Do FODMAP Foods Trigger IBS Symptoms?

While irritable bowel disease (IBD) and irritable bowel syndrome (IBS) have similar names, they are two different conditions with a few similar symptoms. IBD is an umbrella term, under which are several gastrointestinal diseases including ulcerative colitis and Crohn's disease.

The severity of IBD can depend on genetic markers and the effect of microbes on your immune system.¹ The most common symptom of both IBS and IBD is diarrhea. Those suffering with IBD may also experience anemia, fever, extreme weight loss and bloody stool.

IBS can cause constipation, diarrhea or both. Some have complained of being gassy or bloated and 70% diagnosed with IBS report having suffered severe food poisoning.

The intensity and severity can vary and is often induced by specific foods, the size of a meal or even stress. Currently, treatment methodologies are focused on diet, lifestyle and stress reduction as the symptoms frequently disrupt life and social interactions.

Each year IBS accounts for up to 12% of the total number of primary care visits and the financial burden is estimated to start at $21 billion, including direct and indirect medical costs as well as loss of productivity and work performance.²

An Elimination Diet May Reduce Your Symptoms

Symptoms of IBS include depression and anxiety.³ Many find these symptoms are reduced or avoided through eliminating specific foods from their diet. Discovering which foods should be excluded is most easily done using an elimination diet.

The premise of an elimination diet is to exclude foods that negatively affect the gastrointestinal system. Once your symptoms have subsided, it’s safe to begin adding foods back slowly, one group at a time. If symptoms recur, then eliminate the food group that was just added. Try adding just one new group a week so it will be clear what’s causing the problem.

It’s best to start with foods that are known suspects, such as dairy and gluten. However, it turns out there are several foods you may not be aware of that trigger symptoms.⁴ Each of the culprits have carbohydrates that are difficult to digest and that ferment rapidly in the gut, producing CO2.

The four groups of carbohydrates that meet these criteria are fermentable oligosaccharides, disaccharides, monosaccharides and polyols, more commonly known as FODMAPs.

These foods don’t cause issues in everyone but they do create problems in those who have an intolerance that may be related to a different microbial environment in their gut. The list of short-chain FODMAPs foods you may not have considered include:⁵

• Oligosaccharides — This group contains galacto-oligosaccharides (GOS) and fructans. Foods containing GOS include lentils, kidney beans, chickpeas and soy, while fructans are in broccoli, asparagus, garlic and onions as well as wheat and rye.
• Disaccharides — Lactose containing foods such as those made with cow's milk are part of this group; these include cheese (including mascarpone), yogurt, ice cream and custard to name a few.
• Monosaccharides — These are fructose-containing foods such as fruit, honey and high fructose corn syrup.
• Polyols — Apples, apricots, pears, peaches and blackberries contain polyols, as well as products made with sweeteners found in gum, cough drops and mints. These are sometimes listed as xylitol, isomalt, sorbitol and mannitol.

Not all foods high in FODMAPs will trigger symptoms. Adding some back to the diet will be less restrictive and add a greater range of nutrients from whole foods as you watch for recurring symptoms. Many who have tried the diet end up sticking with it since it improves their quality of life. According to Harvard Publishing, some of the foods known to trigger symptoms of IBS are on the FODMAP list, including:⁶

Gut Dysfunction and System-Wide Inflammation

Researchers have found a correlation between gut inflammation and mental health issues such as depression and anxiety, especially in those with IBS. The authors of one study found a high prevalence of anxiety and depression in those with IBS;⁷ as noted in another, researchers theorized alterations in the gut-brain axis may be involved in the association between IBS and depression.⁸

Results from a meta-analysis demonstrated “depression and anxiety levels to be higher in IBS patients than in healthy controls, regardless of the IBS-subtype.”⁹ Gut dysfunction is also associated with system-wide inflammation, affecting more than just mental health.

An increased number of inflammatory cytokines released throughout the body with gut inflammation may affect numerous aspects of your health. They are involved in a spectrum of autoimmune diseases including rheumatoid arthritis, lupus, multiple sclerosis and psoriasis.¹⁰ Cells involved in the process and development of atherosclerosis are activated by cytokines.¹¹

In my article, "Healthy Gut, Healthy You: A Personalized Plan to Transform Your Health," Dr. Michael Ruscio, author and clinical investigator who focuses on gastrointestinal (GI) health, explains development of the connection between the gut and system-wide inflammation.

Think of your gut as a tube running through the inside of your body that starts at your mouth. This may help you may visualize how the gastrointestinal system is central to supporting the entire body.

Since the largest density of immune cells in your body are living in your small intestines and the small intestines are a selective barrier between the outside world and the inside of your body, when this barrier malfunctions you may experience symptoms of inflammation.

You may have "neurological, rheumatological or even dermatological reactions from foods that don't agree with your gut, because of this very broad-acting inflammatory impact," according to Ruscio.

Histamine Food Intolerance May Trigger Symptoms

Another trigger for gut dysfunction is histamine-rich foods. Histamine is a neurotransmitter like serotonin, epinephrine and dopamine.¹² There is always a small amount circulating throughout your body helping to regulate sleep and physiological functions in the gut.

Your body balances ingested histamine by using diamine oxidase (DAO), an enzyme in the gut that breaks it down.¹³ If you have a DAO deficiency it can allow histamine to build up in the body. Histamine also plays a role in the secretion of acid in the stomach. Excess levels can result in dizziness, headaches, sleep dysfunction, high blood pressure and fatigue.

Researchers believe the wide variety of symptoms may mask the extent of histamine intolerance in the general population. Foods rich in histamine and those that liberate it include:

Personalize a Plan to Heal Your Gut

Your first step to a personalized plan is to eliminate all FODMAP foods for two to six weeks, or at least until most of your symptoms have resolved.¹⁴ Since it’s not likely all FODMAP foods are triggering symptoms, it’s now time to add one group of FODMAPs to your diet.

By the end of testing you should be able to identify the groups that trigger the most severe symptoms and those you might be able to eat in small amounts. Your goal is to test slowly and in increments to learn your limits and then test more strategies to reduce symptoms of IBS. The process of eliminating foods from your diet may be overwhelming but there are a few things you may consider to make the journey a little easier:

• Keep a food diary and log your symptoms as you go through the process, so you aren’t relying on memory.
• Gather recipes before starting the elimination diet so you have some go-to meals and won’t have to expend energy after work trying to think of something to make.
• Keep FODMAP friendly foods in the homes of people you spend a lot of time with, such as your parents or your partner. Include snacks and ingredients for a meal or two. Pack healthy snacks you can bring with you or keep at work.
• Remember, while it may be next to impossible to eat out in the beginning, the process will get easier and you’ll start to feel better, which is a powerful motivator.