For patients with irritable bowel syndrome (IBS), following the traditional low-FODMAP diet can be a daunting task.
However, two studies from Michigan Medicine bring new hope, suggesting a simplified version of the diet might be just as effective.
The studies, titled “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,” were both published in Clinical Gastroenterology and Hepatology.
The low-FODMAP diet involves restricting certain carbohydrates (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) that can trigger IBS symptoms.
Patients gradually reintroduce these foods to identify which ones they are sensitive to.
However, this diet can be very restrictive, eliminating foods like garlic, certain fruits, and gluten-based bread, making it hard to follow.
Dr. Shanti Eswaran, the lead author of the first study, expressed the frustration felt by both patients and clinicians: “It’s frustrating for us as clinicians to say, ‘Here, just cut out all these things, and you’ll be fine.’ No one wants to live like that. So, we looked at whether or not we really need to take out everything that’s in the diet. Or if, for some people, they can get away with a modified version of this restriction plan.”
In the first study, participants began with the traditional low-FODMAP diet, but then different FODMAP foods were reintroduced blindly.
The researchers found that patients generally reacted to an average of two FODMAPs, and that individual FODMAPs could cause symptoms on their own.
The most significant finding was that fructans and galacto-oligosaccharides (GOS) were the main culprits in worsening symptoms like abdominal pain and bloating. Fructans are found in foods like onions, garlic, and wheat, while GOS are present in legumes and cruciferous vegetables.
This discovery led to the second study, where an alternative “FODMAP-simple” diet was developed and tested.
Dr. William Chey, chief of the Division of Gastroenterology and Hepatology at Michigan and an author on both studies, explained that the FODMAP-simple diet restricts only fructans and GOS, unlike the traditional low-FODMAP diet which restricts all five FODMAP groups (polyols, lactose, and fructose included).
The results showed that the FODMAP-simple diet led to similar reductions in key IBS symptoms as the traditional low-FODMAP diet.
There are several benefits to this simplified approach. Starting the traditional low-FODMAP diet can be challenging, depending on a person’s existing eating habits and available food options.
The restriction period can also lead to weight loss and deficiencies in nutrients like iron and calcium. Additionally, cost can become an issue, as more restrictive diets often require expensive substitutes for common foods.
Dr. Prashant Singh, the lead author of the second paper, noted, “Cost becomes an issue, because the more exclusion you have to do, the more substitutes you’d have to purchase.
Let’s say you are somebody who eats green beans, beans, and chickpeas, and now you must substitute all of that. Or you’re substituting in gluten-free bread or lactose-free milk, which is more expensive than lactose-containing milk. All of those costs add up very quickly.”
While further research is needed before the FODMAP-simple diet can be widely recommended, the initial results are promising.
Fewer people dropped out of the FODMAP-simple diet compared to the traditional low-FODMAP diet, as it was less restrictive and less likely to cause weight loss.
“We think FODMAP-simple has real potential of changing how we practice this diet in the future,” Singh said.
The research team also included Samara Rifkin, M.D., Theresa Han-Markey, M.S., Samuel W. Chey, M.P.H., and Gregory Dean, M.D. Their work provides a hopeful outlook for IBS patients, suggesting that a less restrictive diet can still offer significant relief from symptoms.
If you care about health, please read studies that vitamin D can help reduce inflammation, and vitamin K could lower your heart disease risk by a third.
For more health information, please see recent studies about new way to halt excessive inflammation, and results showing foods that could cause inflammation.
