Identifying Trigger Foods to Manage IBD

If you have inflammatory bowel disease, the mere act of eating can feel like running toward a monster waiting to pounce. The first step in taming the monster is learning which foods are triggering.

It seems like every day, the internet floods my social media feeds with terrible advice about living with inflammatory bowel disease (IBD), claiming every food under the sun triggers flare-ups or poisons my gut biome.

Sometimes, it feels impossible to find real wisdom.

But I’ve found some nuggets of good advice to consume, such as the importance of identifying trigger foods to find a diet that soothes the effects of IBD. The problem is that IBD is variable, and so are people’s food triggers.

The internet loves to apply catch-all methods to various conditions, but the key is experimenting with the elimination of specific foods to track your triggers and curate a diet that fits your body’s specific needs.

Join the free IBD community!

Connect with thousands of members and find support through daily live chats, curated resources, and one-to-one messaging.

Sign up

Why does IBD make food such a trial?

“Food intolerances are common in patients with IBD; some foods may be pro-inflammatory,” says gastroenterologist Dr. Aja McCutchen. “Therefore, avoiding trigger foods and pro-inflammatory foods is a critical step in management.”

I learned the hard way that not everyone with IBD has the same trigger foods. And even more frustrating, I can’t always rely on the same foods consistently being triggers for me.

Foods seem to affect me in cycles, with my body flaring some days and being unresponsive on others. I’ve also developed intolerances to foods that once passed through my gut unnoticed, like dairy.

“Different people have different triggers, and even at different times of our life, certain foods can start to become triggers that didn’t used to be,” says nutritionist Michaella Mazzoni.

The general rules to live by in a flare

While there’s no cheat sheet for navigating the world of food with IBD, a few general rules still apply. Following these overall guidelines has helped me tame the worst of my stomach demons.

McCutchen says that if you have severe diarrhea or short bowel, it’s best to avoid foods that increase stool output, such as fruits, vegetables, and grains, as well as ultra-processed foods. “Some electrolyte drinks, including Gatorade, may worsen the diarrhea,” she adds.

She also suggests avoiding high fiber foods such as raw vegetables and fruits during flare-ups because these may worsen symptoms. Some people with IBD are also lactose intolerant, so minimizing or avoiding dairy may alleviate bloating symptoms.

“For some patients, omega-3 fatty acids — the kind in flax seeds, oily fish, and other foods — can help ease inflammation,” says Dr. Hana Patel, a general practitioner for the National Health Service (NHS). “A few small studies suggest a diet low in FODMAPs (sugars that are hard to digest) can ease IBD symptoms.”

Patel adds that alcohol and caffeine may also trigger symptoms for some people with IBD.

Identifying your trigger foods

“Triggers and responses vary between patients due to genetic differences, our gut microbiomes, medications, and lifestyle,” says McCutchen. “Our microbiomes are as unique as our fingerprints, so there is no one-size-fits-all.”

And because foods may develop into triggers over time, while others stop affecting us, identifying trigger foods is often an ongoing process. You’ll need to keep on top of what you’re ingesting to get to your body’s truth.

Start by following your current diet, tracking its effects closely with a food diary, Mazzoni advises.

“As a starting point, I usually recommend keeping a food diary with your symptoms for 1 week,” says Mazzoni. “During that first week, don’t change anything in your diet; just eat as you normally do, and then you can review and see if there are any relationships between [specific] foods and IBD symptoms flaring up.”

When you’re ready to start eliminating foods, experts recommend a few possible methods:

• gradual approach
• full elimination diet
• low FODMAP diet

Which option you select depends on your body and lifestyle. But no matter which you choose, McCutchen recommends maintaining a high protein diet throughout the elimination process due to the risk of malnutrition associated with IBD.

The gradual approach

If you struggle with harsh dietary rules, worry that a sudden change could trigger an IBD flare, or simply want to ease into a new way of eating, try a gradual elimination diet.

To start, choose one food to remove from your diet. Just one.

Consider eliminating high fiber or dairy foods first to see whether one of these common triggers applies to you. Remove it from your diet for 1 week to monitor the effects, noting any diarrhea, constipation, stomach cramps, and other symptoms.

Remember that food intolerances and irritations don’t only show up as symptoms in the gut. Also take note of any aches, pains, headaches, hives, itching, tiredness, or concentration issues.

“Keeping a diary can be a helpful way to understand how certain food makes you feel; over time, you can start to see a correlation,” says Mazzoni.

She recommends working with a dietitian, a nutritionist, or another healthcare professional to help implement an elimination diet while minimizing the risk of nutrient deficiencies developing during that time.

A full elimination diet

A full elimination diet involves cutting out all potential food triggers at once for 2 to 4 weeks, tracking the progress, and then reintroducing them, one at a time, during “challenge periods.”

You must be symptom-free for around 5 days before attempting a food challenge. It’s not worth triggering a flare just to try a cube of cheese.

When reintroducing a food, avoid eating large amounts at first. Start with something small, like a chunk of cheese or a coffee, and gradually increase the intake for 3 days to see whether symptoms develop.

If symptoms do recur, tag that food in your diary as a trigger and eliminate it completely.

Wait until symptoms clear before introducing another challenge. If there is no irritation, introduce a new challenge food every 3 days.

Feeling your way with FODMAPs

A full elimination diet can feel intimidating, so a hybrid approach might be to try a low FODMAP diet first. It has fewer restrictions, so it might be easier to transition from your current diet.

“During a trial of the FODMAP diet, for example, there is a 2-week to 6-week elimination period, followed by a slow reintroduction of FODMAP items one at a time, with a few days between to allow recognition of pattern changes,” McCutchen says.

Finding the joy in food again

Once you’ve identified your triggers and eliminated them from your diet, it doesn’t have to mean an exodus of all food joy.

Try experimenting with new recipes so you can find trigger-friendly alternatives to your favorite dishes.

“I encourage my patients to allow themselves grace and time when learning to love food again,” McCutchen says. “Learning to smell and enjoy food, cooking your own meals, and sharing the emotions associated with the eating experience are all essential to recovering a healthy relationship.”

“I find that once you can really understand what trigger foods are for you, because we tend to feel so much better when we avoid them, it becomes a little bit easier to avoid those foods,” Mazzoni says. “Of course, I definitely don’t recommend that people try to be perfect, because that stress will not be great for your health either!”

“I go with the 80/20 or 90/10 rule — basically, trying to keep the foods that most help you feel healthy and minimize symptoms,” Mazzoni adds. “You can then have a little bit of a relaxed approach to some of the foods, which maybe don’t necessarily make you feel amazing but you love eating them.”

The takeaway

Battling constant flare-ups of IBD symptoms made food my enemy for years, but once I was able to identify my trigger foods, I was able to befriend eating again.

Your unique body defines your dietary needs, so don’t be disheartened if your first attempt at an elimination diet has some rocky patches. Be patient with yourself and your gut.

Tracking and confronting our food monsters is a trial, and it sure does get exhausting. But the battle is worth it. After all, we may not be able to slay our food monsters entirely, but we can prevent them from harming us, and we can forge new alliances with foods we love.