Can a Low FODMAP Diet Help IBD? 7 Things to Know

When patient advocate and author of the blog OwnYourCrohns, Tina Aswani Omprakash, 35, reached an impasse with symptoms related to her inflammatory bowel disease (IBD), she turned in frustration to her nutritionist. On her nutritionist’s suggestion, Omprakash, who lives in New York City, decided to give the low-FODMAP diet a try.

What Are FODMAPs Anyway?

FODMAPs stands for “fermentable oligosaccharides, disaccharides, monosaccharides, and polyols,” all sugars that are common in foods. If these small sugars go unabsorbed and hang around in the intestines long enough, they can produce diarrhea and abdominal bloating and cramping, depending on where they linger. People who have irritable bowel syndrome (IBS) can sometimes get symptom relief through steep reductions in FODMAP intake. Furthermore, this dietary intervention has shown significant treatment benefit in several well done clinical trials of patients with IBS. The benefits for people with IBD, however, are less clear.

Low FODMAP Diet Pitfalls

Going low-FODMAP is not for the weak at heart. “It was kind of daunting at first to realize how much I had to cut out,” says Omprakash. In the end, after trying it for a couple of months, she saw some symptom relief, but emphasizes that because of her additional history of many surgeries, IBS, and having no colon, her experience is quite individual. Omprakash does not currently adhere to a strict form of the diet. 

All such interventions for a system as sensitive as the gut likely will be as individual. Kelly Issokson, RD, CNSC, is an IBD Dietitian (clinical nutritionist) affiliated with the Cedars-Sinai Nutrition & Integrative Inflammatory Bowel Disease Program in Los Angeles. She says that for certain IBD subgroups, there may be benefit of the low-FODMAP diet. 

However, this diet is not for everyone. People with IBD should talk with their health providers before making any significant dietary changes. With that caveat in mind, here are 7 things to know if you’re considering a low-FODMAP diet. 

1. Benefits in IBD are specific to circumstances. One analysis of the collective findings from several studies showed that a low-FODMAP diet can reduce symptoms of nausea, bloating, gas, and diarrhea if IBD is inactive, says Issokson. Patients without active inflammation seem to gain the most benefit, she says, noting that patients with constipation usually see the least benefit. 
2. It can be a hard diet to follow. Omprakash calls it “daunting,” and Issokson says one of the toughest parts is having to avoid onions and garlic, which, as she notes, “seem to be in nearly every food!”
3. It doesn’t put the brakes on active IBD or reduce IBD activity. Issokson says evidence to date shows no benefit of low-FODMAP in these cases and that constipation can even worsen for some people. 
4. Focus on good fiber sources. Because the diet might exacerbate constipation in some people, attention to fiber is crucial, says Issokson, ticking off some examples to consider including: green bananas (ripe bananas are high in FODMAPs), cooked carrots, nut butters, chia seed, and kiwi.
5. It’s not a long-term commitment. The diet can trigger unwanted decreases in gut bacteria diversity, so it’s not a long-term diet to follow, says Issokson. In addition, because it’s so restrictive, it can really hammer on quality of life. On the physical front, low calcium intake is another risk. 
6. Work with a registered dietitian. Doing so is important to ensure an appropriate and nutritionally sound approach to the diet, says Issokson, who urges a consult with a clinician before any big dietary changes.
7. You can individualize it. For example, patients with IBD may not need to follow a complete low-FODMAP diet and can gain symptom improvement by reducing only fructans (commonly found in wheat and onion), says Issokson. 

Emily Willingham writes about health and medicine. Her work has appeared at Scientific American, Everyday Health, Sharecare and others. She is co-author with Tara Haelle of The Informed Parent: A Science-based Resource for Your Child’s First 4 Years.

Medical reviewer and Oshi physician-partner Matthew J. Hamilton, MD is an Assistant Professor of Medicine at Harvard Medical School and a specialist in Gastroenterology, Hepatology, and Endoscopy at Brigham and Women’s Hospital Crohn’s and Colitis Center in Boston. He is a leading member of the research team at the BWH Crohn’s and Colitis Center, and has garnered national recognition for his research into the underlying inflammatory processes of IBD.