Both the low FODMAP diet and the low histamine diet can be beneficial for managing symptoms of irritable bowel syndrome (IBS), but they target different aspects of digestive health. The choice between the two diets depends on the specific symptoms and triggers experienced by an individual with IBS. Here's a comparison of the two approaches:
Low FODMAP diet: The low FODMAP diet is primarily focused on reducing the consumption of certain carbohydrates that are poorly absorbed in the small intestine. FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) can be fermented by gut bacteria, leading to gas production and symptoms like bloating, abdominal pain, and altered bowel movements. The low FODMAP diet involves a temporary elimination phase followed by a reintroduction phase to identify specific trigger foods. It can be effective in reducing symptoms for many people with IBS, particularly those with bloating, gas, and diarrhea-predominant symptoms.
Low histamine diet: The low histamine diet focuses on reducing the consumption of foods that are high in histamine or trigger the release of histamine in the body (see previous blog post). Histamine is a compound involved in immune responses and is naturally present in certain foods. Some individuals with IBS may have impaired histamine metabolism or increased sensitivity to histamine, leading to symptoms such as headaches, skin rashes, flushing, and gastrointestinal issues. The low histamine diet involves avoiding histamine-rich foods and histamine-releasing foods. However, it's important to note that the low histamine diet is not effective for everyone with IBS and may only be relevant for individuals who have confirmed histamine intolerance.
In some cases, individuals with IBS may benefit from implementing both the low FODMAP and low histamine approaches.
However, a study published in 2021 (1) demonstrated that an IgG-led elimination diet outperformed a low FODMAP diet for a cohort of IBS patients. This is really interesting, because in theory it would be a lot less restrictive and the group only eliminated foods which they had a sensitivity to.
An IgG elimination diet, also known as an IgG food sensitivity or intolerance diet, is an approach used to identify and manage potential food sensitivities or intolerances based on the presence of IgG antibodies in the blood. It involves eliminating specific foods from the diet that are believed to trigger an immune response mediated by IgG antibodies.
Here's how an IgG elimination diet generally works:
Testing
Elimination
Reintroduction
Personalised diet plan
Testing:
To initiate an IgG elimination diet, a blood test is conducted to measure IgG antibodies against a panel of various foods. The test aims to identify foods that may be associated with elevated IgG levels, suggesting a potential sensitivity or intolerance. The test that I most often use in clinic is the KMBO FiT Test.
Elimination phase:
Based on the results of the IgG antibody test, specific foods that showed elevated IgG levels are eliminated from the diet. These eliminated foods are typically categorised into different levels of reactivity, and the duration of the elimination phase may vary (often ranging from a few weeks to a few months).
Reintroduction phase:
After the elimination phase, foods are gradually reintroduced one at a time to evaluate the individual's response. This is done to determine which specific foods may trigger symptoms or exacerbate underlying conditions. The reintroduction is typically conducted in a systematic manner, allowing a few days to observe any reactions before introducing the next food.
Personalised diet plan:
Based on the reintroduction phase results, a personalized diet plan is developed, which involves avoiding or minimising the consumption of foods that triggered symptoms or showed reactivity during the test. The goal is to establish a diet that is well-tolerated and minimises symptoms.
Remember that most of your immune system resides in your gut, and that a sensitivity to a food is ultimately an immune response. Therefore, addressing gut health is at the centre of food sensitivities but remember that gut healing takes time. Patience and consistency are key throughout the process.
(1) Ostrowska, Lucyna, Diana Wasiluk, Camille F. J. Lieners, Mirosława Gałęcka, Anna Bartnicka, and Dag Tveiten. 2021. "IgG Food Antibody Guided Elimination-Rotation Diet Was More Effective than FODMAP Diet and Control Diet in the Treatment of Women with Mixed IBS—Results from an Open Label Study" Journal of Clinical Medicine 10, no. 19: 4317. https://doi.org/10.3390/jcm10194317
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