Food help for irritable bowel syndrome (IBS)

~25-45 million Americans have IBS (10-15% of adults). Women have 2x prevalence. Subtypes: IBS-D (diarrhea-predominant), IBS-C (constipation-predominant), IBS-M (mixed). Diagnosis is clinical (Rome IV criteria) — no specific test. Diet is the most powerful tool: Monash University low-FODMAP diet reduces symptoms in 75% in 4-6 weeks.

Low-FODMAP diet (Monash University protocol)

FODMAP = Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols. Fermentable carbohydrates that the small intestine doesn't absorb well. Three phases:

• Phase 1: Elimination (2-6 weeks) — eliminate ALL high-FODMAPs. NOT permanent.
• Phase 2: Reintroduction (6-8 weeks) — reintroduce one FODMAP at a time to identify specific triggers. Most tolerate 2-4 FODMAPs.
• Phase 3: Personalization — personalized diet based on findings. Only avoid YOUR specific triggers.

High-FODMAP foods — avoid phase 1

• Oligosaccharides (fructans, GOS): wheat, rye, garlic, onion, beans, lentils, chickpeas, broccoli (florets), asparagus, artichokes, cashews, pistachios.
• Disaccharides (lactose): cow/goat/sheep milk, yogurt, fresh cheese, ice cream.
• Monosaccharides (free fructose): apple, pear, mango, watermelon, honey, high-fructose corn syrup, agave.
• Polyols: apple, pear, peach, plum, cherry, cauliflower, mushrooms, sweeteners ending in -ol (xylitol, sorbitol, mannitol, erythritol).

Low-FODMAP foods — allowed phase 1

• Grains: white/brown rice, oats, quinoa, potatoes, sweet potatoes, polenta.
• Vegetables: carrots, zucchini, spinach, lettuce, kale, potatoes, squash, cucumber, tomato (1 medium/day), red pepper, broccoli (stems only).
• Fruits: banana (not ripe), orange, kiwi, strawberry, raspberry, blueberry, grapes, cantaloupe.
• Proteins: chicken, turkey, fish, eggs, firm tofu, lean meat (no garlic/onion marinades).
• Dairy: lactose-free milk, almond milk, hard cheese (cheddar, parmesan), lactose-free yogurt.
• Nuts: almonds (10), walnuts, macadamia nuts.
• Fats: olive oil, butter, coconut oil.
• Sweeteners: table sugar, maple syrup, stevia.

Low-FODMAP resources

• Monash University Low FODMAP Diet App — ~$10. The most reliable source, updated with research.
• FODMAP Helper — free.
• FODMAP Friendly — Australian certification seal.
• Work with FODMAP-certified dietitian — reduces errors. Find: monashfodmap.com/training/online/dietitian-directory.
• MNT (Medical Nutrition Therapy) under Medicare/Medicaid CPT 97802-97804 if you have diabetes/CKD; out-of-pocket $80-200/session, many sliding-scale.

Other dietary strategies

• Soluble fiber:
  • Psyllium (Metamucil, Konsyl) — 1-2 tbsp/day. Improves IBS-C and D.
  • Oats, chia/flax seeds.
• Enteric peppermint oil: IBgard, Pepogest 180-200 mg 3x/day — reduces pain in studies.
• Specific probiotics: Bifidobacterium infantis 35624 (Align), VSL#3 (Visbiome), Lactobacillus plantarum.
• Eat slowly, chew well.
• Same times daily.
• Hydration 8 glasses/day.
• Avoid gas: avoid straws, gum, sodas.

Medications by subtype

• IBS-C (constipation):
  • Linaclotide (Linzess) — guanylate cyclase-C agonist. ~$580/month list. AbbVie myAbbVie Assist program.
  • Plecanatide (Trulance) — ~$580/month. Salix Pharmaceuticals copay program.
  • Lubiprostone (Amitiza) — chloride channel activator. ~$420/month; generic available.
  • Tenapanor (Ibsrela) — FDA approved 2019. NHE3 inhibitor.
  • Polyethylene glycol (MiraLAX) — OTC, $10-15/month. Simple first line.
• IBS-D (diarrhea):
  • Loperamide (Imodium) — OTC $5-10/month.
  • Eluxadoline (Viberzi) — mu-opioid agonist. ~$1,150/month. AbbVie myAbbVie Assist. NOT if no gallbladder.
  • Rifaximin (Xifaxan) — non-absorbable antibiotic. ~$2,500 per 14-day course. Salix CarePath.
  • Alosetron (Lotronex) — women with severe IBS-D only. REMS due to colonic ischemia.
  • Cholestyramine (Questran) — if bile acid malabsorption. Generic.
  • Ondansetron (Zofran) — off-label for IBS-D. Generic.
• Antispasmodics (all subtypes):
  • Dicyclomine (Bentyl) — generic ~$15/month.
  • Hyoscyamine (Levsin) — generic ~$15/month.
  • Useful for postprandial pain.
• Antidepressants for pain:
  • Amitriptyline 10-50 mg/night — first line for IBS pain. Generic.
  • Nortriptyline, desipramine.
  • Duloxetine (Cymbalta).
• IRA Medicare Part D $2,000/year cap (PL 117-169).

Mind-body therapy

Psychological treatments for IBS are as effective as medications:

• Gut-Directed Hypnotherapy (GDH) — 7 sessions, 60% sustained improvement. Apps Nerva, Mindset Health (~$70/month).
• CBT for IBS — CPT 90834/90837 covered by Medicare.
• Yoga, mindfulness.
• Apps: Nerva, Zemedy, IBS Coach.

SNAP, Medicare, Medicaid

• SNAP covers low-FODMAP foods (protein, grains, allowed fruits/vegetables).
• SNAP medical deduction (7 CFR 273.9(d)(3)) — patients 60+ or SSDI/SSI deduct expenses >$35/month.
• SSI/SSDI rare for IBS alone — but with comorbidities (depression, anxiety, fibromyalgia).

Community resources

• International Foundation for Gastrointestinal Disorders (IFFGD) — iffgd.org. Spanish resources.
• American College of Gastroenterology (ACG) — gi.org.
• IBS Patient Support Group — ibspatient.org.
• Monash University Low FODMAP Diet — monashfodmap.com.
• Rome Foundation — theromefoundation.org.
• Mayo Clinic IBS — mayoclinic.org.
• HealthWell Foundation, NeedyMeds, Patient Advocate Foundation.

Celiac and food → · IBD Crohn's/colitis → · Apply for SNAP →

Versión en español →