Is a Low-FODMAP Diet Best for IBS?

Ahh, the feeling of gas building in your bowels, pants growing tighter by the second, and a general feeling of fatigue settling in your entire body. Yes my friends, that’s irritable bowel syndrome (IBS) coming for a visit. Gas, bloating, abdominal discomfort, and fatigue didn’t come alone though; diarrhea and subtle nausea made a special appearance too. The old gang back together. They tend to pop-in when I’m feeling anxiety, stress, and unworthiness.

How about you? Can you relate? If so, you’re not alone. IBS affects 11.2% of the world’s population, with the majority of sufferers being women. Symptoms can vary too; however, common ones include abdominal pain or discomfort, bloating, nausea, heartburn, drowsiness, gas, diarrhea, and/or constipation. Unfortunately, the cause of IBS is unknown, which makes getting to the root cause tricky. Many researchers hypothesize that it’s a multi-factorial condition that may include mental health (stress, depression, etc.), a hypersensitive gut-brain axis, inflammation, overgrowth of bad bacteria, abnormal gut motility, gut mucosal permeability, and impaired immune function to name a few. Regardless, your doctor may diagnose you with IBS if you’ve had recurrent abdominal pain or discomfort for at least three months and it's accompanied by two or more of the following: improvement with a bowel movement, associated with a change in frequency of stool, and/or associated with a change in appearance of stool. Individuals are usually more specifically classified based on their stool appearance such as IBS-diarrhea (IBS-D), -constipation (IBS-C), -mixed (IBS-M), and -unsubtyped (IBS-U, doesn’t fit any of the other stool appearances).

Since IBS doesn’t have a go-to cause, this makes treatment options an exploratory process. Research has found that nutrition therapy, psychological therapy, hypnotherapy, yoga, and lifestyle changes can improve symptoms and therefore, improve quality of life. Studies have shown that the most promising nutrition therapy is a low-FODMAP diet. FODMAP stands for fermentable, oligosaccharides, disaccharides, monosaccharides, and polyols. Basically, these are types of carbohydrates that are poorly absorbed in the small intestine and highly fermentable by our gut flora. Translation: they have the ability to increase gas production and draw in water, which can affect how fast digested food leaves our bowels. Researchers believe some individuals may be more sensitive to these types of carbohydrates than others, thus causing IBS symptoms.

Researchers put this thought-process in action, and found that following a dietitian-directed, low-FODMAP diet significantly improved symptoms of diarrhea, bloating, abdominal pain, and thus quality of life, both physically and mentally, in IBS diagnosed patients. Another study showed that after following a low-FODMAP diet for three months, these improvements were sustained three months after re-introducing higher FODMAP foods into their diet.

Which brings me to the best part of this research—it’s not a life-long diet. It’s important to note that these foods are higher in fiber, which means they are highly beneficial for our gut health. When these foods are fermented, they become short-chain fatty acids (SCFA), which are shown to improve colon health by feeding colon cells, inhibiting tumor cells (anti-carcinogenic), assisting the body in killing colorectal cancer cells (induces apoptosis, anti-carcinogenic), and are anti-inflammatory.

If you decide you want to work with a dietitian to trial a low-FODMAP diet for your symptoms, this nutrition therapy should only be short-term (~8 weeks) due to its restrictive nature. While it’s a low-FODMAP diet and not a no-FODMAP diet, studies have shown individuals still tend to consume less calories and fiber, which is why it’s extremely important to work with a dietitian who can write meal plans for you to ensure you are consuming enough calories, fiber, and other nutrients.

And the best, best part of all of this??? You don’t have to do the diet to see benefits. Curve ball. One study found that when comparing the benefits of a low-FODMAP diet to a balanced (i.e. no restrictions) Mediterranean diet where higher FODMAP foods were evenly spread throughout the day, the subjects receiving the Mediterranean diet still saw improvements in symptoms and were 86% more likely to adhere to the plan (vs. 3% in the low-FODMAP group). Again, it's important to work with a dietitian to ensure you are doing this correctly. Neither option is right or wrong. It truly depends on what feels right for you.

I’d love to hear from you. Please comment below or send me an email with your biggest takeaway. Also, if you’d like to improve your IBS symptoms and gut health, send me an email and let’s work together!

If you thought this blog was helpful or know someone who would benefit from it, please like it and share it with them.

With love, Steph

References

1. Harvie, R. M., Chisholm, A. W., Bisanz, J. E., Burton, J. P., Herbison, P., Schultz, K., & Schultz, M. (2017). Long-term irritable bowel syndrome symptom control with reintroduction of selected FODMAPs. World Journal of Gastroenterology, 23(25), 4632-4643. doi: 10.3748/wjg.v23.i25.4632.

2. Paduano, D., Cingolani, A., Tanda, E., & Usai, P. (2019). Effects of three diets (low-FODMAP, gluten-free and balanced) on irritable bowel syndrome symptoms and health-related quality of life. Nutrients, 11(7), 1566-1576. doi: 10.3390/nu11071566.

3. Pedersen, N., Ankersen, D. V., Felding, M., Wachmann, H., Vegh, Z., Molzen, L…. & Munkholm, P. (2017). Low-FODMAP diet reduces irritable bowel symptoms in patients with inflammatory bowel disease. World Journal of Gastroenterology, 23(18), 3356-3366. doi:10.3748/wjg.v23.i18.3356.

4. Roncoroni, L., Bascunan, K. A., Doneda, L, Scricciolo, A., Lombardo, V., Branchi, F.,… & Elli, L. (2018). A low FODMAP gluten-free diet improves functional gastrointestinal disorders and overall mental health of celiac disease patients: a randomized controlled trial. Nutrients, 10(8), 1023-1037. doi: 10.3390/nu10081023.

5. Wiffin, M., Smith, L, Antonio, J., Johnstone, J., Beasley, L, & Roberts, J. (2019). Effect of a short-term low fermentable oligosaccharide, disaccharide, monosaccharide and polyol (FODMAP) diet on exercise-related gastrointestinal symptoms. Journal of the International Society of Sports Nutrition, 16(1), 1-9. doi: 10.1186/s12970-019-0268-9.