Diet is important for a healthy gut. For patients with IBS, consuming the proper foods keeps your gut healthy and may reduce triggered episodes of diarrhea, constipation, or painful cramping and bloating.
The Low FODMAPs Diet reduces specific sugars and increases other nutrients to improve IBS gut health and strengthen gut wall integrity. It begins with a more restrictive phase, where patients are more strictly limited based on their IBS subtype–this is to get symptoms under control and set the stage for the next level. Following successful adherence to this first part, foods are slowly added into the diet to test for tolerance and ability for their proper digestion. By the end of this stage, patients have a diversified list of ‘safe foods’ that usually do not trigger IBS symptoms.
What are FODMAPs?
FODMAP is an acronym that stands for fermented oligosaccharides, disaccharides, monosaccharides, and polyols (sugar alcohols). These are sugars that on the chemical level, can be difficult to digest due to the molecular groups attached to them.
The Chemistry Behind FODMAPs
On the molecular level, sugar (glucose) is converted to energy in the body in a process called cellular respiration. Food you eat is broken down into four main groups–carbohydrates, proteins, nucleic acids and lipids (fat), which are then broken down into their smallest form. The irony of this process is that it takes energy to break things down. To this end, enzymes present in the stomach and intestines aid in this process, reducing the amount of energy required, and resident bacteria can also offload some of the burden.
Some materials, however, are harder to break down than others. Of the four macromolecule groups, carbohydrates (the sugars) are the easiest to break down; but within this group there is also a hierarchy of easiest to hardest to digest. The molecules shown above–glucose, fructose and galactose–are aromatic molecules, meaning they are ringed structures. Due to their ringed structure, these molecules are very stable–and therefore take more energy to break.
The second picture contains poly-ols, or sugar alcohols. These molecules contain many -OH, or alcohol subgroups, which are highly attracted to water. As water gathers around the molecule, it can deter enzymes, which are proteins that catalyze reactions to break them down. This makes it difficult for them to be broken down.
What Happens to FODMAPs in the Gut?
Most food is broken down in the small intestine, with much of the nutrient absorption occurring in the first two sections (the duodenum and jejunum). However, FODMAPs sugars have a tendency not to be broken down properly, and end up in the large intestine.
Location is important in digestion. The large intestine is less equipped for absorption; instead, it houses the majority of the gut microbiome, or the resident bacteria that break down hard-to-digest materials like certain proteins or fats. For the most part, these bacteria are anaerobic, meaning they do not break down sugars through cellular respiration like your body does, but through fermentation. Fermentation is good in moderation, but for an IBS patient, whose gut is predisposed to bacterial dysbiosis, a diet high in FODMAPs can lead to bacterial overgrowth and infection, as well as malabsorption of important nutrients, and the abnormal bowel movements common to IBS due to improper digestion.
The bottom line: a low FODMAPs diet can keep those bacteria in check and your gut healthy.
Reducing FODMAPs In Your IBS Diet
Knowing your IBS subtype is important for knowing how to proceed with the low FODMAPs diet; this is because the subtype, defined by your predisposition to certain bowel movements such as diarrhea or constipation, will tell your dietician how much fiber to initially incorporate.
Fiber is an important molecule that helps promote digestion; that said, if you are predisposed to diarrheal movements (IBS-D), your FODMAPs diet will likely reduce fiber as well, and slowly reintroduce it over the course of a few weeks. If you experience mostly constipation (IBS-C), your low FODMAPs diet may incorporate more fiber to regulate bowel movements.
Conventional low FODMAPs is divided into three stages:
First Stage: Elimination
The most restricted phase, the first step is a complete moratorium on consuming FODMAPs. This means no dairy, no highly processed food, no sugary drinks, alcohols or caffeines, as well as reducing consumption of:
- Wheat-based foods,
- Legumes such as beans or lentils,
- Some vegetables known to irritate the gut lining such as onion and garlic,
- Fruits high in sugars including apples, pears, peaches, cherries, and in some cases, oranges.
In order to proceed to the next stage, the patient needs to show significant reduction of symptoms, with the goal of this initial part to get IBS under control.
Second Stage: Reintroduction
This stage slowly reintroduces some of the foods mentioned above, in an effort to identify ‘trigger foods’, or foods that lead to recurrence of IBS symptoms.
This stage can take some time, but at the end, you will have a list of ‘safe foods’ that you can eat worry-free without fear of incurring the wrath of your gut.
Third Stage: Maintenance
This is the last part, which includes adhering to the list of safe foods developed over the first and second stages. Avoiding or limiting consumption of foods that are not on the list can help in managing IBS symptoms.
Other IBS Lifestyle Improvements
Adhering to the low FODMAPs diet is only one of the multitudes of small changes you can make to your daily regimen to support your gut health and reduce IBS symptoms:
- Hydration: Drinking enough water is essential for proper digestion. Dehydration makes it more difficult for the body to break down complex carbohydrates such as oligosaccharides and disaccharides; this can in turn lead to gastrointestinal issues.
- Sleep: Getting the right amount of quality sleep is key for regulating digestive processes. Aim for 7-9 hours of uninterrupted sleep each night for best results.
- Stress Management: Digestion is regulated by a system called the ‘brain-gut axis’ (in scientific literature, also known as the HPA axis). When we are stressed, the brain sends chemical messengers to the stomach and intestines to reduce digestion, in an effort to redirect resources to more critical zones, like the limbs for ‘fight or flight’ response. Conversely, when we are less stressed, we digest with higher efficacy–it is important to reduce stress through practicing mindfulness and seeing a licensed therapist where needed.
- Exercise: Exercise does a lot for us–it regulates blood flow, it improves cardiovascular health–and it also aids in digestion. Regular exercise reinforces routine gut health, keeps your mood lighter, and boosts immunity.
Support from Evinature
No matter where you find yourself on your gut health journey, our team at Evinature is here for you!
Our free online gut health assessment uses a dedicated algorithm to find a personalized Evinature protocol that best fits you and your lifestyle, while our devoted Clinic Support team can be reached at clinic@evinature.com for any questions related to Evinature, our products, or your IBS gut health. We can’t wait to hear from you!
Summer Pitocchelli-Schwartzman
