IBS/IBD and FODMAPs

by Kim Andersen
IBS (Irritable Bowel Syndrome) and IBD (Inflammatory Bowel Disease) are often confused because they are triggered by many of the same foods and situations, involve chronic inflammation of the colon and often express identical symptoms, but not always. Most people will suffer from abdominal pain, diarrhea, constipation, bloating and gas.1

What is the difference between IBS/IBD?

Although IBS and IBD are very similar because they involve chronic inflammation and result in initially the same experience, they do have distinct differences:

  • With IBS, there are no ulcers or lesions.
  • It only occurs in the large intestine (Colon).
  • The primary disfunction is improper Peristalsis.2
  • With IBD, Peristalsis can be functioning correctly.
  • The primary problem is a group of bowel issues that cause chronic inflammation in different parts of the entire gastrointestinal (GI) system.2

The scope of the causes for IBD are too in-depth to be handled here, but the same remedies for IBS will also contribute greatly to the recovery of IBD sufferers.1

How do you get IBS

What actually triggers the chronic inflammation in the first place likely is the result of time and a number of causes, but how it escalates is understood. When you are triggered, you produce gas that stretches and expands the colon beyond its normal compacity, which in turn irritates the lining and can even cause microtears.3 If the lining is given time to recover fully, the body can manage the incident. When the colon is exposed to repeated irritation and expansion, chronic inflammation sets-in. 2 The result is a loss of proper Peristalsis. It should be noted here that repeated use of laxatives also disrupt the natural rhythm of Peristalsis and may contribute to the development of IBS.5

Peristalsis is the rhythmic contracting of the muscular wall of the intestine to move the contents through the colon toward the rectum. As it contracts, it absorbs water and nutrient from the bolus moving through it. Waste material, stool, collects in the rectum until it is expelled through the anus as a bowel movement.2

With IBS, and again not necessarily but possibly IBD, the muscle contractions are abnormal. In some cases, the abnormal contractions can cause the bolus to quickly move through the colon, resulting in a watery stool or diarrhea, because there was not enough time for the colon to absorb the excess water. The opposite is also possible. The contractions can be to slow and the colon absorbs too much water from the bolus, resulting in constipation and a hard stool. IBS sufferers can experience both conditions.2

What are the triggers?

The primary trigger seems to be specific foods: grains, refined sugars (cane, coconut, guava), milk sugar or lactose, and certain fibres that are found in legumes and Omega 6 fatty acids like soy, corn and canola, with the oil being the greater culprit.1 It’s important to note that all these food triggers are high FODMAP foods.

Another culprit is stress.1 Stress affects the mind, but what it does to the central nervous system and the adrenals impacts the colon. When you are under stress your muscles, including your GI track, tighten up for action and your adrenals begin to produce cortisol. This is the fight/flight response and would be very useful if you were running for your life. Tight muscles prepare you to spring into action and the cortisol increases the sugar in your blood for a burst of energy. This is another reason why you produce cortisol when you exercise. The insulin that is produced by the pancreas sends sugar to the cells for energy, shuts down a number of other functions that would slow you down, like liver and digestion functions, sex hormone production, repair and fat burning, so prolonged stress has a huge impact on the body. This situation also applies to the consumption of carbohydrates and sugar, both of which need insulin to process.

With repeated stress/carbohydrate and sugar consumption the liver gets fatty, even before you see a single pound. A fatty liver is inefficient in producing bile and enzymes and filtering toxins on a daily basis. These digestive deficiencies, among other things, allows complex molecules to enter the colon, triggering an inflammatory response. The tightened muscle wall, associated with prolonged stress, further interferes with the natural tension and flex of the colon, increasing inflammation further.

I would also like to add alcohol to this list, because when you drink alcohol it puts your liver in toxic shock and it cannot undertake any function for the Gut until it has recovered. The liver requires roughly 1 1/2 hours to recover from a 4oz glass of wine. If you drink a glass of wine with dinner your liver can not make bile, enzymes or filter toxins. You will not have a properly functioning GI tract while eating, which will result in an inflammatory response in the colon.

What can you do?

It's hard to get stress out of your life and it can take time and new skills to accomplish. Learning to cope and alleviate your stress is a big part of the puzzle and it is necessary to undertake the challenge in order to recover from IBS.4

The consumption of alcohol is an immediate area for improvement. Knowing that drinking alcohol causes immediate problems to the digestive functions of the liver, suggests that the enjoyment of that glass of wine might be better enjoyed an hour after eating or an hour or so before. Avoiding alcohol altogether is best, but if you enjoy drinking don't eat at the same time.

For many, food choice will have the biggest impact on recovery.4 The FODMAP system helps to identify healthy foods (fermentable and Polyols) that may currently be causing inflammation and unhealthy foods that always cause inflammation. It should be noted here that the healthy foods that are high FODMAP foods can be eaten once the colon is repaired.1 They should be slowly reintroduced in small quantities.

What are high FODMAP foods?

FODMAP is a list of foods that cause inflammation in the colon and is an acronym for: 1

  • Fermentable – (carbs) digested by gut bacteria/produces gas with a disrupted Peristalsis
  • Oligosaccharides – (few sugars) grains, garlic, onions and legumes/ 50% of the problem
  • Disaccharides – (two sugars) dairy products with lactose sugar/casein allergy
  • Monosaccharides – (one sugar) fructose, fruit, corn syrup, sugar/40% of the problem
  • And
  • Polyols - (sugar and fibre found in some fruits and vegetables) sorbitol and mannitol

High-FODMAP foods to avoid1:

  • Broccoli
  • Cauliflower
  • Asparagus
  • Brussels sprouts
  • Cabbage
  • Peas
  • Mushrooms
  • Onions
  • Shallots
  • Garlic
  • Artichokes
  • Okra
  • Beetroot
  • Fennel
  • Leeks
  • Fruits
  • Avocado
  • Dairy products with carbohydrates- milk, ice cream, yogurt, process cheese, kefir
  • Legumes
  • Grains
  • Starched- potatoes (reg, yam & sweet), tapioca, arrowroot
  • Sugar- all kinds, including honey, but not sugar alcohols or monk fruit
  • Cashews and peanuts
  • Pistachio

High FODMAP foods increase gas in the colon, which stretch and expand it beyond normal capacity, causing chronic inflammation. On a low-FODMAP diet, you want to consume plenty of low-FODMAP foods and avoid all high-FODMAP foods.

Low-FODMAP foods1:

  • Bean sprouts
  • Green beans
  • Bok choy
  • Bell pepper
  • Carrot
  • Herbs
  • Cucumber
  • Lettuce
  • Tomato
  • Zucchini
  • Eggplant
  • Radish
  • Squash
  • Meats
  • Seafood
  • Feta cheese
  • Hard cheeses
  • Lactose-free, low carb diary
  • Almond and possibly Coconunt Milk in moderation at 1/2cup
  • Eggs
  • Dark chocolate
  • Macadamia, Walnuts, Pecans, Almond and Pine nuts
  • Pumpkin, Sesame, Sunflower seeds
  • Flax, Chia and Psylium Fibre

Dr. Eric Berg suggests that if you do the low-FODMAPs diet for 3 months and see no improvement, it may help to cut out all vegetables and do a Carnivore Diet for roughly two months to allow your gut to completely settle down. Then resume the low-FODMAP diet.1 The Carnivore Diet is not a permanent diet, but one undertaken in extreme situations. Be sure to fully research how to do a Carnivore Diet before proceeding or seek the help of a professional. A low-FODMAP diet can be a permanent diet that promotes life-long, Gut health.

References:

  1. 1.Berg, Eric MD. Fodmaps and IBS https://youtu.be/CwKXVDUJEMo , 2022.
  2. Nucleus Medical Media. Irritable Bowel Syndrome IBS. https://youtu.be/eKLqFnAmK6c 2019.
  3. Berg, Eric MD. The Most Common Nutrient Deficiencies in IBD. https://youtu.be/Ob8sR4A-UIA , 2022.
  4. Berg, Eric MD. Irritable Bowel Syndrome IBS: Top 5 Tips. https://youtu.be/v_41TUmJs9k , 2022.
  5. Villines, Zawn. Lazy Bowel: What To Know. Medical News Today. Medically reviewed by Cynthia Taylor Chavoustie, MPAS, PA-C. Jan 10, 2022. https://www.medicalnewstoday.com/articles/327136 ,2022.

     

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