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Try a FODMAPs diet to manage irritable bowel syndrome

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Understanding Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that affects 10% of people in the United States annually. The symptoms of IBS, which include cramping, diarrhea, gas, and bloating, can significantly affect a person's quality of life.

One way people manage IBS symptoms is through their diet. While avoiding trigger foods is a common approach, the low FODMAP diet, developed in Australia, has shown to be successful in managing IBS symptoms.

What is the low FODMAP diet?

FODMAP is an acronym that stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols. These fermentable short-chain carbohydrates are prevalent in the diet and include fructans and galacto-oligosaccharides (GOS), lactose, fructose, sorbitol, and mannitol.

Researchers have discovered that the small intestine does not absorb FODMAPs well. This leads to an increase in the amount of fluid in the bowel and gas production because bacteria in the colon easily ferment them. The increased fluid and gas in the bowel leads to bloating, changes in the speed with which food is digested, and symptoms like gas, pain, and diarrhea. Therefore, eating less of these types of carbohydrates should decrease these symptoms.

Studies have shown that a low FODMAP diet improves IBS symptoms, with one study showing that 76% of IBS patients reported improvement with their symptoms while following the diet.

Foods to eat less of on the low FODMAP diet include lactose, fructose, fructans, GOS, and polyols. Examples of these foods are cow's milk, yogurt, fruits like apples and pears, vegetables like garlic and onions, grains like wheat and rye, and sweeteners like sorbitol, mannitol, and xylitol.

Low FODMAP Diet for IBS Management: What to Eat and What to Avoid

Irritable bowel syndrome (IBS) affects 1 out of 10 people in the United States each year, causing symptoms such as cramping, diarrhea, gas, and bloating. Diet is one way people manage IBS symptoms. A common treatment approach is to avoid the foods that trigger symptoms, while others follow the low FODMAP diet, which has shown success in managing IBS symptoms.

What is the low FODMAP diet?

FODMAP stands for "Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols," which are fermentable short-chain carbohydrates found in many foods. The small intestine does not absorb FODMAPs very well, which can lead to bloating and changes in digestion speed. Eating less of these carbohydrates should decrease these symptoms.

Foods to Avoid:

Lactose: Cow's milk, yogurt, pudding, custard, ice cream, cottage cheese, ricotta cheese, and mascarpone.

Fructose: Fruits such as apples, pears, peaches, cherries, mangoes, and watermelon; sweeteners such as honey and agave nectar; and products with high fructose corn syrup.

Fructans: Vegetables such as artichokes, asparagus, Brussels sprouts, broccoli, beetroot, garlic, and onions; grains such as wheat and rye; and added fiber such as inulin.

GOS: Chickpeas, lentils, kidney beans, and soy products; vegetables such as broccoli.

Polyols: Fruits such as apples, apricots, blackberries, cherries, nectarines, pears, peaches, plums, and watermelon; vegetables such as cauliflower, mushrooms, and snow peas; and sweeteners such as sorbitol, mannitol, xylitol, maltitol, and isomalt found in sugar-free gum and mints, cough medicines, and drops.

Foods to Eat:

Dairy: Lactose-free milk, rice milk, almond milk, coconut milk, lactose-free yogurt; hard cheeses such as feta and brie.

Fruit: Bananas, blueberries, cantaloupe, grapefruit, honeydew, kiwi, lemon, lime, oranges, and strawberries.

Vegetables: Bamboo shoots, bean sprouts, bok choy, carrots, chives, cucumbers, eggplant, ginger, lettuce, olives, parsnips, potatoes, spring onions, and turnips.

Protein: Beef, pork, chicken, fish, eggs, and tofu.

Nuts/seeds (limit to 10-15 each): Almonds, macadamia, peanuts, pine nuts, and walnuts.

Grain: Oat, oat bran, rice bran, gluten-free pasta such as rice, corn, quinoa, white rice, corn flour, and quinoa.

It's important to meet with a registered dietician if you are considering this diet to make sure your eating plan is safe and healthy. The dietician will have you eliminate FODMAPs from your diet and gradually add the carbohydrates back in one at a time, monitoring your symptoms with the help of a food diary and symptom chart.

The low FODMAP diet has shown potential in helping people with IBS. Although some health professionals believe it's too restrictive, proponents of the diet report that people stick with it because of how it improves their quality of life.

Potential Risks and Considerations

While the low FODMAP diet can be effective for some people with IBS, there are potential risks and considerations to keep in mind. The elimination phase of the diet can be challenging and may lead to a lack of diversity in the diet. This can result in reduced intake of beneficial nutrients, including fiber, which is important for gut health.

The reintroduction phase of the diet is also critical, as it allows individuals to identify their specific trigger foods. However, this phase can be time-consuming and requires careful monitoring of symptoms. Additionally, some people may find the process of reintroducing foods to be overwhelming and may need the guidance of a healthcare professional.

Another consideration is the potential impact of the diet on social situations. The elimination phase may require individuals to avoid certain foods in social settings, which can be challenging and lead to feelings of isolation. It is important to have a support system in place and to communicate with friends and family about the dietary restrictions.

Personalization and Long-Term Maintenance

One of the strengths of the low FODMAP diet is its personalization. After the elimination and reintroduction phases, individuals can create a personalized diet plan based on their specific trigger foods. This can help to maintain long-term symptom relief and improve overall quality of life.

However, the long-term maintenance of the diet can be challenging. It is important to work with a healthcare professional to ensure that the diet is nutritionally balanced and sustainable. Additionally, the diet may need to be modified over time as symptoms change or new trigger foods are identified.

The bottom line

The low FODMAP diet has shown a potential to help people with IBS reduce their symptoms and improve their quality of life. However, it is not appropriate for everyone and should be undertaken with the guidance of a healthcare professional. The diet requires a significant amount of time and effort, but for many people with IBS, the benefits outweigh the potential risks and considerations. With careful monitoring and personalization, the low FODMAP diet can be an effective treatment option for managing IBS symptoms.

Caroline Buckee

Caroline Flannigan is an epidemiologist. She is an Associate Professor of Epidemiology and is the Associate Director of the Center for Communicable Disease Dynamics.

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