Crohn’s disease and ulcerative colitis are the most common forms of inflammatory bowel disease (IBD). They are estimated to affect half a million people in the UK. If you have IBD, you’re likely familiar with the frustrating cycle of flare-ups and symptom management. While medication plays a crucial role, dietary changes can also significantly impact your quality of life. One approach gaining traction is the association with IBD and the low FODMAP diet, but what exactly are FODMAPs and can they truly benefit those living with IBD?
What are FODMAPs?
FODMAP is an acronym for Fermentable Oligo-, Di-, Monosaccharides and Polyols. These are short-chain carbohydrates found in many common foods. In a healthy gut, they’re broken down and absorbed without issue. However, in individuals with digestive sensitivities (IBS – irritable bowel syndrome) or conditions like IBD, FODMAPs can ferment in the large intestine. This leads to bloating, gas, diarrhoea and abdominal pain – symptoms that often overlap with IBS/IBD flare ups.
What is IBD?
Crohn’s disease and ulcerative colitis are both forms of IBD, which cause chronic inflammation in the gut. While Crohn’s can impact any part of the digestive system, ulcerative colitis targets the large intestine. Both cause abdominal pain, fatigue and diarrhoea. Currently, there’s no cure, but medication and dietary changes can manage symptoms and improve quality of life. See the Crohn’s and Colitis Foundation for more information.
The low FODMAP approach
The low FODMAP diet involves a three-phase process: elimination, reintroduction and personalization. During the elimination phase, high-FODMAP foods are temporarily removed from the diet for several weeks until symptoms improve. This allows individuals to identify if FODMAPs are contributing to their symptoms. The reintroduction phase involves gradually reintroducing FODMAPs into the diet one group at a time, monitoring for reactions. Finally, the personalization phase helps create a sustainable, long-term eating plan that minimizes problematic FODMAPs while maximizing dietary variety.
Benefits for IBD management
There is a plethora of research demonstrating the effectiveness of the low FODMAP diet for IBS symptoms. The low FODMAP diet improves symptoms in over 75% of IBS sufferers. There are less studies looking at the efficacy in IBD patients. However, a 2022 systematic review and meta-analysis found that a low FODMAP diet significantly reduced overall gut symptoms and improved quality of life compared to a regular diet. Participants reported less bloating, pain, and urgency, leading to an overall improvement in well-being.
New hope
Exciting new research (2024) from the Francis Crick Institute have found a genetic link between DNA and IBD. A weak section of DNA, coined ‘Master regulator for inflammation‘ is found to be present in 95% of IBD sufferers. This is a genetic defect present at birth in those who go on to develop IBD. A spokesperson for the team said “This is undoubtedly one of the central pathways that goes wrong for people to get inflammatory bowel disease”. Drugs already exist that seem to reverse the disease in laboratory experiments and the research team are now aiming to run human trials. For more on this visit the BBC website.
Important considerations
It’s crucial to understand that the low FODMAP diet doesn’t directly address the underlying inflammation associated with IBD, but can help with symptoms. Medications and the treatment plan recommended by your IBD team remain essential for managing disease activity. Although the research shows an improvement in overall symptoms and therefore quality of life, it didn’t show a significant impact on stool consistency or inflammatory markers. For more information on Crohn’s and ulcerative colitis see the Crohn’s and Colitis Foundation.
Before to decide…
- Check with your GP or Dietitian: Before embarking on the low FODMAP journey, consult a FODMAP-trained dietitian. A specialist can guide you through the diet and give practical tips to help you manage the diet and of course ensure you’re getting proper nutrition
- Not a cure, but a management tool: The low FODMAP diet is not a cure for IBD, but it can significantly improve symptoms
- Long-term commitment: Following the low FODMAP diet requires planning and commitment. However, the potential relief from both IBD and IBS can make it so worthwhile
You’re not alone – a FODMAP Dietitian can help
If you need expert advice and support, an IBS Dietitian can use knowledge and experience to help you with the low FODMAP diet. It can be difficult to do alone, but with support, sufferers can identify their triggers and improve management of IBS and IBD symptoms. A FODMAP dietitian will provide practical ways to help you fit the low FODMAP diet into your lifestyle. Ensuring that you still get all the nutrients you need from your food. I offer a free initial telephone consultation, so why not arrange a call today.
Conclusion
So, research about IBD and the low FODMAP diet shows promise for managing functional gastrointestinal symptoms in people with IBD. While it doesn’t address inflammation, it can significantly improve quality of life by reducing bloating, gas, pain and other uncomfortable symptoms. If you’re looking for additional ways to manage your IBD, discuss the low FODMAP diet with your IBD team and explore if it might be right for you.
