Should You Go Low Carb If You Have IBS?

Should You Go Low Carb If You Have IBS? - DrR Feature Images LowCarb IBS

Is feeding your microbiome the best approach if you struggle with IBS or other digestive issues? According to the data, this may not be the best approach for a variety of reasons.


Is there a consensus for the amount of carbs that are best for digestive issues like IBS? According to the data, there is a consensus that a lower carbohydrate approach may be more tolerable if you’re experiencing digestive problems.

A couple of protocols to consider include:

Paleo diet

  • This is a good place to start. The paleo protocol removes a lot of common allergenic foods like gluten, dairy, and refined sugars. By removing these foods, you’re removing common sources of carbohydrates.

Relationship with food

Low FODMAP

  • This is a great option if you need to reduce the amount of fermentable carbohydrates that feed bacteria. It’s been shown to significantly help those with IBS. The low FODMAP diet isn’t necessarily a low carb diet, but it reduces certain types of carbs that may be contributing to your symptoms.

Other diets to consider that are helpful for digestive problems include the Specific Carbohydrate Diet (SCD) and the Fast Track Diet.

Experiment with a couple of diets to see which one works best for you. The carbohydrate component is usually addressed as part of the guidelines in that particular diet.

Some people do better on a paleo or low FODMAP diet that is a little higher in carbs. Others do better on one of these protocols that is lower in carbs. Start out with lower carb and slowly increase your carb consumption to find your tolerance level.

How does the microbiome influence this? Do people with digestive issues need to feed their bacteria in order to feel better?

For many people with digestive issues, feeding your bacteria is not the best approach. The healthier a person is, the better they tend to do with foods that feed the microbiome, like fiber and prebiotics. This helps bulk the stool and make bowel movements easier and more consistent.

The challenge if you have digestive issues is that the bacterial feeding approach tends to be problematic and exacerbate symptoms. You may need to design your diet and supplement program around limiting your bacterial growth.

Low FODMAPOne study of 20 patients with IBS were put on the low FODMAP diet for 3 weeks. 85% of the patients experienced a notable improvement in their symptoms. From there they were divided into two groups.

One group stayed on low FODMAP and one group started on 16 grams per day of FOS (fructooligosaccharides). 80% of the low FODMAP group maintained their improvements. Only 30% of the FOS group maintained their improvements.

In this case, prebiotics don’t seem to be very helpful. The people on the low FODMAP diet saw improvement in their symptoms and inflammation. However, there were some markers, such as microbiota levels and SCFA (short-chain fatty acids), that looked less healthy on paper even though the patient felt significantly better.

There is another component that has to do with the immune system and the gut that is pretty interesting. A key mediator of the immune system and the gut is histamine. If your immune system in your gut activates, that causes a release of histamine. Also, if you have too much bacteria in the gut, those bacteria release histamine, which can cause further immune activation. Histamine and gut bacteria are strongly linked.

Many people do not have healthy immune systems. You may be prone to over-activation of your immune system.

It has been shown that while following a low FODMAP diet, you may yield an eight-fold decrease in histamine. This may be another component of why a low FODMAP diet is helpful.

Another argument that comes up sometimes is once you have healed your gut, then you can go on a higher fermentable protocol. This does have some truth to it. We recommend starting on a more narrow, lower fermentable diet, and then begin adding in more foods and more variety. The goal for you is to find the broadest, most diverse diet that makes you feel good.

However, looking at another study in patients who were in remission from Crohn’s disease, half of the patients went on a high FODMAP diet and they saw a doubling of their symptoms. So ramping up your fiber and prebiotics once you’re asymptomatic may not be the best idea.

Diet is probably the best way to get some prebiotics in your system rather than fiber supplements, which are more concentrated.

SIBOAgain, someone who is super healthy would probably be just fine with a high FODMAP diet. However, those with imbalances in the gut may find high doses of fiber and prebiotics to be problematic.

Despite all the expert claims that say you must feed your microbiome to be healthy, if you have a compromised digestive system, you may do best limiting certain carbohydrates, fiber, and prebiotics in your diet.

You know your body better than anyone. Listen to it, and feed it in a way that helps you thrive.

For more information on the best diets for gut health, check out our podcast here.

What do you think? I would like to hear your thoughts or experience with this.

Dr. Ruscio is your leading functional and integrative doctor specializing in gut related disorders such as SIBO, leaky gut, Celiac, IBS and in thyroid disorders such as hypothyroid and hyperthyroid. For more information on how to become a patient, please contact our office. Serving the San Francisco bay area and distance patients via phone and Skype.

Discussion

I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!

16 thoughts on “Should You Go Low Carb If You Have IBS?

  1. Hi, I’ve been a patient of a colleague of yours for a yr.
    I have been on a low fodmap diet for 2 yrs and treatment of various herbs and/or rifaximan, etc for those 2 yrs and still have sibo
    Is it healthy to live on a low fodmap diet ?

  2. Thought I would chime in with a question…
    I have been suffering with bowel issues ever since I was a kid, but I was able to manage with a few painful bouts of diarrhea a week , otherwise it was normal. My diet growing up was not the best (fast food, soda, pizza, etc..) top that with a few surgeries (i.e. Antibiotics) and drinking formula instead of breastfed. Started to get into body building in HS, this helped me “clean” up my diet. But I was literally forcing food down my throat in pursuit of gains! Bowel movements where amazing in the morning, yet I had horrible gas all day… To combat this I tried my first probiotic supplement which spiraled me down a life altering path of IBS-C. I have tried everything… Paleo, keto, GF/DF, rotational diets, elimination diets, high carb/low fiber, high fiber, SIBO treatment (Botanicals mainly comprised of Berberine, oil of oregano, allicin) probiotics, magnesium, Iberogast-motility agent, probiotics, fiber sups, prebotics, fasting, low protein, vegan, there is probably more but you get the picture. Most of these protocols have been at least 1-2 month trials, some longer (gluten free/dairy free multiple bouts of 3-6 months at a time). Still have issues. I am active and love to exercise and play sports but I cannot seem to handle a lot of volume due to the GI restrictions. Being 26, I know that something has to give… this condition is the bane of my existence and has become an obsession of mine (probably not healthy as I am sure I am causing stressing myself out over the issue). I am at a point now where I am living with little restrictions and honestly, the results are about the same. Would love to hear some tips/tricks that have worked for anybody out there. I am over playing the “buy these supplements” game as I have spent thousands of $ on things that did not work but I am open to suggestions. Much love 🙂

    I have worked with clinicians ranging from naturopaths to gastros… None have been able to help! Any tips? I know that is a lot! Thanks.

    1. This is basically me. Im still trying to figure out the best way to live with IBS-D by for me (unfortunately) a lower carb/higher fat approach works best, as well as smaller portions (also unfortunate).

    2. @Ryan Hail – the low-fodmap diet has worked wonders for me. I didn’t see you mention it in your list of things tried. You can download an IBS app suited to low fodmap and check if you can eat things before you actually do. I have a much, much, much happier life.

    3. Low fodmaps helps me a good bit, but the #1 thing that has helped regulate my IBS-C has been following the blood-type diet. I know that correcting IBS is not considered one of the objectives of that diet, but it has worked the best of anything I have tried (SCD, very low carb, fibers, acacia, supplements, most of what you have tried.)

      May not work for anyone else, but makes a big difference for me. Oh, and before, probiotics seemed to have little impact on my gut, but on the blood-type diet, probiotics seem to add in their bit of improvement too.

      Hope this helps.

    4. This may sound absolutely crazy, but Phentermine 37.5 mg has worked better then any diet or meds given by gastro dr. I went on a diet that they also gave me this Rx. It has worked better than anything I have been given in the past and better than any kind of diet. I would be close to having accidents on my drive to work almost daily. After starting this med, it stopped. Wish there was something out there that could eliminate IBS because it sucks that you can’t stay on the med forever. Also, low carb made my IBS even worse. I will assume because of all the veggies you eat.

  3. I was suffering from IBS C for many years and no treatment worked. But when I started Ketogenic diet, the IBS disappeared and now I am a happy person.

  4. Hi, I’ve been a patient of a colleague of yours for a yr.
    I have been on a low fodmap diet for 2 yrs and treatment of various herbs and/or rifaximan, etc for those 2 yrs and still have sibo
    Is it healthy to live on a low fodmap diet ?

  5. I was suffering from IBS C for many years and no treatment worked. But when I started Ketogenic diet, the IBS disappeared and now I am a happy person.

  6. Thought I would chime in with a question…
    I have been suffering with bowel issues ever since I was a kid, but I was able to manage with a few painful bouts of diarrhea a week , otherwise it was normal. My diet growing up was not the best (fast food, soda, pizza, etc..) top that with a few surgeries (i.e. Antibiotics) and drinking formula instead of breastfed. Started to get into body building in HS, this helped me “clean” up my diet. But I was literally forcing food down my throat in pursuit of gains! Bowel movements where amazing in the morning, yet I had horrible gas all day… To combat this I tried my first probiotic supplement which spiraled me down a life altering path of IBS-C. I have tried everything… Paleo, keto, GF/DF, rotational diets, elimination diets, high carb/low fiber, high fiber, SIBO treatment (Botanicals mainly comprised of Berberine, oil of oregano, allicin) probiotics, magnesium, Iberogast-motility agent, probiotics, fiber sups, prebotics, fasting, low protein, vegan, there is probably more but you get the picture. Most of these protocols have been at least 1-2 month trials, some longer (gluten free/dairy free multiple bouts of 3-6 months at a time). Still have issues. I am active and love to exercise and play sports but I cannot seem to handle a lot of volume due to the GI restrictions. Being 26, I know that something has to give… this condition is the bane of my existence and has become an obsession of mine (probably not healthy as I am sure I am causing stressing myself out over the issue). I am at a point now where I am living with little restrictions and honestly, the results are about the same. Would love to hear some tips/tricks that have worked for anybody out there. I am over playing the “buy these supplements” game as I have spent thousands of $ on things that did not work but I am open to suggestions. Much love 🙂

    I have worked with clinicians ranging from naturopaths to gastros… None have been able to help! Any tips? I know that is a lot! Thanks.

    1. This is basically me. Im still trying to figure out the best way to live with IBS-D by for me (unfortunately) a lower carb/higher fat approach works best, as well as smaller portions (also unfortunate).

    2. @Ryan Hail – the low-fodmap diet has worked wonders for me. I didn’t see you mention it in your list of things tried. You can download an IBS app suited to low fodmap and check if you can eat things before you actually do. I have a much, much, much happier life.

    3. Low fodmaps helps me a good bit, but the #1 thing that has helped regulate my IBS-C has been following the blood-type diet. I know that correcting IBS is not considered one of the objectives of that diet, but it has worked the best of anything I have tried (SCD, very low carb, fibers, acacia, supplements, most of what you have tried.)

      May not work for anyone else, but makes a big difference for me. Oh, and before, probiotics seemed to have little impact on my gut, but on the blood-type diet, probiotics seem to add in their bit of improvement too.

      Hope this helps.

    4. This may sound absolutely crazy, but Phentermine 37.5 mg has worked better then any diet or meds given by gastro dr. I went on a diet that they also gave me this Rx. It has worked better than anything I have been given in the past and better than any kind of diet. I would be close to having accidents on my drive to work almost daily. After starting this med, it stopped. Wish there was something out there that could eliminate IBS because it sucks that you can’t stay on the med forever. Also, low carb made my IBS even worse. I will assume because of all the veggies you eat.

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