IBS and the Low FODMAP Diet
Do you feel bloated 30 minutes after eating a meal? Or unexplainable abdominal pain, cramping, gas, diarhhea or constipation?
A few years ago, I heard about the low FODMAP diet being an effective way to treat Irritable Bowel Syndrome (IBS). I have been hearing more and more about it and wanted to write a post about it since FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polysaccharides, which is basically any fermentable carbohydrate, I was going to add this post to the Carb Series, however, I decided its best as another guy health post. For the most part, the mechanism behind IBS has largely been a mystery and so typical treatment only targets symptoms and doesn't get to the root of the problem. Just recently though, I listened to a few podcasts with Dr. Kenneth Brown as a guest. He is a Gastroenterologist and researcher studying mostly the gut as well as IBS and a number of other gut related diseases. I found his interviews pretty interesting since I'm very fascinated by gut health and have suffered from IBS for about 10 years. It’s a complicated syndrome with stress servings as a large contributor to its symptoms. In fact, two-thirds of IBS sufferers have a preexisting psychological issue, such as anxiety or depression, prior to its development. And many sufferers develop stress, anxiety and/or depression after experiencing IBS because of the nature of its symptoms. So stress management along with probiotics are used for treatment as it is thought that a disrupted gut microbiome is to blame.
Let’s go over the symptoms of IBS. Typically, IBS sufferers feel abdominal pain, straining, urgency, incomplete evacuation, nausea, and bloating along side diarrhea, constipation or both (1). The symptoms can be exacerbated by lack of sleep, stress, not enough or too much fibre, alcohol, a poor diet, certain prescription medications (birth control, SSRI’s, statins, blood pressure drugs, and a few others) and certain food additives like artificial sweeteners ending in ‘ol’. It is estimated that up to 28% of North Americans are affected and it’s the number one reason for missed days of work (1).
Having had IBS for over 10 years, I have tried a number of things to keep symptoms to a minimum, including regularly getting 7-9 hours of sleep, exercising, eating minimal wheat, dairy, artificial sweeteners, alcohol and fried foods and trying to keep stress to a minimum. On a positive note, having IBS has made me pay close attention to my body and what it is telling me, and I am far healthier for it. I was feeling pretty good for several years until this fall. It is known that stressful events or chronic stress can have a big impact on the gut microbiome and it can take several months to even years to return the gut to normal, which can greatly exacerbate symptoms for IBS sufferers. Large stressful events can even cause the onset of IBS in some people. I suspect that our wedding, though it was amazing and everything was perfect, may have disrupted my gut. I felt awful this fall, though I was eating really well and even getting up early to stretch and do yoga before work and exercising. I had terrible heartburn and was feeling really bloated and awful after dinner. By January 1st, I thought I really need to change my approach. I am very determined to treat my digestive issues with nutrition and not medications. I quit refined sugar, and started following a low FODMAP diet and now I feel so much better. I think a few more months eating this way and I may be back to normal and will start to reintroduce some of the high FODMAPS foods I love such as cherries, peaches, pears, watermelon and the occasional piece of whole grain bread.
So, if you have IBS and are having difficulty managing your symptoms, than I strongly suggest you give the low FODMAP diet a try for even just a few weeks to see how you feel.
What are FODMAPS?
FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polysaccharides. Basically, any carbohydrate that isn’t absorbed well in the small intestine moves to the large intestine, which prompts fluid to enter the gut. This can cause discomfort and diarrhea, for certain people. FODMAPS then start to ferment, which causes bloating, gas, cramping and even nausea for IBS sufferers. Most people, however, don’t feel any of these symptoms and fermentable fibre or prebiotics are a healthy part of ones diet as they keep the good bacteria happy and fed.
I want to note that high FODMAP foods aren’t necessarily unhealthy, in fact many of them are really good for your gut. However, if you have IBS and are experiencing a flare up, or you are experiencing a lot of digestive issues, it is worth a shot to temporarily follow a low FODMAP diet and see if your symptoms decrease.
For a full list of high and low FODMAP foods, please see here. (I don't necessarily support other parts of that site)
A low FODMAP diet should only be followed for the short term (several months), until symptoms improve and then foods that were eaten in the past with no issues can start to be reintroduced. Many high FODMAP foods are very nutritious and their fermentable fibre is advantageous to eat for our gut bacteria. Following a strict low FODMAP diet for an extended period of time can therefore actually make symptoms worse by starving some good bacteria. If going back to your regular diet after being on the low FODMAP diet for an extended period of time brings your symptoms back, then I suggest reintroducing a few high FODMAP foods that you suspect don’t cause issues and eat small portions of them. But also, you may have another issue causing gut discomfort. Email me if you’d like to discuss it further.
Also, if symptoms persist after trying the low FODMAP diet, there are other ways to mitigate them. Managing stress is extremely important for IBS. Exercise, meditation, yoga, stretching, using the sauna or hot tub, as well as learning to say no to people and engagements, surrounding yourself with positive, like-minded people and doing pleasurable activities can all help to reduce stress. If you have anxiety or depression, seeing a therapist may be beneficial as well. Another way to help IBS symptoms is to find your food intolerance's. The best way to do this is an elimination diet, or just eliminating foods you know cause you discomfort.
I have a lot of experience with IBS, food intolerance, stress management, elimination diets, and the low FODMAP diet. If you find you are having difficulty with your digestion, then please, don’t hesitate to ask me questions, or fill out a New Client Form, as I am positive I can help you feel better.
For more information on IBS and the low FODMAP diet as well as how to get the Monash University FODMAP food app, visit Monash University Research
1. Foxx-Orenstein, A. E. (2016). New and emerging therapies for the treatment of irritable bowel syndrome: an update for gastroenterologists. Therap Adv Gastroenterol, 9(3), 354-75.