Managing IBS with low-FODMAP diet: What you need to know

Hyderabad: The low-FODMAP diet has emerged as a critical dietary intervention for individuals suffering from irritable bowel syndrome (IBS) and other digestive disorders.

By temporarily restricting certain carbohydrates known as fermentable short-chain carbohydrates, this diet aims to alleviate symptoms such as bloating, gas and abdominal pain.

Developed through research at Monash University, the low-FODMAP diet provides a structured approach to identifying specific food sensitivities, allowing individuals to tailor their diets for optimal digestive health.

Understanding the low-FODMAP diet

FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols.

“These are fermentable short-chain carbohydrates that are difficult for some people to digest. A low-FODMAP diet temporarily restricts these carbohydrates to relieve uncomfortable symptoms and give the digestive system a rest,” said Hyderabad nutritionist, Dr Deepa Agarwal.

How do FODMAPs affect gut health?

Fermentable: These are foods that gut bacteria ferment, producing gases as a byproduct. This can lead to symptoms such as gas, bloating, and abdominal discomfort.

Oligosaccharides: These soluble plant fibres, known as prebiotics, feed beneficial gut bacteria.

“Common sources include onions, garlic, beans, lentils, and many wheat products. Sensitivity to oligosaccharides may explain some cases of non-celiac gluten sensitivity,” said Dr Vimalkar Reddy Eppa, a gastroenterologist at PACE hospitals.

Disaccharides: Lactose, found in dairy products and human milk, is the primary sugar in this group. Lactose intolerance is widespread and can cause digestive issues.

Monosaccharides: Fructose, the sugar found in fruits, is the key sugar in this group. Not all fruits are problematic, as issues depend on quantities and proportions.

Polyols: Sugar alcohols used as artificial sweeteners and naturally found in some fruits fall into this category. “Polyols can cause digestive discomfort in some individuals,” noted Dr Agarwal.

Why are FODMAPs difficult to digest?

FODMAPs are short-chain carbohydrates that need to be broken down into single molecules to be absorbed in the small intestine.

“Since FODMAPs can’t be broken down, they pass into the large intestine, where bacteria ferment them, producing gases and fatty acids. This fermentation process can cause symptoms like gas, bloating, and abdominal pain,” explained Dr Eppa.

Are FODMAPs bad for everyone?

Not necessarily, stated doctors. FODMAPs can be beneficial for digestive health as they feed gut bacteria, part of a symbiotic relationship.

“However, for people with sensitive guts, FODMAPs can cause significant discomfort. “For some, the byproducts of fermentation lead to chronic symptoms,” said Dr Agarwal.

Who benefits from a low-FODMAP diet?

The low-FODMAP diet is often recommended for people with irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO).

Studies indicate that many individuals with these conditions benefit from the diet. It can also serve as a short-term elimination diet for those with digestive problems, helping to identify specific food sensitivities.

The three phases of a low-FODMAP diet

Elimination Phase: This phase involves avoiding all high-FODMAP foods for two to six weeks. This period allows the digestive system to reset.

Reintroduction Phase: Over about eight weeks, high-FODMAP foods are reintroduced one at a time to test tolerance. This phase helps identify which foods are problematic.

Maintenance Phase: A customised diet is developed based on individual tolerance levels. This phase ensures a balanced, nutritious diet that avoids problematic foods.

Foods to eat and avoid on the low-FODMAP diet

Low-FODMAP foods include:

Proteins: Plain-cooked meats, tofu, eggs.

Fruits: Grapes, strawberries, pineapples.

Vegetables: Carrots, spinach, zucchini.

High-FODMAP foods include:

Legumes: Beans, lentils.

Processed meats: Sausages, deli meats.

Fruits: Apples, watermelon, stone fruits.

“Consult a healthcare provider before starting the diet. They can offer guidance, menu plans, and troubleshooting tips. A registered dietitian can help navigate the complexities of this diet,” said Dr Agarwal.

What if a low-FODMAP diet doesn’t work?

Not everyone benefits from the low-FODMAP diet.

If it doesn’t work, other elimination diets and therapies are available. “It’s important to follow the diet under expert guidance,” advised Dr Agarwal. “Your healthcare provider will monitor your nutrition and suggest alternatives if necessary.”

“The low-FODMAP diet can significantly relieve symptoms for those with IBS, SIBO, and other digestive issues. By systematically identifying food sensitivities, individuals can achieve a balanced and symptom-free diet,” she concluded.