FODMAP: The Untold Story of The Best IBS Diet There Is
FODMAP: The Untold Story of The Best IBS Diet There Is
The Low FODMAP diet has emerged as a frontline therapy for treating IBS symptoms. But what is it, and where did it come from?
Many IBS sufferers find some degree of symptomatic relief by following a low FODMAP diet. The Low FODMAP diet involves minimizing certain fermentable carbohydrates found in many foods, which are well-known to trigger IBS symptoms.
A Brief History of FODMAPs
The notion that specific types of carbohydrates could contribute to digestive distress was proposed as early as the 1940s. Lactose, for example, was one of the earliest sugars to get attention as a potential problem. By the end of the 1960s, lactose intolerance was well-established in research literature. By the end of the 1980s, fructose malabsorption had garnered similar attention, and just like lactose, there seemed to be a number of people who would feel better by cutting it out.
However, it wasn't until the 2000s that researchers at Melbourne's Monash University, led by Dr. Peter Gibson and Dr. Susan Shepherd, began to connect all the dots and systematically investigate the relationship between multiple types of carbohydrates and IBS symptoms.
The Monash University researchers identified an umbrella group of poorly absorbed, fermentable carbohydrates that seemed to trigger IBS symptoms. For lack of a more unifying name, these troublesome sugars were bundled into the acronym FODMAPs, which stands for the four main categories of fermentable carbohydrates: "fermentable oligosaccharides, disaccharides, monosaccharides, and polyols."
While many of us have no problem digesting them, they can create excess fermentation for others, which can cause bloating, cramping, or other IBS symptoms. Some well-known examples of these sugars, on top of lactose and fructose, include sorbitol and xylitol. Fructans are less well-recognized, but the foods that contain them, like onions, garlic, and wheat, are common IBS triggers.
The Low FODMAP Diet for IBS: It Works!
The Monash team ran clinical trials and published several studies to assess the efficacy of the low FODMAP diet in managing IBS symptoms. These studies showed promising results, ushering in a wave of scientific interest and many more clinical trials worldwide.
As a result of the past two decades of study, the low FODMAP diet stands tall as one of the most robustly substantiated clinical diets for a health condition (IBS) that we know of.
A 2016 review in Clinical and Experimental Gastroenterology concluded that up to 86 per cent of IBS patients saw improvement in symptoms across the board, including flatulence, bloating, pain, constipation and diarrhea.
In 2021, a British Medical Journal meta-analysis reviewed 13 randomized control trials encompassing 944 people, finding that the low FODMAP diet significantly outperformed all other dietary interventions.
In 2023, an updated narrative review of all published data on the use of the low FODMAP diet for adults and children was published in Nutrients. Across 15 randomized control trials on adults and four on children, the low FODMAP diet consistently outperformed traditional diets, general dietary advice, psyllium therapy, and moderate or high FODMAP diets. The authors concluded that significant evidence supported the use of the low FODMAP diet for IBS and the use of it as a first-line therapeutic strategy.
Just Remember: FODMAPs Aren't Bad!
It's important to point out that many plant foods rich in FODMAPs are typically considered very healthy!
Cabbage, broccoli, artichokes, and asparagus, all high in FODMAPs, are just a few of the fibre and micronutrient-rich foods that can support healthy bowel movements and foster a diverse gut microbiome. But food relationships are highly individual, and there is no one-size-fits-all solution.
Even among IBS sufferers, food reactions vary significantly from one person to the next; one person may find that milk is crippling and wheat is no problem. For another, it may be just the opposite!
This is why the low FODMAP diet is best thought of as a safe and thorough starting point to reduce IBS symptoms for most people across the spectrum of individual reactions. Since this blanket approach cuts down on all the well-known offenders, it provides an excellent starting point for just about anyone with any type of IBS.
After the initial period of eliminating FODMAPs as much as possible for a few weeks, the next step is to methodically reintroduce medium FODMAP foods. The goal is to arrive at a sustainable, individualized, long-term diet solution that minimizes IBS symptoms without feeling restricted.
Meanwhile, the elimination phase can be much more delicious than you might think! Check out the fantastic nutritionist-developed Rily low FODMAP recipes with the link below.
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Black, C. J., Staudacher, H. M., & Ford, A. C. (2021). Efficacy of a low fodmap diet in Irritable bowel syndrome: Systematic review and network meta-analysis. Gut, 71(6), 1117–1126. https://doi.org/10.1136/gutjnl-2021-325214
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