Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder characterized by symptoms such as abdominal pain, bloating, gas, and irregular bowel movements. Managing IBS often involves dietary adjustments, with the low FODMAP diet being a commonly recommended approach. However, the Mediterranean diet, known for its anti-inflammatory benefits and overall health promotion, has emerged as another potential strategy. This article explores how the Mediterranean diet can be a beneficial approach for managing IBS symptoms, either as a standalone strategy or in combination with the low FODMAP diet.
Understanding Irritable Bowel Syndrome (IBS)
IBS is a condition that affects the large intestine, leading to a range of uncomfortable symptoms. While the exact cause of IBS is not fully understood, dietary factors are known to play a significant role in symptom management. 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.
The Low FODMAP Diet: An Overview
The low FODMAP diet is a dietary strategy designed to manage symptoms of IBS and other gastrointestinal issues. FODMAPs are fermentable short-chain carbohydrates that are poorly absorbed in the stomach. These carbohydrates are found in certain foods like fruits, vegetables, legumes, dairy, and sweeteners. The diet involves three phases:
- Elimination: High-FODMAP foods are removed from the diet.
- Reintroduction: Foods are gradually reintroduced to identify individual triggers.
- Maintenance: A personalized diet is maintained, limiting 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.
The Mediterranean Diet: A Holistic Approach
The Mediterranean diet represents a dietary pattern, recipe and preferences unique to the food cultures surrounding the Mediterranean sea. It is 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.
Read also: A Review of the Mediterranean Diet in Kidney Disease
Another important part of a Mediterranean style diet is HOW you eat. Meals are enjoyed with friends and family savouring the company and the food. In addition, it’s important to be active whether its walking to the shops, doing chores or going for a bike ride. It doesn’t matter what you do, as long as you enjoy it.
How to follow a Mediterranean diet:
Eat daily:
- Olive oil on salads, in cooking or dipping bread - aim for 3 tbsp per day. Must incorporate 3 tbspn’s of olive oil.
- Include vegetables or fruit at all meals and snacks. I have a lot of roasted vegetables in my diet.
- Nuts & seeds with meals and for snacking.
- Choose whole grains e.g.
The Gut Microbiome and 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.
Phase 1 of the low FODMAP diet reduces the consumption of high-FODMAP foods. 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 and the Gut-Brain Axis
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.
Read also: Delicious Mediterranean Recipes
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. 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.
TANDIM Trial
In this recently published TANDIM trial, participants with medically diagnosed IBS were randomly allocated into a “Mediterranean diet” or “habitual diet” and monitored for 6 weeks. After 6 weeks, the group following a Mediterranean diet had improvements in IBS symptoms as well as anxiety and depression. Interestingly, they did not reduce the FODMAPs in their diet during the trial either. This trial shows that you don’t need to focus on restriction and exclusion to improve IBS. Instead, making a few dietary changes like eating more nuts and including more olive oil can be beneficial to improving both IBS and mood disorders.
Flexibility and Variety
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.
Mediterranean Diet vs. Low FODMAP as a First Line of Defense
So for those of us with IBS, do you recommend trying low fodmap or Mediterranean as our first line of defense? The most liberal diet possible is the best diet for anyone. In which case, I would start with the Mediterranean diet as it doesn’t actually mark any foods as completely off the menu. Once we know what impact that has, then reassess and think if any further tweaks are needed.
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.
Read also: Mediterranean Diet, Instant Pot Style
Contrary to other dietary approaches for IBS, it does not eliminate or restrict your favourite foods while still providing surprisingly positive outcomes.
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.