Irritable Bowel Syndrome? Try The Low FODMAP Diet
- 6 mins read
- Diet and Healthy Food
- Rama Manikumar
Dealing with Irritable Bowel Syndrome or IBS can be tricky. IBS is a chronic disease where patients experience cramping, abdominal pain, constipation, etc. Sadly, there is no cure for IBS as such. The only way to deal with IBS is to make some lifestyle changes and manage symptoms. This includes making some serious dietary changes.
If you’re an IBS patient, you probably wonder what to eat and what to avoid, lest your symptoms flare up. Figuring out what food works best for you can be a real challenge sometimes. Luckily, there’s a diet called the low FODMAP diet out there that helps you understand just that. Let’s understand what FODMAP is and what this diet includes.
What are FODMAPs?
Let’s just clear one thing up. FODMAP is not an actual map! It’s an acronym for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. Don’t worry, they’re just a couple of sugars. What’s unique about them is that some people experience digestive stress after eating these sugars. The symptoms include cramping, diarrhoea, constipation, bloating, gas, and flatulence.
How are the different FODMAP sugars digested and absorbed?
Here is a table explaining how the different types of FODMAP sugars are digested and absorbed.
|FODMAP sugar||Sources||Digestion and absorption process|
|Oligosaccharides||Wheat, rye, onion, garlic,
artichoke, low-fat dairy products, pulses, legumes, some nuts
|We lack enzymes to break down oligosaccharides, hence they are not absorbed. They are fermented by gut bacteria, in some cases, producing gas.|
|Disaccharide||Milk and milk products||The enzyme lactase breaks down the disaccharide called lactose. As we grow older, lactase production decreases. The gut bacteria ferment then ferments lactose, leading to symptoms of bloating and flatulence in some susceptible individuals.|
|Monosaccharide||Mango, fig, honey, fructose corn
syrup, the sweetener in dairy products, jam
|Excess fructose (a monosaccharide) consumption can cause fructose malabsorption. This can cause an increase in water in the small intestine and ultimately lead to functional gut symptoms like diarrhoea, bloating, etc.|
|Polyols||Stoned fruit, apple, cauliflower, mushroom, sugar-free gum||They are passively absorbed in the small intestine. High doses can cause an increase in small intestinal water.|
IBS and FODMAP: What’s the link?
IBS symptoms can be tough to manage. Diet can be a useful tool in managing IBS symptoms. A diet for IBS, developed in Australia, is seeing a lot of success in managing IBS symptoms. It’s called the low FODMAP diet. Basically, it involves eating foods low in FODMAP and avoiding those high in FODMAP.
This diet has been backed up by studies and research stands in its favour. One study from the Journal of Human Nutrition and Dietitics even found that 76% of IBS patients following the diet reported improvement in their symptoms. So if you are an IBS patient, it might be worth your while to give it a shot.
Low FODMAP diet: What you can eat
Your first thought about this diet could be ‘Oh so I need to say goodbye to all the high FODMAP foods’. But if you go through the list of foods rich in these sugars, you’ll find that they’re all a part of your diet. It can be hard to let go of all of them. Fortunately, this is not how this diet works.
Low FODMAP is a three-step elimination diet:
- First, you stop eating certain foods (the high FODMAP foods).
- Next, you slowly reintroduce them to see which ones are troublesome.
- Once you identify the foods that cause symptoms, you can avoid or limit them while enjoying everything else worry-free.
Let us look at these 3 steps in more detail.
Step 1: Restriction
In this step, you are advised to avoid all high FODMAP foods. This includes foods like:
- Dairy-based milk, yoghurt and ice cream
- Wheat-based products such as cereals, bread and crackers
- Beans and lentils
- Some vegetables, such as artichokes, asparagus, onions and garlic
- Some fruits, such as apples, cherries, pears and peaches
You can incorporate some of these foods in your meals instead:
- Eggs and meat
- Certain cheeses such as brie, Camembert, cheddar and feta
- Almond milk
- Grains like rice, quinoa and oats
- Vegetables like eggplant, potatoes, tomatoes, cucumbers and zucchini
- Fruits such as grapes, oranges, strawberries, blueberries and pineapple
There are written diet sheets, smartphone applications and cookbooks available that can help you adhere to your low FODMAP diet.
Don’t worry, you do not have to follow these restrictions permanently. Your doctor may recommend you to follow it for around 4-6 weeks. You can notice an improvement in your symptoms in the first week itself. However, some people may take longer.
Step 2: Reintroduction
The next step is the reintroduction of different high-FODMAP foods slowly. The aim of FODMAP reintroduction is for individuals to identify which FODMAPs they can consume without exacerbating their IBS symptoms.
In step 1, we saw a lot of restrictions in terms of diet. This raises the question, how to sustain it, especially since all the major food groups are prohibited. This is where Step 2 comes into the picture. FODMAP reintroduction involves challenging our system with different FODMAPs to assess their tolerance. It serves two purposes:
-To understand what type of FODMAPs you can tolerate.
-What amount of FODMAPs can you tolerate.
It is advised that you undertake this step with the help of a trained dietitian or a healthcare professional.
During reintroduction, you are challenged to foods containing one particular type of FODMAP while still restricting the rest. This testing is done over a period of 3 days in increasing doses. The foods used in the challenges should be selected in a way to ensure all types of FODMAPs are tested.
Before moving on from one food challenge to another, it is important for the symptoms to be minimal. A 3-day interval between two challenges with strict FODMAP restriction is advised. If no symptoms are observed, you can move on to the subsequent challenge.
If a food or food group doesn’t present with any symptoms, it can be incorporated into the diet after all FODMAPs have been tested.
Maintaining a food diary or a symptom chart can be useful in keeping track of your reactions to various foods.
This step involves constructing a modified FODMAP diet in which restriction is continued but those FODMAPs/foods that did not induce symptoms during the reintroduction step are now included in the diet. Depending upon the type and amount of a particular food you could tolerate in Step 2, your diet is personalised to include different foods. This aims to improve the nutritional quality you are getting through your food. According to studies, about70% of the IBS patients showed a sustained benefit from this type of diet.
It is important to understand that changing your diet is only a part of treating IBS. Consult your doctor to better understand what foods you should avoid/include in your meals. Though some healthcare professionals might think the low FODMAP diet is too restrictive, it has shown great success in many IBS patients. You need to figure out what works best for you. The right diet, proper medications, and effective stress management can help you deal with IBS symptoms successfully. Remember, don’t let IBS halt your life.
- Food and Nutrition FODMAP Diet: What You Need to Know Available at https://www.hopkinsmedicine.org/health/wellness-and-prevention/fodmap-diet-what-you-need-to-knowAccessed on 4 Aug 2021
- Try a FODMAPs diet to manage irritable bowel syndrome Available at https://www.health.harvard.edu/diet-and-weight-loss/a-new-diet-to-manage-irritable-bowel-syndromeAccessed on 4 Aug 2021
- Staudacher HM, et al. Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome. J Hum Nutr Diet. 2011 Oct;24(5):487-95.