IBS, GI Distress, and Low FODMAP Diet

When clients send in their weekly update document, there is a question asking clients to detail how their digestion was over the course of the previous week. We often get reports of bloat, abdominal discomfort, etc. and with that, sometimes clients will ask about more “drastic” measures to try to combat these feelings. Because of this, I want to discuss acute, or for lack of a better term, “normal” GI discomfort vs. true Irritable Bowel Syndrome (IBS). I will also dive into the utilization of elimination diets, specifically the low FODMAP diet.

Let me start by discussing normal GI distress. While it may be uncomfortable, I want people to know that our bodies manifest GI distress/discomfort as a defense mechanism response to factors such as those listed below. Typically, we can correct these GI issues through small changes to our daily routine, and no food elimination is necessary. Here are some reasons why you may be experiencing bloating, abdominal pain, gas, diarrhea, constipation (or alternating):

1. You are stressed out.
   This is the biggest one that I see as a coach. Whether you are changing jobs, moving, stressed about your nutrition plan because you are type A, stressed about the scale, etc. etc. etc. your body WILL manifest that stress by way of GI distress and irregularity. We need to be able to acknowledge the stressful triggers and be proactive about coping with them. More often than not, this leads to the subsidization of all symptoms. #CTFO

2. You are drinking too much water before, during, and after your meals.
   I recommend clients to try to stop drinking any significant amount of fluid ~30 minutes before meals, only taking sips during meals, and then no significant amount of fluid until ~30 minutes after the meal.

3. Eating on the run.
   I feel like I am beating a dead horse here, but it is absolutely imperative that you eat in a parasympathetic state (rest and digest) to enable appropriate digestion to take place. If you are eating as you’re running out the door, in the car, in front of the tv, while doing work, etc. your body is going to be more focused on the other activities you are trying to do while simultaneously eating. Thus, digestion is put on the backburner. Often times the traffic, tv show, emails, etc. are creating stress (even if it is subconscious) and eliciting the sympathetic state (fight or flight) to take over, the complete opposite of what we want.

4. Being out of routine, especially when traveling.
   Your body loves consistency so whenever you are out of routine whether that be with a sleep schedule, in a new environment, on vacation, etc., there is a large possibility that you will have some GI distress. Nothing is wrong with you.  Get your sleep, drink your water, and keep moving.

5. You are eating food too frequently.
   Take a mental note of what a typical day looks like for you nutritionally and see if there are any foods that you are just absolutely crushing. Sometimes sensitivity can occur due to the cumulative effect, not because you can’t tolerate the food in appropriate quantities.

6. Inappropriate macronutrient distribution at meals.
   When we read these reports from clients on GI discomfort and don’t see any of the above-listed issues, we like to send out a food timing questionnaire for them to fill out. This gives us a good look at mealtimes, macro distribution at meals, and food selection. Because of the flexible dieting approach, sometimes clients will have meals where the distribution of their macros is not necessarily “optimal” and may be contributing to their feels. We can offer suggestions on how to break the food up better and/or give suggestions for alternative food choices (we see this a lot with pre and post-workout meal selection) and that tends to help.

While there are many more contributing factors, these are some of the ones we see the most frequently in our work. Take note that none of these require the elimination of foods/food groups to fix. By simply being aware of these factors and then controlling them, most issues will be resolved. Do you see something that resonates with you on this list? I bet you do.

Now, on to IBS. This is kind of a trashcan diagnosis for having chronic or recurrent GI disturbances (lasting > 3 months), whereas normal GI distress will be fleeting. It is reported that 50% of gastroenterologist visits are for complaints of IBS, but the fact of the matter is that only 10-15% of people are truly suffering from IBS. Because the symptoms of IBS are similar to those listed for normal GI disruption, people tend to jump to the extreme (imagine that) and start eliminating foods rather than to start by tackling the lifestyle issues. The problem with self-diagnosing and then looking for a “quick fix” via food elimination is that oftentimes this leads to a nice cascade of unnecessary food elimination, food fear, and prolonged symptoms. Now, there is no doubt a time and place for elimination methods such as the low FODMAP diet, which is an evidence-based elimination diet method that has been shown to provide symptom relief in up to 75% of individuals. That being said, hopefully, everyone is now clear that this is not necessary for everyone (or even the majority).

What are FODMAPS? FODMAP stands for fermentable oligosaccharide, disaccharide, monosaccharide, and polyols. FODMAPS are short-chain carbohydrates that are poorly absorbed in the small intestine, are osmotically active (aka pull water into the intestines) and are readily fermented by bacteria. As a result, common symptoms in individuals who are sensitive to high FODMAP foods (there are high and low FODMAP foods) include bloating, gas production, abdominal pain, etc. (similar to both normal GI distress and IBS). An important note: high FODMAP foods do not cause IBS, they may simply contribute to the symptoms of IBS. Also, the low FODMAP diet does not magically cure IBS, but it may help temporarily relieve symptoms as well as help determine an individual’s threshold for specific foods during the re-introduction phase. Every individual will vary in which FODMAP’s they react to, if any, and also the severity of the reaction will vary from person to person. The high FODMAP elimination phase for most individuals should really only be for 2-4 weeks or until improvement has been achieved. From there, high FODMAP foods must start to be re-introduced slowly and strategically with the client taking note of when they experience a flare-up of symptoms. It can then be determined if the particular food can be tolerated, tolerated in low quantities, or not tolerated at all.

It is crucial to have the guidance of a professional to aid in the elimination as well as the reintroduction phase of the low FODMAP diet. The reason being is that often times people will experience symptomatic relief and therefore be scared to start adding back any of the foods they eliminated. This is where we can run into problems. Nutrient deficiencies can start to occur, specifically with fiber (although this is a topic for another day), and calcium due to the foods that are eliminated. This elimination diet is not a life-long approach. It should be used therapeutically. We want to be able to find a balance between symptomatic relief without unnecessary restriction, and that will look different for everyone. A final medical disclaimer, while there is evidence supporting the use of the low FODMAP diet with IBS, the research is still inconclusive on its usefulness for Irritable Bowel Disease (IBD). If you are suffering from Crohn’s, ulcerative colitis, etc. please consult with your doctor.

The overarching message here is to first and foremost take a look at lifestyle factors that may be contributing to GI irregularities. While it may not be the popular or sexy thing to do, it is the right thing to do. Do not jump to self-diagnosis. If you are someone who is suffering from IBS, then there is research to support the use of the low FODMAP diet to help alleviate symptoms as well as bring awareness to what foods may be the most problematic. Keep in mind, however, that at the end of the day we need to get to the root cause and not just put a bandaid on it. Whether it be chilling out while you eat, or addressing the root cause of your IBS, the aim is to reduce symptoms and improve quality of life without restriction.