If you’re interested in nutrition, you’ve probably heard of the Mediterranean diet. After all, it’s consistently ranked by nutritional experts as the best diet. It has been shown to reduce the risk of many chronic diseases and is a great way to eat when it comes to overall health.
However, if you live with irritable bowel syndrome (IBS), you may be following a low-FODMAP diet to help manage your symptoms. You probably don’t want to miss out on the benefits of the Mediterranean diet, so you might be wondering: is it possible to follow a low-FODMAP Mediterranean diet?
Here, I will review the foods included in the Mediterranean and low-FODMAP diets and provide tips for combining the two to improve your overall health and better manage your IBS.
What is the Mediterranean diet?
The Mediterranean diet is a way of eating that originated in the countries bordering the Mediterranean Sea. It emphasizes fresh fruit and vegetables, whole grains, nuts, legumes, fish, and extra virgin olive oil.
The Mediterranean Diet is more than just a diet – it’s a way of life that not only focuses on what you eat but also how you live.
It emphasizes the importance of enjoying meals with friends and family and being physically active in addition to dietary recommendations.
The Mediterranean diet has been widely studied. It provides many health benefits. These include:
- Reduced risk of heart disease.
- Protection against brain aging and reduced risk of Alzheimer’s disease.
- Reduced risk of type 2 diabetes.
- Reduced risk of certain types of cancer.
- Improvement of non-alcoholic fatty liver disease.
- Reduction of inflammation in the body.
What is the low-FODMAP diet?
The low-FODMAP diet reduces symptoms by limiting foods containing carbohydrates that are poorly absorbed in the small intestine and released in large quantities in the colon. Once in the large intestine, these sugars present in certain foods are fermented by bacteria, leading to symptoms of bloating, gas, constipation, and abdominal pain. The FODMAP diet also limits the absorption of small, osmotic carbohydrate molecules that increase the water load in the colon, resulting in symptoms of loose stools and diarrhea.
What does the acronym FODMAP stand for?
F = Fermentable (rapidly fermented by bacteria in the colon)
O = Oligosaccharides (fructans and galactooligosaccharides or GOS)
D = Disaccharides (lactose)
M = Monosaccharides (fructose in excess of glucose)
A = And
P = Polyols (sorbitol, mannitol, xylitol and maltitol)
To understand why FODMAPs can make symptoms worse in people with IBS, it’s important to understand how IBS works. Although we are still learning about its causes, we do know that people with IBS have what is called “visceral hypersensitivity”. This means that their pain threshold in the intestines is lower than average.
When FODMAPs are fermented by your gut bacteria, they can cause increased gas production. For people with visceral hypersensitivity, this gas production can be very painful.
The low FODMAP diet is often used for symptom management of IBS. It has three phases: the elimination phase, the reintroduction phase, and the integration phase.
During the elimination phase, all foods high in FODMAPs are eliminated or recommended in very small amounts. This involves limiting wheat products, onions, garlic, most legumes, some high-lactose dairy products, and a number of fruits and vegetables.
Once the elimination phase is over and symptom relief is achieved, we move on to the reintroduction phase. During the reintroduction phase, you systematically introduce the different types of FODMAPs one at a time so that you can determine exactly which FODMAPs cause symptoms for you and to what extent.
Finally, once the FODMAP tests are complete, we move on to the maintenance phase. This involves limiting FODMAPs that caused symptoms while reintroducing high-FODMAP foods that did not cause symptoms.
Unfortunately, many people who avoid FODMAPs do not get out of the elimination phase. This means that they severely restrict their diet for too long. Additionally, people don’t always replace high-FODMAP foods with high-fiber, low-FODMAP alternatives. This often leads to not consuming enough fiber. Since fiber is an important source of fuel for our intestinal bacteria, this can impoverish the diversity of our microbiota and accentuate its imbalance.
The Mediterranean diet and IBS
A study is underway on the combined effects of the FODMAP and Mediterranean diet on the management of IBS symptoms as well as the impact of this combined diet on the microbiota. Having spoken briefly with the lead author of the study, Ms. Petsis Kasti, the results so far are very positive. They will be published during the year of 2023.
In IBS, we often see an imbalance between “good” and “bad” bacteria in the gut. This is associated with increased levels of inflammation in the gut. Recent studies have linked the onset of IBS to low-grade mucosal inflammation. The combination of mucosal inflammation with visceral hypersensitivity and impaired intestinal motility could be the underlying cause of the onset of IBS. Mucosal inflammation in patients with IBS is often linked to a history of infectious gastroenteritis induced by bacteria, parasites, or viruses, called post-infectious IBS.
Since we know that the Mediterranean diet can help reduce markers of inflammation in the body, it’s possible that following a low-FODMAP Mediterranean diet may lead to lower levels of inflammation in people with IBS. Although studies have yet to be conducted in this area, it is an interesting potential treatment option.
Table of Foods From the Mediterranean Diet To Include in Your Low-FODMAP Diet for More Efficiency
|Olives and olive oil||Hydroxytyrosol (phenolic compound)||Anti-inflammatory|
|Nuts||Alpha-linolenic acid (omega-3)||Anti-inflammatory|
|Grapes and wine||Resveratrol
|Oranges||Quercetin (phenolic compound)||Prebiotic
|Tangerines, clementines||Quercetin (phenolic compound)||Anti-inflammatory|
|Tomatoes||Quercetin (phenolic compound)||Prebiotic|
What can I eat on a low-FODMAP Mediterranean diet?
Luckily, there are still plenty of foods you can eat on a low-FODMAP Mediterranean diet!
Extra virgin olive oil is the fat of choice in the Mediterranean diet. It contains mostly monounsaturated fats and is also rich in polyphenols. Try drizzling it over a salad, using it in marinades or sauces, or pouring it over cooked gluten-free pasta, vegetables, or 100% sourdough bread. You can also enjoy olives as snacks, as an aperitif, and add them to several recipes.
Vegetables are an important source of fiber in the low-FODMAP diet. Try to include a wide variety of low-FODMAP vegetables. These include carrots, cucumber, lettuce, oyster mushrooms, parsnips, potatoes, spinach, etc.
You may also feel comfortable including low-FODMAP vegetables in smaller portions. These include eggplant (1 cup), green beans (15 beans), red peppers (1/3 cup), broccoli (heads only, 3/4 cup), cabbage (3/4 cup), corn (canned, 1 cup), zucchini (1/3 cup) and Roma tomatoes (1 small) or other tomatoes (1/2 cup).
Low-FODMAP fruits are another great source of fiber. Some popular low-FODMAP fruits include bananas (firm bananas because FODMAPs increase as bananas ripen), oranges, kiwi fruit, papaya, and blueberries.
For more variety, you can also include low-FODMAP fruits in smaller portions. These include blueberries (1 c), fresh pineapple (1 c), raspberries (⅓ c), strawberries (5 medium), and grapes (6).
Grains are an often-overlooked part of the low-FODMAP diet, but there are actually many low-FODMAP grains that you can enjoy. Try brown rice, buckwheat, oats, quinoa, millet, or spelt sourdough bread.
Aim for at least two pulse-based meals per week. While it’s true that many legumes are high in FODMAPs, canned chickpeas (1/4 cup) and canned lentils (1/2 cup) are two of the low-FODMAP legume options.
The Mediterranean diet recommends a moderate consumption of fish. Aim for at least two servings of fish per week. Try to include fatty fish like salmon, trout, and sardines. They are high in omega-3 fatty acids, which have been shown to reduce inflammation. Try to favor fish with sustainable fishing.
Nuts are a big part of the Mediterranean diet. All nuts (except cashews and pistachios) are low in FODMAPs, at about 10 nuts at a time. Nuts contain good fats and fiber, and some are even rich in omega-3s like walnuts!
Just because you follow a low-FODMAP diet to manage your IBS symptoms doesn’t mean you can’t enjoy the benefits of a Mediterranean diet and good food diversity. With a few small adjustments, you can combine the two diets for maximum efficiency!