Through changes to your diet and lifestyle, the nutritional management of Irritable Bowel Syndrome (IBS) aims to improve your quality of life and decrease the frequency and severity of your symptoms so you can live life to its fullest.
The dietary cause of the symptoms associated with IBS is largely due to a group of carbohydrates called FODMAPs and the low FODMAP diet is a dietary approach that can help alleviate IBS symptoms by limiting the intake of these specific carbohydrates.
What are FODMAPs?
FODMAPs is an acronym used to describe different types of carbohydrates that are found in a lot of everyday foods. It stands for:
Fermentable
Oligosaccharides
Disaccharides
Monosaccharides
And
Polyols
These are poorly broken in your small intestine and are then fermented by the gut bacteria in your large intestine. This process produces gas which can irritate the more sensitive nerve endings that people with IBS have throughout their gut.
FODMAPs are also small and increase the amount of water delivered throughout the gut, which is called an osmotic effect. The gas produced by the large intestine in combination with this osmotic effect can alter the way your gut moves leading to:
Uncomfortable bloating and stomach distension (pregnant looking belly)
Excessive and/or painful wind
Stomach pain and discomfort
Constipation and/or diarrhoea
FODMAPs are found in many common foods including fruit, vegetables, grains and dairy. Although these carbohydrates are poorly absorbed in everyone, they are believed to affect and cause symptoms in people with IBS because their guts are more sensitive.
It is important to remember that FODMAPs are not the cause of IBS, however limiting these in the diet can help you control your IBS symptoms.
What is the FODMAP Diet?
The FODMAP diet is a therapeutic diet used as part of the medical treatment and management for those with IBS.
The major goal of the FODMAP diet is to find a balance between good symptom control and to expand your diet to include as much variety as possible.
It is important to note that it has 3 phases and that the entire FODMAP process should be completed to avoid restricting your diet unnecessarily.
Phase 1 – Low FODMAP or Elimination (we will be focusing on this phase in this blog post)
Phase 2 - Reintroduction or Challenge
Phase 3 – FODMAP Personalisation
This will take around four months to complete and research shows, that when followed with the support of a specialised IBS and FODMAP Dietitian, it can help improve gut symptoms in up to 80% of people.
Phase 1 – Low FODMAP or Elimination
This usually occurs over 2-6 weeks. During this phase of the diet you will need to limit any high FODMAP foods and substitute these with low FODMAP alternatives. Restricting high FODMAP foods enables us to determine if you are responding to the low FODMAP diet and whether it is resulting in a decrease in your IBS symptoms.
The low FODMAP diet can be restrictive, and people often struggle with the amount of variety and adding flavour in their diet. FODMAPs also contain fibre and are natural prebiotics, so those on a low FODMAP diet can struggle with meeting their fibre requirements which can lead to constipation.
So, a big consideration is the long-term consequences of a low FODMAP diet. And this is one of the main reasons why it is only recommended to be followed for the short period of only 2-6 weeks.
Simple Steps To Help You Start The Low FODMAP Diet
I see so many people struggle with following the low FODMAP diet and they often feel confused and overwhelmed due to conflicting information and lack of support and guidance. This often lead to them following it incorrectly and feeling as though it has not worked for them or completely giving up on the diet without finding symptom relief.
I understand how confusing it can be so here are the simple steps you can take to start following the low FODMAP diet so you can feel confident.
1. Get the support of an expert IBS and FODMAP dietitian. Before starting any new diet, it is always a good idea to talk to an IBS dietitian who can help you determine whether the low FODMAP diet is appropriate for your needs. We can also give you step by step guidance to ensure you follow the diet correctly while enjoying the foods you love.
2. Swap regular wheat bread for low FODMAP options. These include spelt, sourdough or gluten free. An important thing to keep in mind is that you don’t have to go gluten free to manage your IBS unless you have been diagnosed with coeliac disease. In fact, many gluten free foods contain high in FODMAPs ingredients, which can cause symptoms.
3. Swap your dairy foods to low lactose and low FODMAP options. These include lactose free milk, Greek yoghurt, soy milk made from soy protein and hard cheeses. Similar to gluten, going dairy free is not necessary to manage IBS, unless you have a diagnosed dairy allergy. There are still loads of low FODMAP options you can enjoy!
4. The low FODMAP diet does not have to be bland or boring! Add flavour to your meals by:
Using spices or herbs like basil, chili, cumin, ginger, pepper, rosemary or thyme on meat, fish, chicken, or vegetables.
Use maple syrup instead of honey to sweeten baked goods or cereal.
Swap onion and garlic for garlic or onion infused olive oil, the green parts of leek or spring onions or chives.
5. Swap high FODMAP fruit and vegetables for low FODMAP options.
Low FODMAP fruits include strawberries, grapes, cantaloupe, kiwi fruit and unripe bananas.
Low FODMAP vegetables include carrot, tomato, cucumber, broccoli, green capsicum and green beans.
6. Foods containing protein and fats are generally low FODMAP. This includes margarine and butter, oils, meat, chicken, fish, tuna and eggs.
7. Drink water, regular or decaffeinated coffee or black tea instead of herbal teas and fruit drinks or juices.
8. Don’t forget about lifestyle habits! This is one of the most common reasons I see people being unsuccessful on the FODMAP diet. You might think it is actually the low FODMAP diet that is not working, rather than your lifestyle habits causing symptoms. These including eating habits, movement, sleep hygiene, stress management and self-care.
Remember, the low FODMAP diet can be challenging and is not suitable for everyone with IBS. It is important to work with an Accredited Practising Dietitian who is trained in IBS and the FODMAP to ensure that you are meeting your nutritional needs while on the diet and who is able to provide you with alternative strategies if the diet is not a good fit for you.
If you’re FINALLY ready to ditch the diet confusion and find relief from your IBS, CLICK HERE to watch my FREE Masterclass to discover my proven 3 phase roadmap and the surprisingly simple steps you can take to start reclaiming your life from IBS in as little as 2 weeks.
References
Gibson PR, Shepherd SJ (2010). Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. Journal of Gastroenterology and Hepatology. 25: 252–258.
Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC (2006). Functional bowel disorders. Gastroenterology. 130: 1480–1491.
National Institute for Health and Care Excellence (NICE) (2008). Irritable bowel syndrome in adults: Diagnosis and management of irritable bowel syndrome in primary care. CG61.
Tuck C & Barrett, J (2017). Re-challenging FODMAPs: the low FODMAP diet phase two. Journal of Gastroenterology and Hepatology. 32 (Suppl 1): 11–15.