Could a Low-FODMAP Diet be the Missing Link for IBS Sufferers?

What are FODMAPs?

You may have been hearing about FODMAPs lately and may be wondering what the heck they are. If you or someone close to you has Irritable Bowel Syndrome (IBS) or Small Intestinal Bacterial Overgrowth (SIBO), I’ve got plenty of useful and helpful information to share.

First let’s start with what FODMAP stands for. FODMAP is an acronym that represents:

F ermentable
Oligosaccharides
Disaccharides
Monosaccharides
And
Polyols

FODMAPs are a group of short-chain carbohydrates (sugars and fibers) that are widely present in the Western diet. FODMAPs are present in the foods of many other cultures across the globe, but the bulk of them are found in the Western diet.

Research has shown that for some people, FODMAPs can trigger symptoms when they are poorly absorbed in the small intestine and then fermented in the large intestine when bacteria have a feast and trigger symptoms of IBS such as: gas, bloating, distention, constipation (IBS-C), diarrhea (IBS-D) or an alternation between IBS-C and IBS-D.

Some types of FODMAPs include:

garlic
onions
wheat
apples
honey
agave
high-fructose corn syrup (HFCS)
inulin
mushrooms
milk
sugar alcohols
and more

FODMAPs are known to trigger symptoms of IBS for people with sensitive guts. Sensitive guts can’t handle too much of one or too many FODMAPs per sitting or over the course of a day or two.

For the people who are not affected by FODMAPs, it’s not clear why they are not as susceptible but some experts believe their guts are not built to be as hypersensitive as those with IBS; they do not have an alteration in their intestinal microbiota; they do not have a pre-existing psychological condition, past disturbing life event, handle stress differently and stress therefore does not interfere with their gut, gut bacteria or the signaling between the brain and the gut; their environment can also play a role in keeping symptoms at bay.

There is no “one size fits all” approach to relieving symptoms for IBS. However, a low-FODMAP diet has been shown to provide relief for up to 75% of people who try the diet. (1)

The Low-FODMAP Diet

Most of the talk around FODMAPs is about the Low-FODMAP diet, an elimination diet. It was developed in Australia by Dr. Sue Shepherd, Advanced Accredited Practicing Dietitian and Accredited Nutritionist, and Dr. Peter Gibson, Director of Gastroenterology at The Alfred and Monash University. Even though the diet was developed a few years ago, it still evolves as researchers at Monash University continue to test several different types of foods for their overall FODMAP content. One of the main goals of this elimination diet is to reduce the overall load of FODMAPs in the diet for 2 to 6 weeks, during the elimination phase. Some people start to feel relief right away or within the first two weeks while others may take a little longer. This is why there may be a few weeks difference in the suggested time frame for the elimination phase. Without the help of a FODMAP-trained nutritionist or dietitian, the elimination phase may take up to six weeks or longer because it is tricky to navigate and is very easy to make a mistake by eating the wrong foods or the wrong amount of foods.

Some of the keys to success with the Low-FODMAP DIET come from:

Getting acquainted with low- and high-FODMAP food lists
Paying attention to serving sizes
Carefully reading food labels
Keeping a detailed food and symptom diary to uncover trigger foods or stressful situations that might have triggered symptoms.

The other goals of the diet come during the rechallenge phase and reintroduction phases. This is when a person systematically consumes one high-FODMAP food at a time from each FODMAP group and “challenges” them in small to larger serving sizes to understand their individual tolerance. Once they know what to avoid, they then reintroduce the high-FODMAP foods they know their body can tolerate.

5 Quick Facts About the Diet

The low-FODMAP diet is a wheat-free diet, not a gluten-free diet. Small amounts of wheat are allowed on the diet.
People with Inflammatory Bowel Disease (IBD) may find the diet can help them, but they should only try the diet when not experiencing a flare-up.
Although garlic and onions are avoided on the diet, garlic-infused oil or wheat-free asafetida powder make great substitutes.
The diet has been shown to be effective for about 75% of those who truly follow the diet carefully and with supervision. (1)
Just because a food is wheat-free or gluten-free doesn’t mean it’s free of FODMAPs. Examples: pear and apple juice are high in FODMAPs and are used in some wheat-free cookies. Inulin (or chicory root) is a high-FODMAP and found in wheat-free and gluten-free products like baked goods, bread, protein supplements and more.

Many people will stay on the diet long-term because they’ve avoided all high FODMAPs and finally feel much better. They become too nervous to reintroduce FODMAPs back into their diet. However, staying on the diet long-term is highly discouraged. This is because several high-FODMAP foods are actually prebiotics that the gut needs to nourish the good bacteria already in the large bowel or colon. Prebiotics act as a fertilizer for the good bacteria and probiotics introduce good bacteria into the gut. Good bacteria grow and the good-to-bad bacteria ratio is therefore improved. A healthy ratio of good-to-bad bacteria is believed to positively influence overall health from the stomach to the brain.

Following the low-FODMAP diet has been life changing for some – a life without constant bloating, distention, constipation and/or diarrhea, not to mention embarrassment, missed work days and a lack of social life or willingness to be active. Learn about how a low-FODMAP diet can help with IBS! Take a tour through my blog www.FODMAPLife.com to learn more

Reference:

(1) Gibson PR, Shepherd SJ. Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. J Gastroenterol Hepatol. 2010;25(2):252-258.