Assessing the Low FODMAP Diet: Is This Approach Right for Me?
Explore the Low FODMAP diet for IBS relief. Learn about FODMAPs, benefits, risks, and who should consider this dietary approach. If you are frustrated and unsure how to get relief from IBS and if a LowFODMAP diet is right for you, read on!
What are FODMAPS?
FODMAP is an acronym that stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols. Say what?!
The term “saccharide” means sugar, where “oligo”, “di” and “mono” refer to the number of sugars in a chain: mono = 1, di = 2, oligo = 2+.
These are forms of fermentable sugars (aka carbohydrates) that are not absorbed or digested in the gut. These come from foods such as fruits, vegetables, beans, legumes, grains, nuts, and some sweeteners.
This does not mean these foods are unhealthy. In fact, these foods are great sources of fibers that are needed to maintain a healthy bacterial population in our gut as they act as a prebiotic which you can think of as fertilizer for our gut bacteria.
FODMAPs and IBS:
As mentioned in a previous blog post, most of our gut bacteria SHOULD reside in the large intestine. But this is not always the case. When there is an imbalance of bacteria (dysbiosis) in the large or small intestines, or a larger amount of bacteria in our small intestine, these foods can be fermented by the bacteria and cause a host of unpleasant symptoms like:
Gas
Bloating
Abdominal pain
Distention
Changes to bowel habits: diarrhea, and/or constipation
Irritable bowel syndrome is a common diagnosis for this list of symptoms. One can imagine a balloon being filled with air when FODMAP foods are consumed when there is dysbiosis in our gut bacteria. The bacteria then feast on and ferment these FODMAPS, producing gasses under pressure leading to those unpleasant symptoms.
What is the Low FODMAP Diet?
The Low FODMAP diet is an evidence-based dietary approach designed to help manage symptoms of irritable bowel syndrome (IBS) and other functional gastrointestinal disorders (FGIDs) by reducing intake of specific types of FODMAPs as described above.
Keep in mind the diet is a LOW but not NO-FODMAP diet. In fact, these FODMAP foods are actually good for our gut microbiome but for some suffering with IBS they may produce unpleasant gastrointestinal symptoms.
Keep in mind the diet is not a gluten-free or dairy-free diet, however, a Low FODMAP diet can be combined with a gluten and/or dairy-free diet for those with celiac and/or food sensitivities and intolerances.
Certain foods have a tested serving size associated with the type and or amount of FODMAP which makes a food Low- Moderate- or -High FODMAP
Below is a list of higher and lower FODMAP foods- keep in mind it does not list specific quantities and/or assess an individual’s specific tolerance.
Low FODMAP Food List
This diet is meant to be a short-term diet for 2-8 weeks followed by a reintroduction phase lasting as long as or greater than the diet itself to pinpoint a person’s individual tolerances to certain FODMAPs. That being said, there is not one size fits all with tolerances to FODMAPs.
The idea is to return to as broad a diet as possible in the long run so that we can nourish our body and our gut microbiome with the widest variety of foods as possible.
If you do plan to embark on this diet or have been told to try this diet without much direction the Monash University FODMAP app is a must. But first, let’s see if this diet is appropriate for you.
Is this the best diet for IBS?
The Low FODMAP diet is primarily recommended for individuals suffering from symptoms of Irritable Bowel Syndrome (IBS) or other functional gastrointestinal disorders (FGIDs) such as functional bloating or functional diarrhea. These conditions are common and can significantly impact quality of life. In studies a lowFODMAP diet as a first-line therapy has shown beneficial improvement of symptoms of pain, symptoms, and quality of life in both children and adults suffering from IBS.
It's important to note that the Low FODMAP diet is not a one-size-fits-all solution. Before starting this diet, individuals should be properly assessed and diagnosed by a qualified healthcare professional to rule out other potential conditions that may mimic IBS symptoms like small intestinal bacterial overgrowth which I talked about in a previous blog post.
Considerations and nuances of the LowFODMAP Diet:
An individual's tolerance to FODMAPs may vary. We can think of FODMAPs like a bucket and everyone’s bucket size and amount full at a given time may differ. You may be able to tolerate ½ cup of beans one day but then another day when you ate other FODMAP foods your bucket may almost be full and the same serving of beans may lead to insta-bloat and other GI symptoms. Sometimes it’s also not about the food!
The Monash University App is a good way to learn which foods and serving sizes are considered low, moderate, and high FODMAP. Additionally, not everyone reacts to the same FODMAPs which is why the 3- phased approach: remove, reintroduce, refine is important and allows you to learn about your individual tolerances to FODMAPs.
Other considerations for IBS:
Diet is one piece of the puzzle to consider when it comes to supporting your gastrointestinal health and finding relief from symptoms. However, focusing solely on diet alone would be misguided as an integrative approach is often needed for irritable bowel syndrome and only focusing on diet may lead to other problems.
We have to consider the mind-body-gut connection and address it. For example: is a person carrying a larger than normal load of stress, is poor sleep or eating hygiene playing a role, are medications affecting the GI tract, and is (lack of) overall variety in the diet affecting a person’s symptoms? All of these are inputs into the bi-directional talk between the gut and the brain and do have effects on IBS symptoms.
Risks and precautions of a Low FODMAP diet:
The Low FODMAP diet is an elimination diet and not without risks! Anytime we eliminate foods we may risk reducing the overall nutrient intake in the diet.
On a Low FODMAp diet fiber-rich foods are often restricted in an effort to control symptoms. This is a problem because fiber is what feeds the good bacteria in our colon and can be beneficial for a multitude of reasons and Americans are already not meeting their daily fiber goals! Dysbiosis is one reason for irritable bowel syndrome and our gut bacteria love to have a variety of fibers in the diet so it’s like a cat chasing its tail when we restrict fibers further —> more dysbiosis.
While the Low FODMAP diet can be highly effective for managing symptoms in certain individuals, there are situations where it may not be appropriate or advisable:
Lack of Proper Diagnosis: If you haven't been formally diagnosed with IBS or FGIDs, it's important to undergo appropriate medical evaluation before starting the Low FODMAP diet. Other conditions such as inflammatory bowel disease (IBD), celiac disease, or food allergies/intolerances can cause similar symptoms and require different management approaches.
When you have tried the LowFODMAP diet and after 2-8 weeks are not seeing a noticeable difference in GI symptoms. At this point, it is best to investigate other potential causes for symptoms and work with your provider to avoid this unnecessary restriction.
Pregnancy or Lactation: The Low FODMAP diet may not be suitable for pregnant or breastfeeding individuals due to potential nutritional limitations and restriction of certain foods
History of Eating Disorders: Individuals with a history of disordered eating, restrictive eating, or a diagnosed eating disorder should not attempt a low FODMAP diet. Restrictive diets can potentially exacerbate psychological and physiological issues related to eating disorders, and further damage one’s relationship with food and lead to nutritional deficiencies.
Long-Term Restriction: The Low FODMAP diet is intended to be a short-term intervention to identify and manage trigger foods. Prolonged restriction of FODMAPs without proper guidance can lead to nutritional inadequacies, particularly in fiber intake, and have negative consequences on the gut microbiome and therefore one’s overall health.
If you are considering starting a lowFODMAP diet, please do so with some guidance from a practitioner who understands the challenges discussed here and can help guide you to make the appropriate decision if this diet is right for you. I am happy to consult with you to determine if a Low FODMAP diet makes sense for you!
