December 27, 2022

IBS FAQ Part 4: How to Reduce the Perils and Reap the Rewards of the Low FODMAP Diet

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This month I’ve been answering your most pressing questions about IBS. I covered IBS basics — symptoms and causes. I talked about IBS testing and treatment. Then last week I focused on food and IBS triggers.

So what do you do about IBS? Now that you know the causes, triggers, and tests, you’re ready to know how to deal with it.

Even if you’ve been diagnosed with IBS, you may have come away from your doctor’s appointment discouraged and uncertain about what you can do to improve your symptoms — and your life. Unfortunately, many doctors don’t know how to advise you on IBS. They may write you a prescription. Or they may tell you there’s nothing you can do, or worse yet, that there’s nothing really wrong with you.

If you’ve had this experience and lost hope, I want to encourage you. Just because your doctor didn’t help doesn’t mean that there isn’t help available. It is entirely possible to improve your IBS symptoms. I’ve helped hundreds of patients take back control and live their lives without being constantly slowed down by their digestion.

While I utilize a variety of testing and techniques to get to the bottom of your IBS symptoms and improve them. The low FODMAP diet is the most common tool I use to improve IBS for the vast majority of my patients. But this therapeutic eating plan is complex, and most people have a lot of questions. So let’s dig in and answer a few of them.

Low FODMAP FAQ #1: What are FODMAPs?

FODMAP is an acronym that stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. These aren’t unhealthy foods. And for people with healthy digestion, FODMAPs are an important source of nutrients in their diet that don’t cause them any problems. But if you have IBS, FODMAPs are likely an issue for you. These short-chain carbohydrates ferment in your gut and draw water into your intestine resulting in symptoms like gas, bloating, pain, constipation, and/or diarrhea.

Low FODMAP FAQ #2: Which foods contain FODMAPs?

FODMAPs are hard to avoid. You’ll find them in vegetables like garlic and onions, many fruits, dairy products, and more. And FODMAPs hide. Food labels do not list FODMAPs specifically. So you have to know what you’re looking for if you’re trying to avoid or limit them in your diet.

Low FODMAP FAQ #3: So if I have IBS, should I stop eating FODMAPs?

The short answer is no. That may surprise you. If FODMAPs trigger IBS symptoms, you’d probably expect that totally avoiding them is a good idea. But like I mentioned above, FODMAPs aren’t bad for you. In fact, they contain nutrients that your body really needs. They also provide the prebiotics that the bacteria in your microbiome need to stay healthy and balance your gut health.

That being said, there is a strategic way to eliminate some FODMAPs from your diet for a limited time in order to reduce or even eliminate your IBS symptoms. And it’s known as the low FODMAP diet.

Low FODMAP FAQ #4: What is the low FODMAP diet?

The low FODMAP diet is a specific, therapeutic eating plan that can help improve your IBS symptoms. On the low FODMAP diet, you don’t eliminate all FODMAPs for all time. There are three stages in the low FODMAP diet:

Stage 1: Restriction

During this first phase, you’ll cut out all high FODMAP foods for 4 – 8 weeks. You may feel better within the first week, or it may take the entire first stage before you notice significant symptom reduction. But stick with it. As much as 75% of people on the low FODMAP diet see improvement in their symptoms within 6 weeks

Stage 2: Reintroduction

During the 6 -10 weeks of stage 2, you will systematically reintroduce high FODMAP foods into your diet. By adding FODMAPs back one at a time and tracking your symptoms, you and your practitioner will be able to figure out which of these foods bother you, along with your overall FODMAP tolerance.

Stage 3: Personalization

The third stage (also known as the “modified low FODMAP diet”) is where you take the data from stage 2 and create a plan that will both reduce your symptoms and make sure you have the nutrients you need. You’ll eat some of the FODMAPs you tolerate well and avoid the ones you don’t. Ultimately, your practitioner will help you bring in as many high FODMAP foods as you can tolerate.

While you’re on the diet you’ll track not only the specific FODMAPs you eat, but also the amounts. Even low FODMAP foods can become high FODMAP foods if you eat too much at one time. Both the specific foods and the FODMAP amounts will change as you work your way through the stages.

Low FODMAP FAQ #5: The low FODMAP diet seems really complicated. Is it worth it?

It’s true that the low FODMAP diet is complicated. But for most IBS patients, the low FODMAP diet is 100% worth the trouble. According to the evidence gathered from four high quality studies, the low FODMAP diet has an 81% chance of relieving stomach pain and a 75% chance of reducing bloating. Other studies suggest that eating the low FODMAP diet can also improve flatulence, diarrhea, and constipation.

In my practice, I’ve seen the low FODMAP diet make a tremendous difference not just in specific IBS symptoms, but in the quality of life of my patients.

Low FODMAP FAQ #6: Do I have to stay on the low FODMAP diet forever?

No! In fact, it’s not safe to stay on it for too long. Research shows that long term FODMAPs elimination can alter the balance of your microbiome, or gut bacteria. That’s why the low FODMAP diet is done in stages. The first stage is the most restrictive. But then as you work your way through the program, you can add back in more and more foods.

There may be some high FODMAP foods that you will always want to avoid — or at least limit. But the goal of the low FODMAP diet is to get you back to eating a wide variety of foods while still keeping your symptoms at bay.

Low FODMAP FAQ #7: Can I do the low FODMAP diet on my own or do I need to work with a practitioner?

While there are lots of diets and therapeutic eating plans that are fine to do on your own, the low FODMAP diet isn’t one of them. The low FODMAP diet can be problematic to try on your own for a few reasons:

It’s really complicated. Most people benefit from the support of a practitioner who can help them navigate the diet by providing guidance on what to eat, what to avoid, and how to keep track.
Doing it wrong can be harmful. FODMAPs contain important nutrients that your body needs. They also help you maintain a healthy microbiome. A knowledgeable practitioner can guide you through the diet so you get the full benefit while reducing the risks.
During the second stage of the diet you’ll be adding FODMAPs back in a controlled manner. The planning, implementation, and interpretation of the results of the elimination phase will go much smoother if you have a practitioner guiding you. It’s easy to lose track, misinterpret symptoms, or rush through the elimination phase. And if this happens, you won’t really know which FODMAPs you tolerate, and which ones you don’t.

You may be working with a doctor on your IBS. But if you’re ready to try the low FODMAP diet, I highly recommend you add a new person to your health team. Most doctors don’t know the ins and outs of this diet and don’t have the time to walk you through it in a way that will be genuinely supportive.

If you’re ready to get your IBS symptoms under control with a practitioner who specializes in IBS and the low FODMAP diet, click the link below. I’m here to help!

References

https://www.monashfodmap.com/about-fodmap-and-ibs/frequently-asked-questions/

https://www.healthline.com/nutrition/low-fodmap-diet

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This month we’re talking about all things SIBO — small intestinal bacterial overgrowth. Specifically, I want to answer the SIBO FAQs I hear about this underdiagnosed condition that can cause all sorts of unpleasant digestive symptoms from diarrhea to bloating and more. Last week we covered SIBO basics FAQs — what it is, what causes it, and how it’s diagnosed. So if you’re not familiar with SIBO that would be a good place to start. But if you’re struggling with SIBO, what you probably care about most is how to treat SIBO. So those are the FAQs we’re covering today. Let’s dive in… Can SIBO be treated? The short answer is yes. Once you have a SIBO diagnosis — usually from a non-invasive breath test — SIBO can be addressed at its source. However, the treatment depends on the underlying cause and severity of the condition. What are the treatment options for SIBO? Antibiotics are often used to clear out the bacterial overgrowth, but it's important to address any underlying factors that may have led to the overgrowth in the first place. But antibiotics will reduce the amount of bacteria in your small intestine — and also your symptoms. But antibiotics aren’t without a downside. Yes, they kill the excess bacteria that’s causing you problems. But they also kill the good bacteria that lives in your large intestine — where it belongs. Fortunately, there are other options. Some naturally-minded practitioners (like me), use options like herbal antibiotics that have fewer side effects. And don’t let the word “herbal'' fool you into thinking they won’t work. Herbal antibiotics have proven to be at least as effective as the antibiotic rifaximin. Can diet help with SIBO? Yes! Emphatically, yes. In fact, dietary adjustments are one of your most powerful weapons against this bacterial overgrowth. The bacteria that are partying in your small intestine are living things. That means they need food to survive. So a combination of medication and bacteria starvation will help you get rid of SIBO more quickly than medication alone. So your treatment plan should include some dietary adjustments. Some people do really well on the low FODMAP diet. Or your practitioner may recommend a SIBO specific diet like one of these: 💡 SIBO Specific Diet by Dr. Allison Siebecker This diet — also called the Specific Carbohydrate Diet (SCD) — involves avoiding certain carbohydrates that feed bacteria in the small intestine, in addition to limiting FODMAPs. Foods are color-coded as green (legal), yellow (limited), or red (avoided) to help navigate the restrictions. 💡 SIBO Bi-Phasic diet by Dr. Nirala Jacobi This diet combines the low FODMAP diet with the SCD, but is divided into two phases. The first phase involves eliminating all fermentable starches for up to 6 weeks — starving the bacteria in the small intestine. In the second phase, a few starchy foods are reintroduced to feed the beneficial bacteria in the large intestine. 💡 The low histamine diet This diet can be helpful for those with SIBO who are showing signs of histamine intolerance. This is when your body has trouble breaking down histamines — chemicals involved in the immune system. You foods with high histamine levels like fermented foods, tomatoes, eggplant, and spinach, while prioritizing fresh, unprocessed foods with low histamine levels. This diet may reduce symptoms like headaches, skin irritation, and diarrhea. 💡 Elemental diet This is the most restrictive SIBO diet and involves two weeks of liquid-only nutrition. Your nutritional drink will contain pre-digested nutrients. The idea is that you can quickly absorb the nutrients before they have a chance to feed the bacteria in your small intestine. 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I was dealing with a lot of symptoms of IBS and knew that dietary changes would help. My IBS was causing daily bloating, abdominal cramping, and frequent bowel movements. I had heard the low FODMAP diet is restrictive, and I was so overwhelmed at first after reading up on it so I wanted to have professional guidance. Alyssa was amazing in how she walked me through each step. I was not only successful but it was easy. I feel so much better!!

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