The low-FODMAP diet is one of the best-studied interventions. There is a lot of research behind this. Up to 86 percent of patients with IBS experience improvements in their gastrointestinal symptoms, including abdominal pain, constipation, diarrhea, abdominal distension, and gas. If you see a gastroenterologist with these symptoms, the low-FODMAP diet is a common dietary recommendation a GI doctor would make.
When working with someone, my recommendations are based on the person, their lab work, and their current diet. In conventional medicine, IBS is a general diagnosis for many different symptoms. It doesn’t explain why the person is experiencing it. The goal in functional medicine is to dig deeper for people with IBS, inflammatory bowel disease, and other gastrointestinal problems, to understand the root cause and to provide personalized recommendations. For some people, I could start by removing all processed foods, adding more whole foods, and cutting down on added sugar, which we know can promote bacterial overgrowth. And then we see what kind of symptom resolution can happen. People can achieve significant results through these initial interventions – and by working on managing their stress.
For people who already have a healthy diet and report persistent gas or gas that cannot be tied to certain foods, I’ll investigate whether FODMAPs appear to be a potential trigger. When someone says they eat a lot of vegetables, some fruit, fats like avocado and olive oil, seafood, some grains, and occasionally a little meat, that’s a flag for me. This is often the case with people who are already eating healthy, eating more vegetables, and having symptoms: They will tell me that no matter what they eat, they feel bloated. But that certain foods seem to make it worse: raw vegetables and fruits, beans and lentils, and soups, which usually include garlic and onions. They might also indicate alcohol and overeating. Some will suggest that they had antibiotics before symptoms started, which may be an indicator that their gut microbiome is out of balance.
Also, keep in mind that while GI symptoms are most common in those with bowel disorders, the health of your bowel affects many metabolic, inflammatory, autoimmune, mood and cognitive processes. Bowel disorders can also manifest themselves in autoimmune diseases, brain fog, poor concentration, poor memory, depression and anxiety.