If you have IBS, or Irritable Bowel Syndrome, you’re all-too-familiar with the symptoms: gas, pain, diarrhea that alternates with constipation. You also probably know that the standard treatments—drugs that either slow down intestinal activity, or speed it up (as the case may be), plus a high-fiber diet—don’t work very well and could actually make symptoms worse.
A growing number of people with the condition are embracing a relatively new IBS diet approach that claims to stop symptoms for good. Known as FODMAPs, the diet eliminates fibers and sugars suspected of causing symptoms. But is FODMAPs the best IBS diet approach for everyone?
About 20 percent of people in the U.S. have IBS. It’s a major cause of work and school absenteeism, and the most common diagnosis among gastrointestinal doctors. IBS really is a “diagnosis of elimination.” That means when patients with IBS are examined, doctors will find nothing obviously wrong with your bowels–no inflammation, no polyps or strictures, no celiac disease, no cancer.
That leaves doctors and patients struggling to manage their symptoms, says registered dietitian Patsy Catsos, who has had both IBS and ulcerative colitis. Looking for answers for herself, she’s kept a sharp eye on IBS diet research for the past 25 years. She first heard about a treatment called the FODMAPs elimination diet in 2007, found it relieved many of her symptoms and decided to share her knowledge with others. The result is a book, IBS: Free at Last (www.ibsfree.net.)
FODMAPs is short for Fermentable Oligo-, Di,- and Mono-saccharides And Polyols, a group of fibers and sugars in the diet that are capable of causing IBS symptoms for some people. “FODMAPs are poorly absorbed, rapidly fermented, and tend to disrupt fluid balance in the gut,” Catsos explains. Fermentation by bacteria and yeast in the GI tract produces carbon dioxide and other gases, along with alcohol and other toxic byproducts. With an IBS diet that limits FODMAPs, Catsos says, “you are depriving the bacteria of their favorite foods and limiting their ability to multiply.”
FODMAPs are found in variety of foods, some of which people with IBS have learned to avoid: milk, beans, cabbage. But others are surprising. They include some types of yogurt, apples and pears, honey, wheat, soy milk, mushrooms, onions and garlic, sugar-free candy, and high-fiber bars, especially those that contain chicory root extract, or inulin, a type of soluble fiber. (Catsos calls these “IBS bombs.”) Inulin is also found in some yogurts, including Activia, which is marketed specifically for bowel health.
Fructose is a member of the FODMAP family, so people need to limit their intake of foods like soda, sweetened fruit drinks and sweet tea, all of which often include high-fructose corn syrup. Luckily, there are a lot of good low-FODMAP foods people can choose from instead.
Catsos recommends eliminating all foods that contain FODMAPs for two weeks. If FODMAPs are causing your IBS problems, your symptoms may resolve in just a few days.
Then, follow the elimination period by reintroducing one FODMAP carb at a time, and noticing your symptoms. Over time, you will find an IBS diet that allows a certain number of servings of FODMAPs a day without causing problems.
“This approach takes a big picture look, and looks at the additive effects of all these foods,” Catsos explains. “The beauty of FODMAPs is seeing the forest, not just the trees, and having a strategy and a plan to help you figure out what is going on.”