Use of FODMAP diet for IBS

[Jasoony1]

I'd like to know what you think about the low FODMAP diet for treating IBS - I've read mixed reviews and also is there a connection between anti-reflux meds (PPI's) or proton pump inhibitors and incidence of IBS. My symptoms have gotten worse over the years and I've read that the anti-reflux meds may be contributing to this.

[Julie Thompson]

Hi Jasoony1
The evidence base for the Low FODMAP diet is that it works for around 70% of people - that of course means that it does not work for 30%. The evidence published so far has been with a dietitian providing this treatment and my experience has been that people are trying this diet without the specialist help, meaning it might not be as effective in that situation. If you do want to try the diet it is worth considering - do ask for a referral to a dietitian to help you. The diet is an exclusion re-introduction diet and the re-introduction part is important to find out which FODMAPs are a problem for you and also to ensure you include some of the FODMAP foods that you do tolerate. Some FODMAPs are prebiotics and are good for promoting good bacteria in your large bowel. I will leave the other part of this question (PPIs) to the other experts on the panel.

[Dr Helen Webberley]

Hi, thank you Julie for your previous very comprehensive answer.

Regarding PPIs, there is some concern that long term use of these is contributing to some health problems, including interfering with bacterial growth in the bowel, and IBS symptoms.

The best way to take PPIs is to just limit them to when you really need them rather than take them every day regardless. Also, when stopping PPIs there may be some rebound in heartburn symptoms that can be eased by something like gaviscon until they pass.

If your PPI is used to treat an actual ulcer then discuss this properly with your GP before reducing.

I hope this helps, Dr Webberley

[Dr Nick Read]

The research indicates that eliminating FODMAPs helps up to 70% of people with IBS, but it also depletes the bacteria in your colon. This is why the proponents of this diet say that it is not a diet for life and you should reintroduce some of the foods you have eliminated under the guidance of a dietitian. Many people find the reintroduction difficult, but it is important. That is why it has been suggested that a simplified version of the low FODMAP diet - by restricting pulses and onions - may help some people as a initial treatment. .
There is certainly a link between oesophageal reflux and IBS. Patients often report that symptoms of both may occur together and certainly some antacid medication, especially that containing magnesium salts can upset the bowels, while acid blockers may contribute to small intestinal bacterial overgrowth in some people. This has been suggested as a cause of IBS in the United States. . . .