A low-FODMAP diet can often relieve IBS symptoms, but it’s a challenging protocol. A new study suggests there may be an easier road to relief.
A low-FODMAP diet can often relieve IBS symptoms, but it’s a challenging protocol. A new study suggests there may be an easier road to relief.
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Nutrition Diva is hosted by Monica Reinagel, MS, LDN. Transcripts are available at Simplecast.
Hello I’m Monica Reinagel and you are listening to the Nutrition Diva podcast, a show where we dig into the latest nutrition research, headlines, trends and fads so that you can make more informed decisions about what you eat!
If you have IBS, or know someone who does, you're probably familiar with the low-FODMAP diet. For the past decade or so, it's been considered the gold standard dietary approach for managing distressing IBS symptoms like abdominal pain, bloating, diarrhea and/or constipation. (Some people alternate between the two). And while it can be very effective, the low FODMAP approach can be challenging to implement and maintain.
But some new research just published in the journal Nutrients, suggests there might be a simpler path to relief, one that could be just as effective while being considerably easier to implement and maintain.
But before we talk about this promising new alternative approach, let's quickly review what the low-FODMAP diet is and why it works. FODMAP is an acronym that stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols. These are specific types of carbohydrates that can be poorly absorbed in the small intestine. When these unabsorbed carbs reach the large intestine, the beneficial bacteria that live in the gut go to, fermenting these carbohydrates and producing a lot of gas in the process. They also draw water into the intestine through osmosis. For IBS sufferers, who often have heightened sensitivity to intestinal pressure and distension, this combination of gas and fluid can trigger painful symptoms.
The low-FODMAP diet works by limiting foods high in these fermentable carbs. But here's where it gets tricky: FODMAPs are found in a wide variety of otherwise healthy foods - including many fruits, vegetables, grains, and dairy products. Following a low-FODMAP diet means avoiding or limiting things like:
Not only is the list of foods to avoid quite extensive, but the diet is typically implemented in phases. There's an initial elimination phase lasting 2-6 weeks, followed by a systematic reintroduction phase where you test your tolerance to different FODMAP groups. The goal is to eventually customize the diet to your individual tolerances.
While this systematic approach can be very effective, it requires significant education, planning, and commitment. Many people find it difficult to maintain, especially in social situations or when eating away from home. It can also be nutritionally challenging if not properly planned, since it eliminates many nutrient-rich foods.
Which brings us to this latest research, suggesting that there might be a simpleran simpler solution.
That simpler way is called SSRD—which stands for Starch- and Sucrose-Reduced Diet. And while it might sound similar to a low-carb diet, it's actually more targeted. Instead of restricting all carbohydrates, it focuses specifically on reducing two types: starch (found in foods like bread, pasta, and potatoes) and sucrose (the kind of sugar that is added to foods.)
Now, I’ll grant you that these are two pretty big categories of foods. But it is still a bit simpler than trying to keep track of all 7 of the FODMAPs.
The idea behind this approach stems from recent discoveries about IBS. It turns out that some IBS sufferers may have variations in genes that produce certain digestive enzymes—particularly one called sucrase-isomaltase. This enzyme's job is to break down sucrose and some starches in your small intestine. If you're not producing enough of it, these carbohydrates don't get properly digested and absorbed.
Just like FODMAPs, these poorly digested carbs can end up causing trouble further down in your digestive system—drawing in water and getting fermented by bacteria, leading to those all-too-familiar IBS symptoms.
But here's where the SSRD approach differs from low-FODMAP: Instead of restricting all the different types of fermentable carbs and then slowly testing each group to see which ones you can tolerate, you simply reduce your intake of starch and table sugar. That means:
You can still eat many foods that would be restricted on a low-FODMAP diet, such as legumes and dairy products. And unlike the low-FODMAP diet, there's no complex reintroduction phase to navigate.
But the big question is: Could something this simple really work as well as the more comprehensive low-FODMAP approach? That's exactly what researchers in Sweden set out to discover.
Researchers recruited 155 IBS patients and randomly assigned them to follow either SSRD or a low-FODMAP diet for 4 weeks. Then they followed up with the participants 5 months later to see how they were doing. Here's what they found:
Both diets were equally effective. About 80% of patients reported significant improvement in their symptoms. About a quarter of them were symptom free at the end of the 4 weeks. Both groups also saw similar improvements in various symptoms beyond digestive issues, including fatigue, headaches, back pain, and other physical complaints. Both groups also reported a reduction in sugar cravings but this effect was more pronounced in the SSRD group.
Of the subjects that had experience with both approaches, they preferred the SSRD diet to the low-FODMAP by about 2 to 1, reporting that it was easier to follow and, for some, more effective.
The researchers followed up with the subjects several months later to see how they were doing. About 6 in 10 of those on the SSRD diet were still following that approach, although perhaps not quite as strictly. Only about 4 in 10 of those on the low-FODMAP diet were still following that regimen, which, again, suggests that the SSRD was a little easier to stick with.
Interestingly, though, even those who largely reverted to their previous eating habits still reported a reduction in symptoms six months later, suggesting that even a brief dietary intervention to reduce IBS symptoms can have lasting benefits. It may also be that the study period made it easier for subjects to identify which foods were particularly problematic for them, and that they continued to avoid those foods, even if they weren’t following the entire dietary protocol.
Aside from being effective in managing IBS symptoms, the SSRD diet may have a positive effect on other aspects of diet that have nothing to do with IBS, such as weight management and cardiovascular health.
So what does all this mean if you're struggling with IBS symptoms? First, it's encouraging to know that you may have options. While the low-FODMAP diet remains a proven approach, this research suggests that a simpler strategy might work just as well, as well as being more sustainable.
If you're considering trying this approach, the SSRD study protocol allowed:
But what's particularly interesting is how participants ultimately simplified the SSRD approach. According to the study, many found they could maintain their improvement by focusing on just two key principles:
Of course, everyone's IBS is different, and what works for one person may not work for another. But given that this approach is relatively simple to implement and appears to have benefits beyond just symptom relief, it might be worth discussing with your healthcare provider as a first-line strategy - especially if you've found the low-FODMAP diet too challenging to follow. I’ll include a link to the study in the show notes for your reference.
If you have a question about today’s episode or a suggestion for a topic you’d like me to cover in a future episode, you can email me at nutrition@quickanddirtytips.com You can also leave me a message at 443-961-6206
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Nutrition Diva is a Quick and Dirty Tips podcast. Our team includes Brannan Goetschius, Nathan Semes, Davina Tomlin, Holly Hutchings, and Morgan Christianson.and Nathaniel Hoopes.
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