Two studies from Michigan Medicine may offer hope to people with irritable bowel syndrome (IBS) who struggle with the traditional low-FODMAP diet.
The findings were published in Clinical Gastroenterology and Hepatology in the papers “FODMAPs aren’t created equal: Results of a randomized reintroduction trial in patients with irritable bowel syndrome” and “Is a Simplified, Less Restrictive Low FODMAP Diet Possible? Results from a Double-Blind, Pilot Randomized Controlled Trial.”
The low-FODMAP diet helps IBS patients by limiting certain carbohydrates (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols), then slowly reintroducing them to find out which ones cause problems.
However, this diet can be very restrictive, cutting out foods like garlic, certain fruits, and gluten-based bread. Many people find it difficult to start and maintain.
“It’s frustrating for us as clinicians to say, ‘Here, just cut out all these things, and you’ll be fine,'” said Dr. Shanti Eswaran, lead author of the first paper.
“No one wants to live like that. So, we looked at whether we really need to take out everything in the diet, or if some people can manage with a modified version.”
In the first study, participants began with the traditional low-FODMAP diet and then had different FODMAP foods reintroduced without knowing which ones. The researchers found that patients usually reacted to just two FODMAPs.
This suggested that individual FODMAPs could cause symptoms on their own, not all together.
The most important finding was that fructans and galacto-oligosaccharides (GOS) were the most likely to cause symptoms like stomach pain and bloating. Fructans are found in onions, garlic, and wheat, while GOS are in legumes and cruciferous vegetables.
This led to the second study, where a simpler “FODMAP-simple” diet was developed. Dr. William Chey, chief of the Division of Gastroenterology and Hepatology at Michigan, explained that the FODMAP-simple diet only restricts fructans and GOS, unlike the traditional diet that restricts all FODMAP groups.
At the end of the study, the FODMAP-simple diet reduced IBS symptoms just as well as the traditional low-FODMAP diet.
Simplifying the traditional low-FODMAP diet has several benefits. Many patients find the diet hard to start, and the restriction period can lead to weight loss and deficiencies in nutrients like iron and calcium.
“Cost becomes an issue because the more foods you exclude, the more substitutes you need to buy,” said Dr. Prashant Singh, lead author of the second paper. “For example, if you usually eat beans and chickpeas, you’ll need to find replacements.
Or you might need to buy gluten-free bread or lactose-free milk, which are more expensive. All these costs add up quickly.”
While more research is needed before recommending the FODMAP-simple diet to patients, the early results are promising.
“Fewer people dropped out of the FODMAP-simple diet compared to the traditional low-FODMAP diet because it was less restrictive and less likely to cause weight loss,” said Dr. Singh. “We believe the FODMAP-simple diet has real potential to change how we treat IBS in the future.”
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