The FODMAP Diet for IBS

By: Beth Kitchin, PhD,RD

As a registered dietitian, I have been counseling patients with a variety of medical needs for years. The condition that has always left me empty handed when it comes to patient advice is irritable bowel syndrome (IBS). Advising patients to limit caffeine, fiber, and sugar alcohols, is the standard and often does not eliminate symptoms.Most of our nutrition texts simply state “the patient should avoid foods that irritate the condition”.  For clinicians, helping patients with IBS can be frustrating as well since we have so little to offer patients.

            IBSis one of the most common disorders that doctors diagnose – but the diagnosis is usually one of elimination after many other conditions are ruled out. Unlike celiac disease and inflammatory bowel diseases like Crohn’s disease and ulcerative colitis, IBS does not damage the intestines or put patients at risk for intestinal cancers. But IBS can be difficult for patients to deal with and can cause much emotional and physical distress. 

           But there may be a new strategy we can try with our patients called the FODMAP diet. The idea behind it is that carbohydrates from 5 different groups maybe highly fermentable, osmotically active, and poorly absorbed in the intestine and contribute to the symptoms of people with IBS. The idea was developed and studied by an Australian nutritionist. While more research is needed to find out if it really works, it does give our patients a new strategy with which to deal with their symptoms.The foods are abbreviated by the acronym FODMAPS: Fermentable Oligo-, Di-, Mono-saccharides and Polyols.

 

           Foods are divided up into the following categories: excess fructose, lactose, fructans, galactans, and polylols. Foods high in excess fructose include honey, dried fruits and apples. But fruits that people may be able to tolerate include bananas, blueberries, oranges and many more. Soft cheeses and regular milk are higher in lactose but hard cheeses like cheddar and lactose-reduced milk may be fine. The fructans category includes asparagus, broccoli and eggplant. Foods high in galactans tend to be the starchy beans and peas like kidney beans and lentils. Polylols include fruits and vegetables like apricots, avocados, peaches and pears. Patients do not have to eliminate all of the foods on the list – but rather try to eat fewer foods from within each category to reduce IBS symptoms.Patients may be able to tolerate small amounts from each category.

 

          I want to stress that there have been few well-done studies on the FODMAP diet. Patient compliance is difficult to monitor and relies on self-report. For many patients, IBS is related to stress and emotions, which can confound the data. Adequately powered randomized clinical trials will be necessary to determine if the diet is truly an effective treatment. However, from a clinical perspective, the FODMAP diet is a reasonable option to offer patients who are struggling with on-going symptoms.

            There is a terrific, easy-to-use list you can print at this website: http://ibs.about.com/od/ibsfood/a/The-FODMAP-Diet.htm    Go to the very end of the article and you will see “For a printable chart of high and low FODMAPs, click here” and it will take you to the list. The list is color coded and easy for patients to follow. I recommend referral to a registered dietitian to help patients develop a healthy, low FODMAP diet.Simply eliminating FODMAP foods could result in nutrient deficiencies if substitutes are not made.

Beth Kitchin, PhD, RD
Assistant Professor, Nutrition Sciences
University of Alabama at Birmingham