The Low FODMAP Diet for IBS: Is It the Best Answer?

FODMAP Diet for IBS

 

In the United States, between 25 and 45 million people suffer from IBS, or Irritable Bowel Syndrome. This condition, which experts define as extreme variations in bowel patterns causing pain and discomfort, affects people of all ages. Two-thirds of those who report IBS symptoms are women.

If you have this disorder, you are well aware of its symptoms: bloating, diarrhea, constipation and gas — all of which can be embarrassing for you to discuss with friends, family and even your doctor. With this embarrassment, you may suffer in silence. In fact, only five to seven percent of those with IBS symptoms seek out treatment or diagnosis.

The good news is that there are many approaches to managing and treating your IBS and other gut disorders you might be having. While some people change their diet, others rely heavily on laxatives, stool softening products and anti-diarrheal medications.

One approach for lessening or eliminating the uncomfortable symptoms of IBS is adapting to a low Fermentable Oligo-Di-Monosaccharides and Polyols (FODMAP) diet. Others use probiotic and prebiotic supplements to promote the growth of healthy bacteria in their guts.

This guide provides more about the low FODMAP diet, probiotics and prebiotics. It also considers the potential benefits of combining all three treatments as a means of relieving your symptoms of irritable bowel syndrome and other gut related conditions.

Understanding IBS: Symptoms

First, we’ll begin by taking a more in-depth look at irritable bowel syndrome, including understanding the most common symptoms and some of the theories concerning the causes of this condition.

Irritable Bowel Syndrome is a unique condition because your symptoms might vary from the person down the street with the same condition. These symptoms may be inconsistent and have varying severity, typically causing at least discomfort but more frequently pain.

IBS Sub-Types

The most common symptoms associated with this disorder can be classified as changes in bowel patterns. There are four subtypes of IBS:

  1. If you experience IBS with constipation, it is called IBS-C. The main symptoms of this particular type of irritable bowel include hard or lumpy stools a minimum of 25 percent of the time, and loose or watery stools a maximum of 25 percent of the time.
  2. If you experience IBS with diarrhea, it is called IBS-D. The main symptoms of this particular type of irritable bowel include loose or watery stools a minimum of 25 percent of the time, and hard or lumpy stools a maximum of 25 percent of the time.
  3. If you experience IBS with both diarrhea and constipation, it is called IBS-M or Mixed IBS. The main symptoms of this particular type of irritable bowel include loose or watery stools a minimum of 25 percent of the time, and hard or lumpy stools a minimum of 25 percent of the time.
  4. If you experience both diarrhea and constipation, but not frequently, this is called IBS-U or unsubtyped IBS. The main symptoms of this particular type of irritable bowel include loose or watery stools a maximum of 25 percent of the time, and hard or lumpy stools a maximum of 25 percent of the time.

The symptoms of IBS are not limited to the variations of bowel pattern movements you experience. There are secondary symptoms, too, which can cause discomfort and pain, particularly if you are experiencing diarrhea as the main symptom. Individuals with IBS may experience bloating, gas, abdominal pain, cramping and/or visible bowel distension.

Irritable Bowel Syndrome is unique in that it commonly presents along with mental health disorders. While the link between the two is not completely clear, it is common for individuals with IBS to also have an anxiety or panic disorder, depression or a post-traumatic stress disorder.

Causes of IBS

Unfortunately, the exact causes of Irritable Bowel Syndrome are not known with certainty today. Experts have strongly considered a wide range of causes and the possibility that a combination of these symptoms could result in the development of IBS symptoms.

IBS CausesAccording to the National Institute for Diabetes and Digestive and Kidney Diseases, these causes include:

  • Problems with the brain and the signals it sends to the nerves in your gut, which are responsible for controlling your small and large intestines.
  • Problems with motility of your gut. This could include slow motility that results in constipation or fast motility causing diarrhea. Spasms in the gut are also common, causing you to have abdominal pain and gut hyperactivity after meals.
  • Enhanced sensitivity of the nerves in your gut to pain and discomfort. Some experts believe the brain of those suffering from IBS may respond differently to pain.
  • The combination of a mental health disorder and damage to the gut lining. This combination can lead to the development of a gut infection that could result in irritable bowel syndrome.
  • Overgrowth of bacteria in the small intestine, which normally have few bacteria present. The presence of excessive bacteria in the small intestine is known to cause gas, diarrhea and weight loss. Some experts speculate it can also cause IBS.
  • The chemicals in your body responsible for sending nerves signals. They may be present at a different level than the average human being. GI hormones are also varied, and women who are premenstrual see an increase in their symptoms.
  • Genetic history. You may be more likely to develop IBS if a family member in a previous generation has suffered from the disorder, though there is not a clear link between genetics and IBS.
  • Eating certain foods. Spicy, fatty and carbohydrate-heavy foods may cause you to experience IBS symptoms or increase their severity.
  • History of abuse. In some cases, IBS develops in individuals who have been physically or sexually abused.
  • Experiencing stressful situations may result in IBS symptoms or your IBS worsening.

Treating Irritable Bowel Syndrome

According to the International Foundation for Functional Gastrointestinal Disorders, between nine and 23 percent of the world’s population suffer with Irritable Bowel Syndrome. Since no cure exists for Irritable Bowel Syndrome, these people are forced to consider a wide variety of options for managing the symptoms of their disorder.

No Cure for IBS

It is common for individuals with irritable bowels to rely heavily on laxatives to relieve chronic constipation, while others may experience chronic diarrhea and rely heavily on an anti-diarrheal medication. However, the effectiveness of these medications over an extended period of time is uncertain, and some believe there may be negative consequences to the gut after their chronic use. Experts in the field suggest taking laxatives sparingly, which presents a problem for those who experience constipation on a regular basis.

Since medication simply manages the symptoms, does not provide a long-term solution and may have harmful side effects after long-term use, many consider how their diet and lifestyle could affect the disorder. Experts suggest keeping a food diary and watching for the foods and times of day that seem to trigger the symptoms.

One approach is the low FODMAP diet plan, which some believe could provide long-term relief for Irritable Bowel Syndrome.

Low FODMAP IBS Diet: The Rules

FODMAP Diet Rules

With the low FODMAP diet, you significantly reduce your consumption of certain carbohydrates. Many believe doing so can relieve the symptoms of Irritable Bowel Syndrome.

The low FODMAP diet plan doesn’t restrict all carbohydrates — only those that are FODMAPs, which include:

  • Fruit, honey, high fructose corn syrup and other foods with high fructose levels
  • Dairy products
  • Wheat, garlic, onion, inulin and other fructans
  • Legumes such as beans, lentils, soybeans and other galactans
  • Certain sweeteners and stone fruits including apricots, avocados, peaches and any other polyols

Some people believe they should avoid FODMAP foods because they pull water from the intestine. People also believe these foods can become difficult to digest. When eaten too often or in too large of quantities, the bacteria present in the gut then ferment what your gut can’t digest. Many of the experts who believe in the low FODMAP diet for IBS also suggest decreasing fiber intake, which can cause additional bloating and gas.

If you’re following the low FODMAP IBS diet, experts advise you to consume a wide range of low FODMAP foods including meats, lactose-free or low-lactose dairy, gluten free grains, fruits and vegetables. You may be able to eat certain FODMAPS in moderation, but should adjust your intake based on your symptoms before and after you eat them.

The Low FODMAP Diet and Gut Health

The connection between certain foods and the way your body digests them is the guiding principle behind adopting a low FODMAP diet for IBS. The belief is that FODMAP foods are difficult for the gut to absorb and digest, which results in the bacteria present in the gut fermenting them. Then, after the bacteria ferments them, you experience the trademark IBS symptoms of bloating and gas.

For the best results, experts suggest you consult with a dietician as you adopt the low FODMAP diet. The main drawback of this eating plan is the strict rules you need to follow. There are many limitations on what you can and cannot eat, often making it difficult to find foods you enjoy. Many struggle with the idea of “forbidden” foods, especially foods they enjoyed eating in the past. A dietician can ease the transition and assist you in finding new foods to eat.

Probiotics for IBS

If you struggle with the strict rules of a low FODMAP diet, then you’ll be happy to discover a newer approach to combatting gastrointestinal disorders: probiotics. Probiotics are a daily supplement of one or more types of bacteria that may be beneficial to your gut. Available in pill and powder form, as well as in probiotic-enriched foods such as yogurt, the goal is to increase the amount of “good” bacteria in your gut. When healthy bacteria are present, they can balance the bacteria already present and encourage an increase in gut health. You should take probiotics with a meal to improve the symptoms of intestinal infections, irritable bowel syndrome, pouchitis, symptoms of antibiotic use, ulcerative colitis, and Crohn’s disease.

There are some drawbacks, however, to taking probiotics. There is no way to know for sure if the probiotics you are taking are the type of bacteria your unique system needs. We also don’t know how much of the beneficial bacteria survives in your gut. Probiotics can’t survive in high heat or acid, both of which exist in your stomach.

Prebiotics for IBS

Despite their similar name, a prebiotic is much different from a probiotic. Prebiotics are a specific type of food fiber found growing in plants that can fertilize the healthy bacteria already present in your gut. There is no guessing if prebiotics can be beneficial for your unique system since they help grow what we know is helpful to your gut health. Moreover, heat and acid have no effect on prebiotics.

Our guts need a balanced combination of fibers and bacteria to properly digest foods and maintain health. Prebiotics, which are a non-digestible fiber, are naturally found in many types of fruits and vegetables. The presence of prebiotics in the gut can encourage microorganisms to grow and become more active in the gut. As a result, the gut can improve its abilities to process hard-to-digest foods and absorb the nutrients that are important to gut and overall health. Studies have shown a marked improvement in the most common IBS symptoms including bloating, gas and constipation.

Although prebiotics occur naturally in many foods, many individuals may have trouble consuming enough fruits and vegetables to maintain a healthy and beneficial level of prebiotics for IBS. Full-spectrum prebiotic supplements like Prebiotin are the easiest way to get the prebiotics you need to maintain a healthy gut and help prevent IBS symptoms.

The Best Way to Relieve Irritable Bowel Syndrome: Combine Your Efforts

If you’re suffering from irritable bowel syndrome, chances are, there is no one single cure for your discomfort and pain. You may feel discouraged or hopeless. Living with irritable syndrome can be very difficult. You may feel embarrassed discussing your symptoms with coworkers, friends or family. IBS symptoms can interrupt your routine and daily life activities.

The good news is there is hope for living with irritable bowel syndrome. The right combination of diet and supplements may be exactly what you need to relieve your symptoms and get back to living on your own schedule. The best approach to IBS is a multi-faceted one, which includes diet changes, probiotics and prebiotics.

Many people who have adopted the low FODMAP diet have experienced marked relief of their irritable bowel symptoms. Research also has shown both probiotics and prebiotics can have positive results for many dealing with irritable bowel. By combining these approaches, you can find the perfect plan for managing your symptoms. A qualified nutritionist or doctor who is knowledgeable about the low FODMAP diet, probiotics and prebiotics can assist you in developing a plan of action.

2 comments

  1. Al & Maureen Metcalf says:

    Our son is currently in a clinical remission state of ulcerative colitis, His diet is basically low fodmap, with no gluten, dairy, soy red meat, or canola and of course no known GMO components, since he does not eat commercially processed food products. He cannot take any of the usually prescribed drugs for management of his condition, due to severe allergic reactions to such. So far, so good. He also takes D3, K2, an organic multi, turmeric, Boswellia occasionally if bloating and feeling of inflammation starting, and a probiotic However, his gastroenterologist is also suggesting he supplement with Prebiotica, which so far is not avalable in Canada as a Health Canada approved supplement that can be covered by any medical, So he is currently waiting for Canadian approval.

    I do have an observation and sort of a question: Some IBD sufferers have obtained relief of symptoms long term with the addition of either goat or bovine colostrum, while others say it does nothing for them. That makes me wonder if the autoimmune response that apparently results in either Chrone’s or ulcerative colitis is somehow the immune system attacking the cells of the lining of the intestinal tract because of some functional and/or metabolic factor(s) normally within the cells being turned-off by a pathogenic response to either food allergens and or environmental toxin exposures. In other words, the cause is not the body suddenly just turning on its own cells, but that the cells have already been compromised, so the immune system rushes to protect by attempting to rid the body of what it perceives as rogue cells. Kind of backwards thinking to what we usually understand as autoimmune responses. Rather than there not being a cause for the autoimmunity, there is/are pre factor(s) that already have compromised the cells.

    Sort of like a light switch that has been turned off. Now it must be turned back on for the cells to resume their proper roles. Without turning the switch back on, the cells will continue to be perceived by the immune system as foreigners, or as tissue to be attacked and eliminated. Thus, there is inflammation, pain, and ulceration as a result.

    For some folk, whatever has turned the cells off of their proper function does switch back on, and remission, sometimes permanent, occurs. Somehow we have a feeling there are unknown, or otherwise unresearched factors that result in what appears to be spontaneous recoveries. But for most folk, intervention in the form of dietary changes, anti-inflammatories, and even immune suppressors are prescribed to bring the autoimmunity response under some form of control, but this approach ultimately seems to be a temporary bandaid at best, so the underlying cause that switched off the cells is not addressed directly.

    Why does colostrum work for some people? It goes back to the reason colostrum is the first food a human or animal receives. The colostrum turns-on the digestive tract cells and appropriate enzymes etc to prepare the digestive tract to receive and digest food (milk.). It also boosts the immune system and programs it to recognize pathogenic bacteria, viruses, etc to protect the newborn from disease, and supports the growth of beneficial bacteria growth, and the maintenance and growth of the lining of the entire digestive tract. Usually, this initial few days of colostrum will benefit the individual for the remainder of life. However, obviously, there are factors that may reverse this life-long benefit, so another switch to turn the digestive system back-on must again be applied along the way.

    For some folk, taking a colostrum supplement does act in a similar manner on the digestive tract as occurred at birth, to turn the switch back on, just as it did in infancy! For others, the colostrum has no apparent obvious effect because the issues have become such that the “lightbulb itself is burned out”. So no matter how many times the light switch is flicked to the on position, the light cannot turn on until the lightbulb is changed, which will require more than simply flipping the switch. It will require a 16 foot ladder and an appropriate new bulb replacement! That will take a team climbing the ladder one step at a time, (a multi-layered step by step approach.)

    Therefore, I wonder if sometimes the natural colostrum which may have the on-switch ability is ignored by gastroenterologist simply because it does not always immediately work for everyone off the bat. But actually may be beneficial coupled with the step-by step approach as the new lightbulb is installed! In other words, instead of suppressing the immune system to slow the autoimmune attacks, if possible isolate the reason for those attacks on the bodies own cells. Now, so far, that approach has remained a tall order! Somehow, the intestinal flora balance seems key to this approach, and that is where pre and probiotics come into play, following ridding the body of any pathogenic disease organisms such C-diff etc using antibiotics. But once any infection has been successfully eliminated, don’t just leave the patient in limbo wondering how to re-populate their digestive tract with the good guys! Treatment is multi-faceted, and rebuilding the immune system is imperative to prevent further infections while healing takes place. Suppression of the immune system leaves the patient vulnerable, and long term does not allow proper healing to take place, but rather seems to lead to revolving downward spiral bouts of flare-ups.

    We wonder if colostrum, even if it does not seem to initially be doing anything, should be added to any treatment regime, since it is a positive immune booster, an epithelial cell support for healing and restoration of the gut lining, and feeds the good bacterial flora, among many other benefits, rather than immune suppressing prednisone, and the side effects of strong drugs long term.

    Just a thought!
    Respectfully,
    Al and Maureen Metcalf

    • Brianna says:

      Unfortunately, the scientific jury is still out on colostrum as it pertains to Crohn’s and UC. I remember when it was touted as the antidote for chronic wasting disease from AIDS before more studies were conducted demonstrating no efficacy. The immune boosting idea behind colostrum also plays into the interest in whole, unpasteurized milk that many believe is better than commercialized, processed milk. Regardless, at this time, there is simply not good science to support colostrum as an IBD treatment. No doubt it likely plays a role in disease development but as the writer points out, there is more to the story. For example, identical twin Crohn’s studies show that while both may have been breast fed, only one may develop Crohn’s while the other never does. It’s a complex interplay. – Wilson Jackson, MD

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