Are you running to the bathroom every time you eat?  Do you feel constipated and bloated after certain foods?  Has a physician told you that you may have IBS?  These are all reasons to try a Low FODMAP diet.

My understanding of IBS (Irritable Bowel Syndrome) and all of it’s baggage has come, not from my education, but from delving knee deep into treatment after my sister was diagnosed.  After years of seeing patients in my clinic frustrated and seeking relief – I was finally introduced to the Low FODMAP diet by a physician my sister was seeing.  Believe me, at first I was skeptical.   However, the proof is in the pudding (as they say) and the results for both my sister and my patients speak for themselves.  After just a few short weeks, patients report less bloating, less diarrhea, and less GI symptoms in general.  What I can say is that IBS masks as many different symptoms and comes in all shapes and sizes. The basics are as follows.

What is IBS?

As Maria from The Sound of Music says- “Let’s start at the beginning – a very good place to start.”  What exactly is IBS? The term Irritable Bowel Syndrome is used as an umbrella term for several different more specific subtypes of disorders.  As defined by the smart guys at Harvard, “IBS is a gastrointestinal disorder that affects the small and large intestines. With IBS, your gut becomes more sensitive, and the muscular contractions of your intestines don’t work the way they should.”  As with many GI (gastrointestinal) disorders, there is no definitive test for IBS. This means physicians will look at a patient’s symptoms, along with health history, and come up with a diagnosis. The most common symptoms are cramping, excessive gas, bloating, constipation or excessive diarrhea.  These symptoms can be isolated or may come in some combination.

What are the Different IBS categories?

Depending on your symptoms, there are actually 3 subtypes of IBS.  According to the American Journal of Managed Care, “The IBS subtypes comprise 3 classifications based on the predominant bowel disorder and include IBS-D (diarrhea), IBS-C (constipation), and IBS  – M (with mixed symptoms).” Based on my experience, IBS-D is much more common, has more side effects, and is also harder to treat. However, IBS in general greatly affects a person’s quality of life.  One study of female IBS patients found that IBS- D and IBS- M was associated with higher amounts of anxiety and comorbidities (meaning other conditions).  In another study, patients with IBS were found to have significantly lower scores for physical functioning, emotional well-being, and social functioning – with more bodily pain and fatigue than the US general population.

IBS vs Crohns, Colitis, Celiac Disease, SIBO

Now let’s make this even more complicated.  IBS mimics the symptoms of other GI related disorders such as crohns, colitis, celiac disease, or even lactose intolerance.  As mentioned above there is no way to definitely diagnose IBS.  Other GI disorders can be narrowed down using tests. Celiac disease, a true autoimmune disorder, can be diagnosed with a blood test or biopsy of the gut.  SIBO (small intestine bacterial overgrowth) can be diagnosed with a blood test and breath test (need to test?  Try this!).  The others?  A physician must narrow down through health history, symptoms, stool samples, scope results and other factors.  Sounds confusing, right?  This is why IBS is often misdiagnosed or simply given the broad diagnosis of Irritable Bowel Syndrome.

What causes IBS?

IBS disorders can be caused by a host of foods, or combination of foods, or medications, or stress, or hormones – the list goes on. This is where a registered dietitian comes in – determining what foods may or may not be causing symptoms to worsen. One quick disclaimer before we get to low FODMAP foods and low FODMAP recipes:  The low FODMAP diet and any other diet modification made during treatment of IBS may just be a tool to reduce symptoms. 

Meaning, the gut must be healed of the initial problem. In fact, research shows that up to 78% of IBS symptoms may actually have a condition called SIBO (small intestine bacterial overgrowth).  SIBO is another GI related condition that essentially means bad bacteria has overtaken the gut.  Interested in learning more? Here is a great article on SIBO and how to determine if you are at risk.

What do I do if I think I have IBS or SIBO?

As with any other medical issue, make sure you visit a qualified practitioner to determine medical management of IBS – which may include antibiotics or anti inflammatory medications.  While antibiotics are NOT preferred for long term treatment, the cause of IBS may be “bad” bacteria in the gut and must be initially treated with antibiotics. My recommendation during antibiotic treatment is a good probiotic. You can find my favorite probiotics in a previous blog post I wrote about the best probiotics. I have two pro tips for treatment when discussing IBS and SIBO:

1.  Find a physician that treats GI disorders, but isn’t afraid to cross over into the functional medicine category.

2.  Read about your symptoms on an evidence based website and ask for tests!  Since IBS is an umbrella, you’ll want a further diagnosis to figure out the CAUSE of the symptoms, not just treat the symptoms.  A great resource for different types of SIBO tests can be found here on the Functional Nutrition Blog.

What is Low FODMAP diet?  How Can the Low FODMAP diet help IBS symptoms?

Finally!  What is the Low FODMAP diet and how can it help?  Low FODMAP is defined as foods low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs).  Yes, that sounds ridiculous, and even with a nutrition degree I barely remember what all those words mean!  However, the Low Fodmap foods have been shown to significantly reduce symptoms of IBS, at least in a subset of patients.  And, as far as my practice is concerned, it certainly has improved many of my patients symptoms.  Low FODMAP has been studied extensively by the folks at MONASH university in Australia.  Not only did they develop the actual Low FODMAP diet, they have published a ton of research on Low FODMAPS.  They also developed an AMAZING app that can help you navigate both foods and Low FODMAP recipes for IBS.

Click here to get the Low FODMAP App from Monash University:  GET THE APP

SMXLL

Low FODMAP foods for IBS.

A quick guide to low FODMAP foods can be found at the bottom of this article. The trick to low FODMAP is figuring out what foods work for you.  I have patients that can re-introduce several foods after a 3-4 week period.  The main goal is to eliminate high FODMAP vegetables, fruit, dairy and gluten.  It is important to remember the restriction is not forever! In fact, some professionals have noted that following a strict low FODMAP diet long term could lead to nutritional deficiencies.  I usually recommend my patients try for a minimum of 3 weeks or until symptoms are reduced.

Low FODMAP recipes for IBS.

I have to admit, when my sister was first diagnosed with IBS and it was suggested that she follow the low FODMAP diet, I was completely overwhelmed.  I had not learned about the low FODMAP in grad school, and it is a relatively unknown treatment plan in “western medicine”. It seemed so restrictive. However, once we started a deeper dive, it became much more manageable.  The main problem I had was removing garlic and onion, but it can be done! Here are my top five low FODMAP recipes for IBS.

Low FODMAP Breakfast.

Coconut Yogurt with Berries and Gluten Free Granola!

Since milk yogurt is out on low FODMAP, this is such a nice alternative.  There are many brands available- but my favorite includes the SO Delicious brands and Kite Hill.  Mix it with some blueberries and Gluten Free Granola and enjoy!

Want to make your own version?  Try this one today!

Homemade Coconut Yogurt

Low FODMAP Lunch.

Tacos!

I was very concerned about onion free tacos- but let me be the first to say you barely miss it!  The recipe here has a great taco seasoning for low FODMAP diets. One of the most difficult parts of low FODMAP cooking is the limited seasonings since garlic and onion are out.  Thankfully, some smart person developed a low FODMAP garlic infused oil – and it hits the spot!  Link below to my amazon affiliate link… yum!

Low FODMAP Taco Recipe

Low FODMAP Snacks.

Dark Chocolate Peanut Butter Energy Bites!

There are plenty of Low FODMAP snacks available in “to go” forms, but these peanut butter bites are so easy!  Made with dark chocolate and peanut butter- they pack the perfect combination of protein, carbs and fat. These are great as a snack or after a workout, or even for a Low FODMAP breakfast.

Low FODMAP Peanut Butter Energy Bites.

Low FODMAP Dinner.

Salmon with Maple, Mustard and Dill  

Really, the sky’s the limit here.  Most recipes can be tweaked to be Low FODMAP friendly.   However, I have a few favorite Low FODMAP recipes for IBS that I tried when my sister was diagnosed.  The easiest and most tasty is this salmon recipe from the Low FODMAP recipe for IBS queen, Kate Scarlata.  She was the original Low FODMAP dietitian that my sister discovered during her treatment. She has a ton of resources on her site.  This can easily be served with Low FODMAP vegetables and maybe this Low FODMAP Veggie Saute.

Low FODMAP Salmon

Low FODMAP Dessert.

Dairy free ice cream?  Yes! 

You’ve certainly seen the aisles of the supermarket filled with dairy-free options- most of which are low FODMAP.  Looking for a favorite brand? Hands down my favorite is the Halo Top version of peanut butter cup- it is soy-free, dairy free and vegan.  Several flavors are available in the plant based version- you can find it here. Or, If you are feeling adventurous- here’s an easy at home recipe.

Low FODMAP Strawberry Ice Cream

And there you go!  Low FODMAP recipes for IBS.  Life does not end with IBS, and you certainly don’t have to starve!  As always, if you have any questions or if you feel like you could use further nutrition intervention – shoot me an email!  I’d love to help!

Happy Eating!

Kate

contact@thedietitiandiet.com

Resources (yes, there are a lot!):

  1. Nutritional Care Manual. Irritable Bowel Syndrome. 2012.
  2. https://www.health.harvard.edu/diet-and-weight-loss/a-new-diet-to-manage-irritable-bowel-syndrome
  3. Academy of Nutrition and Dietetics. Application of the low FODMAP diet for IBS: webinar. February, 2010.
  4. Scarlata, Kate. The Complete Idiot’s Guide to Eating Well with IBS. July, 2010.
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3966170/
  6. https://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/symptoms-causes/syc-20360016
  7. https://www.ajmc.com/journals/supplement/2018/evidence-based-management-of-ibsd/evidencebased-management-of-irritable-bowel-syndrome-with-diarrhea?p=5
  8. https://www.ncbi.nlm.nih.gov/pubmed/26838486
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