November/December 2012

Elimination Diet May Relieve
IBS Symptoms

By Lindsey Getz
Aging Well
Vol. 5 No. 6 P. 32

Doctors are finding it is increasingly common for older adults to be diagnosed with irritable bowel syndrome (IBS), once thought to be a disorder among the younger population. In fact, a study published in Geriatrics found that 10% to 20% of the older adult population had symptoms that were characteristic of IBS. While there is no definitive cure for this colon disorder, a special diet called the FODMAP diet is showing some promise of relief.

FODMAP is an elimination diet whose acronym stands for the series of short-chain carbohydrate foods that are to be avoided: Fermentable, Oligo-, Di-, and Monosaccharides and Polyols. The theory is that consuming foods high in FODMAPs can increase the volume of liquid and gas in the small and large intestines, leading to some of the common IBS symptoms such as gas, bloating, and pain.

“FODMAPs have a cumulative impact on GI [gastrointestinal] symptoms in the individual with IBS so when implementing the diet in an elder client, simply trying to restrict some of the bigger FODMAP culprits, like apples, pears, onion, garlic, and wheat, may be enough to minimize some of their ongoing IBS symptoms without putting them on the complete elimination diet,” says Kate Scarlata, RD, LDN, author of The Complete Idiot’s Guide to Eating Well With IBS. “Although the low FODMAP elimination phase of the diet does restrict many foods, including some fruity favorites like applesauce, pears, and watermelon, the diet does allow bananas, cantaloupe, blueberries, grapes, and more in a one serving per meal or snack time increment.”

Melinda R. Ring, MD, medical director of the Center for Integrative Medicine and Wellness of Northwestern Memorial Physicians Group in Illinois, says every person has some trouble with FODMAPs because these foods always form gas. It’s just that some patients are more sensitive to those effects than others. “It’s important to remember that everyone has a threshold,” Ring says. “Some people may be able to tolerate certain fruits or fruits in small amounts. High-fructose fruits like watermelon, apples, and pears tend to be the most problematic.”

The Australian researchers who developed the FODMAP diet first touted its benefits in 2005. Scarlata says an article in The Wall Street Journal last fall has helped ramp up its recognition in the United States, but Ring says she’s disappointed to find that many physicians are unfamiliar with the diet. “I’d like to say that it will become more mainstream in the near future, but I’m still surprised to find that many physicians have never even heard of it,” she says. “Unlike gluten intolerance and other food sensitivities that are getting a lot of press, a large portion of the public and even the medical community don’t know about fructose intolerance and its link to IBS.”

One positive aspect of the FODMAP diet is that patients generally know early in the course of the diet whether or not it will work for them. “Whatever is in the GI tract is what’s causing the symptoms so patients know pretty quickly if they’re getting relief by avoiding certain foods,” says Joseph H. Sellin, MD, a professor of medicine at Baylor College of Medicine and director of gastroenterology at Ben Taub General Hospital in Houston. “It’s not like a drug that has to build up in your system and may take a few weeks until you feel the results.”

Ring says that when considering the FODMAP elimination diet for patients, the most important thing physicians can do is ask the patient to produce a diet history. He or she needs to identify after what meals GI symptoms develop. “If they can target which meals and which foods are causing worsening of the symptoms, that’s incredibly helpful,” Ring says. “Physicians need to focus more on looking for a cause of the symptoms. For a long time, physicians have just said, ‘You have IBS—it is what it is.’ But eliminating foods that exacerbate the symptoms can help heal the patient’s gut and possibly even relieve their symptoms.”

Careful Monitoring
While the FODMAP diet is safe for most individuals, Ring says anyone suffering from malnutrition should not undertake an elimination diet without supervision. “I’ve seen patients who don’t know what to substitute the eliminated foods with and end up with a limited diet that lacks nutrients,” she says. “That can lead to deficiencies.”

Sellin adds that patients who suffer from constipation should know that the FODMAP elimination diet could worsen their symptoms. “The diet does eliminate a lot of fiber so patients who suffer from constipation could experience an exacerbation of their condition,” he says.

Closely working with a dietitian can ensure that a patient can safely complete the diet without causing any deficiencies or exacerbating constipation. Scarlata says a “good understanding of the diet and a creative dietitian can help make the diet well balanced and still very tasty.”

“The low FODMAP diet can be easily implemented in the elderly population, but considering constipation can be an issue in this population, it’s important to encourage adequate low FODMAP sources of fiber such as oat bran, rice bran, potatoes with skin, whole oats, small amounts of flaxseed and chia seeds, and allowable vegetables and fruit,” she adds.

Ring hopes the FODMAP diet will continue to gain more recognition among physicians. “It’s such an easy thing for patients to try,” she says. “It’s not a medication and it’s not harmful. It’s just a matter of removing some foods from the diet and seeing if the patient feels better. I’ve seen many older patients who have suffered with gut issues for decades and are amazed that when they do a program along these lines they see a difference right away. Many will even say, ‘I wish someone had told me about this 50 years ago.’ I’d certainly like to see more patients finding that kind of relief from their IBS symptoms.”

— Lindsey Getz is a freelance writer based in Royersford, Pennsylvania.