This is a thorough review of the low FODMAP diet guide for IBS and SIBO. Do you have frequent recurrent symptoms of abdominal pain, bloating, abdominal distention, constipation, diarrhea or both? If those symptoms have been affecting you at least once a week for the last three months then, you probably have an Irritable Bowel Syndrome (IBS) and might have Small Intestinal Bacterial Overgrowth (SIBO) as well.
IBS affects 15% of the general population and almost 95% of the people having IBS also have SIBO as the underline cause. Therefore, it would be highly recommendable that you asked a physical to help you with this condition and to make the correct diagnosis of what is causing these symptoms to find the underline cause.
Keep reading to learn about a diet that will help you heal your gut and get rid of those bothersome symptoms. It´s called the low FODMAP diet, it was developed in Australia in 2014. The clinical medicine-based study was a randomized controlled trial where 45% of the patients suffering from IBS experienced symptoms reduction after following this diet.
- What is the low FODMAP diet?
- Guide to starting the low FODMAP diet
- Does the low FODMAP diet work?
- Risks of the low FODMAP diet.
- High FODMAP foods
- Low FODMAP foods
- My final opinion of the low FODMAP diet for IBS and SIBO
What is the low FODMAP diet?
The low FODMAP diet is a meal plan low in short-chained carbohydrates: Fermentable Oligosaccharides Disaccharides and Monosaccharides and Polyoles (FODMAP). This type of diet limits de ingestion of lactose (whole milk, soft cheese), fructose fructants (some fruits such as mangoes, apples and pears), galactans (beans and lentils) and alcohols (polyols such as sweeteners, sugar-free gums, mints).
This fermentable foods are poorly absorbed by the small intestine so, they can be found in the colon undigested. This food particles that remain undigested in the colon are quickly fermented by gastrointestinal bacterial which causes an osmotic reaction so, there is an increase of water in the gastrointestinal tract.
The consequence is excess gas production due to bacterial fermentation and excess water distention due to the osmotic reaction of the intestine. All this changes lead to alterations in the gastrointestinal motility and visceral hypersensitivity which explain the IBS and SIBO symptoms such as bloating, flatulence, abdominal pain, diarrhea or constipation.
Guide to starting the low FODMAP diet
If you suffer from IBS and SIBO, you will have to change your food eating habits in order to get better. I will give you some tips on how to start the low FODMAP diet.
First, you should eliminate high FODMAP foods for 6-8 weeks. Then gradually reintroduce one food at a time to identify the ones you don´t tolerate because they trigger the symptoms. Finally, Reintroduce one food every 2-4 days and have a 2-week break between bothersome foods. When your symptoms are completely relieved, you can add one by one high FODMAPs son that you can identify which high FODMAP foods are causing you the bothersome symptoms.
Start cleansing your body by choosing foods that are easy to digest and absorb like chicken broth or bone broth, soups, compotes, soft food, fruits, vegetables (peeled and boiled), egg, chicken and fish. The preparation of the meals should be without too much fat like roast, grilled, or in the oven. At the beginning eliminate all kinds of fats but, as soon as you are feeling better, start using only healthy fats like olive oil, canola oil, vegetable oil or avocados. Healthy oils are very important for your body: brain, skin, alleviates constipation and helps you feel more satiated in every meal so that, you don´t feel very hungry in between meals.
It´s important to eat proteins so, find the protein that is safe for you, that you can tolerate, for some people it could be eggs, chicken, fish and fewer people tolerate lean cuts of meat. If you need to gain weight, start to acknowledge your tolerance to low fiber grains and starchy carbohydrates, usually rice is well tolerated but, some people might not tolerate potatoes at the beginning, gluten free bread could be a good option as well.
Adjusting to the low FODMAP diet.
Remember to start with small portions and it´s recommendable to wait at least 48 hrs before you can eat that same food again to see how you feel. If you feel good then you can slowly increase the amount and the frequency. You have to try to see what is best for you because there is not one-diet-fits-all approach.
Some people might need to take digestive enzymes to help the digestion process. Prebiotics and probiotics also help for better digestion, some people might tolerate deslactosed yogurt which is a great source of probiotics, or you could always try any other kind of probiotics such as pickles and, it will depend on how you can tolerate this food.
It´s important that you start with low amounts of fermented foods to use as probiotics, for instance, you could start with a tablespoon of yogurt once a week and as you tolerate it, you can slowly increase the frequency to twice a week, three times a week until you can tolerate it every day. Also, you can slowly increase the amount as you can tolerate it.
Be careful with leftovers, it´s better to freeze them than to keep them in the fridge because many people react to food left in the fridge because of the histamines release. Also, it´s recommendable to buy organic products if you can afford them because they are healthier, you will be free from the pesticides and chemicals that usually come in fruits, vegetables and meats.
Does the low FODMAP diet work?
There are some clinical medicine-based studies that confirm that the low FODMAP diet works. On study was a randomized clinical trial that concluded that a low FODMAP diet decreases abdominal pain frequency as the main symptom of Irritbale Bowel Syndrome (IBS). This double-blind, crossover trial, measured the gut microbiome biomarkers and concluded that it may be associated with low FODMAP diet efficacy.
A recent study is a meta-analysis made in August 2017, it concluded that there is enough significant evidence that a low FODMAP diet reduces IBS symptoms, specially abdominal pain and bloating. There is another recent study from September 2017 that recognizes the low FODMAP diet as the first-line therapy for irritable bowel syndrome (IBS) treatment because all the symptoms improve such as abdominal pain, abdominal distention, bloating, gas, diarrhea and or constipation. They also encourage to share this information and to apply it to clinical practice.
Risks of the low FODMAP diet
The low FODMAP diet should be carried out under medical supervision and only for a short period (2-6 weeks) the lesser the better because it has risks for your overall health if you follow it for a longer period.
There is medicine-based evidence that this diet has some risks. There is one review study that sets the alarms for this type of diet. Some risks are as follows:
- The low FODMAP diet has precise indications for the treatment of IBS symptoms, it should not be used as a diagnostic approach for gluten sensitivity
- The fermentable fructants galacto oligosaccharides also have prebiotic effects so, taking them out of the diet for a long period might affect the microbioma, in other words, may reduce the good bacteria that normally live in the gut. Studies on this matter hasn´t been made yet.
- Following this diet for too long might increase the risk of disordered eating behavior such as orthorexia nervosa, in other words, the person becomes too anxious about eating some foods and, restricts too much in the diet, causing nutrition problems and affecting her relationship with food because there is an obsessive behavior on food planning, purchasing and preparation.
High FODMAP foods
Lactose: is the carbohydrate found in cow´s, sheep´s or goat´s milk. Lactose intolerance is caused by the lack of the lactose enzyme which digests the lactose. Therefore, the symptoms of bloating, gas, abdominal pain and diarrhea appear when people with lactose intolerance eat dairy products such as whole milk, yogurt, cheese specially soft, ricotta or cottage cheese, or ice cream.
Fructans: are carbohydrates with excessive fructose. Some people might have lack of the enzyme that break the fructose-fructose bonds so, might experiment gastrointestinal symptoms when they eat fruits with higher fructose ratio such as mangoes, pears and apples. Also, there are some vegetables high in fructants such as wheat, onions and garlic.
Galactans: are carbohydrates malabsorbed because the intestine doesn´t have the enzime needed to break them down. An example of this food group are grains and lentils. Therefore, eating them produces gas and gastrointestinal bothering.
Low FODMAP diet guide
Some examples of low FODMAP foods are:
Dairy: hard cheese, almond milk, lactose free milk or coconut milk yogurt
Fruits: bananas, strawberries, blueberries, avocados, lemons, pineapples.
Vegetables: lettuce, spinach, carrots, tomatoes, potatoes.
Grains: brown rice, corn, oats, oat bran, gluten free bread, cereals, pastas and crackers without honey.
Nuts and seeds: walnuts, almonds, macadamias, sesame seeds, sunflower seeds
Sweeteners: sugar, pure maple syrup
Proteins: fish, chicken, lean meat, eggs
My final opinion of the low FODMAP diet for IBS and SIBO
In my opinion, there is enough evidence-based medicine that supports the use of the low FODMAP diet as the first-line treatment for Irritable Bowel Syndrome (IBS). However, it should be followed under medical supervision by an experienced physician because of its negative risks on health if not done correctly and for an excessive period.
In my opinion, the low FODMAP diet is an unhealthy diet to follow for a longer period than the established time of 6-8 weeks. Therefore, you should gradually and slowly reintroduce one by one the high FODMAP foods which are mostly the prebiotics and probiotics that your body needs for a healthy gut function. Definitely, you can´t stay on the low FODMAP diet forever because you will start to have nutritional deficiencies.
Also, it´s recommendable to give your gut a rest of 12 hours fasting at night, so if you ate dinner at 7 pm, you wouldn´t eat any food until 7 am next morning. During the night fasting it´s really important that you drink water to clean you intestines. These hours of night fasting will give your intestines a rest and to clean and work properly.
Meal spacing 4-5 hours between meals is a good recommendation to allow the cleansing wave to work properly. During that time you could have some tea or coffee without milk neither sugar nor calories.
Don´t forget the use of prebiotics (onions, garlic, radishes). Those are the low fiber carbohydrates that you could tolerate in order to feed the good bacteria in your colon. And always take some probiotic (yogurt, pickles) in order to allow the good bacteria to proliferate in your colon. Of course, the prebiotics and probiotics should be omitted during the first few weeks of the FODMAP diet and then, you can reintroduce them in very small amounts one by one, and increase slowly the frequency and the amount that you can tolerate that won´t trigger the gastrointestinal symptoms.
Most importantly, remember that, there is not one-size-fits-all approach for the nutrition, diet and treatment of gastrointestinal disorders so, listen to your body and see what makes you feel better, always under the guidance of a physician who has experience in treating this conditions.
If you would like to know more about irritable bowel syndrome IBS and SIBO, read my article about what is IBS and SIBO. Also, if you would like to have up to date information about these important conditions read my article about IBS and SIBO news.
If you have any comments, feel free to leave them in the section below.
Dr. Verónica Giannoni