The low FODMAP diet has been gaining popularity lately for its efficacy in the treatment of irritable bowel syndrome (IBS). IBS is defined as a chronic and lifelong disorder of the gastrointestinal (GI) tract with no definable structural or biochemical cause and can significantly impair quality of life. Standard treatments for IBS have been lifestyle and stress management approaches as well as medications and referral to a registered dietitian. One recent study showed that, unfortunately, only 50 percent of patients reported satisfactory relief of symptoms with standard dietary modifications. In that same study, authors found that 86 percent of patients had reported relief of symptoms while following a low FODMAP diet.
FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. These are rapidly-fermentable carbohydrates, which are poorly absorbed in the gut. FODMAP consumption for healthy individuals offers many benefits such as natural laxation, provide a good source of prebiotics and the fermentation by-products such as short-chain fatty acid production may protect against colon cancer. Some people may experience negative GI side effects from consuming foods containing FODMAPs, such as people with IBS.
The diet has two phases, the elimination phase and the reintroduction phase. The elimination phase lasts for 6-8 weeks and restricts high FODMAP containing foods. Restriction includes many common foods such as milk, yogurt, cheese, apples, pears, watermelon, stone fruits, garlic, onion, wheat, rye, legumes and artificial sweeteners ending in “ol”. A GI doctor and dietitian can play an important role in educating patients on what foods to avoid and also to provide them with appropriate substitutes that will provide adequate nutrition to prevent deficiencies. As for the reintroduction phase, small amounts of high FODMAP containing foods are added back into the diet one at a time to evaluate for tolerance, with the goal of as much diet variety as possible without triggering negative symptoms.
The main benefit of the low FODMAP diet is that it has a good success rate in alleviating symptoms for IBS patients but there are some disadvantages and it may be difficult for all IBS patients to follow. Examples include: 1) It is a very strict diet and requires a significant time commitment, 2) It may not be suitable for people who rely heavily on convenience foods due to physical or social-economical circumstances 3) Limiting dairy products without appropriate substitutions can increase risk of developing osteoporosis. While more research needs to be done on the low FODMAP diet, current research supports this diet approach based on promising evidence that it may alleviate some negative GI symptoms in people with IBS.
A great visual with lists of high and low FODMAP containing foods can be located on www.ibsgroup.org and the direct link to the PDF file is http://www.ibsgroup.org/brochures/fodmap-intolerances.pdf
If you are interested in learning more about nutrition counseling sessions with a registered dietitian at Noble Hospital, please call 413-568-2811 ex: 5671 for more information.
