LOW FIBRE DIET SHEET FOR THE TREATMENT OF IRRITABLE BOWEL SYNDROME (IBS)
Fibre is that part of plant foods that our digestive system is unable to break down. It is found in cereals, fruits and vegetables and any foods containing them.
Some people find that too much fibre in their diet can aggravate symptoms of diarrhoea, bloating, flatulence and abdominal pain. Following a low fibre diet may help to decrease these symptoms. This diet should be followed for four weeks.
The following list will help you to make low fibre choices in your diet. You may find that you can gradually introduce some of the higher fibre foods back into your diet to a level that you can tolerate. This should be discussed with your dietitian (see back pages).
It is important that you have an adequate fluid intake. You should aim to have between 8- 10 cups of fluid daily.
If you are constipated or become constipated whilst on this diet you can take either of the following two bulking agents to relieve your discomfort. If these do not relieve your constipation, use Milpar as well.
1. Normacol Granules (gluten free)
One sachet after breakfast : one sachet after dinner. The granules should be washed down, without chewing, with plenty of water. The dose can be increased to two sachets, twice daily, if necessary. Normacol can be bought over the counter at a Chemist.
2. Celevac Tablets (gluten free)
Two tablets to be taken, twice daily, with 300ml liquid. The dose can be increased to six tablets, twice daily if necessary. Celevac can be bought over the counter at a Chemist.
3. Milpar (Liquid paraffin and magnesium hydroxide oral emulsion (gluten free)
Take 5-20ml when required. 4. Movicol NB. Do not use Fybogel, Lactulose or Senna as these may aggravate your IBS symptoms. SUITABLE FOODS UNSUITABLE FOODS
Meat and Fish: All types Except products made with wholemeal pastry or breadcrumbs Dairy Products:
Milk – all types Cheese – all types Yoghurts – natural or fruit flavoured Cream Eggs Fromage Frais
Fats and Oils: Butter Margarine Cooking & Salad Oils
Cereals & Baked Products:
White flour and baked products made Wholemeal, brown, bran with white flour e.g. bread, pastry, and soya flours and foods made crumbles, *pasta, *spaghetti, with these flours. *macaroni Wholemeal pasta.
*White rice, tapioca, sago, cornflour Brown rice. custard and blancmange.
Rice Krispies and Cornflakes. Wholegrain cereals e.g. Weetabix, All-Bran, porridge, muesli and any cereal with added nuts and/or dried fruit.
Plain biscuits e.g. Rich Tea, Digestive, bran biscuits, Morning Coffee, Marie, Ginger Nuts flapjack, biscuits containing nuts or dried fruit, e.g. Fig rolls, Garibaldi.
Plain crispbreads and crackers Rye and whole grain crispbreads Oatcakes.
*White rice, pasta and potato should be eaten whilst still hot. When cooled, these foods become more resistant to digestion, effectively increasing their fibre content. The same applies to cook chilled ready meals which should be avoided. FRUIT Maximum of two portions a day in addition to a glass of fruit juice. Where possible avoid the skins and seeds. A portion is one fruit or a small dessert bowl of fruit. SUITABLE FOODS UNSUITABLE FOODS Apples Dried fruit Apricot Banana chips Cherries Bananas Fruit Cocktail Blackberries Grapefruit Cranberries Grapes Currants Kiwi Dates, figs Lychees Gooseberries Mango Loganberries Melon Prunes Nectarine Raisins Oranges Raspberries Peaches Redcurrants Pears Sultanas Pineapple Plums Rhubarb Satsumas Strawberries Tangerines
VEGETABLES Maximum of two portions a day in addition to potato. Where possible, avoid skins, seeds and stalks. A portion is 80g weight/2 tablespoons/dessert bowl of salad.
SUITABLE FOODS SMALL PORTIONS UNSUITABLE FOODS OCCASIONALLY Asparagus Beansprouts Pulse-type beans e.g. Aubergine Green/French/Runner baked, broad, butter, kidney Beetroot beans Brussels sprouts Carrot Broccoli florets Chick peas Celery Cabbage Lentils Courgette Cauliflower florets Peas Cucumber Mange-tout Sweetcorn Leeks Parsnips Lettuce Spinach Marrow Spring Greens Mushroom Sweet potato *Onion (only if tolerated) Pepper *Potato (not cold) Radish Swede Tomato MISCELLANEOUS
SUITABLE FOODS UNSUITABLE FOODS
Ice cream, lollies, sorbets Jelly, milk puddings
Honey, syrup, lemon curd Nuts, seeds Jam, marmalade (avoid pips/seeds) Peanut butter Crisps Marmite, Bovril Wholemeal savoury snacks Cereal bars
Corn snacks
Boiled sweets, chocolate, toffee Confectionery containing fruit and nuts
Seasoning, spices Pickles and chutneys
Tea, coffee, cocoa, Ovaltine Squashes, fizzy drinks *(avoid if prone to wind) Fruit juices Soups, Oxo Lentil, pea and bean soups
Chewing gum (if prone to wind) EXAMPLE OF A MEAL PLAN
Breakfast: Fruit juice Cornflakes or Rice Krispies Milk White bread with margarine or butter Marmalade or jam or honey
Mid-Morning: Tea or coffee Plain biscuit
Lunch: Sandwiches made with white bread or crackers or plain crispbread Yoghurt, corn snack Portion of fruit
Mid-Afternoon: Plain scone or plain biscuit Tea, coffee or squash
Evening Meal: Meat or fish or chicken or eggs Allowed vegetables Potatoes or pasta or white rice
Milk pudding, fruit-flavoured yoghurt, suitable fruit or cheese and biscuits Squash
Supper: Milky drink, tea or coffee REINTRODUCTION OF HIGHER FIBRE FOODS If, after a one month’s trial of the low fibre diet your symptoms are improved, you should try introducing foods from the list below. These reintroductions give a gradual build up of fibre in your diet. The aim is to determine the level of fibre that you can tolerate before provoking symptoms again.
Week 1
Try eating the skins on fruit and vegetables e.g. apples, pears, potatoes.
Week 2
Try an extra piece of fruit per day e.g. bananas (but not dried fruit) OR an extra portion of vegetables from the moderate fibre list.
5 portions per day of fruits and vegetables (not including potatoes) are recommended long term for a healthy diet).
NB. (one glass of fruit juice counts as one portion of fruit).
Week 3
Try replacing white bread with wholemeal bread.
Week 4
Try a higher fibre breakfast cereal e.g. Weetabix, Shredded Wheat, Bran Flakes.
Week 5
If you are still symptom free, you may like to try dried fruit or vegetables from the high fibre list.
Please remember that these reintroductions give a gradual build-up of fibre in your diet. The aim is to identify a level of fibre that you can take comfortably.
You may find that you can eat high fibre vegetables on days when you do not have wholemeal bread and high fibre breakfast cereals or vice versa.
If this is the case, try varying the sources of your fibre intake on a daily basis to achieve a balanced diet.
Bulking Agents (Normacol Granules Or Celevac Tablets) Individuals who needed to take Normacol or Celevac to prevent constipation while on the low fibre diet, should find that as dietary sources of fibre are reintroduced they can reduce or even stop this bulking agent. This should be discussed with your dietician.