How to relieve irritable bowel with foods without FODMAPs?

Irritable bowel syndrome is complex and causes major problems in terms of quality of life. There are several types of irritable bowel syndrome: constipation predominant, to diarrhea predominant, mixed form (constipation and diarrhea) or not defined. These symptoms are very characteristic of functional colopathies and particularly the alternation between constipation and diarrhea. Other digestive symptoms are noticeable such as bloating, abdominal pain, a swollen stomach, but also reflux. In addition, extra-digestive signs are also noted: joint and muscle pain, headaches, cystitis repeated.

This syndrome has multifactorial causes, including:

• pathophysiological : specifically visceral hypersensitivity, inflammation of the intestinal wall, but above all hyperpermeability of the intestinal mucosa leading to easier entry of toxins into the enterocytes (cells of the mucosa). A background imbalance is also a main source of diagnosis, and particularly intestinal dysbiosis (imbalance of the intestinal flora).

• psychological : strong emotions and stress promote symptoms.

• bacterial : bacteria Brachyspira would be responsible for pain and digestive disorders.

• food : Most patients tend to attribute the symptoms to the foods ingested during previous meals, leading to many unnecessary restrictions.

Indeed, food is a frequent source of consultation. Weakened intestines cause symptoms of intolerance and bloating following the ingestion of foods that are difficult to digest. This is why this syndrome is often confused with lactose intolerance and celiac disease (gluten intolerance). Therefore, it is essential to realize of the breathing tests with measurement of hydrogen and methane in exhaled air during a load test, in order to diagnose a possible gluten intolerance or lactose intolerance. For irritable bowel syndrome, the diagnosis is made when the characteristic disorders are chronic and longer than 3 months.

Basic advice on healthy eating in the context of functional intestinal disorders is very important before excluding any food. Indeed, to avoid any deficiency and any social damage, nutrition is based on the following principles:

• Optimize omega-3 intake : these polyunsaturated fatty acids are important in the inflammatory response, in particular by soothing inflammation that may be present in cases of irritable bowel syndrome. We recommend that you bring foods that are sources of omega-3 every day and at every meal: small oily fish (mackerel, sardines, etc.), rapeseed oil, hemp oil, walnut oil and camelina oil, affiliated eggs. blue white heart”.

• Provide antioxidants : vitamins C and E, beta-carotenes, polyphenols, all these nutrients help reduce inflammation by limiting the phenomenon of oxidative stress. The latter is linked to an overproduction of free radicals not stabilized by antioxidants, the intake of which is too low in modern diets. We recommend that you bring foods rich in antioxidants to each meal: colorful fruits and vegetables (peppers, cranberries, blueberries, prunes, raspberries, cabbage, etc.), dried fruits, spices (astaxanthin, turmeric, cumin, etc.).

• Favor foods that are sources of magnesium : a magnesium deficiency can be a source of bloating. Indeed, magnesium plays a role in relaxing the muscles of the intestine, which facilitates digestion. In addition, it helps reduce stress which is very characteristic of functional intestinal disorders. We recommend that you optimize magnesium intake to a minimum of 300 mg per day: waters rich in magnesium (Rozana, Hépar, Badoit), 150 g of white beans, 200 g of flageolet beans, 200 g of red beans. Dark chocolate is a good source of magnesium (152 mg per 100 g of dark chocolate); you can eat a square (30 g) to boost your intake.

• Exclude irritating foods such as alcohol and excessive cooking, which support the phenomenon of fermentation and gas production, inducing bloating.

• Providing prebiotics while following a normal light diet : prebiotics are present in dietary fibers which are carbohydrates not digested by the intestines and are the preferred food of colonic bacteria. Functional colopathies seem to be facilitated by low fiber intakes, so we recommend a normal light diet which consists of providing between 25 and 30 g of fiber per day, while avoiding excesses. These contributions make it possible to rebalance the intestinal flora by limiting dysbiosis (imbalance of the flora between good and bad bacteria). We recommend that you promote prebiotic fiber intake by consuming foods that are sources of prebiotics 1 to 2 times a day: asparagus, banana, onion, leek, artichokes.

If these tips aren't enough to relieve your symptoms, it will be wise to refer you to a doctor or dietitian to detect intolerances (gluten, lactose, FODMAPs).

FODMAPs (Fermentable Oligosaccharides Disaccharides Monosaccharides An/a Polyols) are carbohydrates not digested by the intestines and rapidly fermentable by bacteria in the colon (fructans and galactans, lactose, excess fructose, polyols). Their digestion promotes the production of intestinal gas causing irritation of the colonic mucous membranes and digestive disorders such as bloating. THE low FODMAP diet allows, not to cure, but to limit symptoms leading to a very complicated quality of life for those who suffer from it. An estimated 68-76% success in alleviating irritable bowel symptoms.

However, this diet is very restrictive and leads to significant social complications and in particular isolation. This is why it is essential to be followed by a doctor or a dietician in order to discuss the various problems. In addition, it is important to first detect a gluten intolerance (guide to gluten intolerance and diet) or a lactose intolerance (guide to lactose intolerance and diet) before starting such a restrictive diet, hence the importance of monitoring.

The low FODMAP diet must be carried out with the help of a health professional specializing in nutrition (dietitian-nutritionist or nutritionist doctor). Indeed, if it is poorly implemented, this diet can be a source of micronutrient deficiency, social isolation and intestinal dysbiosis (imbalance of the intestinal flora). Therefore, this diet takes place in three phases:

• A first phase symptom relief 4 to 6 weeks minimum in which it is recommended to partially or completely eliminate foods rich in FODMAPs likely to be the source of the symptoms. It is recommended to wait a few days without symptoms before starting the reintroduction phase.

• A second phase of gradual reintroduction of foods to test tolerance. Indeed, the goal is to reintroduce these foods in order to eliminate all risks of micronutritional deficiencies, social exclusion and decline in quality of life due to these intolerances. In addition, these fibers are essential for the health of the intestinal microbiota, because they act as prebiotics. It is therefore imperative to reintroduce them. Furthermore, studies have shown that improvement of symptoms remained even after reintroduction of FODMAPs. 

• A third phase of power customization depending on the patient.

The reintroduction of FODMAPs is done via an ingestion test of a group of FODMAPs in small quantities, for example milk for Disaccharides (lactose). It is necessary to test tolerance to milk in small quantities and increase the doses gradually in 3 stages in order to define a threshold for each, while alternating with a day of rest for each dose. It is recommended to reintroduce them outside of meals to easily identify symptoms and not to confuse them with another food. If the symptoms experienced are moderate, we stop the reintroduction and switch to another food.

After 3 days of rest, it is possible to follow this same path with another group of FODMAPs such as honey for Monosaccharides (fructose). Please note, we only reintroduce one family of FODMAPs per week.

Fructans are carbohydrate chains composed of a few fructose units and are considered prebiotics (food of probiotics which are colonic micro-organisms). In fact, they are not absorbed by the intestines and 99% are found in the colon where they are digested by colonic bacteria through fermentation. The latter induces the production of intestinal gases such as methane, hydrogen and carbon dioxide, and consequently symptoms of bloating.

We recommend you :

• of decrease, or even eliminate, your consumption of food sources of Fructans, depending on your tolerance, for 4 weeks: jerusalem artichoke, cabbage, onion white, garlic, leeks (white part), artichoke, chicory, rye, products containing wheat (bread, pasta, cereals), biscuits and appetizer cakes made from wheat or rye.

• Concerning secondary sources (wheat, barley, rye and their derivatives), reduce the quantities is often enough to improve symptoms.

• to try to reintroduce these foods after symptoms have subsided in order to limit any micronutritional, vitamin and fiber deficiencies.

All legumes are rich in galactans (raffinose and stachyose). Like fructans, these polyols (long carbohydrate chain composed solely of galactose) are not digested by the intestines and are 99% fermented in the colon. These galactans are used in the food industry as a thickener or stabilizer.

We recommend you :

• of decrease, or even eliminate, your consumption of legumes, depending on your tolerance, for 4 weeks: chickpeas, red beans, lentils, white beans, broad beans, split peas.

• to try to reintroduce these foods after symptoms have subsided in order to limit any micronutritional, vitamin and fiber deficiencies.

A deficiency in lactase (lactose-digesting enzyme) is noticed in 70% of the population. This deficiency leads to the fermentation of excess lactose by colonic bacteria, which causes gas production and therefore abdominal pain.

We recommend you :

• of test your tolerance with lactose. Often, the residual lactase activity allows a tolerance of 12 g per day of lactose (240 mL of milk, or a full glass).

• of decrease, or even eliminate your consumption of dairy products rich in lactose, depending on your tolerance, for 4 weeks: milk, yogurt, fresh and melted cheese, cream, ice cream, milk-based preparations (milk chocolate, sauces, etc.).

• of look at the labels industrial products, as they may contain lactose.

• to try to reintroduce these foods after alleviation of symptoms in order to limit any deficiency, particularly in calcium.

These foods are rich in monosaccharides (especially fructose). Indeed, in case excess fructose, the latter cannot be assimilated in the intestines and is therefore transported to the colon to be degraded by the fermentation flora. Once again, this fermentation induces an overproduction of gases causing bloating (hydrogen, methane and CO2).

We recommend you :

• to avoid excesses foods rich in fructose with a fructose/glucose ratio greater than 1: apple, pear, mango, honey (7 g max), agave syrup, watermelon, asparagus, snow peas, drinks and industrial sweet products.

• of look at the labels industrial products, as they may contain fructose.

• to avoid total deletion fruit sources of fructose if possible because they are essential for vitamin intake. In fact, health authorities recommend avoiding excess. The following fruits are also low in fructose: lemon, cranberry, apricots, honeydew, clementine, tangerine, white peach, nectarine, raspberries, grapefruit.

These foods are rich in polyols (sorbitol, maltitol, xylitol, mannitol). These carbohydrate compounds are used in sweet industrial products. lightened " Or " without sugar ". Indeed, they generally have a sweetening power (sweet taste sensation) greater than or equal to sucrose (table sugar), while counting fewer calories. However, these sweeteners have hydroxyl groups that are difficult for digestive enzymes to digest. Thus, they are fermented by the colonic flora and are the cause of certain disorders such as bloating, diarrhea or nausea, in addition to being laxative for the most part.

We recommend you :

• to limit or even eliminate “low-fat” or “sugar-free” industrial products from your diet: sweets, chewing gum, refreshing sweets, sauces, “zero calorie” or “light” drinks, breakfast cereals, cakes.

• of restrict, or even eliminate certain fruits and vegetables rich in polyols, depending on your tolerance, for 4 weeks: avocado, mushrooms, cauliflower, stone fruits (peach, cherry, plum, etc.).

• to try to reintroduce these fruits and vegetables after alleviation of symptoms in order to limit any vitamin and fiber deficiency.

These fruits and vegetables are very often tolerated by people suffering from functional colopathies. In fact, they are low in FODMAPs and their consumption is considered safe at the symptomatic level. In addition, onion and leek are often wrongly eliminated. In fact, it is the white parts of these foods that contain FODMAPs. THE green parts are therefore amply tolerable.

We recommend you :

• to direct you towards the fruits and vegetables following: green beans, lettuce, carrot, chives, cucumber, tomato (65 g max), zucchini, onions (green part), leeks (green part); banana, orange, clementine, grapes, melon, blueberries, raspberries and strawberries.

• to consume as little as possible 5 servings of fruits and vegetables per day, with a prevalence for vegetables, in order to avoid micronutrient and vitamin deficiencies.

Rice is the grain product most often consumed by people suffering from irritable bowel syndrome. In fact, this food is free of FODMAPs and gluten. In addition, it is important not to limit your consumption of grain products since they are the main source of carbohydrates for the body. In fact, these are considered the body's favorite fuel.

We recommend you :

• consume cereal products low in FODMAPs and gluten at each meal, at a minimum height of 150 g cooked. It is recommended to consume them with vegetables and protein source foods to have a complete meal.

• to move towards the following cereal products: rice, gluten-free bread and pasta, oats, quinoa, gluten-free biscuits and cakes, rice or corn cakes.

• If you are looking for a particular type of bread for your daily consumption, the sourdough spelled bread may be wise. Indeed, “leavened” means that this bread has a culture of bacteria and yeast added to the flour, digesting fructans.

Yogurts are often much better tolerated than other dairy products. In fact, yogurt is made up of more than a billion milk bacteria having their own lactase, which allows lactose to be digested very easily. In addition, lactose-free or low-lactose dairy products are also very well tolerated by people suffering from functional colopathies. It is important not to eliminate dairy products since their calcium intake is essential for the body.

We recommend you :

• to move towards the following dairy products: lactose-free milk, yogurt with or without lactose, aged cheeses having less than 0.3 g of lactose per 100 g (cheddar, parmesan, Comté, Reblochon, Cantal, Gruyere, Emmental, etc.), semi-hard sheep's and goat's cheeses generally having less than 1 g of lactose per 100 g (in logs, bricks, crottin or fresh cheese).

• to consume dairy products reasonably : 2 to 3 per day maximum, 30 g maximum of cheese.

These foods are free of FODMAPs or indigestible foods. They are also rich in protein allowing to optimize immune defenses thanks to amino acids. However, be careful with excess meat, fish and eggs, because they are rich in lipids which can be difficult to digest in excess.

We recommend you :

• to bring at lunch and dinner one of the following protein-rich foods: meats, fish, poultry, firm and soft tofu, tempeh.

• to consume legumes like tofu and tempeh 2 to 3 times a week.

Breakfast :

• Cottage cheese
• Oatmeal
• Cranberry
• Agave syrup

Lunch :

• Beet salad with rapeseed oil
• Guinea fowl
• Wholemeal pasta with turmeric
• Cauliflower
• Dark chocolate square

Snack :

• Prunes
• Cashew nuts

Dinner :

• Onion omelette
• Red beans
• Leek
• Natural yogurt

Breakfast :

• Cup of lactose-free milk
• Gluten-free bread toasts with butter
• Banana

Lunch :

• Tomato salad with hemp oil
• Beef minced steak
• Basmati rice
• Green beans
• Firm tofu

Snack :

• Some strawberries
• Natural yogurt

Dinner :

• Tempeh
• Gluten-free pasta
• Carrots
• Piece of Reblochon

• The stress is the main source of irritable bowel syndrome. It is wise to direct yourself towards relaxation exercises (yoga) and cardiac coherence in order to reduce this stress. Moreover, essential oils also seem very effective in cases of stress.

• The quantity and quality of sleep are also essential in the context of functional intestinal disorders since they promote stress. Indeed, it is during the night that cellular renewal takes place in abundance, poor quality sleep therefore disrupts this proper functioning. Once again, essential oils are very effective against insomnia and to improve disturbed sleep.

• Sports activity is highly recommended in cases of irritable bowel syndrome, both morally and physically. In fact, sport facilitates intestinal peristalsis (contraction of the muscles of the intestine allowing the food bolus to move forward in the digestive tract). This helps fight constipation. Sport also helps relieve stress and episodes of anger. Indeed, physical activity induces a synthesis of dopamine (happiness hormone) and tryptophan. The latter is a precursor of serotonin (well-being hormone), which is itself a precursor of melatonin (sleep hormone). In this way, sport plays a beneficial role in well-being and quality of sleep.