FODMAP Dietitian

How does a low FODMAP diet work?

Most of the research on FODMAPs has actually been done in Australia by Monash University. They have developed a standardised FODMAPs dietary protocol which has been tested and trialled. This forms the diet that we use as Monash University FODMAPs accredited and trained specialists. The diet involves extensive elimination of FODMAPs, and reintroduction under supervision with a FODMAP dietitian. The diet forms three stages:

1. Elimination phase. Removing all FODMAP foods for 2 -4 weeks
2. Challenge phase. Single reintroduction of FODMAP foods
3. Reintroduction phase. Reintroducing previously challenged foods that passed.

The aim of the FODMAP diet is to determine which specific foods are triggering symptoms, rather than eliminating FODMAPs altogether if possible.

Why do FODMAPs cause IBS?

Not all people experience bowel issues from FODMAPs, but for some, they can trigger IBS. When FODMAPs reach the large intestine, your gut bacteria (microbiota) use them as fuel to ferment. The fermentation process produces gas. This happens for everyone, usually without any issue. However, in some people, the volume of water and/or type of gas can cause problems. There are a few reasons pain and discomfort such as distension, wind and bowel changes might occur:

• An extremely sensitive gut wall;
• Food moving slower than normal through the intestines, attracting more water and gas;
• A different makeup of bacteria in the colon, which produces a different gas (hydrogen) rather than the usual methane gas;
• A general gut microbiome imbalance where bad bacteria outweighs the good

Uncomfortable, painful and embarrassing symptoms can appear within 4 hours of eating. As a FODMAP dietitian, experience shows the symptoms are most often unrelated to the type of food eaten in the most recent meal, and more related to a meal eaten 1-2 days earlier. This can make it quite challenging to understand just what is triggering your IBS on your own.

Can anyone follow a low-FODMAPs diet?

A low-FODMAPs diet should not be followed long-term, and we recommend you only undergo elimination and challenge with dietary supervision. Our recommendation for a low-FODMAPs elimination diet is a maximum of four weeks.

Sadly, we’ve met people over the years who have started the diet (usually without an experienced FODMAP dietitian) and found they reacted to a high number of FODMAPs foods. While removing the foods may have relieved some symptoms, it can often see people stuck on the elimination-style phase for years. The problem is, a very restrictive diet removes so many foods, we can end up deficient in key nutrients. The deficiency can even make symptoms (and sensitivity) worse. Suddenly, you’re reacting to more and more things at the drop of a hat, and life looks and feels, far from normal.

A low-FODMAPs diet is an effective and evidence-based tool for uncovering true food intolerance. However, it is only intended to be used as a tool. It is important that we don’t see this diet as a permanent solution to irritable bowel or other gut issues.

If eliminating FODMAPs has seen symptoms improve, you may be hesitant to “rock the boat” with the challenge phase. If that’s you and you’re stuck halfway through the process, we encourage you to get the professional support you need to progress.

Is it really FODMAPs causing your IBS?

While FODMAPs are often presented as the first port of call when it comes to finding the cause of irritable bowel syndrome, we don’t believe this should be the case. This can even be passed on by well-meaning professionals. Our experience shows that hidden behind a sensitivity to foods, can often be an unhealthy gut microbiome, or other gut-related conditions. These issues can often make FODMAP sensitivity worse.

We like to think of our health a little bit like a garden, and our gut microbiome is the soil. If our soil is rich in key nutrients, then good bacteria outweigh the bad. This good soil produces plants that thrive and are resistant to pests and disease. If our soil has been depleted, then it won’t contain those key bacteria. Anything we plant does not thrive. And what’s more, the plants can be less hardy, and more prone to disease. Our microbiome is much like this. If the bad bacteria outweighs the good, we fail to thrive too.

Just as removing any visible bugs on the plant will help it in the short term, removing FODMAPs can ease symptoms. But if it’s the soil (microbiome) that needs fixing, that’s always the best way to ensure long term health.

So maybe FODMAPs isn’t your first option for IBS. That’s why it’s a great idea to speak to us before you start any low-FODMAP diet. The Tree of Life Nutrition gut protocol may be the more appropriate first step in understanding the underlying causes of your IBS.