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If you have ever experienced the symptoms of Irritable Bowel Syndrome, you have likely heard of the dietary protocol known as the low FODMAP diet. But what is a FODMAP? And how do you know if it is something worth considering? Here we discuss an overview, how it is used and what you need to know before getting started.
What is IBS?
Firstly some background into conditions of the gut. Irritable Bowel Syndrome affects between 7-15% of the world’s population and describes a spectrum of functional bowel symptoms such as pain, uncomfortable bloating, diarrhoea, constipation and painful flatulence(1).
There can be many attributing factors to the development of IBS which may include changes to the gut microbiome, psychological factors like stress and anxiety (gut-brain axis dysfunction), genetics and underlying issues relating to diet and lifestyle (i.e inadequate dietary fibre, lack of fluid intake, sedentary lifestyle).
How is it treated?
While symptoms of IBS can fluctuate from mild to very severe, it is important to speak to your healthcare professionals about how you can manage it day to day. Treatment options vary depending on your presentations and can range from natural remedies and psychological interventions like hypnotherapy, to those targeting what and how we eat.
For some people experiencing IBS, there may be small changes in their eating and drinking habits that can have a big impact on symptoms. These typically involve moderating your intake and type of fibre from foods, increasing fluid intake or cutting back on common irritants such as caffeine, alcohol or spicy foods. For other people, a more structured approach is warranted. This is when you may be prescribed a Low FODMAP Diet.
Enter the low FODMAP Diet.
The first thing to understand with any type of dietary protocol, is that it is best to seek the professional help of an Accredited Practicing Dietitian before commencing. A rise in popularity of the low FODMAP diet has bred misinformation about its uses and it is important to discuss this protocol with your healthcare team before making any changes.
The low FODMAP diet is what is known as an ‘elimination diet’ where certain foods known to trigger symptoms are removed from everyday eating for a length of time, before being gradually reintroduced(2). Foods that are eliminated on the low FODMAP diet are often healthy and nutritious and the low FODMAP diet is not intended to be followed for a long period of time.
When we work with clients using this protocol, we ensure it is not a one-size-fits-all approach. As with any lifestyle factor, nutrition and diet are highly individual as are your symptoms and underlying causes. We do not want the everyday task of eating to feel like a chore and hence any protocol should be entered with support and advice to get you back to food freedom as soon as possible.
What is a FODMAP?
So what does this funny little acronym actually mean? FODMAPs stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols – in short, very small types of carbohydrates! These carbohydrates are found in many foods from vegetables, to dairy, fruits, grains and even nuts. You may be wondering how such tiny things can be attributed to such painful symptoms. FODMAPs attract water into the gut, acting like tiny sponges. In the large intestine the trillions of little bacteria that make up a healthy microbiome work on FODMAPs, fermenting them and producing gas in the process(3). For individuals without any underlying gut disorders, this process happens with relatively minimal issues. For those experiencing IBS the malabsorption of FODMAPs can cause severe reactions leading to painful symptoms.
How does the Low FODMAP diet help?
The aim of the low FODMAP diet is to achieve a period without symptoms to give the bowel rest and to identify any foods that particularly trigger symptoms. Following a thorough assessment with your health care team such as your GP and a Dietitian, the low FODMAP diet protocol for IBS follows a three-stage process.
Firstly, a period where foods identified as being high in FODMAPs are swapped for low FODMAP alternatives. You may have come across the lengthy and complicated lists of high vs low FODMAP foods which can be overwhelming to read let alone live by. This is where the help of a Dietitian is essential to minimise the impact it has on your everyday life.
In stage 2 these previously eliminated foods are reintroduced back into your meals. This may sound like a simple process however this stage requires specific staging of introduction to ensure symptoms are not too severe and that any trigger foods are properly identified.
Finally, in stage 3, your dietitian will work with you to personalise your dietary recommendations based on the results from stage 2. This gives you the confidence to widely and freely enjoy foods knowing any triggers and how to manage them. We aim to provide you tailored advice to reduce, resolve and manage your IBS symptoms so you can focus on living your best life, pain-free (and without the worry of an IBS flare-up). Long term, a diet high in nutritional value with proper hydration and regular joyful movement can assist you in managing these symptoms and promote holistic health and well-being.
We are here to help!
While this process can sound daunting, appropriately trained Dietitians through the Monash University Low FODMAP program are experts in guiding you in this journey. Dietitians combine scientific literacy with counselling skills and expert knowledge in food and nutrition to help tailor to your individual experience and work towards feeling better.
Evidence suggests that when delivered under the guidance of a dietitian and followed appropriately, a low FODMAP dietary protocol can alleviate symptoms in many people experiencing IBS symptoms(2).
Are you struggling with IBS?
Download this free IBS Guide & Checklist to help you take back control and live a life free from bloating, abdominal pain, reflux, diarrhoea, or constipation.
References:
Hookway, C., Buckner, S., Crosland, P., & Longson, D. (2015). Irritable bowel syndrome in adults in primary care: summary of updated NICE guidance. Bmj, 350, h701. https://doi.org/10.1136/bmj.h701
Halmos, E. P., Power, V. A., Shepherd, S. J., Gibson, P. R., & Muir, J. G. (2014). A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology, 146(1), 67-75.e65. https://doi.org/10.1053/j.gastro.2013.09.046
Basnayake, C. (2018). Treatment of irritable bowel syndrome. Aust Prescr, 41(5), 145-149. https://doi.org/10.18773/austprescr.2018.044
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