If you have IBS or an Inflammatory Bowel Disease (IBD), like Crohn’s or Ulcerative Colitis, and believe gluten is causing your symptoms, you may be avoiding the right foods, but for the wrong reason.
Side note: Celiac disease? Gluten is definitely your problem, but it may not be your only problem. Many people with celiac disease also have IBS.
Gluten is part of the protein structure in wheat. Its had a ton of attention in the media and from health and wellness bloggers and books. While some people without celiac disease do have Non-Celiac Gluten Sensitivity (NCGS), most people are actually reacting to the carbohydrate in wheat…not the protein. A gluten-free diet isn't as effective in relieving IBS symptoms as the Low FODMAP Diet.
Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols (FODMAPs) are small sugars and fibers that are poorly digested by many people with IBS and some with IBD.
FODMAPs are little food particles that can cause big problems like gas, pain, bloating, diarrhea, and constipation in people with IBS/IBD.
However, following a low FODMAP diet – one that restricts all FODMAPs for a time then systematically reintroduces them – can improve IBS and IBD symptoms (less data on IBD, but still promising), quality of life, fatigue, anxiety, and depression. The diet doesn’t work in everyone, but it produces significant benefits in around 70% of IBS patients who try it.
The Low FODMAP Diet is a medical diet (read: not a fad) that has been tested in over 20 clinical studies. You don’t want to undertake this diet alone, at least not if you want it to work. Research shows that working with a dietitian familiar with the diet is important to have the best outcomes.
The elimination phase of the diet is strict (think Whole30ish) and the reintroduction phase is super important, because you want to figure out what foods you can add back into your diet long-term and which ones have to stay out…at least for awhile. Also, because so many foods are eliminated, there is a risk that you could become deficient in some nutrients if you don’t make the right substitutions.
By following the diet myself, I’ve been able to reintroduce a lot of high FODMAP foods over time, but I find that there are some (hello, onions) that are still off-limits. There is no single approach to starting the Low FODMAP Diet. There are dietitians in the US who teach the diet, but not many that are actually trained on it through Monash University – where the diet was developed and most of the research is still being done. If you feel you would be best served by working one-on-one with a dietitian, I recommend calling your gastroenterologist and asking about a local dietitian then checking into their training or search online through gastrogirl.com.
However, if you are interested in participating in an online program developed and led by a Monash-trained dietitian that will walk you through the Low FODMAP Diet at your convenience and at a low cost then sign-up for a webinar on The FODMAP Fix to determine what plan is best for you.
References:
Gibson, P.R., Shepherd, S.J. (2005). Personal view: food for thought—Western lifestyle and susceptibility to Crohn’s disease: the FODMAP hypothesis. Aliment Pharmacology Ther 21:1399 –1409.
Maagaard, L., Ankersen, D. V., Végh, Z., Burisch, J., Jensen, L., Pedersen, N., & Munkholm, P. (2016). Follow-up of patients with functional bowel symptoms treated with a low FODMAP diet. World journal of gastroenterology, 22(15), 4009.
O’Keeffe, M., Lomer, M.C.E. (2017). Who should deliver the low FODMAP diet and what educational methods are optimal: a review. Journal of Gastroenterology and Hepatology 32(Suppl 1):23-26.
Schumann D, Langhorst J, Dobos G, Cramer H. Randomised clinical trial: Yoga vs a low‐FODMAP diet in patients with irritable bowel syndrome. Aliment Pharmacol Ther. 2018;47(2):203-211
Staudacher, H. M., & Whelan, K. (2017). The low FODMAP diet: recent advances in understanding its mechanisms and efficacy in IBS. Gut, 0:1–11. doi:10.1136/gutjnl-2017-313750