What are FODMAPS and what is the low FODMAP diet?
FODMAPS are a group of short-chain carbohydrates (fibres and sugars) that are not absorbed properly in the gut. The acronym stands for fermentable, oligosaccharides, disaccharides, monosaccharides, and polyols. The low FODMAP diet was developed by researchers at Monash University, and it limits foods that have been shown to aggravate the gut and cause Irritable Bowel Syndrome (IBS) symptoms like intestinal bloating, gas and pain.
Irritable Bowel Syndrome (IBS) is a functional gut disorder, and symptoms include stomach pain, cramping, bloating, diarrhea and/or constipation. To diagnose this condition, typically your doctor will review your symptoms and compare them to a standardized set of diagnostic criteria. In addition to this, they may conduct additional tests to rule out other possible conditions. Some of these tests could include a hydrogen breath test, colonoscopy, biopsy, stool tests, and lab tests.
75% of people who live with IBS will experience relief from their symptoms once they do the low fodmap diet for 2-6 weeks to identify their food triggers. A challenge with the low fodmap diet is that it is difficult to do without the guidance and support from a trained clinician. As a result, the low fodmap diet can lead to stress, confusion, and puts a person at risk for becoming deficient in certain nutrients. Working with a registered dietitian helps to overcome these challenges.
Here are five common misconceptions I see in my practice with clients who have tried the low fodmap diet on their own, and why working with a dietitian to better manage your IBS symptoms may be more beneficial.
MYTH 1: You have to follow a strict diet long-term.
Oftentimes clients anticipate that the low fodmap diet is something they need to stick with for life; this is far from the truth! The low fodmap diet is an elimination diet that is implemented for a period of 2-6 weeks. Once this 2-6 week phase is complete, an individual will then begin the rechallenge phase to identify which fodmap containing groups are triggers for them. During the rechallenge phase, one fodmap group is introduced at a time using specific portions recommendations made by the RD. A dietitian will work with that person to create a plan to implement the rechallenge phase.
MYTH 2: It is the same as going gluten and dairy-free.
Clients will often say they have started the low fodmap diet on their own by eliminating dairy and gluten. They will then come to me frustrated because they are still experiencing bloating and cramping. While it is true that some dairy and gluten-containing foods are high fodmap, it is not specifically gluten and dairy in isolation that we are looking at. With dairy-containing foods, it is actually a sugar called lactose that is high fodmap, and this is what we want to limit our intake of during the elimination phase. In fact, a low FODMAP diet doesn’t have to be dairy-free; lactose-free dairy is low FODMAP.
When it comes to gluten-containing foods that are high fodmap, we are looking at wheat and barley. These food sources are high in fermentable carbohydrates called fructans, which may be a trigger for some people living with IBS.
MYTH 3: Since probiotics are good for digestive health, taking any high-quality probiotic will help with IBS.
It is possible that probiotics and/or certain supplements could help in managing your IBS symptoms- but not just any kind!
Supplements such as probiotic or digestive enzymes are often a part of a person’s IBS management plan, however, choosing the right one that is going to help achieve your desired health effect is critical. For example, a probiotic is not usually used interchangeably for different health ailments. The type of probiotic that you would use for diarrhea will likely differ from the type you would use for constipation, and this is because the type of strain is going to have different health effects. Another scenario I often see with clients is that they take digestive enzymes to better manage their IBS symptoms. I wouldn’t typically recommend a digestive enzyme until after we have isolated what fodmap groups are causing triggers for the person- because the type of enzyme that I am going to recommend is going to depend on the type of fermentable carbohydrate that is a trigger for them. A dietitian can help to guide you in choosing the right probiotic, digestive enzyme, and/or other supplement(s), IF this is an appropriate tool for you to incorporate into your IBS management plan.
MYTH 4: As long as you cut out high FODMAP foods, it doesn’t matter what you eat.
The low fodmap diet can be very restrictive and difficult to adhere to, plus we also have to address the overall healthfulness of one’s diet as well. Eliminating IBS symptoms while causing nutrient deficiencies or increasing the risk of other disease is not beneficial overall.
The low fodmap diet is great for the reason that it does not completely cut out any food groups during the elimination phase; however, a common challenge for people is ensuring they are consuming a diverse enough diet to meet their nutrition requirements. A dietitian will work with clients to personalize the low fodmap diet based on personal preference and develop a plan to ensure your diet is diverse enough so that you aren’t at an increased risk of nutrient deficiencies.
MYTH 5: You can never eat out if on a low FODMAP diet.
Eating out can be such a daunting task- especially during the elimination phase. As a result, it may feel as though there is never a good time to start the low fodmap diet because there are always social events where food is present. FODMAPS are sneaky and can be present in foods that you may have thought were safe. Your dietitian will help you to identify these foods and will provide you with support so you can still enjoy social gatherings while adhering to your low fodmap plan.
TIPS when eating out:
Try these pro tips when you are on a low FODMAP diet and eating out. Check the restaurant’s menu online ahead of time to see if there are options you can have. If there is something you want that needs to be modified, give the restaurant a call ahead of time. They will appreciate the heads up and will have the ability to accommodate your needs better.
Choose a restaurant that has a good range of gluten and dairy-free options. This will eliminate wheat, barley, and lactose, which are major fodmap sources. Here are some ideas for options you could have when eating out:
- Pizza places that allow you to build your own pizza with gluten-free crust (e.g. PICO in Toronto)
- Steak or chicken breast without the marinade, steamed carrots or green beans with fries (as long as they are not seasoned with onion and garlic). Make sure to pass on the ketchup as it is high fodmap
- Sushi without soy sauce, avocado, hoisin, or tempura
- Burger (as long as the patty is without onion and garlic) with lettuce, tomato, mayo, mustard, and cheddar cheese (low lactose cheese), on a gluten-free or lettuce bun
Having a happy and healthy gut plays such a vital role in our quality of life. When our digestive system is not working the way that it is supposed to, it can wreak havoc on our state of mental well-being and quality of life. It is possible to get to a place where you can confidently manage your IBS symptoms.
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NutriProCan’s IBS treatment protocol is designed to help eliminate or decrease GI symptoms, including gas, bloating, pain, diarrhea, constipation and stomach upset.
Monash University Low FODMAP diet guide (2018) Retrieved from https://www.monashfodmap.com/
Peery AF, Dellon ES, Lund J, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology 2012; 143:1179.
Böhn L, Störsrud S, Liljebo T, et al. Diet low in FODMAPs reduces symptoms of irritable bowel syndrome as well as traditional dietary advice: a randomized controlled trial. Gastroenterology 2015; 149:1399.
McKenzie YA, Alder A, Anderson W, et al. British Dietetic Association evidence-based guidelines for the dietary management of irritable bowel syndrome in adults. J Hum Nutr Diet 2012; 25:260.
Mearin F, Lacy BE, Chang L, et al. Bowel Disorders. Gastroenterology 2016.
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