Low FODMAP Diet Beneficial For Some IBS Subtypes

August 19, 2022

You may have tried the FODMAP diet as a treatment option if you suffer from irritable bowel syndrome (IBS). According to a recent study in the journal Gut, the composition of an individual's microbes may be able to predict how well they would respond to a low-FODMAP diet.

"This new research is very exciting, and shows a potential to further individualize IBS treatment with nutrition therapy," says Caroline Green, RDN, LD, a registered dietitian nutritionist specializing in intuitive eating and GI disorders in Columbia, South Carolina. "It may help us as clinicians be able to predict how well a low-FODMAP diet may work for someone, based on their type of IBS and which types of bacteria are found in their gut microbiome."

About the Study

Researchers in this study examined particular microorganisms in distinct microbiomes. The researchers looked at stool samples from people with IBS versus controls (people who don't have IBS) to see the response and microbiota changes after 4 weeks on a low FODMAP diet. They wanted to see if certain types of bacteria could help them predict how well someone may respond to the low-FODMAP diet. IBS-P (pathogenic-like) and IBS-H (health-like) subtypes of the microbiota were identified as two separate microbiota profiles. Additionally, they discovered that those with the IBS-H subtype did not benefit from a low-FODMAP diet.

It's interesting to note that the low FODMAP diet did cause a change in microbiota in IBS-P patients, which improved their responsiveness to this dietary therapy. Because of changes in the gut microbiota and the kinds of metabolites produced, the researchers claim that the low-FODMAP diet is effective for persons with the IBS-P subtype.

"Being able to identify specific strains of bacteria that are involved in the digestion and metabolism of specific carbohydrates may help guide the low FODMAP Diet," explains Andrew Akhaphong, MS, RD, LD, a registered dietitian for Mackenthun's Fine Foods.  "Though more research is needed, this study shows the potential that identifying specific gut bacteria may be utilized to direct how to approach the low FODMAP diet and long-term maintenance."

What Is a Low-FODMAP Diet?

The abbreviation FODMAP refers to a group of short-chain carbohydrates (sugars) that are poorly absorbed in the small intestine and includes fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.

"The term 'fermentable' in the acronym is attributed to the gut bacteria and their rapid ability to ferment these carbohydrates, leading to symptoms," says Akhaphong.

Onions, garlic, bread, pasta, milk, beans, and a few fruits and vegetables are among the foods high in FODMAPs. These foods are very healthy, but some of them may cause symptoms in IBS sufferers and may therefore need to be avoided. Experimenting with a low FODMAP diet can help people identify which foods are causing their symptoms, but it should be noted that this usually only involves a small number of foods, not the entire list. According to studies, eating a low-FODMAP diet can assist with many IBS symptoms. In one study, it was discovered that more than 75% of IBS sufferers stated their symptoms were well controlled by the FODMAP diet. So, many IBS sufferers—but not all—seem to benefit from the low FODMAP diet.

How a Low-FODMAP Diet Works

The low FODMAP diet, according to Akhaphong, involves three stages: elimination, reintroduction, and customizing or maintenance. Working with a dietician, you initially cut out foods rich in FODMAPs for two to six weeks (or sometimes longer). It's important to note that the elimination phase is brief.

"The low FODMAP diet is not meant to be followed long-term," says Akhaphong. "It requires guidance from a dietitian and/or physician to ensure nutritional adequacy."

After that, you and a dietician reintroduce a certain quantity of a FODMAP meal to check if it causes any symptoms. One food is gradually introduced at a time, and you work with a dietician to monitor each one and any symptoms it could bring on.

"The end goal is to determine the most tolerated amount of that item before one experiences symptoms," says Akhaphong.

Importantly, because it is highly complex and restricted, the low FODMAP diet must only be administered under physician supervision. Additionally, a low FODMAP diet is not meant to help you lose weight.

"A low FODMAP diet is a medical nutrition therapeutic diet, meaning it should be done under clinical supervision by a physician or gastroenterologist and dietitian for people with IBS," she says.

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