As some of you might know I went to a workshop on FODMAPs last week because you guys know I love all things gut health. This is a newer therapeutic diet in the nutrition and dietetics world (I didn’t learn about it in school), so I wanted to educate myself beyond a google search. I know this subject isn’t everyone’s cup of tea, but I took a poll on Instagram and the majority of you wanted to learn more as well.
What is Irritable Bowel Syndrome (IBS)?
This isn’t the most glamorous topic to be discussing, but the fact is that IBS affects about one in seven Americans. It is a condition that is characterized by gut symptoms including abdominal pain, intestinal gas, bloating, constipation, and diarrhea. These symptoms can be extremely debilitating and affect one’s quality of life.
This is probably the most frustrating and vague diagnosis someone can get when they are having unexplained gut issues. IMO the doctor basically has no clue what’s wrong and is like “hey you have IBS……follow this IBS diet…good luck…bye!” IBS can be hard to track because symptoms seems to come and go without much of a pattern; making it difficult to pin point the offender/s.
There are many different factors that can contribute to IBS symptoms and diet is a main factor I will focus on. Other factors include: stress, anxiety, hormones, microbiome, inflammatory response, gut motility issues, or an unusual response to an infection like gastroenteritis.
What is Small Intestinal Bacterial Overgrowth (SIBO)?
SIBO is a newer diagnosis popping up in the wellness community. It is defined as an overgrowth of normal colonic bacteria in the small intestine/bowel.
SIBO is still somewhat misunderstood, but causes may include a weakened immune system, abnormally slow gut motility, low levels of stomach acid, and physical abnormalities of the small intestine. Many people do not have clear risk factors for SIBO.
Symptoms of SIBO are constipation, bloating, diarrhea, malabsorption, weight loss and malnutrition. These symptoms clearly overlap a lot with IBS and this is because many people who suffer from IBS also test positive for SIBO. SIBO is most commonly diagnosed using hydrogen and methane breath test ordered by your doctor.
There is no actual clinical research to guide in the treatment of SIBO. Many suffers are told to follow the IBS diet as well. Treatment of SIBO is complex and should include treatment of the underlying disease and include nutritional support and antibiotics. Once an antibiotic course is finished then it would be appropriate to start a low FODMAP diet to treat SIBO.
What are FODMAPs?
So what the heck are FODMAPs?? They are certain sugars and certain fibers in your diet that for some can trigger diarrhea, constipation, excess gas, bloating, and stomach pain. FODMAPs diet has a lot of emerging research to support its effectiveness in treating IBS. If standard IBS treatment has failed then following this protocol may be appropriate.
FODMAPS
F = Fermentable
O = Oligosaccharides (short- chain fibers such as fructans, GOS, and inulin ex: wheat, barely, garlic, beans, nuts, seeds, inulin, chicory root, etc.)
D = Disaccharides (lactose ex: lattes, milk, cottage cheese, ice cream)
M = Monosaccharides (fructose ex: honey, agave, apples, pears, mangos, etc)
P = Polyols (sugar alcohols, the “ol sweeteners” ex: sugar-free gum and candy, cauliflower, avocados)
It’s important to note that unlike other adverse food reaction “FODMAP” foods do NOT cause IBS; more there is an abnormal response to these foods. Having one high FODMAP food won’t necessarily cause a significant reaction…it’s more about the cumulative load ingested. Symptoms can be delayed once again making it challenging to know what food is the culprit. Therefore, portions and timing matter!
It’s also important to note that high FODMAP foods aren’t “unhealthy”. For example, apples, asparagus, and garlic are high FODMAP foods. Another misconception is that gluten is a FODMAP and that’s false.
Following a low FODMAP diet should only be implemented for 2-3 weeks max before foods are methodically reintroduced. I’m not going to give the specifics of how to do this because you should be working with a trained clinician during this time. If a clinician simply hands you a worksheet that list foods that are “high” and “low” in FODMAPs and wishes you luck then they are doing you a disservice.
Essentially there are 3 phases: elimination phase (lasting 2-3 weeks), reintroduction phase (lasting 6-8 weeks) and maintenance phase where you have developed an individualized meal plan with the right load of FODMAP foods you can tolerate along with all the other nutrients your body requires.
There should be frequent follow up appointments to help guide you through the different phases of this treatment plan. For example, in the reintroductions phase you would add back very specific FODMAPs each week (ex. lactose, fructose, or sorbitol) in certain doses and document symptoms. This will feel very overwhelming and difficult to be successful unless working with a trained clinician.
**NOTE** If someone with IBS strictly follows the FODMAP protocol and does not get full relief then they should be further tested for SIBO. SIBO suffers can get some relief from this dietary intervention, but not complete. Antibiotics are needed to fully treat SIBO.
For more information on FODMAPs this is a great resource that put on the workshop I attended. I also used this article from the World Journal of Gastroenterology to write my post.
xx,
Alix
All information on the The Champagne Theory blog, including but not limited to information about nutrition, health and fitness, is intended for general or background purposes only, and not as medical advice applicable to any individual. Please consult your medical provider or providers for instructions specific to your own medical concerns and condition.
