Irritable bowel syndrome and Low FODMAP diet

Irritable bowel syndrome(IBS) affects about 1in 5 people and is widely prevalent.It is a functional gastrointestinal disorder which is characterised by its predominant symptoms of abdominal pain, bloating, distention, constipation and diarrhoea. The onset of these symptoms can be very variable in its nature and can have debilitating impact on daily lives of people.

What causes IBS is unclear .However,It is believed to be due to dysfunction between our brain and gut communicating.

Diagnosis of IBS should only be made once any anatomical abnormalities ,Inflammatory Bowel disease and coeliac disease have been ruled out.

Treatment of IBS:

For years the dietary interventions to treat IBS have been unclear, however in 2012 King’s college London published their first clinical trial on Low FODMAP diet revealing that Low FODMAP diet significantly improved the symptoms in about 50%-80% of subjects.

Despite the improvement with low FODMAP diet ,it is recommended that before going on it ,one must ensure that the following basic dietary changes have been addressed:

  • Eat slowly and do not rush through meals.
  • Eat smaller portions
  • Reduce your intake of caffeine
  • If you are having regular intake of alcohol, think about reducing the intake.
  • Monitor your fat intake.If it is excessive ,try and reduce it.
  • Avoid spicy food.
  • If stress is exacerbating your symptoms, try mindfulness or yoga

What is Low FODMAP diet?

Food is made of several components like Protein, fats and carbohydrates. Some of the short chain carbohydrates i.e, FODMAPs do not get absorbed well in the small intestine and it travels through the large intestine which is where billions of gut bacteria live.These bacteria will subsequently ferment the FODMAPs causing gas production and typical IBS symptoms. Fermentable carbohydrate also draw water in the large intestine causing loose stools.

Have a look at the following video to understand how FODMAPs affect your symptoms:

My experience shows that about 80%-90% of people do improve with low FODMAP diet.Despite this ,it is not a long term diet .FODMAPs are good for your gut bacteria and being on this long term can have an impact on your gut bacteria.This is why, after the exclusion phase of 4-8 weeks ,it is important to carry out re-introduction.

I have seen several patients in my clinic who prior to seeing me have sought Dr.Google’s advice on this diet or have tried it using Low FODMAP books without much success.

It is recommended following Low FODMAP diet under the guidance of a registered dietitian who is trained in delivering it ,to guide you through the both exclusion and re-introduction phase appropriately.

Further reading:

Staudacher HM, Irving PM, Lomer MC, Whelan K. Mechanisms and efficacy of dietary FODMAP restriction in IBS. Nature reviews Gastroenterology & hepatology. 2014;11(4):256-66.


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