The low FODMAP diet and its positive effect on IBS

Maybe you are one of these people: You eat healthy and really try everything to get your intestinal complaints under control, but they just don’t want to get better. Plenty of fruit, vegetables and whole grains are considered healthy foods and yet for some people they cause digestive problems such as bloating, flatulence, diarrhoea or constipation. How can this be? Some of these foods contain so-called FODMAPs and these are particularly noticeable in people with irritable bowel syndrome. The deceptive thing is that FODMAPs include foods that you would actually think are good for your health: asparagus, cauliflower, beetroot, onions, apples, bananas, avocado, spelt, buttermilk, honey. So why do healthy foods cause discomfort?

What are FODMAPs and why can they cause digestive discomfort?

FODMAPs are certain short-chain carbohydrates and sugar alcohols that are naturally present in many foods. In principle, FODMAPs are not harmful, but are part of the daily diet of health-conscious people. However, Barrett (2017) assumes that the intestines of many people with IBS are sensitive to FODMAPs. (3) By the way, IBS manifests itself differently in each person: for example, it can cause severe diarrhoea in one person, persistent constipation in another, or a mixture of both.

What does the word FODMAP mean?

F – Fermentable

O – Oligosaccharides

D – Disaccharides

M – Monosaccharides

A – And

P – Polyols.

FODMAPs is the abbreviation for fermentable oligo-, di- and monosaccharides and polyols (Mehtab et al., 2019). These can cause digestive symptoms such as diarrhoea, bloating and abdominal pain. (4)

Low FODMAP diet – relief from IBS

According to Bellini et al. (2020), a low FODMAP diet (LFD) is a possible treatment for IBS symptoms such as diarrhoea, abdominal pain and bloating. (1) In some countries, the low FODMAP diet has already established itself as a fixed form of therapy, as it provides promising results for irritable bowel syndrome (IBS). Studies have shown that a low-FODMAP diet can improve symptoms in up to 70% of IBS patients (Camilleri et al., 2014). (2)

Another effective method used now is hypnotherapy (gut directed hypnosis) – and this has even been scientifically proven. If this is something that might interest you, you are welcome to read Mindful gut: This is how effective hypnosis is for IBS.

Dietary changes are best done together with an experienced therapist.

Because a low FODMAP diet severely restricts food choices and has an enormous impact on gut flora, it should only be done under the guidance of a nutrition expert (Bellini et al., 2020). (5) Research shows that the diversity of bacterial cultures in the gut tends to decrease on a low FODMAP diet, but species diversity is essential and also crucial for a healthy gut microbiome (Staudacher et al., 2020). (6)

With the myBioma gut microbiome analysis, you can find out how your diversity is doing and get personalised recommendations to improve your gut health.

How does the low FODMAP diet work? The two phases:

The low FODMAP diet is made up of two phases; a restriction phase (also known as an elimination phase) and a gradual re-exposure to FODMAP-rich foods. Not everyone can achieve freedom from symptoms, but the low FODMAP diet is currently the best available treatment for irritable bowel syndrome.

In the first phase of the low FODMAP diet, FODMAP-rich foods are completely avoided for six to eight weeks. If during this time it is shown that the symptoms improve significantly or normalise, a long-term diet without these substances can be useful. In the second phase of the diet, various FODMAP-rich foods are tested for their individual tolerance (Dugum et al., 2016). (7)

Low-FODMAPs include fish, kale, lactose-free whipped cream and lemons.

Successes of the low FODMAP diet in cancer therapy

But it is not only in the course of IBS that remarkable successes can be achieved; this diet has also proven to be extremely promising in cancer therapy.

Patients with radiation-induced enteropathy after cancer treatment show similar symptoms to patients with IBS. Back in 2017, Larsen et al. investigated whether there could be a positive effect of LFD on symptoms and health-related quality of life in patients with radiation-induced bowel disease. In an open-label, non-controlled pilot study, the FODMAP intake of 11 female patients with radiation-related RD symptoms was successfully reduced within four weeks and those symptoms significantly improved. (8)

Further research is needed

A low FODMAP diet is increasingly being proposed as a treatment for IBS, but controlled long-term studies are still lacking. Potential limitations and concerns about LFD are expressed through dietary adequacy, cost and difficulty in teaching and maintaining this diet. Most of these limitations can be resolved through the involvement of a qualified dietitian who can clearly explain the different stages of LFD and ensure dietary adequacy and adherence. (9)

Should you wish to improve your diet and gut health together with a suitable therapist, please feel free to have a look around the myBioma therapist network.

Refernces

(1) Bellini M, Tonarelli S, Nagy AG, Pancetti A, Costa F, Ricchiuti A, de Bortoli N, Mosca M, Marchi S, Rossi A. Low FODMAP Diet: Evidence, Doubts, and Hopes. Nutrients. 2020 Jan 4;12(1):148. doi: 10.3390/nu12010148. PMID: 31947991; PMCID: PMC7019579.

(2) Camilleri, M., & Acosta, A. (2014). Re: Halmos et al, A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology, 146(7), 1829-1830. doi: 10.1053/j.gastro.2014.01.071

(3) Barrett JS. How to institute the low-FODMAP diet. J Gastroenterol Hepatol. 2017 Mar;32 Suppl 1:8-10. doi: 10.1111/jgh.13686. PMID: 28244669.

(4) Mehtab W, Agarwal A, Singh N, Malhotra A, Makharia GK. All that a physician should know about FODMAPs. Indian J Gastroenterol. 2019 Oct;38(5):378-390. doi: 10.1007/s12664-019-01002-0. Epub 2019 Dec 4. PMID: 31802437.

(5) Bellini M, Tonarelli S, Mumolo MG, Bronzini F, Pancetti A, Bertani L, Costa F, Ricchiuti A, de Bortoli N, Marchi S, Rossi A. Low Fermentable Oligo- Di- and Mono-Saccharides and Polyols (FODMAPs) or Gluten Free Diet: What Is Best for Irritable Bowel Syndrome? Nutrients. 2020 Nov 1;12(11):3368. doi: 10.3390/nu12113368. PMID: 33139629; PMCID: PMC7692077.

(6) Staudacher HM, Ralph FSE, Irving PM, Whelan K, Lomer MCE. Nutrient Intake, Diet Quality, and Diet Diversity in Irritable Bowel Syndrome and the Impact of the Low FODMAP Diet. J Acad Nutr Diet. 2020 Apr;120(4):535-547. doi: 10.1016/j.jand.2019.01.017. Epub 2019 Apr 24. Erratum in: J Acad Nutr Diet. 2020 Dec;120(12):2098. PMID: 31029650.

(7) Dugum M, Barco K, Garg S. Managing irritable bowel syndrome: The low-FODMAP diet. Cleve Clin J Med. 2016 Sep;83(9):655-62. doi: 10.3949/ccjm.83a.14159. PMID: 27618353.

(8) Larsen, Trine & Hausken, Trygve & Ystad, Synne & Hovdenak, Nils & Mueller, Bernd & Arslan, Gulen. (2017). Does the low FODMAP diet improve symptoms of radiation-induced enteropathy? A pilot study. Scandinavian Journal of Gastroenterology. 53. 1-8. 10.1080/00365521.2017.1397186.

(9) Bellini M, Tonarelli S, Nagy AG, Pancetti A, Costa F, Ricchiuti A, de Bortoli N, Mosca M, Marchi S, Rossi A. Low FODMAP Diet: Evidence, Doubts, and Hopes. Nutrients. 2020 Jan 4;12(1):148. doi: 10.3390/nu12010148. PMID: 31947991; PMCID: PMC7019579.