Can the low FODMAP diet be used for managing IBD symptoms ?

Your IBD is in remission but you still experience symptoms such as diarrhoea, constipation, belly pain, abdominal cramps, etc.?

You are not alone!

According to Ozer et al., the prevalence of IBS-like symptoms in IBD patients in remission is 2 to 3 times higher than that in healthy control participants.(1)

Symptoms are not always food-related. Stress, excess or lacks of physical activity, infection, lack of sleep, etc. can trigger your symptoms.

However, dietary pattern plays an important role, and some “unthinkable” foods can be the culprit.

It is not always easy to make the link, and as food intolerance can change over time, it can be even more complicated!

 

Is the low-FODMAP diet appropriate?

The low-FODMAPs approach was actually first created to release IBD symptoms (2).

Nowadays, the low-FODMAP diet is mostly used for people with IBS, but can be used in other circumstances such as in people with celiac disease or IBS who still experiment symptoms.

People with IBD are more likely to have lactose intolerance, and people with Crohn’s fructose malabsorption (3).

In a trial involving 88 patients with IBD (39 Crohn’s disease, 38 ulcerative colitis, 11 IBD unclassified) who were advised to follow a diet low in FODMAPs for at least 6 weeks, there was a significant decrease in the severity of most symptoms and significant improvements in stool consistency and frequency (4).

Hence, some studies suggest that “a diet low in FODMAPs is an efficacious treatment solution in the management of functional bowel symptoms for IBS and IBD patients” (3-6).

However, most of the studies are unblended (no control group) and a low-FODMAP diet is not recommended in everyone.

 

The low-FODMAP diet does not suit to everyone

Benefits of the control of IBS-like symptoms in people with quiescent IBD have be balanced by potential adverse effects. Three main concerns are raised:

• The low-FODMAP diet is restrictive and can lead to nutritional deficiencies such as calcium or iron, as well as lower energy intakes. Malnutrition is very common in IBD patients (3) Thus, following a low-FODMAP diet can worsen the nutritional status or put frail people at risk.

 

• Most of the FODMAP-foods are pre or probiotics. Reducing the consumption of these foods seems to have a negative impact on the microbiota diversity.

• Gut bacteria’s roles are many. They include the regulation of the immune system and the inflammation. By reducing the amount of beneficial bacteria, the inflammation can raise in the already-fragile intestine of people with IBD (3).

 

• The low-FODMAPs diet can be quite overwhelming, and can affect your mental health. However, some people feel so much better in the first phase and stay under a low-FODMAPs diet for weeks. This is absolutely not how the low-FODMAP diet should be done because of reasons mentioned above.

 

So, is the low-FODMAP diet a good idea?

I can’t write a better conclusion than Gisbon’s review:

“Evidence from unblinded and observational studies regarding the efficacy of reducing FODMAP intake for IBS‐like symptoms in patients with quiescent IBD is compelling despite the lack of high‐quality evidence. However, the risks associated with such dietary change have to be seriously considered in this patient group. Dietitian‐led implementation of the diet is strongly recommended” (3).

If you want to give the low-FODMAP diet a try, I highly recommend you to seek for professional advice.

I can’t yet help you as I am not a RD for the moment, but if you want to know more about the low-FODMAP diet and learn very useful tools, you can have a look at my Low-FODMAP diet quick starter guide.

 

Take care,

 

Juliette

 

References

1. Ozer M, Bengi G, Colak R, Cengiz O, Akpinar H. Prevalence of irritable bowel syndrome-like symptoms using Rome IV criteria in patients with inactive inflammatory bowel disease and relation with quality of life. Medicine. 2020;99(19).
2. Gibson PR, Shepherd SJ. Personal view: food for thought–western lifestyle and susceptibility to Crohn’s disease. The FODMAP hypothesis. Alimentary pharmacology & therapeutics. 2005;21(12):1399-409.
3. Gibson PR. Use of the low‐FODMAP diet in inflammatory bowel disease. Journal of gastroenterology and hepatology. 2017;32:40-2.
4. Prince AC, Myers CE, Joyce T, Irving P, Lomer M, Whelan K. Fermentable carbohydrate restriction (low FODMAP diet) in clinical practice improves functional gastrointestinal symptoms in patients with inflammatory bowel disease. Inflammatory bowel diseases. 2016;22(5):1129-36.
5. Maagaard L, Ankersen DV, Végh Z, Burisch J, Jensen L, Pedersen N, et al. Follow-up of patients with functional bowel symptoms treated with a low FODMAP diet. World journal of gastroenterology. 2016;22(15):4009.
6. Zhan Y-a, Dai S-x. Is a low FODMAP diet beneficial for patients with inflammatory bowel disease? A meta-analysis and systematic review. Clinical nutrition. 2018;37(1):123-9.