Diet as a Therapy for Irritable Bowel Syndrome: Progress at Last

Editor's Note: This article was originally written by Magnus Simrén, M.D.

Do you sometimes experience stomach pain, bloating and irregular bowel movements, either constipation and/or diarrhea? If so, you understand how uncomfortable certain foods and activities can make you feel. Now, imagine feeling this way all day, every day. For the millions of patients with irritable bowel syndrome (IBS), dealing with these symptoms is a way of life.

IBS is one of the most common diseases gastroenterologists see every day. For many IBS patients, the disease is a mild annoyance, but for some people it can be disabling. In addition to the high number of patients affected by IBS, the lack of effective treatments creates difficulty in caring for these patients.

With traditional medications not cutting it for the growing number of IBS suffers, the medical community is considering other options, such as diet, to treat and control symptoms. Gaining increasing attention is the low-FODMAPs diet, which restricts consumption of certain carbohydrates and sugars (fermentable oligosaccharides, disaccharides, monosaccharides and polyols). FODMAPs are carbohydrates found in food that pull water into the intestinal tract and may not be digested or absorbed well. Gastroenterologists believe that a low-FODMAPs diet may help decrease gas production, which in turn will reduce the amount of stomach bloating and discomfort.

Now, we finally have high-quality research to back this assumption. A new study in Gastroenterology, the official journal of the American Gastroenterological Association (AGA), by Emma P. Halmos, et al. provides convincing evidence that a diet low in FODMAPs can cut IBS symptoms in half making it a potential first-line therapy for IBS patients. In the study, seventy percent of participants reported a reduction in severity of all key IBS symptoms, including abdominal pain, bloating and bowel habit dissatisfaction.

So, what foods are considered FODMAPs? FODMAPs include fructose (i.e., fruits, honey and high-fructose corn syrup), lactose (dairy), fructans (wheat, onion, garlic, etc.), galactans (beans, lentils, legumes, etc.) and polyols (some sweeteners and stone fruits such as avocado, apricots, cherries, nectarines, peaches, plums, etc.). Although individually shown to contribute to IBS symptoms, the concept of considering all of these sugars collectively as a treatment for IBS is relatively new.

The low-FODMAPs diet may not be easy to follow. Success with the diet will depend on how well a patient understands their food choices and their motivation for altering their diet.

Some low FODMAPs snack and meal ideas from Stanford University include:

  • Eggs scrambled with spinach, bell peppers and cheddar cheese

  • Rice pasta with chicken, tomatoes, spinach topped with pesto sauce

  • Turkey wrap with gluten-free tortilla, sliced turkey, lettuce, tomato, slice of cheddar cheese, mayonnaise, mustard

  • Quesadilla with corn or gluten-free tortilla and cheddar cheese

One common challenge gastroenterologists see patients encounter when moving to the low-FODMAPs diet is a lack of fiber after cutting out wheat, rye and legumes. However, fiber helps move bulk through the intestines and promotes bowel movements, which may lessen the constipation many IBS patients experience. Therefore, it is vital that IBS patients interested in following a diet low in FODMAPs work with their gastroenterologist and a dietician to create an eating plan that best meets their individual needs.

Based on the convincing new research, I wouldn't be surprised if a low-FODMAPs diet becomes as mainstream as the gluten-free diet has become for celiac disease patients. Only time, and added research, will tell. Questions remain, such as how to identify the right patients for this therapy and how to determine how strict the diet must be to work well long term.

Until we have these answers, doctors will continue to preach "healthy eating" habits, such as avoiding large meals, reducing intake of fat, reducing caffeine intake and avoiding gas-producing foods, such as cabbage, beans and onions. Learn more about current treatments for IBS in AGA's patient brochure: "IBS: A Patient's Guide to Living with Irritable Bowel Syndrome."

About the author:

Magnus Simrén, MD, PhD, is a professor of gastroenterology at the University of Gothenburg in Sweden. He is also a consultant in the department of internal medicine and clinical nutrition at Sahlgrenska University Hospital in Gothenburg, Sweden.

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