Defining the Low FODMAP Diet

The low FODMAP diet is a three-step, evidenced based diet to treat functional gut symptoms, including bloating, abdominal distention, diarrhea, constipation, excess gas, and abdominal pain. These symptoms can be present in people with IBS, Crohn’s, colitis, SIBO, following a bout of food poisoning, or in those recovering from an intestinal surgery.

Why is this diet effective for these symptoms and disorders? FODMAPs are short-chain carbohydrates that can be fermented by the bacteria in your gut which can lead to the production of excess gas, bloating, and abdominal distention (often patients say they look “X” months pregnant). The carbohydrates themselves can draw water into the intestine, via osmosis, leading to loose stools, increased stool frequency, or diarrhea.

The three steps of the low FODMAP diet are:

1. The Elimination Phase: This phase is 2-6 weeks of eliminating high FODMAP foods from the diet, then observing the effect on GI symptoms the patient is experiencing.
2. The Reintroduction Phase: This phase is typically 4-6 weeks. FODMAPs are reintroduced one-by-one and any negative GI symptoms are noted. This phase is crucial to avoid long-term avoidance of foods that are well tolerated and unnecessary disruptions to one’s social life and food intake.
3. The Maintenance Phase: Here’s the great thing – once patients have determined their triggers, if they think the benefit of eating a food is greater than the discomfort their gut symptoms may bring, they can absolutely make this choice. The low FODMAP diet is not meant to treat an underlying disease, but instead to help patients manage their gut symptoms. FODMAP intolerances are not allergies. So, once the patient has determined their dietary triggers, they are just moving forward armed with the knowledge they’ve gleaned about their bodies from following the diet, in the way that works best for them.

The Low FODMAP Diet: Mainstream Medicine

Clinical research on the low FODMAP diet has consistently shown that 75% – 86% of people with functional gut symptoms show a meaningful improvement in their gut symptoms after following this diet. That’s a fantastic success rate which rivals the effectiveness of most medications for most health conditions. Food is medicine!

The American Gastroenterological Association recommends the low FODMAP diet as first line therapy for IBS. A recent paper stated, “Of the available options, the low FODMAP diet is currently the most evidenced-based dietary treatment choices for patients with IBS.”¹

Since the diet is complicated to learn and implement, getting professional guidance from a Registered Dietitian can really help patients undertaking the low FODMAP diet to have a clear path forward. It’s wonderful when patients only have to undertake the elimination phase of the diet once and get clear results, and having professional guidance definitely helps here.

The American College of Gastroenterology stated in a recent paper regarding the management of IBS: “In summary, this guideline committee believes that the complexity of the low FODMAP diet, combined with the potential for nutritional deficiencies, and the time and resources required to provide proper counseling on the 3 phases of the plan, requires the services of a properly trained GI dietitian.”²

Elimination Diets

The low FODMAP diet has two phases, the elimination diet period and the reintroduction period. The low FODMAP diet completely eliminates many foods from the diet in this first period. Elimination diets are mentally, socially, and logistically tricky, and shouldn’t be entered into lightly. There are still a lot of foods and variety during this phase but following this diet requires a dedicated period of at least 2 weeks where the patient has committed and is really intentional with what they eat.

My point in saying this is, this diet isn’t for everyone. Symptom severity, how much your daily life and flow are affected by your symptoms, and mental preparedness to embark on such a journey should all be considered. There are other paths for more mild symptoms that I often recommend my patients try first. Other times, it’s a matter of waiting until a client gets past a busy season and is able to carve out a little extra time to attend to this diet.

Patients with a history of any disordered eating pattern should carefully weigh the potential benefits versus the potential triggering aspects of the diet. I don’t recommend patients with a history of disordered eating who are not completely healed from this embark on a low FODMAP diet.

What’s The Tipping Point? Who Should Consider This?

Recently, I worked with an elementary school teacher with severe IBS following a bad intestinal infection. She was having trouble functioning all day at work in a setting where her presence was required and bathroom breaks were limited. She ultimately decided to embark on the low FODMAP diet and tremendously benefitted – she identified her triggers, her symptoms improved drastically, and she was able to find joy in her work again.

Often quality of life, lost productivity, and social isolation can become an issue in people suffering with the gut symptoms the low FODMAP can help address. In these instances, the potential benefits of the diet often outweigh the potential risks and inconvenience factor. These types of stories are a common experience with the low FODMAP diet in people whose bothersome GI symptoms are having a real impact on their lives, functionality at work, and ability to make plans and socialize with friends and family. These types of experiences are what life is about!

Please reach out or book an appointment if I can help you decide whether a low FODMAP diet is right for you, and help guide you on your journey to better digestive health!

References:

1. Chey WD, Hashash JC, Manning L, Chang L. AGA Clinical Practice Update on the Role of Diet in Irritable Bowel Syndrome: Expert Review. Gastroenterology. 2022;162(6):1737-1745.e5.
2. Lacy BE, Pimental M, Brenner DM, et al. ACG Clinical Guideline: Management of Irritable Bowel Syndrome. Am J Gastroenterol. 2021;116(1):17-44.