You may have heard of probiotics, but have you ever heard of the low FODMAP diet?
A low FODMAP (stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols, which are in some foods naturally or as additives) diet cuts out many common foods that may contain high FODMAPs (see handout at the end of this post*). These foods are eliminated or severely limited for 3-8 weeks, then gradually reintroduced into a low FODMAP diet to see if they cause symptoms (elimination diet). This may be difficult to follow, and it is advisable to contact your doctor or dietitian to make sure that you are on the right track and getting enough nutrients.
It is not meant to be a permanent solution because it is very restrictive, but it may work well enough to be a treatment for people with gastrointestinal (GI) problems such as Irritable Bowel Syndrome (IBS), which is a common GI condition that affects the large intestine. Symptoms include cramping, abdominal pain, bloating, gas, and diarrhea or constipation, or both. Triggers could be anxiety, antibiotics, antidepressants, menstrual pain, stress, or high FODMAP foods.
The low FODMAP diet decreases the amount of diverse healthy bacteria in the gut (particularly Bifidobacterium bacteria, which has an inverse association with abdominal pain, so a smaller population of that bacteria increases abdominal pain). This means that supplementing a low FODMAP diet with a probiotic (see graphic below for more information on probiotics) containing that bacteria is more likely to decrease abdominal pain and other GI distress, and return the microbiome to a healthier, more stable state.
A study showed that the low FODMAP diet as a nutrition intervention is superior as compared to a "sham" diet (fake FODMAP diet). In an analysis of all 104 participants, 57% had adequate symptom relief in the low FODMAP diet as compared to the sham diet group (38%). In a more focused analysis of 88 of the participants, 61% on the low FODMAP diet had adequate symptom relief than in the sham diet group (39%).
The researchers hypothesized that a low FODMAP diet would result in a reduction of the Bifidobacterium species. This may be due to the restriction of prebiotic carbohydrates, or an “anti-prebiotic” effect. This study shows that the result of lowered bacteria species can be improved with the addition of a specific probiotic containing the Bifidobacterium species.
104 participants, aged 18-65 with certain types of IBS (diarrhea-predominant or IBS-D, mixed subtype or IBS-M, and unsubtyped or IBS-U, irritable bowel syndrome), were analyzed over a 4 week period for adequate symptom relief and improved gut microbiota. This study did not analyze those with inflammatory bowel disease, diabetes, celiac disease, IBS-C, abdominal pain or discomfort for less than two days during the screening week, following a restrictive exclusion diet already, bowel preparation for investigative procedures, antibiotic therapy, taking prebiotics or probiotics, and change to IBS medication within four weeks before the screening. Participants were only included if they were unfamiliar with the low FODMAP diet to ensure any prior knowledge would not interfere with the objectives of the study.
The participants were randomly assigned to 1 of 4 diet and supplement groups: a sham “low FODMAP” diet with either a probiotic (group 1) or a placebo (group 2), or a true low FODMAP diet with either a probiotic (group 3) or a placebo (group 4). These groups were randomized such that the allocations were prepared and the supplements were labeled by researchers not involved in participant recruitment or screening (resulting in a double-blind study). Both diet groups were described as designed for altering carbohydrate intake, but only one was designed as a true FODMAP diet. The sham diet was specially designed for this study to be an exclusion diet that mimicked the low FODMAP diet by restricting a similar amount of foods and required similar difficulty of dietary change and counseling. Treatment for both diet groups involved similar food lists and ten minute counseling sessions with a registered dietitian who was not blinded to the diet allocation, but was blinded as to the supplement allocation. Both diets would not impact the intake of calories, macronutrients, or fiber.
*This handout shows which foods and drinks that are suitable on a low FODMAP diet versus not. Notice that certain fruits, vegetables, legumes, etc are to be avoided, such as beans, lentils, wheat, dairy products with lactose, high fructose corn syrup, and artificial sweeteners. Some examples of foods and drinks that are ok to eat on a this diet are certain vegetables and fruits, lactose-free dairy, hard cheeses, meat, fish, chicken, eggs, soy, rice, oats, quinoa, non-dairy milks, and small servings of nuts and seeds.
References:
Staudacher HM, Lomer MC, Farquharson FM, et al. A Diet Low in FODMAPs Reduces Symptoms in Patients With Irritable Bowel Syndrome and A Probiotic Restores Bifidobacterium Species: A Randomized Controlled Trial. Gastroenterology. 2017;153(4):936-947. doi:10.1053/j.gastro.2017.06.010
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