The FODMAP diet: Can it treat IBD?

Inflammatory bowel disease, or IBD, includes Crohn's disease and ulcerative colitis. These disorders can occur at any age and are mostly present in developed countries.

In the UK, about 650,000 people are thought to be living with IBD. This disorder is most often diagnosed in young people aged between 20 and 30.

>> Learn more about the difference between IBS and IBD in our article here: IBS and IBD: How are they different and how are they treated? <<

What is inflammatory bowel disease (IBD)? 

Inflammatory bowel disease (IBD) is characterised by inflammation of the lining of the digestive tract, due to malfunction of the immune system. This inflammation leads to tissue damage.

IBD progresses in alternating periods of flare-ups and remission, the main symptoms being:

• Abdominal pain,
• Diarrhoea (between 4 to 20 stools per day),
• Bowel incontinence,
• Loss of appetite and weight loss,
• Extreme fatigue,
• Fever,
• Anorectal symptoms (fissure, abscess).

Crohn's disease affects different segments of the digestive tract, from mouth to anus, while ulcerative colitis affects the rectum and colon.

Both of these diseases are incurable, which is why they are called "chronic". Medications are prescribed to ease the symptoms, and surgery is performed in the most severe cases.

A healthy lifestyle is paramount: regular physical activity and a balanced diet help improve patients' quality of life, and especially their digestive movements.

Certain alternative medicines and complementary practices can also be recommended to improve patients' daily life: sophrology, acupuncture, hypnosis, osteopathy and yoga.

Several factors, both genetic and environmental, have been studied to explain the inflammation of the intestine associated with these diseases. For several years, researchers have been interested in the role of the diet.

A low-FODMAP diet is thought to be effective in improving functional gastrointestinal symptoms in patients with IBD.

What is the FODMAP diet?

Most patients with inflammatory bowel disease notice a link between their diet and the digestive symptoms they experience, which often leads them to elimination diets.

The FODMAP diet, developed by Australian nutritionist Sue Shepard, is said to be one of the diets that has shown benefits only during remission and if digestive symptoms persist.

The term FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. These FODMAPs are short-chain carbohydrates (sugars) that are poorly absorbed by the small intestine and therefore practically indigestible. This lack of absorption leads to fermentation, which distends the colon and causes bloating, gas and abdominal pain.

The FODMAP diet is not a diet in the traditional sense in that it does not aim to trigger weight loss; its goal is actually to identify the foods that contain these sugars and eliminate them from the diet in order to regain normal digestion and bowel movements. However, because many pre-packaged foods, cakes, and sweets are eliminated from the diet due to their FODMAP content, weight loss may also occur.

What foods are allowed? Which foods should be avoided on the FODMAP diet?

FODMAPs are sugars often found in our food. They are divided into 4 groups:

• Oligosaccharides (fructan and galactan): these are found in certain vegetables (onions, garlic, shallots, cauliflower, artichoke, asparagus, beetroot, celery mushrooms, etc.), legumes (kidney beans, butter beans, broad beans, etc.) and cereals (wholegrain rice, oats, bulgur, wholemeal bread, semolina, etc.)
• Disaccharides (lactose): different quantities can be found in dairy products (milk, cottage cheese, cream, yoghurt, etc.)
• Monosaccharides (fructose): these are present in certain fruits, particularly "stone" fruits (apples, blackberries, cherries, currants, figs, lychee, mango, peaches, pears, watermelon, etc.),
• Polyols: These are highly present in "sugar-free" confectionery such as sweets, chewing gum, etc. They are also found in prepared, ready-to-eat-meals, especially in their additives.

Foods rich in gluten (wheat, oats, barley, rye) which are poorly digested by people with food intolerance, can also be added to the list.Many foods are low in FODMAPs and are therefore considered to be "safer" for those affected by IBD, such as:

• Certain vegetables: Such as cucumbers, carrots, lettuce, bok choy, green beans, courgette, celery, red peppers, endive, pumpkin, squash, radish, parsnips, aubergine, potatoes, etc.
• Fresh fruit: Such as citrus fruits (mandarin oranges, clementines, oranges, lemon, etc.), bananas, kiwi, pineapple, grapes, blueberries, melon, rhubarb, etc.
• Dairy products: Lactose-free products (milk, yogurts, etc.), hard cheeses or ripened/matured cheeses like brie, camembert or feta
• Cereals, grains, starches: such as wheat or gluten free breads, almonds, rice, macadamia nuts, peanuts, polenta, millet, etc.
• All meats, poultry and fish.

How long should you follow the FODMAP diet?

The FODMAP diet is not designed to be followed over a sustained period, as there is risk for developing nutritional deficiencies. Eliminating FODMAPs for a few weeks is usually enough to identify the offending foods and relieve digestive problems.

Before getting started, you should talk to your doctor and follow the advice of a nutritionist.It is important to initiate the diet in stages:

• First, remove high-FODMAP foods from your diet
• Then, slowly reintroduce high-FODMAP foods into your diet one by oneto identify which ones give you trouble
• Finally, once you've identified the FODMAPs that cause your symptoms, you can limit or avoid them while resuming a normal diet.

In summary, the FODMAP diet can help people feel better by avoiding certain foods that are high in hard-to-digest sugars that contribute to IBD symptoms. This diet has the potential to help you control symptoms and therefore improve your quality of life!

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