Unlock Gut Health: The Ultimate Guide to Probiotics and the Low-FODMAP Diet

The gut microbiome is a complex ecosystem containing trillions of bacteria, primarily residing in the large intestine. Maintaining a diverse and abundant gut microbiome is crucial for overall health, influencing vitamin production, immune system function, digestion, and even mental well-being. Diet and lifestyle significantly impact the gut microbiome, making dietary interventions like the low-FODMAP diet a key consideration.

Understanding Pre, Pro, and Postbiotics

Pre, pro, and postbiotics are compounds that promote optimal gut health, although they differ significantly in composition. Some are fibrous, some are enzymes, and some are even alive! They all work to promote optimal gut-health for you.

Prebiotics: These are non-digestible fibrous compounds that pass through the upper digestive tract and reach the lower digestive tract, where they serve as food for beneficial gut bacteria, promoting their growth.
Probiotics: These are live beneficial bacteria found in supplements and fermented foods, directly increasing the number of good bacteria in the digestive tract.
Postbiotics: These are waste products created when probiotic bacteria consume prebiotics. They include enzymes, cell walls, and short-chain fatty acids. While research is ongoing, postbiotics may contribute to improving IBS symptoms.

The Gut Microbiome and its Importance

Within your intestines you have millions and millions of bacteria and although that might sound terrifying, most of these bacteria are good for you. They help to improve your digestion, your immune system, your metabolism and much more! Some of these bacteria however are bad for you. Too much bad bacteria can lead to digestive issues and even to dysbiosis which is an imbalance of good and bad bacteria. Dysbiosis can cause constipation, diarrhea, bloating and fatigue, and can lead to more serious problems such as Crohn’s disease and IBS.

FODMAPs and Their Impact on the Gut

FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) are short-chain carbohydrates that are poorly absorbed in the small intestine. They travel to the large intestine, where they are fermented by gut bacteria, producing gas and potentially causing digestive distress in sensitive individuals.

During the elimination phase of the low-FODMAP diet, high-FODMAP foods are restricted, impacting the gut microbiome by reducing the energy source for gut bacteria. It’s really important that as you go through the elimination phase of the low FODMAP diet you do it in a supported way to make sure you’re still providing these gut bacteria with nutrients, so they can do all the great work to support our bodies.

Navigating the Low-FODMAP Diet

The low-FODMAP diet is a strategy employed to manage symptoms of irritable bowel syndrome (IBS). However, it's crucial to remember a few key points:

Short-Term Intervention: The low FODMAP portion of the FODMAP diet is only a short-term intervention strategy and not a long-term diet.
Not Zero-FODMAP: Note that the low FODMAP portion of the diet is a low FODMAP diet, not a zero FODMAP diet.
Focus on Green-Rated Servings: Lots of foods that are listed as red (high FODMAP) in the Monash University FODMAP Diet App still have smaller serving sizes that are low FODMAP (these are the green-rated serves).

Strategies for Maintaining Gut Health on a Low-FODMAP Diet

It’s really important to find those foods that have a good amount of fibre but also have these low FODMAP green-rated serves. Another good option is to include resistant starch, which is a type of fibre that is less fermentable. This type of fibre is less likely to cause gut symptoms but is still a great food for our gut bacteria. Foods that contain resistant starch include underripe bananas (ones that are on the greener side), oats, potatoes and other root vegetables. We also have some prebiotic foods that have low FODMAP serving sizes. For example, beetroot, oats, nuts, canned lentils, and canned chickpeas. Yes, these foods can be high FODMAP but they still have low FODMAP serving sizes that you can use during the first phase of the low FODMAP diet.

Low-FODMAP Prebiotic Foods: There are many high probiotics foods that are also low FODMAP, such as cabbage, eggplant, drained chickpeas, kiwifruit, oats, and almonds. Increasing levels of these foods is a great way to increase your pre-biotic intake.
Resistant Starch: Incorporate resistant starch sources like slightly green bananas, oats, potatoes, and other root vegetables.
Low-FODMAP Prebiotic Supplements: Consider taking a low FODMAP prebiotic supplement! Canprev is a great supplement that contains plant soluble fiber with minimal FODMAPS.

The Reintroduction Phase

The reintroduction phase is about figuring out which of the FODMAP groups trigger your symptoms so you can bring more foods back into your diet. In the long term, we want you to have as many foods in your diet as possible so your gut bacteria get lots of variety. The reintroduction phase gives you a systematic approach that helps you figure out what foods to bring back in while keeping your symptoms settled.

The Role of Probiotics in IBS Management

Many patients with IBS symptoms are likely to have reduced good bacteria in their gut. Increasing your probiotic intake will help restore some of these good bacteria. Some of the most common probiotic supplements are those that contain the Bifidobacterial strain which was mentioned before. Although the evidence is limited, these have been shown to help reduce flatulence and bloating, as well as beneficially improving the gut’s barrier function.

Research on Probiotics and IBS

A network meta-analysis (NMA) showed that different probiotics had different responder rates, and a combination of Lactobacillus and Bifidobacterium might have a better treatment effect on IBS.

Read also: The Benefits of Seed Probiotics

Lactobacillus and Bifidobacterium: Standard network meta-analysis (NMA) showed that Lactobacillus (RR 1.74, 95% CI 1.22-2.48) and Bifidobacterium (RR 1.76, 95% CI 1.01-3.07) were the most effective for the primary efficacy outcome (high certainty evidence); component NMA showed that Bacillus (RR 5.67, 95% CI 1.88 to 17.08, p = 0.002) and Lactobacillus (RR 1.42, 95% CI 1.07 to 1.91, p = 0.017) were among the most effective components.
Combination Therapies: The combination of Bifidobacterium, Lactobacillus, and Streptococcus (RR 1.50, 95% CI 1.10 to 2.05; 9 trials with 892 participants) was the most effective among all the treatment combinations.

Considerations When Choosing Probiotics

Probiotic supplements are available as well, although consulting a dietician before purchasing is advised as there is a wide variety of products.

During the first and second phases of the low FODMAP diet, we don’t want you to try too many things at once, otherwise, you won’t know if the low FODMAP diet is working for you. Our suggestion is to not worry about probiotics during the low FODMAP diet - if they are already in a low FODMAP food (like lactose free yoghurt) then that’s great, but we wouldn’t suggest starting a probiotic supplement.

Prebiotics and IBS: A Closer Look

Prebiotics are fibrous compounds that your body is unable to digest. As a result, these compounds pass through your upper digestive tract and end up for a while in your lower digestive tract. All the good bacteria within our intestines love to feed on these compounds, which leads to increased good bacteria growth. It is clear that prebiotics are very important to help feed our good bacteria, but does it help with IBS? Studies have found that the taking of prebiotics in patients with IBS has helped to improve the level of a particular strain of good bacteria found within the gut called bifidobacteria - which is often low in IBS patients. This potentially means that prebiotics could help in the management of IBS. Galacto-oligosaccharide prebiotics have also shown to help reduce flatulence and bloating in several studies.

Prof. Glenn Gibson, a founding father of prebiotic and synbiotic science, suggested that increasing ingestion of certain prebiotics could increase levels of bifidobacteria. These bifidobacteria in turn could prevent excessive gas production since they are not able to produce gas when fermenting sugars.

Research on Prebiotics and IBS Symptoms

Galacto-oligosaccharides (GOS): Prof. Gibson’s hypothesis was tested in pilot studies where volunteers ingested a prebiotic known as galacto-oligosaccharide (Brand name: Bimuno). Healthy subjects were given 2.8 g/day of Bimuno for 3 weeks. At first, they had more gas: significantly higher number of daily anal gas evacuations than they had before taking the prebiotic (see here). The volume of gas evacuated after a test meal was also higher. However, after 3 weeks of taking the prebiotic, daily evacuations and volume of gas evacuated after the test meal returned to baseline. The microbe populations also started to recover. The relative abundance of healthy butyrate producers in fecal samples increased and correlated inversely with the volume of gas evacuated.

Prebiotic Administration as an Alternative

The bottom line conclusion is that a diet including intermittent prebiotic administration might be an alternative to the low FODMAP diets that are currently recommended for people with functional gut symptoms, such as bloating and abdominal distention.

Read also: Weight Loss with Low-FODMAP

Adverse Events and Safety Considerations

The incidence of adverse events in the probiotics group was higher than that in the low FODMAP diet group. The highest incidence was a gastrointestinal reaction, which could be relieved without special treatment.

Probiotics: The main adverse reactions caused by probiotics are gastrointestinal symptoms, including abdominal pain, abdominal distention, bloating, flatulence, constipation, diarrhea, vomiting, and nausea. Other events included headache, nausea, urticaria, and bloating, rash, fatigue, itching, ear pain, and cold symptoms. Among all patients taking probiotics, Bacillus had the highest incidence of adverse events, with 17 of 23 participants (74.0%).
Low-FODMAP Diet: The only adverse reaction associated with a low FODMAP diet was the deterioration of gastrointestinal symptoms.

tags: #probiotics #and #FODMAP #diet