein list because most of the vegan protein foods are going to be higher FODMAPs. So in that list, we tell you what is, tolerable amounts for patients who need to be, who who eats a vegan diet but but still needs to get their protein.

Jessie Wong 00:07:41 And so you don’t have to cut out more and more food and end up with just rice and chicken, which is sometimes what we see. And it’s, it doesn’t need to be that way. When you look at a grocery list that we have, what we recommend is highlight the food you like and go shop according to the list. And when you see the grocery list, you can see, wow, there’s so much food that you can actually eat even on the low-fodmap diets. But some of them are dosage dependent and so you don’t feel stuck. And that’s a big problem we see okay, what do we want to talk about in regards to different types of diets that we do in our clinic. And also we also heard about at DW and that is the gluten free diet. Would you want to maybe expand on that a little bit. Yeah.

Brooke Keenan 00:08:27 So sometimes if we see people aren’t responding to the low Fodmap diet, or sometimes if we know people have had lifelong digestive digestive difficulties, will actually try and start them on along with a low Fodmap diet, a gluten free diet.

Brooke Keenan 00:08:44 So really you’re supposed to be avoiding wheat on the low Fodmap diet. So it’s it’s not a bigger jump. Too much to do gluten though restricting gluten is a huge challenge. But we’ll have people also cut out gluten. And again, usually that’s the first thing we add back in to challenge that, because that’s the most seems to be one of the most difficult things to cut out. And if we can get you back to eating gluten, then people are generally happier, even if they’re still low friction, because they can have sourdough bread. So yeah, so that we we will layer that in pretty frequently depending on people’s past history.

Jessie Wong 00:09:24 Right. And a gluten free diet is not something we recommend lightly because it’s not always necessary. And it’s an extremely difficult diet to follow. Unlike what media may be telling you, you don’t just cut out pasta, cookies, donuts, cake. You have to remove cross contact and cross contamination as well. It can be really difficult. So that’s not something we would wish upon anyone to try out themselves.

Jessie Wong 00:09:48 Make sure you are working with a dietitian who knows what they are doing when they recommend a gluten free diet, because it is a lot harder than what most people think it is. And then of course, I mentioned a bunch of other diets earlier, like the Sibo diet, the Candida diet, or maybe even the low fermentation diet that you may hear that can benefit people with IBS or with Siebold. These diets, again, they don’t have a challenge face, which means you are going to be stuck at an elimination phase for long term. And at the DW, they actually compare the results of some of these diets, and it is not recommended right now. At this time, the most recommended diet is the low Fodmap diet. We are going to do another episode on the low Fodmap diet, talking about some of the mistakes that we see people make all the time. So you don’t have to make those mistakes. But today we’re going to focus talking about what is the best diet for IBS and, you know, how can you get started appropriately.

Jessie Wong 00:10:49 So I’m going to put in the show notes or in the description under the video or this podcast, The link to get our free resources so you can start the low Fodmap diet appropriately. But Brooke, this is something you know better than I do. Can you tell us what are some of the higher Fodmap foods that we see people react to more often than the other ones?

Brooke Keenan 00:11:13 The research shows, and I find in practice as well. Onions, garlic and mushrooms are some of the biggest food groups that people react to. I would definitely say not too many people are eating mannitol, which is what mushrooms fall in their Fodmap group, but the fruit stands in onions and garlic definitely can cause people problems. And onion and garlic is in practically everything you eat when you eat out. most people cook with a fair amount of onion and garlic. So that can be one of the biggest challenges or the biggest flavor, I guess, to that people will miss when they’re trying to do the low Fodmap diet. So that also will be one of the first groups that we try and introduce.

Brooke Keenan 00:11:56 Sometimes when people are feeling really restricted, not eating onion and garlic, right.

Jessie Wong 00:12:01 And usually to our surprise, most of our clients, after working together, they will be able to reintroduce garlic without any problem at all. Now with garlic and onion, both of them contained a Fodmap called fruit. Ten and ten is of course a bit notorious and and more difficult to digest in most people’s opinion. However, in clinical, when you do deliver peptide properly, it may not cause you that much problem. Then you usually think. So what I would really recommend is work with someone who will help you work through the foundations or the basics of your IBS, and really get you to a better place before reintroducing fall maps. Okay, so and another form of group I want to talk about that. I hear patients tell us all the time is apple and peaches. So that is fructose and sorbitol groups together. So we talked about earlier in our practice we reintroduced 12 groups of FODMAPs and form subgroups. So this is a Fodmap subgroup of two four maps together.

Jessie Wong 00:13:01 Or we really have to do an episode where we go through like what are the different types of FODMAPs? You know how they react in people’s guts, but that will be a different episode that would be coming. So stay tuned. But with Apple and peaches. So they have fructose and sorbitol. And both of these are more osmotic FODMAPs. And what they do is they draw water into your small intestine, and you may feel like it’s causing a lot of gurgling and gushing and maybe even distension in your abdominal area. So when it comes to Fodmap, they have two primary characteristics that causes more symptoms in our gut. One is they draw fluid. Some of them draw fluids into a small intestine. And again they cause gushing and gurgling and maybe a lot of noise in your gut and also distension. So bloating in the middle of your domino area. So some of the Fodmap groups do that. And then all of the Fodmap groups, they are rapidly fermentable. So what thought maps are they basically fermentable carbohydrates.

Jessie Wong 00:14:01 And when they are rapidly fermented in a colon they will cause a lot of gas. sometimes they do smell, but just sometimes a lot of gas. And the trapped gas can cause a lot of pain in patients with IBS. And of course, we know patients with IBS already have heightened gut sensitivity. So any changes of fluid or gas or increasing in fluids and gas in the intestines will cause more symptoms. and which is also why the low Fodmap diet works so well for IBS patients, and it’s the number one recommended diet. It is created by Monash University in Australia. It is researched all over the world and in University of Michigan. They do a lot of research in Europe, they do a lot of research and we are just so excited. There is a diet that can actually help patients with irritable bowel syndrome. All right. I think that is a lot for our listeners to digest. At this time, what we usually like to end our podcast is also sharing a client story to tell you that finding relief from IBS and of course, actually expanding your food from the low Fodmap diet or any kind of restrictive diet is possible.

Jessie Wong 00:15:16 and I want to share with you this client story. Her name is Jennifer. And Jennifer had intense bloating, a lot of constipation, and she actually went to her gastroenterologist and she got a lot of tests done and got a diagnosis of IBS, and she was told to try out a low Fodmap diet on her own. So without being told that it is a short term diet. So she actually bought cookbooks from other dietitians and she was eating the low format diet for a whole year. And see, this is where we find the disconnect between patients and providers are is that you may not necessarily know that this is a temporary diet and people get stuck on the diet. And so when she found me on social media, she saw me making making croissant and she asked me how I could eat croissant while on the low Fodmap diet, and what I told her was I don’t eat low-fodmap diets anymore and she probably doesn’t need to as well. And that’s when she joined our small group program and we actually work through her IBS constipation step by step to help bring her symptoms down.

Jessie Wong 00:16:28 So the first thing we did now she had significant constipation and that was causing most of her symptoms and her bloating. So if you are constipated and there’s two bourdon in your colon and you eat fermentable carbohydrates aka FODMAPs, the FODMAPs are going to be fermented in your colon. It’s going to cause a lot of gas and the trapped gas will be causing you pain. And that’s exactly what happens to her. So the first step, what we did with her is really help her regulate her bowel movement, really help her create a routine so that she would have full evacuations every day. And that reduced her symptom and bloating significantly. Now, routine is key for anybody who struggles with constipation, and what we did with her was really help her eating better, following, a meal routine. So she’s eating three times a day. She’s eating well-rounded meals instead of grazing all day long. And we helped her maybe eat a bigger breakfast and have coffee so that she is having that full evacuation earlier in the day, and she’s not carrying Stu all around her throughout the day.

Jessie Wong 00:17:37 That would be causing her bloating. And then after after we regulated her bowel movements, that’s when we started reintroducing fault maps group by group. Now, if you remember, she’s already been doing the low Fodmap diet for a whole year on her own. There was some parts of the low Fodmap diet that she wasn’t doing correctly, right? She wasn’t reintroducing food, and she actually also wasn’t getting enough fiber as well when she’s doing the low Fodmap diet. Oh, again, reminder to everybody go get our low Fodmap starter guide to help you actually start the low Fodmap diet correctly so you’re not making this mistake. And we’re going to talk more in our next podcast. The mistakes that we see all the time and how you can avoid them. And this is one that we see all the time. People only focus on restriction and not getting enough fiber. When you don’t get enough fiber, you are more likely than not going to be more constipated and have more symptoms. Okay, so and with her, what we did once we regulate her, her habits really bring her symptom down was we kept her at her baseline maybe for a little bit, I think maybe 3 to 4 weeks.

Jessie Wong 00:18:42 And then that’s when we started reintroducing FODMAPs group by group. And guess what? She tolerated all Fodmap groups except one. There was one group of maps that she actually reacted to pretty significantly, even with a small dose. And that was the beans group. So goes plus ten subgroups. So that group of maps she reacted to very quickly, and even at a small dosage, she couldn’t tolerate it. But what I told her at the end of the program is keep challenging it in the future and see if your tolerance level will improve, because sometimes it does take time for your gut to keep healing when you have proper bowel movements every day, and maybe in the future she will be able to tolerate, you know, certain groups that she may not tolerate now. And for her, it was only one group of maps and she could eat croissants nowadays and not worried about croissants bringing her symptoms. So I wanted to share with you her story so that you know there is a better way forward. You don’t have to keep restricting food, even if that’s what your doctor told you to do.

Jessie Wong 00:19:50 If you don’t have a true food intolerance, it’s not necessary to continue the low Fodmap diet for long term. And we hear that from clients all the time is either low-fodmap or a lot of symptoms. Now, in these cases, we really have to dive deeper into your symptoms and see what is going on and resolve maybe the root cause first before reintroducing the max at the end of the program. She wrote the testimonial for us and she said, you know, she no longer have embarrassing gut symptoms and tooting all day long because now she knows how to manage her symptoms better and really understands her body a lot better and knows how to resolve her symptoms if anything does occur. So everybody, I hope that inspires you to not give up and not just live with IBS because you don’t have to. There are better ways to manage your IBS symptoms. Okay, this is a lot. In one episode, we will link all the resources in our show notes and stay tuned. Make sure to subscribe to our podcast so that you get notifications when we have new episodes out.

Jessie Wong 00:20:57 We are going to record topics about different types of jobs. What to do if you have constipation, diarrhea or mixed bout time. We also have another episode about Sibo coming up, and of course we’ll talk more about the low Fodmap diet. So make sure to hit the subscribe button and don’t give up. All right everybody, and thank you, Brooke for joining me today.

Brooke Keenan 00:21:18 You’re welcome. Bye.

Jessie Wong 00:21:20 Thank you for tuning into the IBS nutrition Nutrition Podcast. We hope today’s episode has brought you closer to understanding and managing IBS. Remember, you are not alone on this journey and finding freedom is possible. For more on IBS, make sure to follow us on your favorite podcast platforms and please leave us a five star review! We would really appreciate that you can access links mentioned in this episodes in the show notes. To learn more about your type of ideas and how to identify your own food or lifestyle triggers, Register for our free IBS Masterclass. Three steps to IBS relief for our proven, holistic, three steps approach to managing IBS once and for all, head to IBS dietician.

Jessie Wong 00:22:03 Com forward slash masterclass to register. Until next time, take good care of your gut and here’s to your health and happiness.