Irritable Bowel Syndrome (IBS) affects many Canadians. We previously talked to Dr. Colleen Parker about what IBS is, how it is diagnosed and treated, and what UHN is doing for people with IBS. Today, Laura Bushey, Clinical Registered Dietitian in the Driscoll Family Digestive Health Centre at UHN, discusses the link between IBS, diet and other lifestyle factors, and how dietitian support people with IBS in managing their symptoms.
How diet can impact IBS symptoms
As a chronic gastrointestinal condition, it’s no surprise that diet can play a role in the symptoms people experience.
“Many people with IBS notice a strong connection between their diet and their symptoms,” says Laura. “Eating stimulates the digestive system, which—for those with IBS—can disrupt the communication between the brain, gut and nervous system, leading to discomfort and other digestive issues.”
The low FODMAP diet is a common tool as part of IBS management. It aims to eliminate foods that contain high levels of different types of carbohydrates that can be difficult for some people to digest. The purpose of this diet is to temporarily eliminate foods that may trigger symptoms before slowly adding them back into their diet to determine which specific foods appear to trigger symptoms, and in what quantities.
According to Laura, some studies show that approximately 75% of people who follow the FODMAP diet see an improvement in their symptoms. Others for whom the low FODMAP diet might not be a good fit can benefit from smaller changes, like adjusting fibre, fat, caffeine or alcohol intake.
Helping people with IBS manage their diet appropriately
While the low FODMAP diet can be very helpful for people with IBS, it is an approach best pursued with the support of a registered dietitian.
The low FODMAP diet is meant to be used to identify foods that trigger symptoms. The elimination phase—when foods are cut out to see if symptoms improve—is only the first phase of the diet. The intent of the low FODMAP diet is to identify which foods are triggers and in what amounts, and to build the diet back up over time.
“While restrictive diets can offer temporary relief for some people with IBS, staying on them long-term can actually make symptoms worse,” Laura says. “If someone stays in the ‘elimination’ phase for too long, it can limit their intake of fibre and prebiotic-rich food. This can reduce beneficial gut bacteria and potentially worsen IBS symptoms over time.”
Over-restricting food can also lead to other challenges, like eating a diet that does not meet a person’s nutritional or caloric needs. It can cause significant stress around meal times, which can worsen symptoms. And it also means that people may lose some of the pleasure that comes from enjoying their meals, especially if they have unnecessarily cut out foods they love.
“There’s a lot of confusion online about different diets and strategies, so it’s easy for people to get caught up in cutting out too many foods,” Laura says.
Breaking away from restrictive eating in IBS
After struggling with symptoms like discomfort and pain triggered by different foods, often for years, many people with IBS can develop a complicated relationship with food.
“For those who have been over-restricting their diet out of fear of triggering symptoms, the idea of expanding their food choices can feel really challenging,” Laura says.
Registered dietitian like Laura work with patients to build a treatment plan that works better for their unique needs. Starting with a nutrition assessment to understand an individual’s food tolerances, diet history and other factors like lifestyle is essential before starting a restrictive diet for managing IBS.
“There’s a strong body of research showing that a varied, balanced diet is beneficial for everyone, including those with IBS. While it can be tough to break away from restrictive eating habits, it can also be incredibly rewarding,” Laura says.
Food is central to so many people’s experiences. It can be part of family traditions and culture, celebrations and socializing. By helping people with IBS add more foods back into their diets, registered dietitian like Laura can help people reduce stress around meals and regain some of this joy around food.
“Helping someone rebuild their confidence in their food choices is so fulfilling,” Laura says. “Over time, this leads to greater freedom around food and a better overall quality of life, which is something I’m really passionate about.”
Tailoring IBS treatment for each patient
There is no “one size fits all” approach to treating IBS. The condition is highly individualized—foods that may trigger one person in small amounts may not pose issues for another person. Some people may benefit from a low FODMAP diet to identify food triggers, while others may see improvements by adjusting their fibre intake, meal timing or overall eating patterns.
Plus, IBS care incorporates more than diet alone. As Laura explains, managing IBS often requires a multifaceted approach. Effective treatment often involves a combination of dietary changes, lifestyle adjustments, medications and sometimes psychological therapies. At the Driscoll Family Digestive Health Centre, IBS treatment is provided by a team with diverse expertise, including physicians, nurses and registered dietitian.
“By evaluating a client’s intake and symptoms, we may identify other lifestyle factors—such as stress, physical activity or poor sleep—that affect their symptoms more than their diet. If that’s the case, we often focus on making their diet more flexible while still emphasizing gut-friendly, nutritious foods,” Laura says. “I collaborate closely with our gastroenterology team to offer nutrition advice that aligns with each client’s medical history and treatment plan.
“I’m fortunate to work with a fantastic team at the Toronto Western Hospital gastroenterology clinic, where a variety of treatments tailored to each individual’s needs are offered.”
In addition to providing multifaceted care, the team within the Driscoll Family Digestive Health Centre is also driving research into IBS management and care. This work, and work underway in similar centres around the world, could bring important new options for everyone living with IBS.
“Research is constantly uncovering more about how a healthy, nutrient-rich diet benefits gut health, especially for those with IBS,” says Laura. “As we learn more, it’s likely that we’ll discover even more ways diet can make a difference.”
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