It is not uncommon for patients with IBD to also suffer from Irritable Bowel Syndrome (IBS). When symptoms persist even when your inflammation levels are low, IBS may be why. If you have lingering symptoms consistent with IBS (abdominal pain, gas, bloating, diarrhea), you may want to consider adopting the Low-FODMAP Diet for a period of about 4 weeks (longer use may have an adverse effect on the microbiome). The Low-FODMAP Diet has not been shown to affect inflammation, so it should be considered for symptom relief only.
The Low-FODMAP Diet is a short-term dietary plan that limits the intake of certain types of fermentable carbohydrates, including oligosaccharides, disaccharides, monosaccharides, and polyols. In following the Low-FODMAP Diet, high-FODMAP foods are excluded temporarily and then slowly reintroduced in order to determine which ones in particular trigger symptoms. Patients on a Low-FODMAP diet should incorporate more fruits and vegetables that are low in FODMAPs into their diet, such as berries, nuts, carrots, and green leafy vegetables (see lists below).
Nutritional Therapy for IBD recommends you consult with a dietary professional if you wish to try a Low-FODMAP Diet because it can be a challenge to implement properly. If you are not currently consuming many fiber-containing foods, adding in high-FODMAP foods could cause gastrointestinal symptoms related to the fiber rather than the carbohydrates. In this case, add fiber-containing foods in small quantities at a time to allow the body to adapt to processing more fiber and build the proper muscles and bacteria to handle fiber. High-FODMAP foods draw water into the intestines, which can perpetuate diarrhea. The fermentation of high-FODMAP foods by bacteria in the colon can cause bloating, gas, and cramping pain. If you have a stricture, you should take extra care to first peel fruits and vegetables and cook them well and you may even need to consider pureeing them initially.
- Eggplant, green beans, bok choy, bell pepper, carrot, cucumber, lettuce, potato, tomato, zucchini
- Cantaloupe, grapes, kiwi, orange, pineapple, strawberries
- Almond milk, brie and camembert cheese, feta cheese, hard cheeses, lactose-free milk, soy milk (made from soy protein)
- Eggs, firm tofu, plain cooked meats/poultry/seafood, tempeh
- Corn flakes, oats, quinoa flakes, quinoa/rice/corn pasta, rice cakes (plain), sourdough spelt bread, wheat-/rye-/barley-free breads
- Dark chocolate, maple syrup, rice malt syrup, table sugar
- Macadamias, peanuts, pumpkin seeds, walnuts
- Apples, pears, mangoes, cherries, figs, nashi pears, pears, watermelon, dried fruit (high in fructose)
- Artichoke, garlic, leek, onion, spring onions (high in fructans)
- Mushrooms, cauliflower, snow peas (high in mannitol)
- Wholemeal bread, rye bread, muesli containing wheat, wheat pasta, rye crispbread (Fructans and GOS)
- Red kidney beans, split peas, falafels, baked beans (high in GOS)
- Soft cheeses, milk, yogurt (high in lactose)
- Cashews and pistachios (high in GOS and fructans)
- Honey, HFCS, artificial sweeteners (high in polyols)
Source: Monash University
Considerations for Persistent Symptoms
When inflammation levels are low but some symptoms persist, these dietary techniques can help resolve those lingering symptoms.