Is the low FODMAP diet the next big thing? Because it seems every man and his dog (not literally) is following it or thinking about following it, even if they don’t have IBS…
Healthy people, athletes(1,2,3), the “worried well”, people trying to lose weight and people with gut symptoms including athletes suffering with “runner’s gut”(4).
It’s like it’s kinda fashionable to follow it!
But it’s not going to cure IBS. And there are a few concerns with the diet(5,6,7). Plus, it’s not suitable for everyone either(7,8).
You may know about the low FODMAP diet, but just in case…
Here’s a quick overview:
It’s a diet that limits fermentable carbohydrates, and can be used by people suffering with IBS(5-17).
By manipulating your intake of these fermentable carbs (FODMAPs) you can manage your symptoms. This diet was developed by Monash University researchers in Australia to help manage IBS.
…But… if you have IBS, you shouldn’t just start following it by yourself. You need to have the support of a qualified Dietitian(10-12) who is trained in this (because not every Dietitian is trained and has experience in using this diet).
There’s scope for you to get this diet wrong, to follow the wrong information, to have an inadequate diet which could be overly restrictive and can seem rather difficult to follow without help.
And, don’t follow the low FODMAP diet without first being diagnosed with IBS by your doctor, as your symptoms may be due to another condition.
For example, to be diagnosed with Coeliac Disease, you must be including gluten in your diet (- have foods containing gluten in at least one meal every day for 6 weeks), otherwise Coeliac Disease will be incorrectly ruled out, and this will have health consequences(9).
But many people avoid gluten for various reasons such as, because they think it’s “unhealthy”, because they want to improve their gut symptoms, because they want to cut out carbs, because they thinks it’s good for their exercise performance, because they want to lose weight.
Despite the potential negative issues around the low FODMAP diet, there are loads of research behind its use in helping manage symptoms of IBS(10).
But note, not all sufferers of IBS will respond to the low FODMAP diet, but research has shown up to ~86% improvement(18) and individual results vary.
Also, if you try following the diet by yourself, you’ve got a much less chance of it working, than you have with a qualified Dietitian.
And I wouldn’t recommend you seeing a “diet expert” or nutritionist for the low FODMAP diet for your IBS either, because one, they may get it wrong and cause more harm than good, and two, Dietitians are the only health professional that can assess, diagnose and treat diet and nutrition-related problems(20).
And anyone can call themselves a diet expert, a nutritionist or any other flashy title they wish to give themselves (except “Dietitian”, because it’s a protected title).
Fermentable carbs (FODMAPs) are found in a variety of different foods and drinks and hence the diet can be quite restrictive. These can be found in things like fruits, veg, wholegrain foods and dairy products, which are all part of a healthy balanced diet, like the Eatwell Guide recommends, so it can seem a bit unfair if you eat a healthy diet and then you’re punished by crippling symptoms.
Some of these foods contain one or more FODMAP, which can add to making it seem even more difficult to work out what’s triggering symptoms and what’s not.
But working with a Dietitian can help you work out what’s triggering your symptoms and make sure your diet is nutritionally adequate(6,12).
Some Low FODMAP Diet Uses
There’s now growing research into using this diet in other contexts, such as with IBS (Inflammatory Bowel Disease, umbrella term for Ulcerative Colitis and Crohn’s disease) and with athletes suffering with gut issues/ “runner’s gut” or “runner’s trots”(3). But again, work with a qualified Dietitian to help you manage your condition and gut symptoms.
- It’s not a diet to be followed long term
- The diet is not a lifestyle choice – it’s a means of tackling IBS symptoms (and potentially other conditions too)
- Long term effects of the diet is currently unknown
- It has a negative effect on your gut bacteria(10,16-18) (and therefore work with a Dietitian to help you around this)
- You shouldn’t self-diagnose IBS – if you’re suffering with bowel symptoms, please speak with your doctor, and especially if you also…
- Bleed from your bum or have blood in your pooh
- Have unintentionally lost weight
- The diet isn’t for everyone – e.g. people with an eating disorder(5,7) or may be at risk of disordered eating shouldn’t follow this diet
- Also, your doctor may give you info and advice about the low FODMAP diet (and unfortunately I have loads of stories of this by my previous patients and clients), but your doctor may not be qualified in providing you with the low FODMAP diet. Or they may tell you to follow the Low FODMAP diet and to go “Google it”! – Don’t Google it and attempt to do it by yourself – invest in a Dietitian to support you.
If you suffer with IBS and struggling to manage your symptoms, don’t continue suffering, contact me here.
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References and other reading
- Lis, D., Ahuja, K. D., Stellingwerff, T., Kitic, C. M., & Fell, J. (2016). Case study: utilizing a low FODMAP diet to combat exercise-induced gastrointestinal symptoms. International journal of sport nutrition and exercise metabolism, 26(5), 481-487. Chicago
- Wiffin, M., Smith, L., Antonio, J., Johnstone, J., Beasley, L., & Roberts, J. (2019). Effect of a short-term low fermentable oligosaccharide, disaccharide, monosaccharide and polyol (FODMAP) diet on exercise-related gastrointestinal symptoms. Journal of the International Society of Sports Nutrition, 16(1), 1. Chicago
- Lis, D. M. (2019). Exit Gluten-Free and Enter Low FODMAPs: A novel dietary strategy to reduce gastrointestinal symptoms in athletes. Sports Medicine, 49(1), 87-97. Chicago
- Gaskell, S. K., & Costa, R. J. (2019). Applying a low-FODMAP dietary intervention to a female Ultraendurance runner with irritable bowel syndrome during a multistage Ultramarathon. International journal of sport nutrition and exercise metabolism, 29(1), 61-67.
- Bellini, M., Tonarelli, S., Nagy, A. G., Pancetti, A., Costa, F., Ricchiuti, A., … & Rossi, A. (2020). Low FODMAP Diet: Evidence, Doubts, and Hopes. Nutrients, 12(1), 148.
- Staudacher, H. M., Ralph, F. S., Irving, P. M., Whelan, K., & Lomer, M. C. (2019). Nutrient intake, diet quality, and diet diversity in irritable bowel syndrome and the impact of the low FODMAP diet. Journal of the Academy of Nutrition and Dietetics. Chicago
- Chey, W. D. (2019). Elimination diets for irritable bowel syndrome: Approaching the end of the beginning. American Journal of Gastroenterology, 114(2), 201-203.
- Hill, P., Muir, J. G., & Gibson, P. R. (2017). Controversies and Recent Developments of the Low-FODMAP Diet. Gastroenterology & hepatology, 13(1), 36–45.
- NICE. (2015). Coeliac disease: Recognition, assessment and management. NICE CG 20.
- Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology 2014; 146 (1): 67–75 .e5
- Staudacher, H. M. (2017). Nutritional, microbiological and psychosocial implications of the low FODMAP diet. Journal of gastroenterology and hepatology, 32, 16-19. Chicago
- O’keeffe, M., Jansen, C., Martin, L., Williams, M., Seamark, L., Staudacher, H. M., … & Lomer, M. C. (2018). Long‐term impact of the low‐FODMAP diet on gastrointestinal symptoms, dietary intake, patient acceptability, and healthcare utilization in irritable bowel syndrome. Neurogastroenterology & Motility, 30(1), e13154.
- Mehtab, W., Agarwal, A., Singh, N. et al. All that a physician should know about FODMAPs. Indian J Gastroenterol 38, 378–390 (2019). https://doi.org/10.1007/s12664-019-01002-0
- Manning, L.P.; Biesiekierski, J.R. Use of dietary interventions for functional gastrointestinal disorders. Curr. Opin. Pharmacol. 2018, 43, 132–138.
- Whelan, K., Martin, L. D., Staudacher, H. M., & Lomer, M. C. (2018). The low FODMAP diet in the management of irritable bowel syndrome: An evidence‐based review of FODMAP restriction, reintroduction and personalisation in clinical practice. Journal of human nutrition and dietetics, 31(2), 239-255.
- Staudacher, H. M., & Whelan, K. (2017). The low FODMAP diet: Recent advances in understanding its mechanisms and efficacy in IBS. Gut, 66(8), 1517-1527. Chicago
- Wilson, B., Rossi, M., Kanno, T., Hough, R., Probert, C., Irving, P., … & Whelan, K. (2018). PWE-126 Low fodmap diet effect on IBS gastrointestinal microbiome and metabolites and prediction of response.
- Liu, J., Chey, W. D., Haller, E., & Eswaran, S. (2020). Low-FODMAP Diet for Irritable Bowel Syndrome: What We Know and What We Have Yet to Learn. Annual Review of Medicine, 71, 303-314.
- Marsh A, Eslick EM & Eslick GD (2016) Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta‐analysis. Eur J Nutr 55, 897– 906.
- BDA. Dietitian or nutritionist: https://www.bda.uk.com/about-dietetics/what-is-dietitian/dietitian-or-nutritionist.html