Dietary strategies for IBS elimination: Aims and execution methods
An elimination diet can be a helpful tool for people suffering from Irritable Bowel Syndrome (IBS), a common digestive disorder that affects the large intestine. The aim of such a diet is to identify and eliminate foods that trigger or worsen IBS symptoms.
The most researched elimination diet for IBS is the low FODMAP diet, recommended by the American College of Gastroenterology (ACG). This diet eliminates foods containing FODMAPs, which are short-chain fermentable carbohydrates that are poorly absorbed in the small intestine and can cause symptoms such as gas, bloating, cramping, diarrhea, and constipation.
Common trigger foods to consider eliminating include vegetables like garlic, onions, artichokes, asparagus, and cauliflower; fruits such as apples, pears, mangoes, watermelon, apricots, cherries, figs, nectarines, peaches, and plums; grains such as wheat, barley, and rye-containing products like bread, pasta, cereals, and biscuits; legumes like lentils, chickpeas, beans, pistachios, and cashews; dairy products like milk, yogurt, custard, and soft cheeses; sweeteners such as honey, agave nectar, maple syrup, and artificial sweeteners containing polyols; and nuts and seeds like almonds, walnuts, peanuts, but cashews and pistachios are higher in FODMAPs.
The low-FODMAP diet typically involves three phases:
- An elimination phase where all high-FODMAP foods are avoided for 4-6 weeks.
- A reintroduction phase where foods from different FODMAP groups are systematically tested to identify personal triggers.
- A personalization phase to establish a sustainable diet avoiding only those foods that cause symptoms in the individual.
After the elimination phase, FODMAP foods can be reintroduced gradually, one group at a time. It is crucial to monitor symptoms during this phase to identify which foods trigger IBS symptoms.
While the low-FODMAP diet can be effective, it requires careful monitoring or guidance from a healthcare professional to prevent nutritional deficiencies. Clinical guidelines from the ACG suggest that the low FODMAP diet may be challenging to follow and lead to nutritional deficiencies without proper guidance.
The International Foundation for Gastrointestinal Disorders (IFFGD) recommends a 12-week elimination diet by starting a food diary, eliminating one food item at a time, and monitoring symptoms for 12 weeks. They suggest starting with common triggers like coffee, chocolate, and nuts.
If someone is unsure how to begin an elimination diet, they can seek advice from a registered dietitian. Working with a healthcare professional helps prevent an elimination diet from feeling overwhelming and ensures people eat a varied diet with plentiful nutrients.
However, it's important to note that elimination diets may not be suitable for everyone. For instance, they may be unsuitable for people with a history of eating disorders or those at risk of nutrient deficiencies or malnutrition.
In summary, elimination diets, particularly the low FODMAP diet, can be beneficial and highly effective for managing IBS symptoms. However, they should be conducted under the guidance of a healthcare professional to ensure a balanced and nutritious diet.
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