Irritable Bowel Syndrome (IBS) is a common bowel disorder that produces distressing symptoms such as abdominal pain, severe bloating, and altered stools that can shuttle between diarrhea and constipation.
While changing what you eat won’t cure you, an evidence-based approach called a low FODMAP diet is the most commonly prescribed diet plan to help relieve symptoms of IBS. Studies show that it can reduce symptoms in the majority of patients. However, due to some challenges and risks associated with the low FODMAP diet, it is worth talking to an expert before trying it.
Basics of FODMAP
The low-FODMAP diet targets four types of fermentable carbohydrates: oligosaccharides, disaccharides, monosaccharides, and polyols (collectively referred to as FODMAP). While the names seem somewhat abstract, the foods found in these groups are often all too familiar to those with digestive issues.
Oligosaccharides are found in foods like wheat, beans, garlic, and onions, while disaccharide lactose is prevalent in dairy products like ice cream and milk. Monosaccharides refer to foods that contain excess fructose and are found in things like apples, mangoes, and honey. The last group, sugar alcohols, are found in some artificially sweetened products like chewing gum, and are naturally present in foods like avocados and mushrooms.
Although FODMAP carbohydrates can trigger digestive discomfort for anyone when consumed in large amounts, much smaller servings can make symptoms worse in people with IBS.
A multi-phase approach to a low FODMAP diet
The low FODMAP diet is supposed to be undertaken in three phases. In the first phase, all foods high in FODMAP are eliminated from the diet for an extended period, often four to six weeks. In phase two, you systematically reintroduce restricted foods, noting how well you tolerate increasing amounts of foods you reintroduce. The third phase is the personalization phase, in which you only avoid foods in amounts that cause symptoms.
This multi-phase process can be complex and confusing and requires substantial dietary knowledge. For example, most varieties of soy milk are high in FODMAPs. Extra-firm tofu, on the other hand, while it’s also made from soybeans, is low in FODMAP. The advice of a dietitian can be helpful in following this diet, but insurance coverage and medical referrals can be barriers to scheduling an appointment. As a result, some patients are simply given a list of foods that are low and high in FODMAP.
Risks associated with not reintroducing certain foods rich in FODMAPs
While it can be difficult to avoid foods high in FODMAP, systematically adding the carbohydrate groups to test for tolerance can be even more difficult. Some people are reluctant to reintroduce products, especially if they have experienced significant relief from their symptoms during the elimination phase. This increases the potential for nutritional risks. For example, it is common for people who avoid dairy products to have insufficient calcium intake.
Other lesser-known nutrients, such as magnesium, are also of concern. Some of the best dietary sources of magnesium come from beans and nuts like almonds and cashews, which are usually limited during the initial phase of the diet. Additionally, people with IBS may already be at an increased risk of magnesium deficiency due to digestive symptoms such as diarrhea.
There are also concerns that long-term restriction of foods high in FODMAPs will change the makeup of bacterial colonies in the gut, which can negatively impact gut health and possibly worsen digestive issues over time. Oligosaccharides, in particular, are an important source of energy for beneficial bacteria. This is of particular concern for people with IBS, which have been shown to have lower levels of protective gut bacteria and higher levels of potentially harmful inflammatory microbes. Probiotics have been suggested to restore such bacterial imbalances, but this remains controversial, and the American Gastroenterological Association recently published guidelines that recommend their use in IBS only when participating in a research study.
Low-FODMAP is not for everyone
The low-FODMAP diet is not intended for people without IBS, nor is it suitable for all people with the condition. It should be avoided by anyone with an eating disorder, as it can worsen dietary fears and dietary restrictions. This is particularly noteworthy because people with gastrointestinal issues appear to have a higher prevalence of eating disorders compared to the general population. Additionally, people who already have a restricted diet, such as vegans or those with food allergies, may not be able to meet their nutritional needs through diet. Those who are already malnourished or underweight are also poor candidates. The diet is not as well studied for other gastrointestinal conditions, so it is generally best to avoid the diet if you do not have IBS, unless advised otherwise by a doctor or a doctor. dietitian.
Find an alternative approach
If the low-FODMAP diet is not a good option for you, then simply reducing foods high in FODMAPs in your diet, without completely eliminating any food groups, may be an alternative. If your diet contains many common offenders like garlic, onions, beans, apples, milk, mushrooms, and wheat, a simple reduction can help reduce symptoms.
To find a list of dietitians who can help you make changes safely, click here. Or contact a nutritional practice to ask if anyone is familiar with the low FODMAP diet.
Our sincere thanks to