Madeleine Hull
The FODMAP diet is often recommended for people with irritable bowel syndrome (IBS) to alleviate gastrointestinal symptoms. Since diet plays a key role in managing both IBS and diabetes, some individuals with diabetes may also benefit from the FODMAP diet. Type 2 diabetes (T2D) is a disease characterised by chronic inflammation, and a diet high in FODMAPs may influence the balance of health-related gut microbiota, potentially aiding in the management and prevention of T2D. The FODMAP diet involves limiting fatty foods and consuming appropriate portion sizes, while also including low-FODMAP fruits, vegetables, whole grains, and dairy. Regular exercise can also assist in managing blood sugar levels and improving overall wellbeing.
| Characteristics | Values |
|---|---|
| Prevalence | Diabetes affects around 4% of Australians, while IBS affects around 15% |
| Diet | Carbohydrates are important for people with diabetes as they affect blood glucose levels. Carbohydrate foods include bread, cereals, fruit, vegetables, pulses, and dairy. |
| Fruits | Include 2 servings of low FODMAP fruit each day. One serve is around 150g of fruit (e.g. 1 medium orange or banana, ~10 strawberries, 1 cup of grapes, or 2 small kiwifruits). Limit fruit juice and dried fruit. |
| Vegetables | All low FODMAP vegetables are fine for people with diabetes. They are naturally low in kilojoules, high in fiber, and packed with vitamins, minerals, and antioxidants. |
| Dairy | Include 2-3 servings of low-fat dairy per day. If lactose intolerant, use lactose-free varieties. |
| Legumes | Canned chickpeas and lentils are lower FODMAP options, but other legumes like cannellini beans and split peas are high in FODMAPs. |
| Fiber | High-fiber foods are recommended for people with diabetes to help stabilize blood sugar levels. These include whole-grain bread, pasta, cereal, and brown rice. |
| Exercise | Regular exercise can improve blood sugar control and contribute to overall wellbeing. |
| Type 2 Diabetes | Type 2 diabetes is characterized by chronic inflammation and is influenced by gut microbiota and short-chain fatty acids (SCFAs). A diet high in FODMAPs may be a novel strategy for managing T2D by altering the balance of gut microbiota. |
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What You'll Learn
FODMAP diet and diabetes management
Diet plays a crucial role in managing diabetes. The two most common types of diabetes are Type 1 Diabetes Mellitus (T1DM) and Type 2 Diabetes Mellitus (T2DM), with the latter accounting for up to 90% of all cases. Insulin, a hormone that helps blood sugar (glucose) enter cells to be used as energy, does not work properly in people with diabetes, causing a build-up of sugar in the blood.
The low FODMAP diet has been suggested as a potential dietary strategy for people with diabetes, especially those who also suffer from irritable bowel syndrome (IBS). FODMAP stands for poorly absorbed fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, which are types of carbohydrates. A diet high in FODMAPs can help increase health-promoting bacteria in the gut, such as Akkermansia muciniphila and Bifidobacterium, which are typically reduced in people with T2DM. These bacteria produce short-chain fatty acids (SCFAs) through the fermentation of carbohydrates, which have both pro-inflammatory and anti-inflammatory effects. Modulating the quality and quantity of carbohydrates in the diet may help reduce glucose absorption and alter the balance of gut microbiota, potentially preventing and treating T2DM.
For people with diabetes, it is recommended to include two servings of low FODMAP fruit per day. Examples of low FODMAP fruits include oranges, bananas, strawberries, grapes, and kiwifruit. It is also advised to limit fruit juice and dried fruit, as they are often high in FODMAPs and can be detrimental to dental health. All low FODMAP vegetables are suitable for people with diabetes, as they are naturally low in calories, high in fibre, and packed with vitamins, minerals, and antioxidants.
When it comes to grains, opt for healthy, low FODMAP, higher-fibre, whole-grain foods such as brown rice, basmati rice, polenta, spelt sourdough bread, wheat, and fruit-free muesli. Dairy is also an important part of the diet, with a recommendation of 2-3 servings of low-fat dairy per day. If lactose intolerance is a concern, lactose-free varieties can be consumed. Legumes, while nutritious, can be high in FODMAPs, so it is suggested to opt for lower FODMAP varieties like canned chickpeas and lentils.
In addition to the low FODMAP diet, regular exercise is recommended, as it can improve blood sugar control and contribute to overall well-being. It is also suggested to limit fatty foods and maintain appropriate portion sizes to reduce potential triggers for IBS symptoms.
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Carbohydrates and diabetes
Carbohydrates and blood sugar control in diabetes
Carbohydrates are important in diabetes management because they are broken down into glucose (blood sugar) in the bloodstream, affecting blood glucose levels. Therefore, people with diabetes may need to monitor their carbohydrate intake and choose nutrient-dense carbohydrates.
Carbohydrate counting, or "carb counting", is a common strategy for people with diabetes to manage their blood sugar levels. It involves counting the grams of carbohydrates in meals and matching them to insulin doses. This can be particularly important for those taking mealtime insulin.
There are three main types of carbohydrates: starches, sugars, and fiber. Sugars and starches raise blood sugar, while fiber does not. When choosing carbohydrates, it is recommended to prioritize whole, unprocessed, non-starchy vegetables, such as lettuce, cucumbers, broccoli, tomatoes, and green beans. These vegetables are high in fiber and low in carbohydrates, minimizing their impact on blood glucose levels.
In addition to vegetables, whole, minimally processed carbohydrate sources such as fruits (e.g., apples, blueberries, strawberries) and intact grains (e.g., brown rice, whole wheat bread, whole grain pasta) are recommended. These foods provide essential nutrients while helping to manage blood sugar levels.
It is also important to limit high-carbohydrate liquids such as fruit juice, smoothies, sodas, and sweetened coffees and teas. These liquids can cause a rapid increase in blood sugar levels. Instead, it is recommended to eat whole fruits rather than drinking fruit juice.
For those with diabetes and IBS, a low-FODMAP diet may be beneficial. FODMAPs are found exclusively in carbohydrate foods, so individuals with IBS are familiar with modifying their carbohydrate intake. The low-FODMAP diet involves limiting fatty foods, ultra-processed foods, and large portion sizes, which can trigger IBS symptoms.
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Fibre and diabetes
Fibre is a type of carbohydrate found mainly in fruits, vegetables, whole grains, and legumes. It is an essential part of a healthy diet, offering a range of health benefits, including preventing or managing diabetes. Fibre helps control blood sugar, as it is not absorbed or broken down by the body, thereby preventing spikes in blood sugar. Fibre also helps protect the heart by preventing the body from absorbing fat and cholesterol, thus lowering triglyceride and cholesterol levels. This, in turn, may reduce the risk of heart disease, a common diabetes complication.
Fibre also helps maintain digestive health, acting like a scrub brush to clean the digestive tract and reduce the risk of colon cancer. Fibre keeps you feeling full, as it moves slowly through the stomach, and can help with weight management. It is important to note that a sudden increase in fibre can lead to digestive discomfort, so it is recommended to increase fibre intake gradually and drink plenty of water to aid digestion.
For individuals with diabetes, it is beneficial to include a range of high-fibre foods in the diet, such as fruits, vegetables, nuts, and seeds. Soluble fibre, found in apples, bananas, oats, and certain beans, dissolves in water and forms a gel-like substance in the stomach, slowing digestion and helping to control blood sugar and cholesterol. Insoluble fibre, found in whole wheat flour, bran, nuts, seeds, and the skins of many fruits and vegetables, helps increase insulin sensitivity and promotes healthy bowel function.
Additionally, certain types of fibre, known as fermentable fibre or prebiotics, act as a food source for beneficial gut bacteria, promoting their growth and contributing to improved gut health. Prebiotic fibres swell and form a gel in the gut, trapping glucose and cholesterol molecules, which helps manage cholesterol levels and slows the release of glucose into the blood. This is particularly advantageous for individuals with diabetes, as it improves insulin resistance and lowers the glycaemic index of foods.
It is worth noting that while fibre is an important component of diabetes management, portion control is still crucial, as healthy high-fibre foods often contain carbohydrates that can impact blood glucose levels. Overall, increasing fibre intake is a recommended strategy for individuals with diabetes, offering a range of health benefits and contributing to improved diabetes management.
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Exercise and diabetes
Exercise is a crucial aspect of managing diabetes and prediabetes, regardless of the type. It is a key component of lifestyle therapy for the prevention and treatment of type 2 diabetes (T2D). For type 1 diabetes (T1D), evidence suggests that exercise can help reduce diabetes-associated complications. According to the American Diabetes Association (ADA), adults with diabetes should engage in at least 150 minutes of moderate-to-vigorous aerobic activity weekly, spread over at least three days, and two to three sessions of resistance training on non-consecutive days.
Regular exercise, along with medical nutrition therapy, forms the foundation of diabetes therapy. It offers numerous benefits, including weight management, reduced blood pressure, improved insulin sensitivity, and better glucose control. Additionally, exercise can contribute to overall well-being and improve energy levels, especially for those with IBS.
While exercise is essential, there are physiological and behavioural barriers that individuals with diabetes must navigate. Physiological barriers include diabetes-mediated impairment in functional exercise capacity and increased rates of perceived exertion with lower workloads. Behavioural barriers can include social and psychological factors such as depression and reduced self-efficacy.
It is important to note that the response to exercise can vary based on sex, genetics, and environment, which makes defining the optimal exercise regimen challenging. However, this should not deter individuals with diabetes from staying active. Even if one cannot perform aerobic exercises, there are other forms of physical activity that can be explored to maintain overall health and wellness.
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IBS and diabetes
Diabetes and Irritable Bowel Syndrome (IBS) are two distinct disorders with no physiological overlap, but they are both highly prevalent in the population. Diabetes affects around 4% of Australians, while IBS affects around 15%. A crude estimate suggests that around 150,000 Australians are affected by both conditions, and many more people with IBS are likely to either have undiagnosed diabetes or be at high risk of developing it.
IBS is a gastrointestinal disorder characterised by a group of symptoms that typically occur together, including pain in the abdomen and changes in bowel movements that occur at least one day a week. It is thought to be related to problems with how the brain and gut work together. Diabetes, on the other hand, is a condition where the body cannot properly break down sugars in the small intestine due to a hormone imbalance. This causes a build-up of sugar in the blood, which can lead to nerve damage, also known as neuropathy, in the gastrointestinal tract. This, in turn, can impair the brain's ability to communicate with the gut, causing a slowing down or speeding up of intestinal function, leading to either constipation or diarrhoea—common symptoms of IBS.
Managing both conditions can be challenging, as diet plays a key role in both. People with diabetes are advised to eat high-fibre foods such as whole grains, vegetables, and beans to help stabilise blood sugar levels. However, people with IBS are often advised to limit their fibre intake, as it can trigger symptoms. Legumes, such as beans, may also trigger IBS symptoms, though this isn't true for everyone. Similarly, while people with diabetes are advised to limit their sugar intake, many sugar substitutes are linked to gastrointestinal symptoms and may need to be avoided if you have both conditions.
To manage both conditions effectively, it is recommended to work with a dietitian or nutritionist knowledgeable about both disorders to develop a balanced food plan. This may include incorporating soluble fibre, which can help firm stool and reduce gas, as well as limiting fatty foods and having appropriate portion sizes to reduce potential triggers for IBS. Regular exercise can also assist in managing both conditions by improving constipation and energy levels in IBS, and contributing to overall wellbeing and blood sugar control in diabetes.
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Frequently asked questions
FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. The diet involves reducing the intake of poorly absorbed FODMAPs, which are found in certain carbohydrate foods.
The FODMAP diet can help manage diabetes by reducing glucose absorption and altering the balance of gut microbiota. This can lead to improved insulin secretion and better control of blood sugar levels.
If you have diabetes, it is recommended to include low FODMAP fruits and vegetables in your diet. Healthy, low FODMAP, higher-fibre, whole grain foods include brown rice, basmati rice, and quinoa flakes. It is also suggested to include 2-3 servings of low-fat dairy per day.
Yes, the FODMAP diet can also help improve overall health and manage symptoms of IBS, which is commonly co-existent with diabetes. Regular exercise is also recommended to improve blood sugar control and contribute to overall wellbeing.
