Troubled with IBS? Here’s a complete roadmap to the low FODMAP diet

FODMAP foods and your body

“Most of the ailments come from the stomach” – an old saying which basically means that if your digestive system is faulty the rest of the body will react adversely. Stomach ache, diarrhea, constipation, excessive gas, bloating, flatulence etc. are all symptoms of dysfunction in our digestive system. The cause for these symptoms could be anything but the most common cause is irritable bowel syndrome (IBS). Though not life-threatening, it can be a daily nuisance and a huge hindrance in a healthy and comfortable lifestyle.

An Australian research team at Monash University has developed the most plausible relief for people suffering from IBS. Department of Gastroenterology at the university has been researching this for 10 years and has come up with a diet plan called Low FODMAP diet, which is rapidly becoming popular. But before we take a deeper look at what is FODMAP diet and how is it effective, let’s understand when to use this diet.

Irritable bowel syndrome

Studies show that 10-15% of adults in the world have this problem. IBS can cause acute abdominal pain along with constipation or diarrhea or a combination of both. IBS is mainly caused because of long term problems in the gastrointestinal functions. Our gut, that is the small and the large intestine, is regulated by the brain. Any kind of stress or disturbance could cause dysfunctions in our gut which in turn can cause IBS. It is rapidly becoming the second most common reason for absenteeism from work.

The exact cause of IBS is still unknown. Some people get it genetically; others can contrive it from an earlier trauma or infection. Since it is also driven by disturbances in our brain as well, it is difficult to pinpoint the actual cause but overall any kind of disturbance in bowel movement (motility & sensation), change in eating habits, stress, gastrointestinal problems or menstrual problems can cause IBS. Sometimes people even forget to address these issues because of their daily occurrence which can aggravate the situation.

Brain-gut axis

Brain-gut axis is two-way communication between the brain and the colonic motility which ensures that our digestive system is functioning properly. Any disruption in this communication can cause IBS. Bacteria in our gut (small and large intestine) or in the bowel are responsible to break down the food we eat. There are infinite numbers of bacteria in our digestive system, especially in our gut. Any change to the number or the composition due to say a bacterial infection could trigger IBS.

IBS diagnosis

Since the exact cause of IBS is still unknown, there is no specific test for irritable bowel syndrome. The physician or the doctor might call for multiple tests.  There are, however, a few diagnostic criteria that are often used to determine IBS

• Rome criteria: This is a combination of the most common symptoms displayed by a person suffering from IBS. These include abdominal pain and discomfort. This pain should be associated with

• • Number of a person defecates
  • Relief from pain experienced after defecation
  • And the change in discomfort with the change in consistency of stool

• Manning criteria: These criteria are very similar to that of the Rome criteria, however, it also takes into consideration the amount of mucus in the stool. The more symptoms you have, the greater the likelihood of IBS.

There are a few red flags or alarm signs that the doctor should further check to eliminate them out of the list. These are symptoms of graver problems and the existence of any of these problems should be informed to the physician

• Any history of colon cancer or celiac disease in the family
• Whether the symptoms are early onset of another disease due to old age post 50
• Excessive bleeding with stool
• Any signs of anemia
• Excessive weight loss without any explanation.

In the absence of any biological marker, the partial process of elimination and taking into consideration the physical symptoms of the patient are the best ways for the doctor to determine IBS. Based on the kind of treatment available, IBS can be divided into three types, which takes into consideration the different symptoms: constipation-predominant, diarrhea-predominant or mixed. Depending on the severity of the conditions the doctor might suggest a few dietary or lifestyle changes:

• Counseling: As discussed earlier, one of the main causes of IBS is stress. Seeing a professional for the betterment of your mental health can help reduce the symptoms of IBS. Different tools of psychiatry can be used to achieve the same. Hypnosis, cognitive skill building or simple therapy can help a patient suffering from IBS.
• Probiotics and Antibiotics: The helpful bacteria that are present in the intestinal tracts are called probiotics. Some recent research has revealed that any change in the composition of the bacteria can result in IBS. Also, the doctor might suggest some antibiotics that can get rid of any unwanted bacteria that is affecting bowel functioning.
• Alternative forms of treatment: Yoga and meditation are tools that are directly linked to physical and mental health. Along with that acupuncture or acupressure are alternative forms of treatment which are considered good for IBS. According to a study done by 10 researchers in Boston in 2010, acupuncture brought 37% improvement in people with IBS compared to 4% improvement in people who were part of a control group.

The basics of a low- FODMAP diet

FODMAP diet or low- FODMAP diet is the latest and popular answer to IBS. Three researchers, out of which two are associated with Monash University in Australia, restudied the effects of the low-FODMAP diet in 2017. According to the study, 50%-86% of the people benefitted out of the study that can be clinically proven. International Foundation for Gastrointestinal Disorder, which is an NGO in the US, also promotes FODMAP diets as a solution to IBS symptoms.

What is FODMAP?

It’s an acronym for different kinds of insoluble carbohydrates (short-chain carbohydrates) that if controlled in our diet can help reduce the discomfort and pain experienced due to IBS. FODMAP stands for  Fermentable Oligosaccharides Disaccharides Monosaccharides And Polyols. Different kinds of short-chain carbs that are present in the food we eat are

• Lactose: Lactose though considered as simple sugar has two units of sugar. It needs lactase, an enzyme to break it down to a monosaccharide (one unit of sugar). Genetically a lot of people have a lack of lactase in their body (a majority of Asians and Native Americans) in which case lactose is not absorbed in the small intestine making it a FODMAP.
• Oligosaccharides: These are complex sugar polymers which can’t be broken down and are insoluble in the human body because we do not have the required enzymes. They remain intact creating problems for individuals with sensitive bowels.
• Polyols: Sorbitol and mannitol are the two most common polyols in our diet. These are sugar alcohols which get absorbed in across the intestinal barrier but this process is a slow drawn one. Sorbitol is often used in “sugar-free” products because it burns slowly releasing fewer calories.

Effects of FODMAP on IBS

One thing is common between people who have IBS and people who don’t. We all have almost equal amounts of FODMAP in our system. It only affects people with IBS more. FODMAP creates an osmosis effect in our small and large intestine secreting a lot of fluids. The microbes near the colon try to break the fermented carbohydrates generating a lot of gas. The extra fluid and the gas create tremendous pressure from the inside causing abdominal pain and discomfort. This can induce a forward movement in the bowel leading to diarrhea but it could have a completely opposite effect causing constipation as well.

How to follow the low-FODMAP diet

This diet has two phases. Basically, the logic behind this is to eliminate the FODMAP or low-absorbent carbohydrates that affect the person’s digestive system the most.

Phase 1: During phase 1, all foods which are high on FODMAP are eliminated from the diet. This phase lasts for 3-8 weeks only because FODMAPs are beneficial for gut health.

This is not like food allergies that FODMAPs need to be completely removed from the diet. It needs to be restricted from the diet for a limited period of time so that the system can stabilize. A lot of people get results in the first few weeks, however, some people need to complete all 8 weeks to see any substantial result.

Phase 2: After the 8 weeks of restriction, FODMAPs are slowly added back to the diet to determine something called a Threshold Level.

The slow introduction of FODMAP carbohydrates can help us in determining how much FODMAP one patient can tolerate and which food items are aggravating the symptoms more than others.

This helps in determining the threshold level for the patient which helps in shaping the diet that the person needs to follow.

What should be eliminated?

Food items high on FODMAPs are:

Wheat, onion, and garlic

Well, for most Asians these three ingredients are essential for every meal. However, it seems a small sacrifice to give up these ingredients to get relief from the discomfort and daily trouble IBS causes. As far as the amount of FODMAP is concerned, wheat is one of the lowest amongst the three mentioned here but because it is consumed in such large quantities it is considered high on FODMAP.

Both garlic and onions are a highly concentrated source of fructans which is a FODMAP. It is very difficult to cut these two ingredients out of a diet as they are mostly present in every recipe as the flavoring agent. Even canned or preserved foods might have garlic and onion as an ingredient. Someone who is strictly on a low-FODMAP diet needs to check every label and make sure that these ingredients are not there in their diet.

Alternatives to wheat, onion, and garlic: Brown rice, buckwheat, maize, millet, oats, polenta, quinoa, and tapioca. Garlic can be substituted with flavoring agents are chives, chili, fenugreek, ginger, lemongrass, mustard seeds, saffron, and turmeric.

Fruits and Vegetables

Most fruits as expected are high on FODMAP due to the presence of oligosaccharide fructans. Some fruits, however, contain carbohydrates in the form of glucose which is essential as it gives direct energy to our body. Even then, when consumed in high quantities, it can harm sensitive people. So people on a low FODMAP diet should be very cautious of what fruits they are consuming and in what quantities.

Fruits that are OK to be consumed: Bananas, blueberries, kiwi, limes, mandarins, oranges, papaya, pineapple, rhubarb, and strawberries.

Fruits that should not be consumed: Apples, apricots, cherries, figs, mangoes, nectarines, peaches, pears, plums and watermelon.

Vegetables, on the other hand, are good for health so all we need to do is replace a few with high levels of FODMAP.

High-FODMAP vegetables include Asparagus, Brussels sprouts, cauliflower, chicory leaves, bitter gourd, leeks, mushrooms and snow peas.

Low-FODMAP vegetables include Bean sprouts, capsicum, carrot, eggplant, kale, tomato, spinach, and zucchini.

Dairy and Meat

All dairy products are high on lactose which is also infamous for causing intestinal problems. If at all someone is really fond of dairy then they will need to stick to cheddar cheese, cream, feta cheese, lactose-free milk, and Parmesan cheese. Meats that can be a part of the low FODMAP diet are Beef, chicken, eggs, fish, lamb, pork and prawns.

Low-FODMAP Meal Plan

This meal plan has been sketched out by the International Foundation for Gastrointestinal Disorders.

SIBO: Small Intestinal Bacterial Overgrowth

SIBO is a stomach disorder similar to IBS though it can be cured with antibiotics. Diet restrictions are advised for this disorder as well and low FODMAP diet is proving to be more effective than anything followed before.

Bacterial overgrowth is an infestation of the small intestine by bacteria which usually grow in the colon region. When these bacteria come in contact with the food in small intestine it starts breaking it down too soon creating gas and causing a lot of digestive problems like diarrhea, stomach pain, and malnutrition (in long term).

It is absolutely essential to determine that you have IBS or consult a professional dietician before you go on such a strict regimen of diet because low FODMAP diet restricts some essential ingredients needed in our body. The time periods suggested should strictly be followed otherwise there could be adverse effects like weakness, fatigue and overall degradation of health which is counter-productive.

TL;DR?

References

 

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