The Low FODMAP Mediterranean Diet Approach for IBS
Written by: Keren Reiser, RD
Updated: February 13th, 2024
Symptoms like abdominal pain, bloating, and irregular bowel movements characterize Irritable Bowel Syndrome (IBS). The low FODMAP diet is recognized for symptom relief, while the Mediterranean diet boasts anti-inflammatory benefits and health promotion. Despite their apparent contradictions, especially regarding fibre intake, emerging research suggests a potential synergy between these diets, offering a holistic approach to managing IBS symptoms and enhancing gut health. In this article, I go over the pros and cons of combining the low FODMAP diet and the Mediterranean diet for easing IBS symptoms.
Understanding IBS and Dietary Approaches
The Basics of IBS
IBS is a functional gastrointestinal disorder with symptoms including abdominal pain, bloating, gas, and irregular bowel movements. Different diets have been studied to help reduce symptoms of IBS, with the low FODMAP diet being the most researched. Ultimately, individuals with IBS will discover that some foods agree with them while others do not. Finding the right diet is personal and evolves as patients manage their condition over time.
Some IBS types may involve mild gut lining inflammation, but the effectiveness of the low FODMAP diet in reducing this inflammation is uncertain. On the other hand, the Mediterranean diet is known for its anti-inflammatory effects and beneficial impact on the health of gut bacteria. Incorporating anti-inflammatory foods from the Mediterranean diet could complement the low FODMAP diet by addressing inflammation not targeted by FODMAP restrictions.
What is the low FODMAP Diet?
The low FODMAP diet is a dietary strategy for managing symptoms of irritable bowel syndrome (IBS) and other gastrointestinal issues by reducing or eliminating fermentable carbohydrates known as FODMAPs, found in certain foods like fruits, vegetables, legumes, dairy, and sweeteners. It involves three phases: elimination, reintroduction, and maintenance. During the elimination phase, high-FODMAP foods are removed from the diet, followed by a gradual reintroduction to identify individual triggers. The maintenance phase involves a personalized diet that limits high-FODMAP foods while ensuring nutritional balance. This approach should be supervised by a healthcare professional, such as a registered dietitian, for proper guidance and management of symptoms.
What is the Mediterranean Diet?
The Mediterranean diet represents a dietary pattern, recipe and preferences unique to the food cultures surrounding the Mediterranean sea. It less of a “diet” and more of an inclusive, balanced approach to daily consumption of plant-based whole foods such as cereals, fruits, vegetables, legumes, tree nuts, and seeds; moderate amounts of fish, eggs, poultry, seafood, and dairy; low-to-moderate red wine consumption; and limited amounts of red meat and sweets. Olive oil, is not only included as cooking ingredient, but also as an added source of of dietary fat.
Gut Bacteria’s Role in IBS
Exploring gut bacteria reveals the distinction between beneficial and harmful types of bacteria in IBS, emphasizing the importance of prebiotics and probiotics. Prebiotics are foods that support the probiotics, which are good bacteria in the stomach. Prebiotics and probiotics work together to produce short-chain fatty acids (SCAs), crucial for nourishing gut cells, managing inflammation, and supporting digestive health.
Dietary Fibre and FODMAPs
Phase 1 of the low FODMAP diet reduces the consumption of high-FODMAP foods. FODMAPs are fermentable short-chain carbohydrates that are poorly absorbed in the stomach. FODMAPs are considered prebiotics, and reducing their intake for a long period of time can negatively affect the gut microbiome. This is one of the main reasons that the low FODMAP diet is not recommended as a long-term diet. In contrast, the Mediterranean encourages the consumption of fibrous fruits and vegetables therefore, it is confusing for people with IBS to combine the two diets.
Mental Health Considerations
Studies show that 70 to 80% of people with IBS can improve or eliminate symptoms by following a low-FODMAP diet, but its impact on quality of life and gut bacteria raises some concerns. It may not be suitable for everyone, particularly those prone to anxiety, depression, eating disorders, and disordered eating patterns. The diet’s restrictive nature can exacerbate stress and anxiety around food choices, potentially worsening mental health conditions.
Gut-Brain Axis
In a study exploring the feasibility of the Mediterranean diet for people living with IBS, participants were divided into two groups: one followed the traditional Mediterranean diet and received personalized dietary counselling. At the same time, the control group maintained their regular diet with no counselling. The results indicated that those on the Mediterranean diet reported improved gastrointestinal symptoms, reduction in depressive symptoms and overall quality of life compared to the control group. Although the study has limitations, it highlights the potential benefits of the Mediterranean diet, through its influence on the gut-brain axis, a bidirectional communication pathway between the gut and the brain. By promoting a less restrictive dietary pattern to ease diverse intake of nutrients known to support gut health and reduce inflammation, the Mediterranean can help this connection, potentially easing GI discomfort and improving overall digestive function.
Flexibility
A diet that has variety and emphasis on whole foods can have a positive impact on mental health, helping to reduce symptoms of anxiety and depression. Unlike more restrictive diets, the Mediterranean diet allows for a wide range of foods, making it easier to follow and more enjoyable for individuals. This inclusivity, combined with the diet’s rich nutritional profile, not only supports gut health but also lowers the risk of various diseases, offering a holistic approach to health that benefits both the body and mind.
Pros and Cons of Combining the Low FODMAP and the Mediterranean Diet
Pros:
- Symptom Relief and Reduced Inflammation: The low FODMAP diet offers symptom relief for many individuals with IBS, while the Mediterranean diet’s anti-inflammatory properties may address underlying inflammation and contribute to long-term gut health.
- Enhanced Gut Microbiome: Incorporating low-FODMAP foods, such as walnuts, oranges, and olives that are also part of the Mediterranean diet can support a diverse and healthy gut microbiome, balancing symptom management with the benefits of a rich, varied diet.
- Sustainable and Holistic Approach: Combining these diets encourages a more balanced and less restrictive eating pattern, making it more sustainable and potentially improving quality of life and overall health.
Cons:
- Complexity and Confusion: Navigating both diets simultaneously requires careful planning and knowledge to meet nutritional needs without exacerbating IBS symptoms.
- Potential for Nutritional Deficiencies: Without careful planning, there’s a risk of nutritional deficiencies, particularly if the diet becomes too restrictive or lacks variety.
- Need for Professional Guidance: Successfully combining the low FODMAP diet and the Mediterranean diet often requires the support of a registered dietitian specializing in gastrointestinal health to tailor the diet to individual needs and preferences.
Practical Tips for Combining the Diets
- Start with a Low FODMAP Phase 1 protocol: Reduce FODMAP intake by replacing high FODMAP foods with lower FODMAP alternatives.
- Focus on Low-FODMAP Mediterranean Foods: Emphasize olive oil, lean proteins (like fish and poultry), low-FODMAP fruits and vegetables, nuts, seeds, and whole grains that are compatible with both diets.
- Incorporate Probiotics and Prebiotics Wisely: Choose low-FODMAP sources of prebiotics and consider probiotic supplements to support gut health.
- Personalize Your Diet: Work with a registered dietitian to tailor the diet to your preferences, nutritional needs, and IBS subtype, ensuring a balanced and enjoyable eating pattern.
- Consider Digestive Enzymes: For some individuals, digestive enzymes may help expand food choices by improving the digestion of certain FODMAPs when combined with the MED.
Conclusion
The Low FODMAP, combined with the Mediterranean diet offers a synergistic strategy for managing IBS, balancing symptom relief with long-term gut health benefits. This approach requires careful planning and professional guidance to ensure a nutritious diet that supports overall well-being, making it a sustainable and effective solution for IBS management.
About the Writer: Keren Reiser is a dedicated Registered Dietitian in Ottawa, Ontario, passionate about empowering individuals through personalized nutrition and gastrointestinal health. Focusing on evidence-based approaches, Keren specializes in managing conditions such as IBS, IBD, Celiac Disease, and food intolerances through the strategic use of the low FODMAP and Mediterranean diets alongside Nutrigenomics to tailor nutritional advice to one’s genetic makeup. Her commitment to improving clients’ quality of life is evident in her holistic approach, combining nutritional counselling with practical meal planning to address complex dietary needs. Keren’s work is driven by a deep desire to make meaningful connections, helping her clients navigate their health challenges with empathy and expertise. Learn more about Keren’s approach to nutrition and wellness at kerenreiser.com
References:
Kasti A, Petsis K, Lambrinou S, Katsas K, Nikolaki M, Papanikolaou IS, Hatziagelaki E, Triantafyllou K. A Combination of Mediterranean and Low-FODMAP Diets for Managing IBS Symptoms? Ask Your Gut! Microorganisms. 2022 Mar 30;10(4):751. doi: 10.3390/microorganisms10040751. PMID: 35456802; PMCID: PMC9032697. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9032697/
Dale, H. F., Lorentzen, S. C. S., Mellin-Olsen, T., & Valeur, J. (2023). Diet-microbiota interaction in irritable bowel syndrome: Looking beyond the low-FODMAP approach. Journal Name, 1366-1377. https://doi.org/[DOI here]. Received 08 Mar 2023, Accepted 16 Jun 2023, Published online: 29 Jun 2023. https://www.tandfonline.com/doi/full/10.1080/00365521.2023.2228955
Davis C, Bryan J, Hodgson J, Murphy K. Definition of the Mediterranean Diet; a Literature Review. Nutrients. 2015 Nov 5;7(11):9139-53. doi: 10.3390/nu7115459. PMID: 26556369; PMCID: PMC4663587. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4663587/
Lăcătușu CM, Grigorescu ED, Floria M, Onofriescu A, Mihai BM. The Mediterranean Diet: From an Environment-Driven Food Culture to an Emerging Medical Prescription. Int J Environ Res Public Health. 2019 Mar 15;16(6):942. doi: 10.3390/ijerph16060942. PMID: 30875998; PMCID: PMC6466433. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6466433/
Staudacher HM, Mahoney S, Canale K, Opie RS, Loughman A, So D, Beswick L, Hair C, Jacka FN. Clinical trial: A Mediterranean diet is feasible and improves gastrointestinal and psychological symptoms in irritable bowel syndrome. Aliment Pharmacol Ther. 2024 Feb;59(4):492-503. doi: 10.1111/apt.17791. Epub 2023 Nov 15. PMID: 37969059. https://pubmed.ncbi.nlm.nih.gov/37969059/
Pasta A, Formisano E, Calabrese F, Plaz Torres MC, Bodini G, Marabotto E, Pisciotta L, Giannini EG, Furnari M. Food Intolerances, Food Allergies and IBS: Lights and Shadows. Nutrients. 2024 Jan 16;16(2):265. doi: 10.3390/nu16020265. PMID: 38257158; PMCID: PMC10821155. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10821155/
