Live in health with Dr. Sasha High

Low FODMAP Diet: An Evidence-Based Treatment for IBS

Low FODMAP Diet: An Evidence-Based Treatment for IBS

Do you suffer from gas, bloating, cramps, diarrhea or constipation? Have you been told that you have Irritable Bowel Syndrome? This common condition affects nearly 20% of the population and is more common in women than men. From the medical perspective, if a patient comes in complaining of abdominal discomfort and the symptoms above, IBS is usually a “diagnosis of exclusion”, meaning we want to rule out any more ominous GI conditions first. “Red flags” that might suggest a more serious condition include:

  • blood in your stool
  • abdominal pain at night
  • weight loss
  • fevers/chills/night sweats

If you experience any of these, you definitely want to see your doctor.

Many people think they have IBS because they’ve experienced gas and bloating after drinking milk, or experienced cramping and abdominal discomfort after eating a big pizza. For others, it’s cauliflowers and onions or that delicious Indian chickpea curry at a friend’s house… (Okay, okay, I maaaay be describing myself!). Many people (myself included!) have had these symptoms since childhood and thought this was just the “norm”. Not so, apparently. I discovered in medical school that my cramping and gas were not a normal experience after eating, and learned that I am both lactose and gluten intolerant.

Enter FODMAPs… suddenly I’m not a gassy girl anymore 😉

 

What does FODMAPs stand for?

FODMAPs stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These include specific sugars called fructans, galactans, lactose, and fructose found in various foods. These small chain sugars ferment in your colon and can contribute to gastrointestinal (GI) symptoms, such as bloating, gas, diarrhea and cramping.

 

What does the low FODMAPs diet involve?

The low FODMAPs diet involves eliminating foods that contain these small chain sugars for at least 6 weeks to see if your GI symptoms resolve. After that, you can slowly start reintroducing foods in a stepwise manner to identify which foods are particularly bothersome. It can be a somewhat restrictive diet, so it is not recommended to stay on it forever, but rather as a trial to identify specific food intolerances or the “threshold dose” at which you develop GI symptoms (for example, one may be able to tolerate 1/4 avocado but not more).

 

Does it really work?

There is good evidence from controlled clinical trials to support the use of a low FODMAPs diet as first line therapy for the management of IBS. Here are some studies if you’re interested:

  • Halmos EP, et al. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology. 2014 Jan;146(1):67-75.e5. Epub 2013 Sep 25.
  • Ong DK, et al. Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome. J Gastroenterol Hepatol. 2010 Aug;25(8):1366-73.
  • Staudacher HM, et al. Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome. J Hum Nutr Diet. 2011 Oct;24(5):487-95.

 

How do I get started?

There are lots of lists and tables out there describing low versus high FODMAPs foods, so instead of reproducing it here, I am going to direct you to the Stanford University information sheet available here.

I hope this is helpful for many of you! I have seen improvements in myself, friends and many patients so I am certain that there are many others out there who will benefit. As one friend described it: “My farts no longer stink… it’s LIFE CHANGING!”  (true story! haha enjoy)