Bridging the Gap - Health Equity for all

Follow the FODMAP to the Hidden Treasure of Happy Bowels

Published on:

07 Dec 2023, 1:00 pm

Life is unfair. Then there’s not being able to predict when you’ll spend another day on the toilet. Irritable bowel syndrome (IBS) is a selection of intestinal issues that often include cramping, diarrhea, constipation, bloating, and gas. The exact cause is unknown, but it may be because of an over sensitive colon or immune system. Symptoms vary in severity, and the pain of IBS tends to trigger at least two of the following: <ul> <li>Differences in the appearance of stools</li> <li>Relief after a bowel movement</li> <li>Changes in the frequency of bowel movements</li> </ul> IBS leaves you at the mercy of a highly temperamental digestive system. What foods you can and cannot tolerate vary from person to person, so it’s a trial-and-error game that can be a lifelong battle. You may be blindsided by IBS only cropping up as an adult: suddenly you have to deal with this demoralizing and frustrating health issue that isn’t your fault, and you’re not even sure what’s triggering it in the first place. <figure><img alt="" height="320" src="https://cdn.storymd.com/optimized/XdbVkmU0dB/original.png" width="500" /> <figcaption>Depiction of a person suffering from Irritable Bowel Syndrome (IBS) Source: https://www.myupchar.com</figcaption> </figure> IBS is a common gastrointestinal disorder that affects 1 in 10 Americans, and it can have a significant impact on your quality of life. There’s no cure, so the focus is on symptom management. <h2>Causes and triggers of IBS</h2> The cause of IBS is not clear but may be related to an overly sensitive colon or immune system. The physical processes involved vary but may include spastic movements of the colon (causing cramping), abnormal levels of serotonin in the colon (affects motility and bowel movements), and a bacterial imbalance. For many living with the disorder, managing symptoms requires tracking and avoiding triggers. This is more than just the food you eat; stress and anxiety have been found to play a role in triggering IBS symptoms, for example. The nervous system is involved in the motility of your digestive system, so it makes sense that stress would make your digestive system overactive. Even slight disruptions of the digestive system may be enough to upset your colon with IBS. Lifestyle modifications and home remedies are the first line of action before medication, so physical activity, limiting stress and caffeine, quitting smoking, and taking probiotics or fiber may be recommended. Certain foods set off IBS, and many patients find success with analyzing and modifying their diet. Keeping a food diary and mapping out episodes where the condition is triggered can help to identify and eliminate problematic foods from your diet. <h2>FODMAP</h2> Designing your ideal diet as an IBS patient requires being tuned into your triggers, and there’s a tool in this vein that’s gained traction in recent years called FODMAP. This dietary approach is meant to help people with irritable bowel syndrome (IBS) or small intestinal bacterial overgrowth (SIBO) assess which foods are problematic and which ones reduce symptoms. “The low-FODMAP diet is a temporary eating plan that’s very restrictive,” commented Johns Hopkins gastroenterologist Hazel Galon. “It’s always good to talk to your doctor before starting a new diet, but especially with the low FODMAP diet since it eliminates so many foods — it’s not a diet anyone should follow for long. It’s a short discovery process to determine what foods are troublesome for you.” A FODMAP is a kind of carbohydrate that’s found in certain foods, and studies have established links between FODMAPs and common digestive problems. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols — short-chain carbohydrates that the small intestine finds difficult to absorb. Some people experience digestive issues after eating them. <figure><img alt="" height="576" src="https://cdn.storymd.com/optimized/RA8K87I9q9/original.jpg" width="414" /> <figcaption>Carbohydrates Source: US Department of Agriculture</figcaption> </figure> Foods high in FODMAPs include: <ul> <li>Dairy products like milk, yogurt, and ice cream</li> <li>Wheat products like cereal and bread</li> <li>Certain vegetables: onions, garlic, artichokes, and asparagus</li> <li>Fruits including apples, cherries, pears, and peaches</li> <li>Beans, soybeans, and lentils</li> </ul> Low-FODMAP foods that act as an alternative during the process include: <ul> <li>Dairy alternatives. Lactose-free milk and yogurt, almond milk, coconut milk, and hard cheeses like feta</li> <li>Fruit. Bananas, blueberries, grapefruit, kiwi, lemon, lime, oranges, and strawberries</li> <li>Vegetables: Bean sprouts, bok choy, carrots, chives, cucumbers, lettuce, olives, eggplant, ginger, potatoes, spring onions, and turnips</li> <li>Protein: Beef, pork, chicken, fish, eggs, and tofu (opt for extra-firm)</li> <li>Nuts. Almonds, peanuts, pine nuts, and walnuts (limit to 10–15 each)</li> <li>Grain. Oats and pasta alternatives like white rice, corn, and quinoa</li> </ul> The FODMAP diet has three steps. The first is to eliminate all high FODMAP foods, then slowly reintroduce them to identify which ones are problematic. After identifying problematic foods, you can avoid or limit your intake of them going forward. The elimination process should last between 2 and 6 weeks max. You can then start reintroducing a high FODMAP food back in one at a time every 3 days. Avoiding FODMAPS doesn’t help everyone, but some research has found that it may work to relieve symptoms in upward of 86% of patients. Several studies have reported positively on FODMAPs, but only a few dealing with low-FODMAP diets have been based on randomized placebo-controlled double-blind trials. The quality of evidence in some studies has been criticized and experts have called for more research to clarify the long-term efficacy of this approach. You may have already guessed one of the concerns with the FODMAP diet: a lot of the foods listed as high in FODMAPs are strong nutritional sources. Going on such a restrictive diet has the potential to cause a nutritional deficiency. Commonly cited issues include: <ul> <li>Excluding carbs rich in fructans may lead to a reduction in fiber and iron intake</li> <li>The potentially steep decline in calories may lead to excessive weight loss</li> <li>Cutting out several types of vegetables can reduce natural antioxidants like flavonoids, carotenoids, and vitamin C, or phenolic acid and anthocyanins</li> <li>The lack of dairy may cause a calcium deficiency, both because it’s a major source of the nutrient and because lactose helps to promote its absorption</li> </ul> People already on restricted diets like vegans or those with food allergies may be unable to try out the low-FODMAP diet as it could have too serious an effect on their nutritional intake. Similarly, those who are underweight or suffering from an eating disorder are poor candidates as well. Don’t forget that IBS is incredibly variable. If a low-FODMAP diet isn’t right for you, simply cutting back on high-FODMAP foods rather than eliminating food groups may be a better path. A reduction in common offenders like garlic, onions, beans, apples, milk, mushrooms, and wheat may be sufficient for you. Dietary changes can have a significant impact on IBS symptoms, but doctors often use other therapies too; for example, laxatives and low-dose antidepressants can relieve symptoms. Tools like the FODMAP diet in combination with medications and stress management may yield the best results. Talk to your doctor before committing to the FODMAP diet and they can advise on additional treatments that may further reduce symptoms. <h2>More on Irritable Bowel Syndrome</h2><ul><li><a href="https://soulivity.storymd.com/journal/qj358dqiam-irritable-bowel-syndrome" target="_blank">Irritable Bowel Syndrome (IBS): Symptoms, Causes, Treatment</a></li><li><a href="https://soulivity.storymd.com/journal/j36z9gq1aj-irritable-bowel-syndrome-and-complementary-health-approaches" target="_blank">Irritable Bowel Syndrome (IBS) and Complementary Health Approaches</a></li><li><a href="https://soulivity.storymd.com/journal/yj5dgvk0nm-diets" target="_blank">Diets</a></li></ul>

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