THE FODMAP DIET FOR IBD AND IRRITABLE BOWEL SYNDROME

Irritable Bowel Syndrome (IBS) is a common problem often confused with Inflammatory Bowel Disease (IBD). When those with IBS have been asked if they notice any specific triggers, lactose and other foods containing sugars are often present ( stress, anxiety, and depression too). So, a group in Melbourne, Australia began eliminating a broader group of sugars and carbohydrates from diets. Many of their patients improved–dramatically. 

What's the problem?

Some sugars are not absorbed well in the small intestine. This can cause the sugars to break down (ferment) in the large intestine which results in gas, bloating and cramping.

What is the FODMAP diet?

The poorly digested sugars have been categorized as FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols (food alcohols). Studies show that foods low in FODMAPs reduce bloating, pain and gas and it improves the consistency of bowel movements. As a result, it may help those who have both IBD and IBS.

The FODMAP diet restricts many common foods for up to 6 weeks. After 6 weeks, foods are slowly added back into the diet to identify symptom triggers.  This can make the diet difficult to follow. Dietician support is needed when following the FODMAP diet.

Foods Limited (but not necessarily eliminated) on the Low FODMAP Diet:

• Lactose (dairy)
• Fructose (apple, mango, pear, watermelon, honey, sugar snap peas, high fructose corn syrup)
• Fructans (persimmons, wheat, artichokes, asparagus, beet, brussel sprouts, cabbage, fennel, garlic, leek, okra, onion, peas, radicchio lettuce, shallot, and inulin)
• Galactans (beans, lentils, legumes including soy)
• Polyols (avocado, apricots, cherries, nectarines, peaches, plums, blackberries, lychee, cauliflower, mushrooms, snow peas, sweeteners containing sorbitol, mannitol, xylitol, maltitol, broccoli, corn, eggplant and zucchini)

Further reading

* EP Halmos et al, A diet low in FODMAPs reduces symptoms of irritable bowel syndrome, Gastroenterology 2014;146:67-75.  (Shepard and Gibson, coauthors developed the diet)

**HM Staudacher, et al. Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome. J Hum Nutr Diet. 2011;24:487-95.