Milly Gaines
Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder characterised by abdominal pain associated with defecation or a change in bowel habits. While there is no single treatment for IBS-C that works for everyone, there is evidence that a low-FODMAP diet can reduce the bloating, gas, and pain that are part of IBS-C. FODMAP is an acronym for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, which are types of carbohydrates that are harder to digest. The low-FODMAP diet is a temporary elimination diet that helps people with IBS identify which foods are problematic and which reduce symptoms.
| Characteristics | Values |
|---|---|
| Purpose | To help people with IBS-C identify and manage their triggers and control their symptoms. |
| Foods to Avoid | Fermentable carbohydrates, including sugars, starches, and fibers: oligosaccharides, disaccharides, monosaccharides, and polyols. |
| Foods to Include | Tangerines, soy and almond milk, quinoa, and blueberries. |
| Dietary Tips | Increase fiber intake, especially soluble fiber. Ensure a good balance of fiber and fluids. |
| Duration | Temporary, typically 2–6 weeks for the elimination phase, followed by gradual reintroduction. Not recommended long-term due to potential negative effects on the gut microbiome. |
| Effectiveness | Studies show 70–86% of people with IBS experience symptom relief, but it may not improve constipation in IBS-C. |
| Considerations | Consult a doctor or registered dietitian before starting the diet for proper guidance and management of symptoms. Not suitable for those with a low body weight. |
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What You'll Learn
The low-FODMAP diet
The diet involves three steps: elimination, reintroduction, and maintenance. During the elimination phase, all high-FODMAP foods are avoided for two to six weeks until symptoms improve. High-FODMAP foods include fruits with pits or seeds, such as apples, avocados, cherries, figs, peaches, and plums, as well as soft, unripened, and fresh cheeses like brie, cottage cheese, cream cheese, ricotta, and sour cream. It is important to note that FODMAPs are not inherently bad, as many foods rich in them encourage the growth of good bacteria in the gut.
In the reintroduction phase, each group of high-FODMAP foods is individually reintroduced one at a time, with guidance from a healthcare professional. This allows for the identification of specific FODMAPs that trigger symptoms. The maintenance phase involves creating a personalized diet that limits problematic high-FODMAP foods while ensuring a proper nutritional balance.
While the low-FODMAP diet has been shown to reduce IBS symptoms such as bloating, gas, pain, and diarrhea, its effectiveness in improving constipation is less clear. In fact, the diet's restrictions can make it challenging to obtain sufficient fiber, potentially exacerbating constipation. Therefore, it is crucial to work with a healthcare professional when considering the low-FODMAP diet to ensure it is done safely and effectively.
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High-FODMAP foods to avoid
A low-FODMAP diet is often recommended for people with IBS-C. FODMAPs are a group of fermentable carbohydrates, which include fructo-oligosaccharides (FOS), galacto-oligosaccharides (GOS), disaccharides (e.g. lactose), monosaccharides (e.g. fructose), and polyols (e.g. sorbitol). These types of carbohydrates are harder to digest and can cause excess gas, bloating, and pain in people with IBS-C.
Garlic and Onion: Garlic and onion are some of the most concentrated sources of FODMAPs. They are commonly used as flavoring agents in many dishes, making them difficult to restrict. However, they do offer several health benefits, so they should only be avoided by those sensitive to FODMAPs.
Fruits: While fruits are not entirely off-limits, some are considered high in FODMAPs, particularly those high in excess fructose and sorbitol. These include apples, pears, mangoes, cherries, figs, nashi pears, watermelon, dried fruit, blackberries, peaches, and plums.
Vegetables: Whole vegetables like chopped garlic, sliced onions, scallions, leeks, and pickled onions are high in FODMAPs. It is important to watch for products containing garlic or onion powder or flakes as well.
Legumes and Pulses: These are notorious for causing excess gas and bloating due to their high FODMAP content. Examples include red kidney beans, split peas, falafels, and baked beans.
Dairy: Dairy foods that are high in lactose, such as soft cheeses, milk, and yogurt, are considered high-FODMAP. However, butter and hard cheeses are low in lactose and can be included in a low-FODMAP diet.
Grains and Cereals: Grain and cereal foods rich in fructans include wholemeal bread, rye bread, rye crispbread, muesli containing wheat, and wheat pasta. Other grains like rye contain almost twice the amount of FODMAPs as wheat.
Nuts: Most nuts are low in FODMAPs, but cashews and pistachios are high-FODMAP exceptions.
Sweeteners: Sugar-free mints and chewing gums often contain added polyols like sorbitol, mannitol, xylitol, or isomalt. High-FODMAP sweeteners can increase the overall FODMAP content of a food product.
It is important to note that not everyone should avoid FODMAPs, as they are beneficial for most people. It is recommended to consult a healthcare professional to determine if a low-FODMAP diet is suitable for you.
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Reintroducing foods
A low-FODMAP diet is a common treatment approach for IBS-C. FODMAPs are a group of fermentable carbohydrates, including oligosaccharides, disaccharides, monosaccharides, and polyols. These are types of carbohydrates that are harder to digest.
The low-FODMAP diet is a temporary elimination diet, where all high-FODMAP foods are avoided until symptoms improve or for up to four to six weeks. The goal is to identify which types of foods may be causing your symptoms.
After the elimination phase, each group of high-FODMAP foods is individually reintroduced, and symptoms are monitored. This is done to determine which specific foods trigger symptoms, as this varies from person to person. It is recommended to reintroduce a high-FODMAP food every three days, one at a time, to see if it causes any symptoms. If a particular high-FODMAP food causes symptoms, then it should be avoided long-term.
The reintroduction phase is part of personalizing the low-FODMAP diet to the individual's needs and creating a modified FODMAP-containing diet based on their tolerance. It is recommended to work with a trained dietitian or doctor to safely develop and follow a low-FODMAP diet and to supervise the food reintroduction.
It is important to note that a low-FODMAP diet alone may not be sufficient to alleviate IBS-C symptoms. Other tips to prevent constipation include increasing fibre intake, especially soluble fibre, and staying hydrated.
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Managing constipation
A low FODMAP diet is often considered for managing constipation-type irritable bowel syndrome (IBS-C) if other approaches have not worked. FODMAP is an acronym for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols—types of carbohydrates that are harder to digest.
A low FODMAP diet is a temporary elimination diet that can help identify which types of foods are causing your symptoms. It is restrictive and not meant to be followed long-term. It is typically followed for four to six weeks, after which high FODMAP foods are reintroduced one by one to identify triggers.
While a low FODMAP diet can help reduce the pain, bloating, and gas associated with IBS-C, it may not necessarily improve constipation. However, some people do find that it helps with their symptoms. A low FODMAP diet is more likely to improve symptoms in people with diarrhea as the primary bowel change (IBS-D).
- Increase your fibre intake: Many people with IBS-C feel better when they increase their fibre intake, especially soluble fibre. Soluble fibre is found in some vegetables and fruits, oats, legumes, nuts, and seeds, as well as fibre supplements like psyllium and Metamucil. Resistant starch-rich foods include legumes, cold cooked potatoes, and firm bananas. Including a variety of fibres in your diet will ensure you get the health benefits of all of them. However, it can be challenging to get enough fibre on a low FODMAP diet, so be sure to have a plan to meet your fibre needs.
- Take laxatives as prescribed: If your doctor recommends laxatives, be sure to take them as instructed. Laxatives can help increase stool motility, bulk, or frequency but are usually recommended for short-term use. When misused or overused, they can cause problems, including chronic constipation.
- Stay hydrated: Drinking plenty of water will help keep the stool soft and easy to pass. It is essential to stay hydrated, especially when taking osmotic laxatives and soluble fibre supplements.
- Listen to your body: If you feel the urge to have a bowel movement, go as soon as you can, even if it means using a public toilet.
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The Mediterranean diet
However, combining the two diets can be challenging due to the high-fibre content of the Mediterranean diet and the presence of FODMAPs in certain Mediterranean foods. FODMAPs, or fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, are types of carbohydrates that are harder to digest and can trigger IBS symptoms.
To successfully integrate the Mediterranean diet with low FODMAP principles, strategic substitutions and adjustments are necessary. This involves meal planning, reading labels, and opting for low FODMAP fruits, such as strawberries, blueberries, oranges, and grapes.
Overall, the Mediterranean diet, with its anti-inflammatory benefits and focus on whole foods, may offer a complementary approach to the low FODMAP diet in managing IBS-C symptoms and enhancing gut health.
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Frequently asked questions
FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, which are short-chain carbohydrates (sugars) that the small intestine absorbs poorly. A low-FODMAP diet is designed to help people with irritable bowel syndrome (IBS) have better control over their symptoms by limiting certain foods.
Research shows that a low-FODMAP diet can help reduce the pain, gas, and bloating that is part of IBS-C. However, it may not improve constipation, although some people do find it helps. It is important to note that a low-FODMAP diet is just one of many approaches to managing IBS-C.
It is recommended to work with a dietitian experienced with the low-FODMAP diet. The diet is typically followed for 2 to 6 weeks, after which high-FODMAP foods are gradually reintroduced to identify individual triggers. It is important to note that the low-FODMAP diet is not meant for weight loss and can be challenging due to its restrictive nature.
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