Low FODMAPS Diet for IBS

What's a FODMAP? It's an acronym that stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. FODMAPS include fructans, galactans, polyols, fructose, and lactose.

In plain English? A FODMAP is just a type of short chain carbohydrate that (for some people) is poorly digested. FODMAPS are found in certain fruits, vegetables, milk and wheat. Some manufacturing by-products that are pure FODMAPS (inulin, FOS, GOS) are also commonly added to foods, drinks, and supplements. Note that gluten is NOT a FODMAP.

The low FODMAP diet, and IBS dietary advice in general, can seem overwhelming and contradictory. Hang in there, there are a lot of clear, easy steps to take that should get you feeling better quickly.

First of all, before you can even accept a diagnosis of IBS, let alone start a low FODMAP diet, you need to be tested for gluten intolerance (celiac), fructose intolerance, and lactose intolerance. All of these can mimic IBS but they are different problems, and require different dietary strategies.

If you have these food intolerances ruled out and you do have IBS, then the FODMAP approach isn't always the easiest, fastest, or best way to start. About one third of people with IBS don't have any FODMAP intolerances. The low FODMAP diet can also mistakenly lump together gluten, fructose, and lactose intolerances with IBS, and they are not remotely the same thing. Gluten isn't even a FODMAP - it's a protein. FODMAPS are carbohydrates. Fats, carbohydrates, and proteins are all discrete and unrelated elements.

Also, a low FODMAP diet does not address the well-established global IBS diet trigger foods such as fats and other GI stimlulants or irritants (red meat, dairy, fried foods, soda pop, coffee, caffeine, etc.). Nor does a low FODMAP diet address the critical need with IBS to distinguish between soluble fiber versus insoluble fiber.

The original author of the FODMAP approach in Australia, Sue Shepherd, touched on these crucial issues in her actual scientific research papers, but somehow that info is often dropped as her research is disseminated down the line to America, and from medical papers to more patient-oriented publications. If you follow a low FODMAP diet, make sure you are accounting for this oversight.

First things first, make sure that you've had the tests for those food intolerances so you know what you're truly dealing with. Then, focus on your soluble fiber safe foods, eliminate the universal IBS trigger foods, and be cautious with insoluble fiber foods.

There is an IBS diet cheat sheet you can print out that will give you quick and easy food lists for these concerns.

Remember that with IBS, it is also a matter of HOW you eat, not just WHAT you eat.

Get your foundation diet of Eating for IBS established and see how you do with that. You might not need to take things any further. If you do, then once you're at that point you can add in the low FODMAPS restrictions and see if that offers additional help.

If you take that step, please note that the low FODMAPS approach is one that is specifically recommended to be done only under the direct supervision of a registered dietitian. This is because it is NOT a blanket exclusion diet. You are supposed to carefully figure out which specific (if any) FODMAPS groups you are sensitive to (fructose, galactans, oligosaccharides, etc.), and then find the highest amount you can tolerate. This is to make the FODMAP diet as unrestrictive as possible, and this can only be done on an individual basis.

What you don't want to do is just eliminate, forever, all of the high FODMAPS foods across the board. You might well have a problem with none of them, or just some of them, and to varying degrees. It is a very individualized diet. It can also be complicated, which is why it's supposed to be done with a registered dietitian. It is a serious concern if someone just eliminates all high FODMAPS foods, probably unnecessarily, as you would end up with a very nutrient-poor diet as a result.

In addition, there is growing (and worrisome) research showing that a low FODMAP diet negatively impacts the gut biome, and the healthy bacteria of the gut. As a result, the low FODMAP diet is not suggested on a permanent basis, and research into the consequences of a low FODMAP diet is continuing.

Interestingly, a 2018 study found that prebiotic supplementation could replace the low FODMAPs diet as a treatment for IBS. The study compared the results of a prebiotic soluble fiber supplement plus a Mediterranean-type diet, versus a placebo supplement plus the low FODMAP diet.

Fecal microbiota composition, intestinal gas production, and digestive sensations were all measured outcomes. While both groups showed improved GI symptoms, only the prebiotic group showed significant improvements in microbial composition. Alarmingly, the low FODMAP group actually showed an increase in pathogenic-associated bacteria. In addition, following the dietary intervention, improvements persisted only in the prebiotic group - not the FODMAP group. Learn more about prebiotics for IBS.

If you do work with a registered dietitian on the low FODMAPS diet, make sure they also address the standard high fat trigger foods and GI irritants, and the importance of soluble fiber safe foods. Excluding high FODMAPS foods without adjusting your diet for the other IBS concerns is much less likely to give good overall results.

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   Heather's IBS Diet Cheat Sheet for Irritable Bowel Syndrome     
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