Managing IBS in the Elderly: Low FODMAP Diet

“Managing IBS in the Elderly with a Low FODMAP Diet” was written by dietetic intern Rachel Evans and edited/updated by Aly Bouzek, MS, RDN.

Do you have ongoing problems with stomach pain, bloating, excessive burping, gas, diarrhea or constipation?
Have you been diagnosed with Irritable Bowel Syndrome (IBS)?
Have you noticed your symptoms get worse after eating certain foods?

If answering “yes” to these questions, then a low FODMAP diet might be helpful for managing IBS in the elderly.

Of course, before starting any new diet, it’s important to talk to your doctor or registered dietitian to see if this is a good treatment plan for you.

What is IBS in the Elderly?

Irritable Bowel Syndrome (IBS) is a chronic functional disorder of the gastrointestinal system.

It affects around 10% to 15% of adults. (1)

Symptoms for IBS in the elderly vary from person to person but often include bloating, gas, diarrhea, constipation or a combination of both.

There is no known cause, but genetics, age, diet, lifestyle, infection, or a change in intestinal bacteria may play a role. (2)

The severity and frequency of symptoms of IBS in the elderly are different from person to person. However, there are symptom “triggers” that many people have in common.

Causes of IBS in the Elderly

There is not one specific reason that leads to IBS in the elderly. Instead, there can be multiple reasons and even some trigger symptoms to watch for:

Changes in your nervous system (communication between your intestines and brain)
Gut bacteria (microflora) changes (can lead to diarrhea, constipation, bloating, etc.)
Severe infection (too much bacteria in your intestines)
Inflamed intestines
Muscle contractions in your intestine (strong or weak contractions)

Common Triggers for IBS in the Elderly

Both stress and diet can have a big impact on IBS symptoms.

Stress can wreak havoc on your body. Nerves extend from the brain down into the GI tract. When a person is experiencing stress, the brain communicates through these nerves. As a response, the GI tract is stimulated, and digestive issues may worsen. (1)

Diet is a big factor for IBS in the elderly. Eating large meals and eating specific types of foods often causes a flare of symptoms.

Symptoms for IBS in the Elderly

IBS symptoms tend to be similar across all age groups. The most common IBS symptoms include:

Constipation
Cramping
Diarrhea
Gas
Heartburn
Bloating
Nausea
Vomiting
Abdominal pain
Rectal bleeding
Fatigue
Fever
Depression
Anxiety
Weight loss
Feeling like you have another bowel movement even though you just went
A combination of some or all of these symptoms

Treating IBS in the Elderly

Common treatments for IBS in the elderly can combine multiple methods such as:

Stress reduction
Supplements (such as probiotics or fiber supplements – talk with your doctor first)
Medication (such as laxatives or stool softeners – talk with your doctor first)
Lifestyle changes (such as exercise, slowing down to eat, and not eating alone)
Psychological treatments
Follow a low FODMAP diet

IBS in the elderly should be confirmed and followed with regular doctor visits. Missing a more serious illness or disease or misdiagnosing IBS can have negative consequences for the elderly.

Low FODMAP Diet

The low FODMAP diet was designed to help people find relief from digestive issues including IBS. This can be done by eliminating and then reintroducing specific foods.

By doing this, the low FODMAP diet can help pinpoint which foods are tolerated and which ones are causing trouble.

This blog will explain how to implement a low FODMAP diet safely as well as some meal ideas and tips for success. But first, we’ll learn a little bit more about IBS.

What Makes Up Our food?

Given that diet is a major factor in IBS, it’s important to understand what is in food. And particularly, what nutrients are more likely to aggravate symptoms.

The foods we eat are comprised of three types of nutrients:

proteins
fats
carbohydrates

FODMAPs are only found in carbohydrates.

Therefore, we will focus on learning more about carbohydrates and how they are digested and absorbed.

Carbohydrates

Carbohydrates, also known as sugars and fiber, are the biggest source of energy for your body. There are several different kinds of carbohydrates.

“Trigger” foods often contain short-chain carbohydrates. These troublemakers are referred to as FODMAPs and this is why a low FODMAP diet can help relieve symptoms!

Let’s dig deeper.

What Does FODMAP Stand For?

FODMAP is an acronym for different types of foods. It stands for:

Fermentable: Easily turned into gas by bacteria in your digestive system
Oligosaccharides: Sugar chains that contain 3 or more sugar molecules linked together
Disaccharides: Two sugar molecules linked together
Monosaccharides: single unit sugars
And
Polyols: Sugar alcohols

How Do FODMAPs Cause Symptoms?

FODMAPs contribute to IBS symptoms in these ways (3):

They are poorly absorbed in the small intestine. Unabsorbed FODMAPs continue down the digestive tract into the colon where lots of bacteria live.
FODMAPs are bacteria’s favorite food. Bacteria feed on FODMAPs and quickly turn them into gas, which may cause abdominal bloating and discomfort.
They act as a sponge. FODMAPs draw an excessive amount of water into the colon which can lead to watery stools.

All of this can cause significant discomfort with IBS in the elderly.

Digestion and Absorption of Sugar Chains

To understand why FODMAPs can be a problem, we need to understand how sugar chains are digested and absorbed.

Sugar chains cannot be absorbed into the body unless they are first broken down into single sugar molecules. This is a process called digestion. Enzymes in the intestine work to break down your food.

Absorption happens when the digested foods pass through the intestinal membrane into the bloodstream for your body to use as energy. (4)

Why Aren’t FODMAPs Absorbed Well?

Here is a quick description of each type of FODMAP and an explanation of why they may not be well absorbed.

Oligosaccharides: Fructans are one type of oligosaccharide and are found in wheat, onions, asparagus and garlic. Galacto-oligosaccharides, another type of oligosaccharide that is found in beans and legumes.

Humans do not have enzymes that can break down these chains so these cannot be absorbed. (4)

Lactose: Lactose is a disaccharide, made up of glucose and galactose. Lactose intolerance occurs when enzyme activity to break it down is lacking. When lactose is not broken down it cannot be absorbed. (4)
Fructose: Fructose is a monosaccharide. Although it’s a single sugar unit and does not need digestive enzymes to break it down, it cannot pass freely across the intestinal membrane for absorption; it needs to be transported.

The body’s system for transporting fructose is limited and can get overwhelmed when a lot of fructose has been eaten at once. (5)

Polyols: Polyols are slowly absorbed. And like fructose, if an excessive amount is eaten, then not all polyols will be absorbed. (4)

More FODMAPs in the Diet = Increase in Symptoms

Consistently eating a diet high in FODMAPs can have an effect like what is illustrated in the image below.

A repeated cycle of:

High FODMAP diet
Unabsorbed FODMAPS in GI tract
Increased gas and water in the colon
Increased severity & frequency in IBS symptoms

The key to stopping IBS symptoms is to stop this cycle.

IBS in the Elderly: High FODMAP Food List

Here is a list of common high FODMAP foods. These are the foods you will want to avoid if you decide to start a low FODMAP diet.

Don’t worry, this doesn’t mean you will never be able to eat any of these foods ever again! We are investigating which individual foods trigger you, but we start with all of them.

Fruit: apples, apricots, blackberries, cherries, currants, dates, figs, mango, nectarines, peaches, pears, plums, raisins, watermelon
Vegetables: artichokes, asparagus, beans, beetroot, lentils, garlic, mushrooms, onions, shallot, sweet potatoes
Breads and Cereals: wheat products (bread, crackers, pasta, cereals and pastries), rye bread, rye crackers, sweetened breakfast cereals, chickpea flour, bean flour, naan, couscous
Dairy/Dairy Alternatives: milk, buttermilk, cream, evaporated milk, flavored milk, custard, mascarpone cheese, ice cream, Greek yogurt, yogurt, ricotta cheese
Protein: pistachios, cashews, fish meat that is breaded
Sweeteners: agave syrup, coconut sugar or nectar, date sugar, fructose, fruit juice concentrate, high fructose corn syrup, honey, mannitol, maltitol, molasses, palm sugar, sorbitol, xylitol
Drinks: fruit juice, soft drinks or sports drinks containing high fructose corn syrup, sweetened milk, cow’s milk, goat’s milk, sheep’s milk, soy milk
MISC: hummus, tahini paste, garlic salt, garlic powder, onion salt, onion powder, milk chocolate, white chocolate, cocoa powder, carob chocolate, carob powder, sugar-free: gum, mints, and cough drops

IBS in the Elderly: Low FODMAP Food Lists

Now that we’ve covered what not to eat, let’s focus on what you can eat! Be sure to eat foods from all the different groups listed below.

Low FODMAP Fruits for IBS in the Elderly

It is recommended to eat 2 servings of fruit from the low FODMAP list per day. Avoid having more than 1 serving per meal and stick to a serving size of ½ cup.

Remember when a low FODMAP food is eaten in large amounts it can become high FODMAP!

Low FODMAP Fruits (serving size: ½ cup)

banana
blueberries
cantaloupe
cranberries
grapes
honeydew melon
kiwi
lemon
lime
oranges
papaya
pineapple
raspberries
strawberries

Low FODMAP Vegetables for IBS in the Elderly

It is recommended to eat at least 3 servings of vegetables from the Low FODMAP list per day to help meet the recommended daily intake of fiber. Eat a variety of types and colors to get all the vitamins and minerals your body needs.

Low FODMAP Vegetables (serving size: ½ cup)

arugula
bamboo shoots
bean sprouts
bell peppers
bok choy
cabbage
carrots
chives
chili pepper
cucumbers
dill pickle
eggplants
green beans
kale
lettuce
olives
parsnips
radishes
rutabaga
spinach tomatoes
turnips
potatoes
water chestnuts
zucchini

Low FODMAP Breads and Cereals for IBS in the Elderly

It’s recommended to get at least 6 servings of grain products each day. A low FODMAP diet is not a gluten free diet, only foods that contain a high amount of wheat are restricted such as bread, cereal, crackers, pasta, most desserts.

You can choose the gluten-free version of these items.

Low FODMAP Breads and Cereals

gluten free breads
amaranth
gluten free cereals
gluten free crackers
corn, cornmeal
corn or rice tortilla
grits
millet
oatmeal
oat bran
porridge
sorghum
tapioca
brown or white rice

Low FODMAP Dairy/Dairy Alternatives for IBS in the Elderly

Aim for 3 servings of dairy or dairy alternatives each day. This food group is a good source of vitamin D and calcium which is essential for bone health in the elderly.

Low FODMAP Dairy/ Dairy Alternatives

lactose-free milk
Greek yogurt or lactose-free yogurt without high fructose corn syrup
cheese
rice milk, unsweetened
oat milk, unsweetened
almond milk, unsweetened
hemp milk, unsweetened

Protein Foods for IBS in the Elderly

Include a protein rich food on the low FODMAP list with each meal and snack.

It’s important for seniors to get enough protein in their diet to prevent the loss of lean muscle mass and to support a healthy immune system.

Low FODMAP Protein Foods

meat
beef
poultry
pork
fish, fresh (not commercially breaded)
fish, tinned without sauce
eggs
flax seeds
poppy seeds
pumpkin seeds
sesame seeds
sunflower seeds
chia seeds
firm tofu

Low FODMAP Sweeteners for IBS in the Elderly

The low FODMAP diet is not a sugar-free diet, although, too much sugar should not be consumed for a healthy diet. Use the low FODMAP sweeteners in moderation.

Low FODMAP Sweeteners

aspartame
acesulfame-K
erythritol
maltodextrin
saccharine
stevia
sodium cyclamate
sucralose

Implementing Low FODMAP for IBS in the Elderly

Now that you know which foods are high and low in FODMAPs, we’re ready to get started implementing a low FODMAP diet.

Remember, this process takes time and you are becoming an investigator. We are searching for trigger foods for IBS in the elderly.

Phase 1: Elimination

This stage is very strict, and it’s important to follow the diet as closely as you can to get the most benefit. This phase removes high FODMAP foods from your diet and “starves” the bacteria in your gut, allowing your gut to rest.

You should find some relief from IBS symptoms during the elimination phase (usually within 4-8 weeks). Once this has occurred phase two will begin.

If symptoms do not improve within this time frame, talk to your doctor or registered dietitian. It’s not safe to follow the elimination phase of the Low FODMAP diet for a long period of time. (3)

Phase 2: Reintroduction

Slowly reintroduce FODMAPS into your diet, starting with a food containing only one type of FODMAP (see list below for guidance). Start with a small amount of this food on day 1 and gradually increase the amount each day.

If symptoms do not worsen, this FODMAP may not be troublesome for you.

If you experience a flare in IBS symptoms, do not keep going – you have found a trigger food! Go back to following a low FODMAP diet again. Once your symptoms improve, you may start the process over with a different FODMAP food. (3)

The process to manage IBS in the elderly can take a while, but be patient. The results will be worth it!

Below is an example of how to reintroduce a FODMAP (3):

For reintroducing lactose, try skim or low-fat cow’s milk:

1st Day: 1/4 cup
2nd Day: 1/2 cup
3rd Day: 1 cup

The following are other FODMAPs to reintroduce (4):

Fructose: honey or mango
Lactose: plain yogurt or milk
Sorbitol: blackberries or avocado
Fructans- wheat: bread
Fructans- fruit: grapefruit
Mannitol: cauliflower or sweet potato
Fructose + Sorbitol: apples
Fructans: onion
Fructans: garlic
Galacto-oligosaccharides: black beans, kidney beans, or almonds

Phase 3: Integration

This phase starts when you have found your “trigger” FODMAP foods. You now know what you can and can’t eat to avoid IBS symptoms flares. Continue adding foods back to your diet that aren’t “trigger” foods.

Food and Symptom Diary for IBS in the Elderly

Make sure to keep track of the foods that are being reintroduced and any symptoms that occur after eating them.

The KEY is to figure out which foods can remain in your diet and which foods will need to be avoided long term.

This is a long process and it’s easy to forget what foods you ate, how much you ate, and what symptoms happened.

So, writing things down as you go is so important! IBS in the elderly can be effectively managed.

Low FODMAP Tips for IBS in the Elderly

Here are some general tips to make sure you follow the low FODMAP diet correctly.

Balance out your meals. Aim to include one food from each food group at meals. Eat snacks in between meals if needed.
Eat fiber. Fiber is important for a healthy diet. Choose high fiber foods that are on the low FODMAP list such as: oatmeal, brown rice, quinoa, pumpkin seeds or sunflower seeds.

Don’t forget to eat 2 servings of low FODMAP fruit and 3 servings of low FODMAP veggies each day.

Drink water. Drink at least 8 cups a day to stay hydrated and avoid constipation. Stay away from excess caffeine and alcohol, as these can dehydrate you and worsen IBS symptoms.
Gluten free ≠ FODMAP free. Not all gluten-free foods pass as FODMAP free. Bean flour, chickpea flour or added inulin or chicory root can sometimes be found in gluten-free products.
When in doubt, read the ingredients list. Watch out for ingredients like onion salt, onion powder, garlic salt, and garlic powder.

These are often found in store-bought soups or broths, flavored potato chips, salad dressings and store-bought pizza or pasta sauce.

Low FODMAP Breakfast Ideas

Here are a few Low FODMAP breakfast ideas to get you started:

#1 Breakfast

Oatmeal sweetened with cinnamon and topped with sunflower or pumpkin seeds
½ cup blueberries
Lactose-free milk
Hard-boiled egg

#2 Breakfast

Breakfast burrito: spinach, tomato, and egg scramble with cheddar cheese in a rice or corn tortilla
½ cup of cantaloupe or kiwi
Lactose-free milk

#3 Breakfast

Corn Chex or Rice Krispies with lactose free milk
4 oz strawberry Greek yogurt
Turkey bacon

Low FODMAP Smoothie Recipe

You can also try a delicious low FODMAP smoothie for breakfast, or any time of the day!

INGREDIENTS:

½ cup frozen raspberries or strawberries
¼ cup fresh spinach
1 tablespoon chia seeds
4 oz lactose-free yogurt
½ unsweetened almond milk

DIRECTIONS: Add all ingredients into a blender. Blend until smooth!

Check out more low fodmap breakfast ideas.

Potential Risks of a Low FODMAP Diet for the Elderly

Although a low FODMAP diet is amazing in helping to relieve symptoms of IBS in the elderly, it is important to know the potential risks and issues that may occur.

It’s a complicated diet and should be followed with the support of a dietitian or other FODMAP trained professional.

Not Eating Enough Leads to Unintentional Weight Loss

Simply taking high FODMAP foods out of the diet and not replacing these foods with other low FODMAP foods can lead to decreased nutrient intake and unintended weight loss.

This can be a really big deal for older adults as it can lead to muscle loss and loss of independence.

Remember: a low FODMAP diet is not eating less, it’s eating differently. If you’re finding it hard to maintain your weight, then you may want to add more calorie-dense foods like olive oil, seeds, nuts, cheese, full-fat Greek or lactose-free yogurt and lactose-free whole milk.

Stress and Anxiety Surrounding Eating

Restricting a lot of foods from your diet can potentially cause increased stress around eating. As discussed earlier, stress can worsen symptoms of IBS in the elderly!

Planning meals and snacks ahead of time can help put your mind at ease. Keep in mind this diet is not recommended for individuals with a history of or currently struggling with disordered eating.

Reduced Prebiotic Intake

Prebiotics act as food for the bacteria in your gut. Bacteria in the gut isn’t a bad thing. In fact, having a healthy balance of bacteria in your gut has been linked to improved immune function and mental health. (6)

Prebiotics are found in high fiber foods like fruits and vegetables. As we now know, many of these high fiber foods contain FODMAPs. By reducing FODMAPs in the diet, prebiotics are reduced as well.

During the elimination phase of a low FODMAP diet we are essentially starving the gut bacteria. This is good for relieving the IBS symptoms; although, reduced prebiotic intake for a long period of time may be a cause for concern.

It is unknown what changing our gut bacteria long-term means for our overall long-term health.

We do know that fructans and galacto-oligosaccharides are prebiotics. Therefore, determining if you can tolerate them during phase two is important!

It would be the best case scenario if we can add them back. We would not want to restrict these foods in the diet unless it is necessary (meaning if these foods trigger your IBS). (7)

Low FODMAP Success Rate

The research and studies that have been done on a low FODMAP diet show positive outcomes. One study showed 76% of people were satisfied with the results and reported less abdominal pain, bloating and flatulence.

Another study showed 70% of participants reporting a decrease in IBS symptoms after only one week on a low FODMAP diet. (8,9)

Potential Benefits of Low FODMAP Diet

There are many benefits to following a Low FODMAP diet including:

Identifying your trigger foods
Taking control of bathroom habits
Enjoying food again!
Having more energy and a better quality of life

It’s a long and complicated process, but can have amazing benefits in the end.

And there will be an end. IBS in the elderly can be managed.

Role of the Dietitian in Managing IBS in the Elderly

Every individual is different when it comes to IBS triggers and symptoms. A registered dietitian can work with you to:

Ensure you are meeting all of your nutritional needs during the strict elimination phase.
Help you identify FODMAPs that are your biggest triggers during the reintroduction phase.
Create a customized diet plan that you can follow long-term.

Supportive Resources for IBS in the Elderly

Conclusion on Managing IBS in the Elderly

The low FODMAP diet is scientifically proven to help relieve IBS symptoms and to help with managing symptoms over time. If you or a loved one is suffering from chronic digestive issues that affect your everyday life, a low FODMAP diet may be right for you!

Hopefully this article has given you a better understanding of how the low FODMAP diet works and how to follow it. Best of luck as you or your loved one work to improve IBS symptoms.

References:

Ellis, Esther. Irritable Bowel Syndrome. Eat Right. Published April 12, 2022. Reviewed March 2022. Accessed September 20, 2022. https://www.eatright.org/health/wellness/digestive-health.
Canavan C, West J, Card T. The epidemiology of irritable bowel syndrome. Clin Epidemiol. 2014; 6:71–80. doi:10.2147/CLEP.S40245.
Leech, Joe. Low FODMAP Diet: The D.I.Y. Beginner’s Guide (Plus PDFs). Diet vs Disease. Updated September 14, 2022. Accessed September 20, 2022. https://www.dietvsdisease.org/diy-low-fodmap-diet/.
Parrish, Carol R. FODMAPS Everywhere and Not a Thing to Eat! Published July 2019. Accessed September 20, 2022. https://practicalgastro.com/wp-content/uploads/2019/10/Parrish-July-2019.pdf.
Riby, J, Fujisawa, T, Kretchmer N. Fructose absorption. Am J Clin Nutr. 1993;58(5):748S–753S. https://doi.org/10.1093/ajcn/58.5.748S.
Prebiotics, Probiotics and Your Health. Mayo Clinic. Published February 27, 2021. Accessed September 20, 2022. https://www.mayoclinic.org/prebiotics-probiotics-and-your-health/art-20390058.
Hill P, Muir JG, Gibson PR. Controversies and recent developments of the low-FODMAP diet. Gastroenterol Hepatol. 2017;13(1):36–45. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5390324/.
Staudacher, H, Whelan, K, Irving, P, Lomer, M. Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome. J Hum Nutr Diet. 2011;24(5):487-95. doi: 10.1111/j.1365-277X.2011.01162.x.
Halmos, E, Power, V, Shepherd, S, Gibson, P, Muir, J. A diet low In FODMAPS reduces symptoms of irritable bowel syndrome. Gastroenterology. 2014;146(1):67-75.e5. doi: 10.1053/j.gastro.2013.09.046.