10 THINGS TO KNOW ABOUT THE LOW FODMAP DIET
There is yet another diet being discussed in the press these days. But this time, it’s not a trend that everyone can easily jump on.
This one concerns people who suffer from irritable bowel syndrome, a disorder that causes disturbances in the function of the gut and affects about 10 to 20% of adults but is twice as frequent in women.
IBS symptoms vary from one person to the next but they can include constipation, diarrhoea, changes in bowel habits, flatulence, abdominal pain and bloating.
Developed over a decade ago at Monash University in Australia by dietitian Dr. Sue Shepherd and gastroenterologist Dr. Peter Gibson, the low FODMAP diet is becoming increasingly recognised as an effective way to manage symptoms of irritable bowel syndrome.
But the diet – now well-accepted and practiced Down Under – “is still a relatively new concept in the UK,” according to the Faculty of Life Sciences and Medicine at King’s College London, and only beginning to catch on in the United States and Canada.
A low FODMAP diet is a one that is low in FODMAPs, meaning that it reduces and eases IBS symptoms.
The diet is not a way to improve general health. If you don’t have symptoms that need to be alleviated, there is no reason to follow it. You can enjoy your FODMAPs!
1. What are FODMAPs?
This is the first thing you need to understand.
FODMAP is an acronym for a group of molecules: fermentable, oligosaccharides, disaccharides, monosaccacharides and polyols.
In simple terms, it is a group of natural sugars (carbohydrates) found in everyday foods, which are poorly absorbed and essentially not broken down in the small intestine. As a result, they pass through the digestive tract to the large colon, where they draw water and are fermented by gut bacteria – in turn producing gas, bloating and abdominal distress.
There is an exhaustive list of foods that are high in FODMAPs but the five categories are: fructose (certain fruits), lactose (milk products), fructans (certain vegetables, garlic, onion, wheat, rye), galactans (grains – lentils, beans, chickpeas) and polyols (stone fruits, sweeteners – sorbitol, xylitol).
Therefore, the low FODMAP diet works by eating foods that are low in FODMAPs as it will keep IBS symptoms under control.
2. Can you follow the low FODMAP diet on your own without seeking expert advice?
The answer is no. This diet requires know-how.
The Faculty of Life Sciences & Medicine at King’s College London, says it is “important to seek good quality advice about how to follow the diet” given it has “quite a complex approach.”
It is therefore recommended that you should seek the help of a registered dietitian via your GP or gastroenterologist, and ideally select one who is trained in the low FODMAP approach who will help you to follow the diet carefully.
Because it’s “not as simple as following a list of ‘foods to eat’ and ‘foods not to eat’.”
a) You need to read labels carefully as high FODMAP ingredients are often found in processed foods.
b) There is a lot of information on the web that might not be up to date and create confusion.
c) If you don’t consult a registered dietitian, you might exclude certain foods and miss nutrients that are essential for a healthy and balanced diet.
d) You need to follow the low FODMAP diet properly for it to be effective.
3. Is it for everyone with IBS?
The answer is yes.
That’s according to Helen Stracey, a registered dietitian trained in the low FODMAP approach who heads a team of 20 dietitians at Chelsea and Westminster Hospital in London.
“As evidence is strong to show that a low FODMAP diet for IBS leads to significant reduction in GI symptoms then a low FODMAP approach is recommended for all with IBS,” she said.
4. How effective is it and do results vary from one person to the other?
“Overall evidence has shown the dietary low FODMAP approach has shown to improve symptoms in 75% of the patients, or rather 75% of patients have been satisfied with the results of the diet,” explained the registered dietitian with over 25 years of experience.
“Those with fructose malabsorption are most likely to benefit. Furthermore, the dietary advice being delivered by trained dietitians is essential for success. I see many successes with patients who can’t believe the relief of their symptoms is just down to changing their diet.”
“IBS covers a complexity of symptoms,” she said and “is not straightforward… but overall diet is an essential component of treatment, and yes results do vary from person to person.”
5. Does everyone follow the same eating plan or does it vary by individual?
The answer is no. There is no one size-fits-all approach to this diet.
“The principles are the same but from the start everyone may exclude different categories of the fermentable carbohydrates so the diet does vary with each individual,” she explained.
6. How long should people go on the low FODMAP diet?
The low FODMAP diet works by eliminating all FODMAP foods for a specific amount of time.
“Eight weeks is what we recommend,” said Stracey.
Then individual foods are slowly re-introduced one by one into the person’s diet to determine which ones are well tolerated.
“After trailing the diet and with reintroduction of foods the patient may not need to exclude all low FODMAP foods,” she continued.
7. IBS is so complex. Can this low FODMAP diet be the magic bullet for IBS sufferers and ensure long-term relief in patients?
“I know that a lot of patients that I have seen have felt it is the magic bullet and can’t believe how much it has transformed their lives. Once they understand their diet then the results are long term, often if they sway from their diet, symptoms come back so relief from IBS is sustainable with long term diet,” stated Stracey.
8. Stress is often seen as the main trigger for IBS. Is it the right approach to look at diet first and foremost when external/psychological factors play such a big factor in IBS?
“Stress is always a big consideration for IBS and patients who know they lead a stressful life are encouraged to address and consider relaxation therapies. It is always a good sign for those leading a stressful life to get them to reflect on their symptoms while on holiday or times when their symptoms are improved.
“It’s difficult to answer the question: ‘Is it the right approach to look at diet first.’ Often diet is looked at in combination with psychological factors. Or certainly at the diet assessment, there is a lifestyle assessment as well and stress will be considered in line with diet if it is particularly high.
It really needs a thorough initial assessment before the main plan is agreed which may point to reducing stress, diet, (full or partial FODMAPS) or a combination,” she said.
9. The press is associating the low FODMAP diet with non-celiac gluten sensitivity. Can this diet be effective in this case?
“I don’t think I can truly answer with confidence as it’s an area where more research is emerging and we should wait to see what conclusions that brings,” replied Stracey.
“It is emerging that low FODMAP diets have shown positive impact on some with non-coeliac sensitivity, however more robust research is required in this area.”
10. Is more research needed on the low FODMAP diet?
“As with all nutrition evidence the research is evolving. We don’t know all the answers and there is further research currently ongoing in many areas of FODMAPs. One area of interest with little but evolving research is using it within children,” she concluded.
By Chantal Ouimet – Honestly Healthy online editor.