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Pain Point for People with IBS and Diabetes

10-20 percent of people in the U.S. have IBS and about 10 percent have diabetes. So it’s a good bet that some of you have both! And even those without a diagnosis of diabetes or pre-diabetes may be concerned about managing blood sugar levels to help with mood or fatigue. Diets for these conditions both revolve around the types and amounts of carbohydrates you consume. The pain point? Some of the best strategies for managing diabetes increase symptoms for people with IBS. Sometimes people who work very hard at improving their diets for diabetes run into big trouble with abdominal and bowel symptoms when they do so. But all is not lost. You can learn to manage both conditions, thanks to other strategies for the two that mesh very nicely.

Meat, fish, seafood, poultry, eggs, and oils don’t contain any carbs at all, so they aren’t really part of this discussion. All other foods do contain carbs. Some of them occur naturally in foods, such as lactose in milk, or starch in potatoes. Fibers in foods such as nuts, whole grains and vegetables are technically considered “carbs” too. Sweeteners that may be added to prepared foods are sources of carbs. Some of these carbs are FODMAPS. Others are not.

Here are some important pointers for people with diabetes or pre-diabetes, and things to consider for those who are also limiting their FODMAP intake.

There are many good low-FODMAP sources of fiber that people with diabetes can eat. Delicious lower-FODMAP hummus starts with canned, drained chick peas, which are lower in FODMAPs than those used to make commercial hummus. Scroll down to try this recipe yourself!

There are many good low-FODMAP sources of fiber that people with diabetes can eat. Delicious lower-FODMAP hummus starts with canned, drained chick peas, which are lower in FODMAPs than those used to make commercial hummus. Scroll down to try this recipe yourself!

1. Eat carb-containing foods with low impact on blood sugar. People, this translates to “eat more fiber” in the form of fruits, vegetables, whole grains, and beans. Great advice for diabetics, but it needs to be adjusted to fit with a low-FODMAP diet. Fiber has little impact on blood sugar because it cannot be broken down by humans to its building blocks, sugars, for absorption. Humans can’t digest fiber, but our gut bacteria can, and they produce a lot of gas when they do, in the process called “fermentation.” Fermentation is normal and healthy, and people with resilient guts tolerate the gas produced very well. But for those with IBS, this is a major pain point—when your intestines are distended by gas, it can cause bloating and abdominal pain. The most rapidly fermented fibers are considered FODMAPs. Fortunately, some fibers are fermented slowly enough to be more easily tolerated by people with IBS. These folks can still eat a wide variety of low-FODMAP fruits, vegetables, whole grains, and certain canned or boiled legumes and pulses. Just remember, the "more is better" approach to eating fruits and vegetables won’t work for some people with diabetes and IBS.

Don't make a meal out of cashews! Nuts are relatively low in carbohydrates but they are high in FODMAPs, especially cashews and pistachios; other nuts can be enjoyed in small portions on a low-FODMAP diet.

Don't make a meal out of cashews! Nuts are relatively low in carbohydrates but they are high in FODMAPs, especially cashews and pistachios; other nuts can be enjoyed in small portions on a low-FODMAP diet.

2. Avoid eating or drinking too many carbs at one time. Blood sugar levels rise naturally after a meal, and fall somewhat before the next one. Your body works hard to keep this rise and fall occurring within a healthy range, and you can help by not flooding your system with too many carbs at once. Hurray! This point meshes easily with a low-FODMAP diet, where portions of fruits, certain vegetables, certain whole grains, and nuts must be on the smaller side.

Avoid these pitfalls:

  • Don’t get carried away with nuts. Nuts are low in carbs, so many people who count carbs eat a lot of them. But, they are not especially low in FODMAPs. Limit yourself to just a handful of almonds, walnuts, pecans or macadamia nuts.
  • Don’t overdo foods such as rice and low-FODMAP pastas. They may be IBS-friendly, and “unlimited” in terms of FODMAPs, but they will not do your blood sugar any favors.

3. Distribute carbs throughout the day. This is related to strategy #2. Instead of eating all your carbs for the day at just one or two meals, eat smaller, more frequent meals and snacks. This strategy makes it easier for your body to regulate your blood sugars within the normal range. Smaller intakes of carbs translate to smaller loads of FODMAPs, too, which are tolerated more easily by people with IBS. A happy medium must be achieved here, perhaps 3 meals a day plus one or two snacks if needed. Grazing all day long isn’t a good idea. Your guts function best when they are empty for a little while between meals and snacks. And eating too frequently might make it difficult to manage your weight.

People with a significant diet-related medical condition like diabetes should be under the care of a nutrition professional. Fortunately, nutrition therapy for diabetes is a covered benefit on virtually all health insurance policies, so ask your doctor for a referral. Dietitians who are experts in diabetes are easy to find, but they won’t necessarily know a lot about FODMAPs. To increase your odds of a good match, let your needs be known when you call to schedule.

Lower-FODMAP Hummus

Enjoy flavorful hummus again with this IBS-friendly homemade version. Canned, drained chickpeas are lower in FODMAPs than those that are cooked from scratch or used in commercial hummus.

Ingredients:

1 (14.5 ounce) can chickpeas, drained and rinsed
2 tablespoons water
4 tablespoons fresh lemon juice
2 tablespoons peanut butter
2 tablespoons garlic-infused oil
1 teaspoon sesame oil, dark or spicy
½ teaspoon salt

Procedure:

Measure ingredients into the bowl of a blender or food processor in the order shown. Process until smooth and creamy. Transfer to a serving bowl and drizzle a little extra sesame oil on top to garnish. Serve immediately with fresh vegetables such as carrot sticks and sliced cucumbers.

Serves: 8

Nutrition (per serving): 141 calories, 7.5g total fat, 369.2mg sodium, 15.4g carbohydrates, 3g fiber, 4.2g protein

From IBS-Free Recipes for the Whole Family (2015, Pond Cove Press), by Lisa Rothstein, Patsy Catsos and Karen Warman. Used with permission.

For a printable PDF version of this recipe, click here.

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