Up to 10% of the population worldwide has irritable bowel syndrome (IBS), a gastrointestinal condition that causes recurrent attacks of abdominal pain or discomfort, typically associated with life-disrupting bowel habits.
The great news is that up to 75% of IBS sufferers can experience symptom relief with the low FODMAP diet, according to Monash University, the developers of the diet.
But what is the low FODMAP diet? And how can we best follow it? Read on to find out more.
A Little Bit More on IBS
Those of us with IBS are experiencing extreme bloating and gas pain (elastic waist pants only, please), diarrhea (you know the location of every bathroom), and constipation.
If you have “won” the IBS lottery, you might have all these symptoms and more. Sufferers’ lives get upended, and they are told there is no cure.
Resist the urge to self-diagnose – a medical doctor should always diagnose IBS, preferably a gastroenterologist (GI).
Many medical conditions – some life-threatening – have the same symptoms, and it takes careful screening to determine an IBS diagnosis. Statistically, it often takes years for people to get a proper IBS diagnosis; don’t let that be you!
While there is no known cure, and scientists also do not know why we develop IBS, there is a bright, shining light at the end of this gloomy-sounding tunnel. The low FODMAP diet can eliminate symptoms in up to 75% of those with IBS and can change your life.
What Are FODMAPs?
FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. The acronym was coined by Monash University researchers who developed the low FODMAP diet.
FODMAPs are a group of short-chain carbohydrates that are indigestible or poorly absorbed by certain people. As FODMAPs travel through the gastrointestinal tract, they draw excess fluid into the small intestine and generate gas when they are fermented by bacteria in the large intestine (colon).
This fluid and gas build-up can lead to the symptoms of IBS, such as abdominal bloating and distension, pain, flatulence, and nausea, as well as diarrhea (IBS-D), constipation (IBS-C) or both (IBS-M; mixed).
What Is The Low FODMAP Diet?
The low FODMAP diet has three phases, during which you minimize FODMAPs in your diet; this can provide IBS symptom relief – often dramatically. The diet will help you identify which foods and FODMAPs you tolerate and which trigger your IBS symptoms. The goal is to eat as broadly and nutritionally balanced as possible without triggering symptoms.
It is an evidence-based diet; this is not a fad diet to try on. It is meant for particular patients, and your doctor will suggest it if applicable. Don’t try this at home – ony try the diet on your own without a medical recommendation.
Registered Dietitians to The Rescue
The diet should be overseen by a Registered Dietitian (RD), preferably one who is specifically FODMAP trained. Herein lies the problem though: GIs will not always recommend an RD. This is the single largest gap we see in the patient’s diagnostic path and this failure to recommend the right specialist leaves patients with recurring symptoms.
That said, we often hear that people cannot find a dietitian and/or that they are too expensive. It is true that dietitians are often not covered by insurance (especially in the US), but we see time and again that folks waste money on supplements and foods that end up being wrong for them – and can even make things worse. Plus, you will waste time and remain in pain longer. In addition, RD visits do not have to be long-term. Even 2 or 3 appointments can make a huge difference.
Many RDs now work remotely, so finding a FODMAP-trained dietitian is easier than ever. If you take away five words from this article, it is these: Work with a Registered Dietitian. Your wallet and gut will thank you.
The 3 Phases of The Low FODMAP Diet
The First Phase: Elimination
The first phase, the Elimination Phase, is the most restrictive and is meant to be followed for an average of 4 weeks. If you have heard that the diet is not meant to be followed long-term, those folks are referring to this phase and not accurately describing the diet overall. (The third phase is long-term, as you will see).
During the Elimination Phase, you are significantly reducing FODMAP-containing foods. For the 75% of us who are FODMAP sensitive, this provides huge relief, often within a couple of days. Your system will calm down, and you might feel better than you have in years (cue the angels singing).
The Second Phase: Challenge
The second phase, the Challenge Phase (sometimes called Reintroduction), will last an average of 8 to 12 weeks. You will “challenge” yourself with FODMAP-containing foods, one FODMAP at a time and one food at a time. By the end of the Challenge Phase, you will clearly see what your GI tract tolerates – and what it doesn’t!
This FODMAP roadmap will be specific to you – and is often portion related. You might find out that you can tolerate spaghetti sauce made with garlic, but that recipe for chicken with 40 garlic cloves pushes you over the edge.
Because we will each have a unique relationship with FODMAPs, it is important not to use social media to guide you. “Jane” might have no problem with mangoes, but that bears no relation to what you might experience. Similarly, just because some influencer dubs celery as the devil incarnate does not mean you will have an adverse reaction.
Please note that when you initially challenge yourself with foods and note your reactions, these will not hold across your lifetime. If you do not tolerate apples at first, don’t panic. Your gastrointestinal tract is not static, and neither are your reactions. Six months down the line or so, you can re-introduce a food, and you might have a very different digestive reaction. It is not unusual for folks to be able to tolerate foods later that they could not initially.
The Challenge Phase can be difficult to manage on your own, so work with a FODMAP-trained dietitian. Statistically, you will have a much greater chance of success if you do.
The diet – especially the Elimination and Challenge Phases – will only work if it is conducted in a very structured manner. A medical professional guiding you is immensely helpful for better and quicker results and emotional support. Stress can affect IBS symptoms.
The Third Phase: Integration
The third phase, the Integration Phase (sometimes called Personalization), is when you will take the data you have gathered from the first two phases and integrate that knowledge into your life and eating habits. The timeline for this phase is theoretically for life (i.e., long-term).
The reason why we say theoretically is because it will change. As mentioned before, the goal of the diet is to get you to a place where you can eat as many foods as possible without triggering symptoms. This is both for your positive relationship with food and for what is healthiest for your gut microbiome. It means re-challenging yourself with food. Keep adding foods back into your diet as you come to tolerate them. It is possible to thrive on the low FODMAP diet, not just get by, and I promise you that you can eat very well.
How Do You Know Which Foods Contain FODMAPs?
The million-dollar question! The bad news is that you cannot look at a food and know whether it contains FODMAPs. Even reading labels of prepared foods can be tricky (that’s another article unto itself).
The good news is that there is an easy way to assess FODMAPs. There are two smartphone apps that every single person following the low FODMAP needs: The Monash University smartphone app and the FODMAP Friendly smartphone app. Period. No excuses.
Monash University and FODMAP Friendly are the only two institutions doing original research, lab testing foods, and publicly publishing the results. They are the primary resources.
Unfortunately, there is a plethora of information online (and elsewhere) that claims to present low FODMAP foods and recipes, but they are not accurate.
Upon IBS diagnosis, doctors often hand out a piece of paper with lists of high and low FODMAP foods, and the patient is told to “go follow the diet.” This is not enough information to follow the diet successfully. The lists are woefully incomplete and, at worst, incorrect.
The diet is evolving, and new findings are reported by Monash University and FODMAP Friendly several times a year. If you have the apps, they are updated.
You must vet your sources when it comes to the low FODMAP diet. At FODMAP Everyday® we have a team of Monash University-trained dietitians who write our evidence-based articles. Our brand is FODMAP Friendly accredited, and our head recipe developer is also Monash University trained and FODMAP Friendly accredited as a FODMAP educator.
The low FODMAP diet can eliminate IBS symptoms in up to 75% of those of us suffering from this debilitating disorder.
The first step is to get a diagnosis from a medical doctor. Gastroenterologists are more up-to-date on gastrointestinal issues and can often provide a more accurate diagnosis than a general practitioner. Do not self-diagnose.
The low FODMAP diet is a medically directed diet and should be undertaken only if recommended by a medical doctor. Do not decide to try the diet yourself without this recommendation.
You will have a far greater chance of success with the low FODMAP diet if you implement it along with a FODMAP-trained Registered Dietitian. Do not underestimate this fact. You will ultimately save time and money – and get to a pain-free place faster – if you work with an RD.
The low FODMAP diet was created by Monash University and FODMAP Friendly researchers, who are the diet’s primary resources. Their smartphone apps should be the very first tools that you access.
Unfortunately, misinformation is abundant online about the low FODMAP diet. Vet your sources and stick with Monash University, FODMAP Friendly, and accredited resources like FODMAP Everyday®.
And lastly, know that you can get better! You are not alone. You do not have to live with your IBS symptoms and suffer in silence. There is clinically proven research and systems, like the low FODMAP diet, that can help you enjoy food and your life and improve your gut microbiome at the same time. The low FODMAP diet could be key in this endeavor, and FODMAP Everyday® is here to help you every step of the way.
This article originally appeared on Wealth of Geeks.
Dédé is the Co-Founder of FODMAP Everyday®, a website that teaches millions of IBS sufferers worldwide to thrive on the clinically proven low FODMAP diet. Dédé lives with IBS herself, has been a professional recipe developer for over 30 years, has written 17+ cookbooks, hosted two PBS cooking shows, and was an editor at Bon Appetit magazine. She lives in Massachusetts with her husband and mini bull terrier, Nora.