Low FODMAP diet, Sjögren’s Syndrome and Fibromyalgia: Is there a connection?
As someone living with Sjögren's Syndrome and Fibromyalgia and as an active member of the Sjögren's Society of Canada's support groups, I can attest that digestive issues are often a common theme among us. Let's review the connection between a Low FODMAP diet, Irritable Bowel Syndrome, Fibromyalgia and Sjögren's Syndrome. At the end of this post, I will share an example of a day in the life's menu sample on the Low FODMAP Diet.
Have you ever heard of the Low FODMAP Diet?
Unless you have been diagnosed with Irritable Bowel Syndrome (IBS), or Fibromyalgia, you probably haven’t. It is a therapeutic diet designed to help ease the symptoms of IBS, and its potential effects on symptoms of Fibromyalgia are now being studied as well. This isn’t just a coincidence though, as patients can often have both diagnosed IBS and Fibromyalgia concurrently. Additionally, a 2017 study found that 39% of their study participants with Sjögren’s Syndrome also reported symptoms of IBS and Fibromyalgia! While there is not much research currently available on how the Low FODMAP Diet may ease the symptoms for those with Fibromyalgia or Sjögren’s, it is emerging as an area of interest.
* Sjögren's (SHOW-grins) Syndrome is a systematic autoimmune disease that attacks the body's moisture-producing glands causing dry eyes and dry mouth, but it can also include extreme fatigue, generalized pain and organ involvement, including the digestive system.
What is Irritable Bowel Syndrome?
IBS is one of the most common gastrointestinal conditions in North America. The Canadian Digestive Health Foundation states that IBS affects up to 18% of Canadian adults. The diagnosis is based on ruling out other potential digestive disorders first (i.e. Inflammatory Bowel Disease, Celiac Disease, diverticular disease). According to the Rome IV diagnostic criteria, a person is diagnosed with IBS if meeting a set criteria list:
Recurrent abdominal pain: Occurring at least one day per week, for at least three months
Stool symptoms: Experiencing changes in the frequency of stools or a change in the appearance of the stool – or both.
Persistence of symptoms: Symptoms have been experienced for the last three or more months.
The symptoms experienced by individuals can also include:
acute or chronic abdominal
irregular bowel consistency, habits and motility
gas and flatulence (bloating)
acid reflux or noncardiac chest pain
symptoms are usually present in the day time, especially after having a meal or snack
stress, anxiety, and depression
IBS is a complex condition that is not yet completely understood, however there are medical, mental health and nutritional therapy treatments available to reduce the symptoms. See also the Canadian Digestive Health Foundation for more information.
What is Fybromyalgia?
Fibromyalgia is a condition that affects the central nervous system and is characterized by enduring, persistent pain in the muscles and soft tissue around the joints. Many individuals with Fibromyalgia experience widespread pain, chronic fatigue, disturbed sleep, lack of concentration “brain fog”, mood swings, anxiety, depression, heightened sensitivity to touch and pressure.
Approximately 70% of all patients with Fibromyalgia also have diagnosed IBS, and over half of all IBS diagnosed patients have symptoms of Fibromyalgia. The link between the two conditions is not yet fully understood, but research has shown that many patients with both conditions respond well to changes in diet. Due to the close link between the two, Fibromyalgia could be responsive to the similar medical and nutritional therapy treatments as IBS. There has recently been research into the potential benefit that a Low FODMAP diet may have on Fibromyalgia patients to aid in alleviating symptoms (1).
What is a low FODMAP diet?
FODMAP is an abbreviation that stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These are all carbohydrates that do not get fully digested in the intestines, but are still an important component of a healthful diet because they act as prebiotics to support the growth of beneficial gut bacteria. The types of carbohydrates (aka sugars) that are found in FODMAP foods are fructose, lactose, and sugar alcohols such as sorbitol, mannitol, and xylitol. Examples of the foods that should be restricted when undergoing a Low FODMAP Diet during the initial stage are listed below.
Fruits: apples, apricots, ripe banana, currants, dates, guava, lychee, blackberries, cherries, pomegranate, nectarines, pears, peaches, plums, prunes, figs, mango, boysenberry, watermelon, tamarillo, avocados, dried fruits, and juices containing high-fructose corn syrup.
Vegetables: artichokes, asparagus, fresh beets, brussel sprouts, chipotle chilli, cauliflower, mushrooms, garlic, leeks, onion, okra, bitter melon, shallots, snow/sugar-snap peas, sun-dried tomatoes, and chicory.
Grains: wheat, barley, and rye (they are the main reason why some people think they might be sensitive to gluten as this protein is also found in these grains)
Legumes: baked beans, kidney beans, black beans, fava beans, navy beans, split peas, mature soybeans, and borlotti beans.
Nuts: pistachios, and cashews.
Milk Products: milk (cow, sheep and goat), milk powder, custard, dairy desserts, evaporated milk, ice cream, unripened cheeses (such as ricotta, cottage and cream cheeses), and yogurt.
Sweeteners: sorbitol, mannitol, xylitol, maltitol, and isomalt (common in sugar-free gums, mints, cough medications or drops). Xylitol is commonly recommended as saliva stimulant for people with Sjögren's Syndrome.
Other: oolong, chamomile and fennel teas, carob, chicory root extract, inulin, and rum.
What can I eat when following a low FODMAP diet?
The Low FODMAP Diet is an elimination-style diet that was developed by researchers at Monash University in Melbourne, Australia to help manage the symptoms of those with IBS. It starts out by eliminating all FODMAPs from the diet for 3-8 weeks to alleviate symptoms. Once symptoms are alleviated, FODMAPs are separately reintroduced to their diet, with three days between each reintroduction to allow for the recognition of which FODMAPs cause symptoms and which do not.
Patients undergo this initial discovery period to help identify the FODMAP foods that are causing symptoms, and conduct an assessment of the thresholds for the FODMAP foods they were able to tolerate. This means you find out how much of each food you can tolerate before you experience any of the symptoms. The patient can then develop a diet that avoids those foods, while still including the other beneficial FODMAPs that did not cause symptoms.
On the Menu:
Some examples of recipes for a day in the life of someone who is on the Low FODMAP Diet might look a little like this:
You can find all of these mouthwatering recipes and many more at Monash FODMAP.
Word of Warning!
While this diet can be of great benefit for many, it is important that individuals do not attempt the Low FODMAP Diet without the help of a Registered Dietitian to ensure that nutritional needs are being met. If you have any of the symptoms listed above for IBS or Fibromyalgia, please speak with your healthcare provider to test for potential causes and an accurate diagnosis.
This diet should not be followed as an attempt to lose weight! The highly restrictive nature of this diet eliminates important carbohydrates that are necessary for the growth of important, healthy gut flora.
Special thanks to Cheryl Anderson, 3rd-year nutrition student at Ryerson University who assisted with the research and writing for this post.
See other posts on this series: