Irritable Bowel Syndrome (IBS) is an uncomfortable condition of the digestive system that causes digestive issues including frequent constipation and diarrhoea. Unfortunately, it is a long-term condition which causes discomfort and pain. As well as physical discomforts IBS can also impact mental health, as it can be difficult to manage and an embarrassing condition at times. IBS sufferers are not alone as it is a common condition in the UK, with 1 in 5 people being diagnosed. There are many ways in which to manage or reduce IBS symptoms, but a dietitian may encourage a low FODMAP diet to someone who has not found success in first line strategies. This diet is common for IBS treatment and aims to reduce symptoms by reducing foods that give the digestive system a tough time.
The term FODMAP stands for ‘Fermentable Oligo-, Di-, Mono-saccharides and Polyols’, a complicated mouthful which describes the type of carbohydrates which are not as well absorbed in the small intestine. They also absorb water and become fermented; a low FODMAP diet is essentially one with little fermentable carbs. A low FODMAP diet avoids these foods, aiming to reduce triggers for symptoms and general discomfort. By reducing intake of these foods, we can release pressure from the gut to digest difficult foods allowing it to relax and symptoms subside. Foods that are not easily broken down include milk (due to the lactose in it), fruit and vegetables (as they are very fibrous and contain fructose)and wheat products (which contains gluten). Stubborn foods can cause stomach pain and bloating, some of the most common IBS symptoms. Sometimes people can have difficulties with specific food groups in this category i.e. being lactose intolerant or having celiac disease. For those with IBS, all 3, or a combination, are often experienced. For these people, reducing intake of these troublesome foods is best for managing symptoms.
What can a low FODMAP diet achieve?
Low FODMAP diets aim to reduce the occurrence of IBS symptoms such as bloating, gas, stomach pains, acid reflux and bowel urgencies. IBS symptoms are diverse and specific to patients, but most conditions are underpinned by stomach pains and bloating. These are the symptoms most notably reduced by a low FODMAP diet. Reducing these symptoms are important for improving quality of life and easing physical discomfort so that everyday life is less disrupted. Studies have shown that low FODMAP diets improve these symptoms when the diet is applied consistently. Eventually, the balanced and diverse diet can be reintroduced for recovery after symptoms are managed. As well as improved symptoms, the low FODMAP diet has been shown to improve:
- Mental wellbeing
- Reduce stomach pains
- Reduce bloating
- Improve quality of life
- May increase energy levels
In general, the low FODMAP diet is one step closer to creating a tailored lifestyle suitable for an IBS sufferer’s dietary triggers. It is an important step in managing their specific symptoms, accommodating each body in a unique way to overall improve their quality of life. Beginning a low FODMAP diet is often the beginning of a journey to recovery and management for someone with IBS and can have positive effects on mindset and mental health. However, beginning a low FODMAP diet is not easy; it requires a lot of planning and determination as it is intense and time-consuming. Results are not often seen for the first time until months after dedication.
Stages of the low FODMAP diet
The first step in reducing IBS symptoms through food is by restricting fermentable carbs. This means a strict regime that eliminates all high FODMAP foods from the diet entirely. This first step is almost like wiping the whiteboard clean to start from scratch and find the route of the problem. The reason why foods are eliminated is to determine which foods trigger symptoms and in what amount. The restriction period usually lasts several weeks but it should not be maintained. High FODMAP foods may be troublesome for IBS sufferers but they are essential for gut health and nutrient requirements. Therefore, a low FODMAP diet is recommended as a temporary step in a long-term solution. High FODMAP foods are important for the beneficial bacteria that live in our gut which are in turn, important for overall gut health. The restriction process ends when you no longer have symptoms and then the next stage comes–reintroduction, which we will talk about soon.
Examples of high FODMAP foods which could trigger IBS symptoms:
- Dairy products
- Wheat products
- Sweetened foods
- Orange juice
- Fatty foods
These are just some of the foods which could trigger symptoms; ones which contain lactose, fructose and gluten. Eliminating such a diverse group of food can be difficult and it takes a lot of planning to commit to such a strict diet. Soon we will discuss steps 2 and 3 of the process – reintroduction of high FODMAP foods and a tailored, long-term conclusion known as the ‘modified low FODMAP diet’. These steps begin to see the results of weeks or months of strict elimination and the beginning of recovery and reduced symptoms long-term.