Irritable bowel syndrome (IBS) and IBS-like symptoms are especially common in women with endometriosis, and at least one study has now suggested that following a low FODMAP diet can relieve endometriosis symptoms. FODMAPs are poorly absorbed, short-chain carbohydrates that are readily fermentable by bacteria. Their osmotic actions and gas production may cause intestinal luminal distension inducing pain and bloating in patients with visceral hypersensitivity, something seen in women with both endometriosis and IBS, with in turn, has an impact on gut motility.
In this study, ff the 160 women who met Rome III criteria for IBS, 36% also had endometriosis. Seventy two percent of the women reported a greater than 50% improvement in bowel symptoms after four weeks of a low FODMAP diet compared with 49% in those with no known endometriosis
The Low FODMAP Diet is a diet in which you avoid foods high in specific short-chain carbohydrates which are found in many gut healthy fruits, vegetables, and legumes. Unfortunately, it's a very restrictive diet, making it hard to follow consistently, and for any length of time. Eliminating these foods indefinitely is not only extremely difficult, it’s also not optimal as it removes many healthy foods, including some of the most important foods for gut healing and long-term health like high greens, legumes and beans.
An “IBS-friendly diet “(which is already automatically rolled into the diet plan my new book, Hormone Intelligence,) has been shown to be effective at relieving IBS symptoms — as effectively as stricter elimination plans like the FODMAP diet. This includes eating regular meals, avoiding coffee, spicy foods, and unhealthy fats, and getting ample fiber, fresh fruits and veggies, and good quality fats. But when more is needed, a “FODMAP Gentle” diet is the next best step – it's an easy modification from the plan in Hormone Intelligence, as effective as the full-on FODMAP plan – and is very sustainable over time, without restricting too many foods.
Going “FODMAP Gentle”
When a more advanced approach is needed, my approach is what is called FODMAP Gentle, which has been found to be potentially as effective and more sustainable since it’s far less restrictive. It removes a few foods that are the most significant triggers of gas, bloating, and other IBS and ‘endo-belly' symptoms – the common digestive symptoms that often accompany endometriosis.
Foods to eliminate on the FODMAP Gentle diet include:
- Grains: wheat and rye
- Vegetables: onion, leek, cauliflower, and mushrooms
- Fruit: apple, pear, dried fruit, stone fruit, prunes, and watermelon
- Dairy: milk and yogurt
You can trial a FODMAP Gentle Diet for 30 days. If you don’t see improvement, there’s no reason to continue. If you see some improvement but still have ongoing symptoms, you can either continue for 6 weeks or advance to a full Low FODMAP Diet if you feel it’s needed. Remember, this is not meant to be a long-term diet so it’s important to expand your diet using a reintroduction protocol to re-challenge these foods after about 6-8 weeks. Working with an integrative or functional nutritionist can be helpful in offering guidance.
Getting Fiber on a Low FODMAP Diet
When following a low FODMAP diet, remember that low FODMAP doesn’t mean low fiber. In fact, it’s really important that your fiber intake doesn’t suffer – especially because the goal is improving your gut! There are actually a lot of fiber rich foods that you can include, it just takes a bit more work to remember. Even foods that are considered high FODMAP can be included in even a strict low FODMAP plan in the right amounts, remember it’s “low” FODMAP – not “no.”
Here are a few examples of low FODMAP foods to include for fiber:
- Low FODMAP vegetables (with the skin on when applicable), for example: green beans, bok choy, eggplant, carrots, cucumbers, arugula, and even 1 cup of kale is considered low FODMAP
- Low FODMAP fruit like blueberries and strawberries
- 2 TBS of ground flax seeds or chia seeds
- A small portion of nuts
- ½ cup cooked oats, quinoa, or brown rice
- Potatoes with the skin on
Specific Food Elimination for IBS
Alternatively, you can also first try specific food elimination. A study published just a few years ago looked at eliminating the most common foods that came up on food intolerance testing for those with IBS (mostly women) and results showed significant improvements in IBS symptom scores. As you can see below, some are considered low FODMAP and some are considered high FODMAP – so there’s not necessarily a rhyme or reason there. There’s also some you likely wouldn’t miss at all. While more studies need to be done, it’s reasonable to try for a few weeks before advancing to a stricter plan.
The most common food intolerances on testing included:
- Yellow squash
Resources for a Low FODMAP Diet
If you are exploring a stricter low FODMAP diet, you can try the MONASH University FODMAP app which includes food guides, recipes, shopping lists, a journal, and updates, as well as a filter for personal sensitivities.