If you’ve suffered from intestinal distress as a result of Irritable Bowel Syndrome (IBS), then you’ve probably heard of a low-FODMAP diet. How would you know if a low-FODMAP diet will help you, and what are the signs to look out for?
What is the Low-FODMAP Diet?
The low-FODMAP diet was designed to help those who suffer from irritable bowel syndrome. As such, one of the main aims of this diet is to figure out which foods are responsible for your symptoms and create a sustainable diet for you in the long term.
The term “FODMAP” stands for fermentable oligosaccharides, di-saccharides, mono-saccharides and polyols. In other words, they are certain types of carbohydrates, such as the sugars, starches and fibres commonly found in the food we eat. This is because short-chain carbohydrates like these can be irritating to our digestive tracts. Examples of these are:
Polyols - sugar alcohols or fruits that have pits, i.e. apples
The FODMAP diet is an extremely restrictive diet, albeit a temporary one. The goal would be to eliminate certain types of carbohydrates from your diet, which are often responsible for triggering IBS.
How do you follow a Low-FODMAP diet?
Ideally, the Low-FODMAP diet is done by restricting certain types of food and paying attention to how your digestive system reacts to these restrictions in order to find out what types of foods may be aggravating your IBS symptoms. This is done in 3 steps:
Restriction Although FODMAPS in our diet are generally important for gut health, high-FODMAP foods should be avoided for a period of 3-8 weeks.
Reintroduction This step is to understand which foods your digestive system can tolerate. Specific foods should be reintroduced into your diet to see how you react to them. Your doctor will work with you.
Personalisation After you’ve identified which FODMAP foods aggravate your digestive system, you can then craft a personalised diet with the right foods to improve your quality of life and gut health.
Fret not! Your doctor will work with you and provide guidance as you go through your Low-FODMAP diet.
What are signs that you may need to try the reduced FODMAP diet?
Cramping The intensity of such cramps are variable, the pain ranges from mild to moderate. Frequency of attacks also varies among individuals. However, oftentimes, these attacks come when you face intense emotional stress or, perhaps, just had a really large meal.
Constipation Inability to pass out our stools is known as constipation. Even if the stools do pass, patients with IBS often report stools that come out in small pellet bits that are very hard. They also feel as if they didn’t get much relief after passing motion.
Bloating, gas and flatulence Many patients with IBS often report having their tummies being bloated suddenly after a meal, and we mean abnormally and significantly bloated, beyond your regular “food baby”. This is due to the fermentation of carbohydrates by bacteria, releasing gas in the intestines. This may cause bloating or flatulence.
Diarrhoea Loose or liquid stools are not uncommon for those suffering from IBS. These episodes tend to occur either early in the morning or after meals. They may be either mild or severely debilitating, requiring you to go to the washroom frequently, and even dread travelling long distances without access to a toilet.
How Do Doctors Know if a Low-FODMAP Diet Suits You?
Once again, it’s all about whether or not you fit the bill for IBS patients. Beyond symptoms, doctors take comprehensive history and tests to confirm if a FODMAP diet will help you.
The most common marker for IBS is the Rome IV criteria, which defines IBS as recurrent abdominal pain, on average, at least one day per week in the last three months, associated with >2 of the following criteria [17,25]:
Related to defecation
Associated with a change in stool frequency
Associated with a change in stool form (appearance)
There are 4 main subtypes of IBS that are mainly diagnosed with the help of a chart known as the Bristol stool form scale (BSFS).
IBS with predominant constipation – abnormal bowel movements are mainly constipation (type 1 and 2 in the BSFS)
IBS with predominant diarrhea – abnormal bowel movements are usually diarrhea (type 6 and 7 in the BSFS)
IBS with mixed bowel habits – abnormal bowel movements are usually both constipation and diarrhea (more than one-fourth of all the abnormal bowel movements were constipation and more than one-fourth were diarrhea)
IBS unclassified – those patients who meet diagnostic criteria for IBS but cannot be accurately categorized into one of the other three subtypes.
Lab Testing
Once history is taken, blood tests for a complete blood count and other data will be needed to rule out other causes of abdominal distress such as colorectal cancer, which will definitely not be resolved by changing up your diet.
Signs that a FODMAP Diet May Not Work
Age of onset of IBS after age 50 years
Rectal bleeding or melena
Nocturnal diarrhoea
Progressive abdominal pain
Unexplained weight loss
Laboratory abnormalities (iron deficiency anaemia, elevated C-reactive protein or faecal calprotectin/lactoferrin)
Family history of IBD or colorectal cancer
These are known as alarm features, which warrant further investigation for issues that may be more concerning than simply IBS. Although they are usually negative, these features may warrant doctors to run additional tests to verify if there are any more problematic diseases to watch out for.
Ultimately, it is important to convey both your needs and concerns with your doctor, so that they may work with you in crafting a treatment plan (and diet!) that best suits you.
