Digestive disorders make up the number one complaint that we see in clinic here at The Natural Nutritionist. In recent years a low FODMAP diet has become incredibly popular and rightly so because of the evidence to support its’ impact on poor digestion and provide relief from symptoms related to Irritable Bowel Syndrome (IBS). However, please know this – a low FODMAP diet is not a life sentence.
Put simply, FODMAPs are a group of short chain carbohydrates which are usually well tolerated and in fact provide a host of beautiful benefits, including feeding beneficial gut bacteria. In some however, they are poorly absorbed and can trigger symptoms such as gas, stomach pain, bloating, diarrhoea and constipation. Enter the low FODMAP diet. For further background on FODMAPs, please read FOD-WHATS?
What is the diet?
The Low FODMAP Diet was originally designed by Monash University, and we give credit to them for the incredible work they’ve done and continue to do. Studies have found that a low FODMAP diet can reduce IBS symptom severity by up to 76%.
The classic protocol involves removing all foods high in FODMAPs for a 2-6 week period, following which FODMAP containing foods can slowly be re-introduced. At TNN we recommend following a similar protocol, however the aim is always to progress to the reintroduction of new foods as soon as reasonable. The process, of course, must be tailored to the individual depending on how quickly symptom relief is achieved.
What most are surprised to learn is that sensitivity to FODMAPs is not the same as that of a gluten or lactose intolerance where there is an actual immune reaction. Intolerance to FODMAPs are usually dose dependant. We like to think of it as the ‘tolerance budget’. Once you’ve exhausted the budget you feel the pressure but when under budget, you won’t. As your tolerance to FODMAPs improves, so does the size of your budget.
When is the low FODMAP diet appropriate?
In individuals with unexplained symptoms such as bloating, gas and abdominal pain, the low FODMAP diet will in many cases provide relief. For this reason it’s a great first point of call. However the diet won’t target the root cause of the gut disorder. If you’re still not able to tolerate FODMAPs to any degree following an elimination then it’s important to look at underlying causes. This may mean testing for the likes of:
- SIBO – just over 80% of IBS sufferers test positive for this. See here for background on SIBO if you’re not already familiar;
- Dysbiosis;
- Intolerances, like fructose intolerance;
- Autoimmune conditions, like celiac disease.
Why is this diet not a life sentence?
The primary motivator for this discussion is to highlight the potential pit falls of following the diet for too long. All too often I see the diet being prescribed by GPs or other health professionals, with not enough discussion being had around the reintroduction of foods. This is a huge mistake and can have seriously detrimental effects, including:
- Gut health. That’s right, removing the very foods that initially contribute to negative gut symptoms will, in the long run, make the situation worse. This is because a diet void of these beautiful prebiotic rich foods will literally leave your beneficial gut bacteria starving. Research shows that a long-term low FODMAP diet will significantly alter beneficial bacteria.
- Have you seen the list of foods containing FODMAPs? If not, please refer to the Monash University ‘Low FODMAP Diet’ App. It’s a long list and removing them for life is not conducive to a healthy relationship with food, nor a thriving social life. After a short period of being FODMAP free and introducing other beneficial gut health practices (see Gut Health 101) you should be able to tolerate FODMAP containing foods and choose freely from a restaurant menu.
- Importantly, any underlying and contributing conditions should not be left untreated. If a case of SIBO or dysbiosis is left untreated it will eventually manifest in other ways, including nutrient deficiency, mental health and mood disorders.
You may be reading this and learning about the impact of FODMAPs for the first time. Similarly, you may have been on your own version of a low FODMAP diet with little to no success. Regardless of which, we’d love to work with you in regaining dietary freedom! Book your complimentary 15-minute consultation here.
References:
Staudacher HM et al., 2012. Fermentable carbohydrate restriction reduces luminal bifidobacteria and gastrointestinal symptoms in patients with irritable bowel syndrome. The Journal of Nutrition, 142, 8, 1510-1518.
Staudacher HM et al., 2011. Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome. Journal of Human Nutrition and Dietetics, 24, 5, 487-495.
Pimental M et al,. 2003. Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome. a double-blind, randomized, placebo-controlled study. American Journal of Gastroenterology, 98, 2, 412-419.
Kresser C. 2017. Is a Low-FODMAP Diet Best for Digestive Disorders? Accessed May 3, 2018.