Diet and lifestyle advice

NICE suggests dietary and lifestyle advice for IBS (1)

• people with IBS should be given information that explains the importance of self-help in effectively managing their IBS. This should include information on general lifestyle, physical activity, diet and symptom-targeted medication
• healthcare professionals should encourage people with IBS to identify and make the most of their available leisure time and to create relaxation time
• healthcare professionals should assess the physical activity levels of people with IBS - people with low activity levels should be given brief advice and counselling to encourage them to increase their activity levels
  
  
• diet and nutrition should be assessed for people with IBS and the following general advice given
  • have regular meals and take time to eat
  • avoid missing meals or leaving long gaps between eating
  • drink at least eight cups of fluid per day, especially water or other non-caffeinated drinks, for example herbal teas
  • restrict tea and coffee to three cups per day
  • reduce intake of alcohol and fizzy drinks
  • it may be helpful to limit intake of high-fibre food (such as wholemeal or high-fibre flour and breads, cereals high in bran, and whole grains such as brown rice)
  • reduce intake of 'resistant starch' (starch that resists digestion in the small intestine and reaches the colon intact), which is often found in processed or re-cooked foods
  • limit fresh fruit to three portions per day (a portion should be approximately 80 g)
  • people with diarrhoea should avoid sorbitol, an artificial sweetener found in sugar-free sweets (including chewing gum) and drinks, and in some diabetic and slimming products.
  • people with wind and bloating may find it helpful to eat oats (such as oat-based breakfast cereal or porridge) and linseeds (up to one tablespoon per day)
    
    
• healthcare professionals should review the fibre intake of people with IBS, adjusting (usually reducing) it while monitoring the effect on symptoms. People with IBS should be discouraged from eating insoluble fibre (for example, bran). If an increase in dietary fibre is advised, it should be soluble fibre such as ispaghula powder or foods high in soluble fibre (for example, oats)
  
  
• people with IBS who choose to try probiotics should be advised to take the product for at least 4 weeks while monitoring the effect. Probiotics should be taken at the dose recommended by the manufacturer
  
  
• healthcare professionals should discourage the use of aloe vera in the treatment of IBS
  
  
• if diet continues to be considered a major factor in a person's symptoms and they are following general lifestyle/dietary advice, they should be referred to a dietitian for advice and treatment, including single food avoidance and exclusion diets. Such advice should only be given by a dietitian

Reference:

• (1) NICE (February 2015).Irritable bowel syndrome in adults - diagnosis and management of irritable bowel syndrome in primary care.