30-year-old Shweta (name changed) had been experiencing a range of gastrointestinal issues, including sudden constipation, diarrhoea, acidity, and abdominal pain. After consulting with several gastroenterologists, she was diagnosed with oesophagitis, which explained her symptoms of acidity and indigestion. However, this diagnosis did not account for her chronic constipation followed by episodes of diarrhoea. When she consulted her family doctor, he suggested that Irritable Bowel Syndrome (IBS) could be the underlying cause. While the doctor reassured her that IBS is common and not typically a cause for concern, he recommended she follow a low FODMAP diet with an emphasis on reducing dairy intake.
We at OnlyMyHealth interacted with Dr Bhushan Bhole, Senior Consultant - Liver Transplant and GI Surgery, PSRI Hospital, New Delhi, who not only helped explain what a low FODMAP diet constitutes but also shared whether or not it benefits IBS patients.
What Exactly Is A Low-FODMAP Diet?
A low-FODMAP diet is a type of diet that restricts foods that contain fermentable sugars, or FODMAPs, that are difficult for some people to digest.
Dr Bhole said FODMAPs refers to fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, which are poorly absorbed by the small intestine and can lead to digestive problems.
According to an article published in StatPearls Publishing, these short-chain carbohydrates are associated with worsening or onset of functional gastrointestinal symptoms such as cramping, bloating, and diarrhoea.
As per Johns Hopkins Medicine, low FODMAP is a three-step elimination diet, which includes:
- Restricting consumption of certain foods (high FODMAP foods).
- Slowly reintroducing them to see which ones are troublesome.
- Once the cause of the symptoms is identified, one can avoid or limit them while enjoying everything else worry-free.
Are Low-FODMAP Diets Effective For People With IBS?
Dr Bhole said, "Majority of studies agree that a low-FODMAPS diet may be helpful for IBS sufferers in some cases.
In fact, research suggests that eliminating FODMAPs from a person’s diet has improved symptoms of IBS and coeliac disease.
However, the diet may carry some risks, warned Dr Bhole, advising people to follow it under a doctor's supervision.
In addition, further studies are needed to know how to follow the diet most effectively and how long it could last, he noted.
Common High FODMAP Foods To Avoid
According to Dr Bhole, everybody's response to FODMAPs is unique. Therefore, identifying whether or not FODMAPs are the source of the symptoms is crucial. If consuming FODMAPs is in fact the cause of your symptoms, it is important to know which foods trigger them.
This can be done gradually by reintroducing meals to the affected individual to distinguish between those that are truly harmful and those the patient can handle.
However, research shares a list of FODMAPs that should be avoided to alleviate symptoms:
- Wheat and rye products
- Certain stone fruit, including apricots, cherries, peaches, and prunes), persimmons, watermelons, artichokes, and beets
- Some cruciferous vegetables
- Fennel
- Garlic
- Leek
- Onions
- Peas
- Barley
- Some nuts and seeds
- Lentils
- Chickpeas
- Mushrooms
- Artificial sweeteners
Foods To Eat In A FODMAP Diet
When following a low FODMAP diet, the goal is not to completely eliminate FODMAPs but to minimise them to reduce symptoms for those with IBS, says Dr Bhole.
Here are a variety of foods that you can still enjoy:
- Meats, fish, eggs (without high FODMAP additives)
- Certain nuts and seeds
- Fruits and vegetables
- Grains like oats, rice, and quinoa
However, individual tolerance to FODMAPs varies, so it's important to listen to your body, Dr Bhole reiterates.
Assessing The Potential Risks Of A Low FODMAP Diet
While some individuals may find the low-FODMAP diet beneficial, others may risk certain nutritional deficiencies, as the diet is quite restricted. Dr Bhole says, "... particularly an insufficient intake of fibre can arise and exacerbate gastrointestinal problems, even if the first restricted phase is relatively transitory."
He adds, "The diet is inappropriate for anyone who has a history of disordered eating or who may be at risk of acquiring it since food restrictions can also create an atmosphere that encourages disordered eating."
The doctor concludes by emphasising that the low-FODMAP diet is only one kind of treatment for those with IBS and that it is frequently combined with other forms of therapy, including behavioural and pharmaceutical approaches.