Eating Breakfast with IBS

Many people with IBS avoid breakfast because they are avoiding the symptoms that begin shortly after.  What people don’t realize is that certain foods that are prone to give you IBS symptoms are very commonly eaten at breakfast. In particular, some fruits and dairy are high in FODMAPS, 

In this blog post, you will understand how a low fodmap breakfast might alleviate some symptoms of IBS. We will:

• • Identify ingredients and recipes that are low FODMAP for breakfast
  • Learn strategies for making a low fodmap breakfast
  • Gain confidence in the selection and preparation of low FODMAP breakfast foods for IBS 

What is IBS?

IBS is a chronic condition characterized by symptoms of diarrhea, constipation, flatulence, bloating, and abdominal pain. The disorder is classified by whether diarrhea or constipation is predominant (IBS-D or IBS-C). Prevalence of IBS on a global scale is estimated as 10-20%, with women and people under age 50 experiencing higher rates.  The onset of IBS is often preceded by episodes of anxiety and depression and/or adverse life events.

You can learn more about the main features of IBS below.

It is not entirely known why some people develop IBS. Hypotheses include:

• • Small Intestinal Bacterial Overgrowth (SIBO)
    • This describes a condition in which there are excess bacteria in the small intestine. SIBO can arise from many conditions, but usually the development of the disorder is complex in nature.
  • Chronic intestinal inflammation
    • Visceral hypersensitivity (again, severe abdominal pain)
  • Genetic factors

Because individuals experience a wide range of symptoms in a chronic manner, treating IBS can be difficult. 

Main approaches include:

• • Drugs
  • Therapy
  • Probiotics (newer approach but there is limited evidence)
  • Dietary approaches

An individualized diet should be the first approach to treating IBS due to the lack of side effects and potential efficacy in relieving symptoms by reaching out to a registered dietitian,

Common Dietary Approaches

Consume More Soluble Fibre

Soluble fibre attracts water and creates a gel in the gastrointestinal (GI) tract. Soluble fiber is found in foods such as oats, barley, nuts, beans, lentils, and seeds. Consuming more soluble fiber promotes healthy GI function. 

Low FODMAP Elimination and Challenge

FODMAP stands for: 

• • Fermentable
  • Oligosaccharides
  • Disaccharides
  • Monosaccharides and
  • Polyols

All of these are different forms of carbohydrates that, with normal gut function, are easily digested. In individuals with IBS, these carbohydrates tend to ferment in the gut. Significant discomfort results from both the gas released by fermentation and the intense abdominal pain (visceral hypersensitivity) that those with IBS experience. 

Researchers at Monash University in Australia first proposed that by restricting consumption of these carbohydrates, individuals with IBS may be able to reduce their gastrointestinal symptoms. Since then, it has developed into a new dietary approach for individuals with IBS.

Other Approaches 

These include,

• • Eat small meals throughout the day
  • Limit caffeine
  • Limit alcohol
  • Limit high-fat foods
  • Limit spicy foods

However, there is no strong evidence that these practices constitute an effective treatment method. Dietary approaches to treating IBS are very individualized.  Up to 89% of individuals with IBS have identified specific foods that trigger IBS symptoms in as soon as 15 minutes to 3 hours. 

First, let’s review how food is digested and absorbed in the GI tract. 

• • Food enters the mouth and travels through the esophagus and stomach.
  • It then hits the small intestine, also called the small bowel. At this point in digestion, food has been broken down into smaller particles. The small intestine is where most of these nutrients are digested and absorbed. 
  • What is left continues on into the large intestine (also called the large bowel or colon). The colon is responsible for reabsorbing fluid and some electrolytes. Undigested matter moves through the colon and is expelled by the body. 

Think about it… What happens when food ferments?  Gas is produced. 

The small bowel hypothesis considers that in individuals with IBS, high FODMAP carbohydrates are not well digested in the small intestine. This causes water to be drawn into the small intestine, resulting in bloating, abdominal pain, and diarrhea. 

The large bowel hypothesis considers that in individuals with IBS, high FODMAP carbohydrates that are not well digested in the small intestine continue on into the colon, where the gut bacteria ferment and feed off them. 

The gut bacteria give off gas, resulting in flatulence, bloating, and abdominal pain. These mechanisms may explain why restricting high FODMAP carbohydrates helps alleviate GI symptoms in those with IBS. 

Researchers are still learning more about using a low FODMAP diet to treat IBS. Current research shows that the diet is best for individuals with:

• • Visceral hypersensitivity
    • In these individuals, abdominal pain and bloating may be reduced after following a low FODMAP diet.
  • Altered motility for IBS-D
    • In these individuals, diarrhea may be reduced after following a low FODMAP diet. Studies also report that individuals with greater compliance with the low FODMAP diet report greater symptom reduction. Current evidence makes a strong argument for the short-term efficacy and safety of a low FODMAP diet for IBS patients when supervised by a credentialed healthcare professional. 

Oligosaccharides are found in many food groups – fruits, vegetables, grains, nuts, and legumes. The foods common in breakfasts include:

• • Vegetables (think egg scrambles): garlic, leeks, scallion bulbs, shallot, onion
  • Fruit: banana, currants, dates, dried figs, grapefruit, nectarine, persimmons, plums, prunes, white peaches, watermelon
  • Grains: rye, wheat, barley, 
  • Nuts: pistachios, cashew, soy
  • Teas: oolong, chamomile, fennel, chicory root extract, carob

Disaccharides are primarily found in lactose, which is in dairy products.

• • Dairy: ricotta cheese, cottage cheese, milk, yogurt, ice cream, custard.

Monosaccharides are found in fruits, vegetables, and sweeteners. Foods containing more fructose than glucose are considered in this category.The more common breakfast foods include:

• • Fruit: apples, boysenberry, cherries, fresh figs
  • Sweeteners: Agave, honey, high fructose corn syrup found in fruit beverages

Polyols are found in some fruits, vegetables and artificial sweeteners. These include:

• • Vegetables: mushrooms in omelettes (less than 10 g is ok as long as no other FODMAP food eaten)
  • Fruit: apples, apricots, blackberries, cherries, nectarines
  • Sweeteners (found in chewing gum and sweeteners): Sorbitol, Mannitol, Isomalt, Xylitol

As you can see, the list of high FODMAP foods is extensive and contains foods that are part of a balanced and healthy breakfast – fruits, vegetables, low-fat dairy, grains, nuts, and legumes that are common as breakfast foods.

Fortunately, there are still plenty of nutritious and delicious low fodmap breakfast foods

Some foods can be high or low FODMAP depending on certain characteristics, such as processing or the amount or part of a food. 

• • Scallion bulbs (the white part) are high FODMAP, but the green stalks are low FODMAP.
  • Garlic is high FODMAP, but garlic-infused olive oil is low FODMAP. This is because the high FODMAP carbohydrates in garlic are water-soluble, so they do not leach out into the oil.  

Small portions of foods containing FODMAP foods are often tolerated. You can have one moderate serving of FODMAP each meal. Ask about the EATlove meal planning platform that permits small amounts of FODMAP in a way that is tolerated so that you don’t have to feel deprived of your favourite foods.  Your registered dietitian can prescribe your low FODMAP nutrition prescription into your Eatlove meal plan.

Spinach Frittata

Following a low FODMAP diet may affect the quality of life such as social activities, holidays with continental breakfasts and business day-long workshops that include breakfast offerings.  It is stressful to be in situations (restaurants, friends’ homes) in which you are not in control of what food is offered.  Bring your breakfast low fodmap food with you when you travel.  I keep a cooler in my car and stock my mini-fridge for the weekend when I travel.

• • enjoy peanuts, macadamias, walnuts and most seeds
  • cranberry juice has the least FODMAP (fructose)
  • choose potatoes over pancakes at the breakfast buffet table.
  • choose cantaloupe, grapes, kiwi fruit, orange, pineapple and strawberries
  • drink almond milk, lactose-free milk, or soy milk
  • choose brie/camembert cheese or feta cheese
  • eat more eggs, firm tofu, plain cooked meats
  • cornflakes, oats, quinoa flakes/rice/corn cereals, rice cakes, 
  • use sourdough bread, wheat/rye/barely free for toast

Italian Melon Smoothie

Sweet Potato Egg Nests

FODMAP friendly Cookies

I commonly see people with IBS skip breakfast because they get fewer symptoms this way, but there is another way.  You can have your breakfast with low FODMAPS and feel more energy in the day, rather than fearful of symptoms that may arise. 

When completing the process of eliminating and challenging FODMAP’s with the help of a Registered Dietitian and meal planning, you will discover freedom in eating again when armed with a much smaller list of trigger foods.  You will have a healthy breakfast routine that energizes rather than zaps you. 

Following a restrictive diet is not only challenging, but it poses some hazards. By removing nutrient-dense foods from the diet, or avoiding breakfast, individuals with IBS may have trouble getting enough calories, fiber, vitamins, and minerals. Individuals also may develop a more complicated relationship with food and think that every food is making them sick. 

The low FODMAP diet for individuals with IBS is effective compared to existing dietary recommendations. However, there is no generalized dietary approach that will work for everyone. A treatment plan should be individualized.