Managing IBS with diet: Tips from an expert

Irritable bowel syndrome (IBS) is a common digestive disorder that causes stomach pain and cramping as well as diarrhea, constipation or both. For many kids and teens, symptoms are mild and can be managed with a balanced diet, regular exercise and reducing stress.

But some children have more severe symptoms that require medication or a specialized diet. One diet option is the low-FODMAP diet, a short-term eating plan designed to identify foods that may trigger IBS symptoms. The goal is to follow the diet for 2 to 6 weeks, remove foods that may trigger symptoms, and then slowly reintroduce them to see if specific foods are causing symptoms.

"Because the diet requires removing a lot of foods, it's best done with the guidance of a medical provider so parents feel confident their kids are getting the nutrients they need to grow and feel their best," says Rebekah Ladd, Clinical Nutrition Manager, Pediatric Gastroenterology at Children's Health℠.

What foods can trigger IBS symptoms?

Some carbohydrates are high in FODMAPs which are found in many foods that can make IBS symptoms worse. However, not all carbohydrates are high in FODMAPs. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols – types of carbohydrates that can be difficult for some people to digest.

Some common examples of foods that are high in FODMAPS include:

• Wheat and wheat containing products such as bread, pasta and cereals

• Milk and milk products such as ice cream and yogurt

• Beans and lentils

• Fruits such as mangoes, apples and watermelon

• Vegetables such as onions, garlic, asparagus and peas

• Honey

How does a low-FODMAP diet work?

A low-FODMAP diet temporarily removes foods high in FODMAPs and then gradually adds them back one at a time to identify which foods may trigger symptoms.

“For example, if we cut out wheat for three weeks, then try a piece of wheat bread and symptoms return right away, that might be a food your body doesn’t tolerate well,” Ladd says.

The good news is that many high-FODMAP foods can be replaced with lower-FODMAP alternatives while still providing important nutrients. Our dietitians work with families to identify foods their child enjoys and find good swaps. Some examples might be:

• Potatoes, rice and corn tortillas instead of wheat pasta

• Kiwi, cantaloupe or oranges instead of mangos or watermelon

• Real maple syrup instead of honey

• Green beans or spinach instead of asparagus

• Garlic infused oil (certified low-FODMAP product) instead of garlic or onion

Who might a low-FODMAP diet work well for?

Trying a low-FODMAP diet is not the right choice for every child with IBS. Before starting a low-FODMAP diet, it's important to consider:

• Does the child have any restrictive eating patterns or a history of disordered eating? In some cases, limiting foods further can worsen a child’s relationship with food or increase the risk of not getting the nutrients they need.

• Does the family feel ready and motivated enough to follow the diet consistently? Kids and teens with severe or long-term stomach pain may be more motivated to figure out what’s causing it.

Tips and resources for following a low-FODMAP diet

• Work with a health care provider or dietitian to make sure your child continues getting the nutrients they need for age-appropriate growth and development.

• Plan ahead for restaurants, parties and celebrations so your child has foods they can eat.

• Talk with your healthcare team about timing. It may make sense to avoid starting it right before a vacation, holiday or birthday celebration.

• Look for low-FODMAP alternatives to favorite foods. Some companies, like FODY Foods, make low-FODMAP versions of sauces, seasonings and pantry staples.

• Try this app from Monash University that helps families make meal plans and grocery lists that follow a low-FODMAP diet.

• Find reliable information about IBS and the low FODMAP diet from the Academy of Nutrition and Dietetics.

Learn more

The Pediatric Gastroenterology team at Children’s Health provides comprehensive care for kids and teens with many types of digestive disorders. Learn more about our gastroenterology programs and services, including our Chronic Abdominal Pain Clinic and psychological services for kids with stomach pain.