This real-world observational study shows that the low FODMAP diet is effective in improving IBS symptoms. The one data point I want to share with you, new study, I think it's fairly important from Neurogastroenterology Motility in 2024, looked at about 200 patients with digestive symptoms as IBS. They were given low FODMAP for two to four weeks. regardless of the type of IBS. So some people have diarrhea, some people have constipation, some people have bowl.
So it didn't matter exactly what was going on symptomatically. They found that 75 to 90% of people experienced improvements in abdominal pain, in bloating, and also in quality of life. Leading these researchers to comment, this real world observational study shows that the low FODMAP diet is effective in improving IBS symptoms. Pretty great finding, and this is not the only one of its kind. A 2022 meta-analysis from the journal Gut, Chris Black and colleagues over at Leeds University, they examined 13 randomized control trials and they concluded the low FODMAP diet ranked first for abdominal pain severity, and they commented as follows.
The low FODMAP diet ranked first for abdominal pain severity, abdominal bloating, or distension severity, and bowel habits. A different paper, 2021, they commented, the low FODMAP diet is a useful management strategy for irritable bowel syndrome with data from clinical trials suggesting a 50 to 80% response rate. The low FODMAP diet can correct SIBO and also dysbiosis.
So SIBO being overgrowth, dysbiosis being imbalances. One of the more impressive data points here, 2021 clinical trial, the low FODMAP diet increased two key genus. keystone genuses, if you will, lactobacillus and bifidobacterium, while simultaneously decreasing pathogenic bacteria. And how this works, because you may be saying to yourself, well, isn't that paradoxical that we would consume a diet that can starve bacteria, hence resolving SIBO, but also leads to improvements of the levels of healthy bacteria?
And this is because the ecosystem, when healthy... should foster the right balance of bacterial growth. So when there's overgrowth of SIBO, even though it's an overgrowth of the normal good bacteria, that does lead to inflammation, leaky gut, immune system overactivation, histamine release, and all of this is antithetical to having a healthy gut microbiome. And this hasn't been published, but I would also suspect that if these studies... we're also doing assays for fungus you would see improved balance of fungal populations knowing that the gut functions as an ecosystem so a healthy input that reduces SIBO reduces inflammation histamine intolerance and the like will have beneficial impacts on the healthy bacteria and my theory anyway is on levels of fungus in the gut and by the way if this has been helpful please comment and subscribe This really does help us reach more people who are trying to improve their health.
So it is quite deeply appreciated. 2023 clinical trial, two weeks, low FODMAP, only treatment, 30% eradication of SIBO. Now, in that study, there was another arm that actually combined saccharomyces boulardii probiotic and the clearance rate of SIBO went from 30% to 40%, which is why we are real advocates at the clinic for leveraging diet. with probiotics. So that's mechanism number one.
For those of you who have tested for SIBO and you're positive or you suspect you have SIBO, low FODMAP can help with that, thankfully. But what if you've tested for SIBO and you're negative, which is maybe 60-ish percent of people with digestive symptoms? It could be that you don't have SIBO per se, but you have increased levels of inflammation and also leaky gut. So a different clinical trial. found that lofobmap can decrease inflammation as an erlukin-6 and also decrease two different measures of leaky gut, LPS and serum or blood zonulin.
So more great news. You also may notice that your gut is very sensitive. You very easily feel pain and distension and may also be experiencing this with alterations of your bowel habits, meaning sometimes you're constipated, sometimes you're diarrheal, which are two hallmarks of IBS. What's interesting here is Tarek Mazawi and his group demonstrated that in people with these symptoms, they actually have less serotonin cells in the lining of their gut.
But when going on a low FODMAP diet, and I'll share an image here, this is a stain of the intestinal cells, you actually see an increased density, a normalization of cells like serotonin cells in the lining of the gut, which they postulate might be part of the reason why the low FODMAP diet will be corrective for motility. and also reduce pain. Because serotonin is not only about motility, partially, but it also has an influence on pain signaling. Let's come to some of the tips for implementation.
Here is a quick snapshot of some of the more common foods people consume, whether they are low FODMAP or high FODMAP. And really quick, we do have three different versions of this diet, not to confuse you, but because some people will do just low FODMAP. Some people are looking to combine low FODMAP along with a partial elimination as dictated by a paleo diet.
So we have the standard low FODMAP, the paleo low FODMAP, and then some people are on a vegetarian diet. So we also have the vegetarian version of the low FODMAP diet, just to give you a handout that's going to be most tailored to your needs. When looking at grains, you can have, you can consume low FODMAP, which would be oats, quinoa.
and brown rice, but you want to be avoiding the wheat, the rye, and the barley. So that's the grain piece. Some mainstay vegetables, mainly from the brassica family, are all high FODMAP.
So things that you would want to avoid would be broccoli, cauliflower, asparagus, garlic, onions, and avocado. And just simply swap in for those kale, spinach, carrots, cucumbers, green beans, and zucchini. Fruits can also be problematic.
The main ones here would be to avoid apples, grapes, plums, peaches, and watermelon, and then simply swap in berries like blueberries and raspberries and strawberries. And then dairy can also trip you up as you would imagine because dairy contains this carbohydrate that requires assimilation, lactose. Lactose-free milks.
cheeses and yogurts would be okay. And then most milk other than things that are hard cheeses, you would want to avoid. Again, we have the more comprehensive food lists available for you. Let's come to the best way to implement, because this is something, this is one of the trip wires, so to speak, that we see.
People might get freaked out and say, oh, I can never have broccoli again. I can never have asparagus. Nothing could be further from the truth.
Again, we know that FODMAP tolerance is quite recoverable. But it's the short term that you want to be thinking about testing this diet. The analogy we often use at the clinic is consider this like a rehab plan.
So if you hurt your back, you'd be limited. You'd go to the gym and you'd say, oh my God, there's all these machines and all these activities I can't do. Not forever.
Only for a month or two as tissues heal, you can resume normal activity. Same thing with the low FODMAP diet. So for step one, I would think about making a really simple diet plan. Look at the foods in the low FODMAP column, so to speak.
Eat those. And you're going to know within two weeks, oftentimes sooner, if this is the right diet for you. It should not take weeks and weeks and weeks. So the nice thing about this and a really important principle is if it's the right diet for the individual, they're going to know within one to two weeks. Now, it's not to say all of their symptoms will be resolved.
within one to two weeks, but there's a clear indication that this is working. If we think about this in three phases, the first phase, I like to call the test phase or the prove it phase, try the diet. Do you improve? If so, great. Keep going.
If not, move on to something else. That's only two weeks. I would say four weeks max. If you're not clearly noticing improvement by the four week mark, this is either the not the right diet for you or you're missing something.
Then You ride that wave, right? You're improving. Give yourself, again, if it does seem to be helping, give yourself one or two or so full months on the diet. And once you feel healthy, well, like you're a little bit more robust, your symptoms are kind of in the rear view mirror and you've been stable, at least for a month.
Now we start reintroducing, wherein you may notice One or two or three foods don't sit well, but you should see the majority of these foods be tolerable. So this also begs... a question about how strict you should be when you're doing that prove it or that initial testing phase. Opinions here will vary. Here is the data-driven approach that comes from one of these studies.
They looked at level of compliance, either all-in, totally compliant, or they labeled it some, partially compliant. Those who were all-in had an 89% improvement in their symptoms, whereas Those who were sometimes low FODMAP had an 80% improvement in their symptoms. The difference in outcome between total adherence and partial adherence is minimal. It's fairly nominal.
And this is why we so often will say repeatedly at the clinic, when you're doing this diet, think about 80-ish percent compliance. Don't spin your wheels or freak yourself out about if you're traveling, there's a wedding, a social event. whatever you can have some indulgences. In fact, we look at that as an opportunity to test the waters and see how you do.
Sometimes people will say, huh, I'm actually more tolerant than I thought I would be. Yay. Or they get good reinforcement that, okay, these foods truly are triggers and I'm not quite ready to bring them back in yet.
So the framing of this is really important. Don't make it a perfection or fail. scenario it's not the right way to frame this