Digestive distress is something that most people can understand. Beyond stomachaches, however, there are more serious conditions that can start with abdominal pain. Irritable bowel syndrome and inflammatory bowel disease are two examples of serious chronic conditions that affect the gastrointestinal (GI) tract. Neither disorder has a known root cause so treating them can be both difficult and time-consuming. These conditions can be debilitating and can affect every aspect of your life, from work to family life. Many treatment options revolve around preventing flare-ups of these conditions. This is where the low FODMAP diet comes into play.
What is the low FODMAP diet?
Complex molecule chains, also known as FODMAPs, can be found in a lot of the food we eat. These can be anything from fructans (wheat and rye) to lactose (milk and soft cheese). The low FODMAP diet restricts these foods in an attempt to prevent flare-ups and reduce overall pain.
FODMAP is an acronym that stands for:
- Fermentable
- Oligosaccharides (fructans)
- Disaccharides (lactose)
- Monosaccharides (fructose)
- And
- Polyols (sugar alcohol)
These five collections of molecules are often very difficult to absorb for some people’s digestive system. Poor absorption in the small intestines leads to a large amount of these molecules entering the large intestines. This leads to FODMAP molecules becoming a source of food for bacteria that naturally live in the large intestines.
When the bacteria digests this food source, it can cause symptoms that are often found in IBS and IBD. It does this by expelling hydrogen gas rather than the common methane gas most people are used to. This can cause symptoms such as abdominal pain, flatulence, nausea, bloating, diarrhea, and constipation.
What are the guidelines for the low FODMAP diet?
The low FODMAP diet is a structured eating regimen that is tailored to each person. It starts out by restricting a large amount of foods that are high in FODMAP molecules. This process usually takes six to eight weeks for the body to fully acclimate to the new diet.
Next, often under the supervision of a dietitian, foods are slowly added back into the diet by category. In this way, it is easier to identify which foods most exacerbate the patient and which are safe for consumption. Once this process is complete, a long-term diet plan can be crafted and implemented that excludes any trigger foods. It is also important to note that many foods that are considered very healthy can still contain a high amount of FODMAP molecules.
While the low FODMAP diet is restrictive, it does not limit many varieties of food such as meat, poultry, fish, lactose-free dairy, and many kinds of fruits and veggies. Mostly, this diet focuses on eliminating dairy, certain fruits, beans, lentils, coffee, and artificial sweeteners. Since the diet is complex, it is often a good idea to consult a dietitian. However, you should always consult your doctor before making any major diet changes even when working with a dietitian.
Does the low FODMAP diet actually work?
The FODMAP diet is a relatively new concept and has been around for about 15 years. Since it is so new, there has only been a handful of research studies over the last decade examining the effectiveness of it. For the most part, there has been some compelling evidence to suggest a FODMAP diet can help those with irritable bowel syndrome, although there is significantly less that supports the diet over a healthy-balanced diet for those who suffer from inflammatory bowel disease.
One study compared the relative effectiveness of traditional dietary advice for IBS with the FODMAP diet. It was reported that 76% of FODMAP diet following patients were satisfied with their symptom changes due to the diet. Specifically, many more patients responded that they had overall improvements in bloating, abdominal pain, and flatulence versus a standard diet.
A review of all available data was conducted in 2015. It was found that a significant amount of participants in these studies felt that the low FODMAP diet played a large role in their IBS symptoms. One of the studies even indicates that the new diet can change how the bacteria in the gut react, although its ramifications are unclear.
However, the data to back up the claim that a low FODMAP diet can improve IBS is not abundant. The evidence available at the time were from a few small and short duration studies that could have been more rigorous. The report concludes with the statement:
“We believe that patients should be advised that there is very limited evidence for its use, the ideal duration of treatment has not been assessed in a clinical trial, and its place in the management of IBS has not been fully established.”
However, in a new study that came out in May of 2016, the University of Michigan Health System boasts that a first-of-its-kind clinical trial shows how powerful a low FODMAP diet can be. This study included over 90 IBS patients, half of which followed the FODMAP diet and the other a standard healthy diet.
Over 50% of the patients on the FODMAP diet reported major improvement of abdominal pain compared with only 20% from the other group. Furthermore, there was additional improvement for those in the FODMAP testing group in bloating, diarrhea, and bowel movement urgency. Finally, after one month, the FODMAP group of patients reported a significantly higher improvement in their quality of life compared with the control group.
Have you tried the low FODMAP diet? Has it helped reduce your symptoms and pain from IBS or IBD?