Low Fodmap DietUnderstanding FODMAPS
Suffering from a Sensitive Gut?
Do you regularly experience abdominal pain or discomfort, bloating, excess wind, constipation and/or diarrhoea? You are not alone, Irritable Bowel Syndrome (IBS) is more common than you think. As many as 1 in 5 Australians develop IBS in their lifetime and it affects twice as many women as men.
IBS symptoms can be embarrassing and frustrating to live with. Many of my clients were putting up with gut symptoms for years before they came to see me. This is often the case for IBS sufferers but it does not have to pan out this way for you. The good news is there are many ways to manage these symptoms and gain control of your IBS so you can get your life back.
What Causes IBS?
The exact underlying causes of IBS is unknown, but we know that there are many factors involved. Some of the possible causes are:
• Food intolerances i.e. malabsorption of FODMAP sugars
• Low fibre diet
• Gastrointestinal infection
• Stress, depression or anxiety
• Medications such as antibiotics can change the gut microflora. Some medications may cause constipation or diarrhoea
What is the Low FODMAP Diet?
The low FODMAP diet was developed by researchers at Monash University in Melbourne, Australia. It involves reducing FODMAP intake through dietary changes. The low FODMAP diet is an evidence-based diet and research has demonstrated that it is one of the most effective ways of managing IBS. Up to 75% of IBS sufferers have reported clinically significant improvements in their symptoms by following the low FODMAP diet. Modifying FODMAP intake has also been shown to assist with symptom relief in those suffering from reflux, inflammatory bowel disease, coeliac disease, intestinal resections and small intestinal bacterial overgrowth (SIBO).
What are FODMAPs?
FODMAPS are a collection of short chain carbohydrates or sugar molecules found in many common foods we eat. FODMAP is an acronym which stands for Fermentable, Oligosaccharides, Disaccharides, Monosaccharides And Polyols.
How does FODMAPs Cause IBS Symptoms?
Stay with me as I take you through the digestion process… When we eat, food travels through our digestive system to the stomach and small intestines where they are broken down into simple substances. They are then absorbed and transported through the walls of the small intestines to the bloodstream and distributed to the rest of our body for use as energy.
For some individuals, the FODMAP carbohydrate molecules are poorly absorbed during this process, leading to undesirable gut symptoms. The poorly absorbed FODMAP molecules create an osmotic effect which pulls water into the small intestines, stretching the intestinal wall causing bloating, cramping, wind and diarrhoea. These FODMAP molecules then travel to the large intestine where it becomes food for the bacteria that resides in there. This process of fermentation by the gut bacteria can produce a copious amount of gas such as hydrogen, methane and carbon dioxide, resulting in further bloating, flatulence, cramping and altered bowel movements.
Is The Low FODMAP Diet Right For Me?
It is important that you consult with your doctor first if you suspect that you may have IBS. Some other gastrointestinal diseases or medical conditions such as bowel cancer, coeliac disease, inflammatory bowel disease or endometriosis cause symptoms that are similar to IBS. Your doctor may refer you to a gastroenterologist for further investigations before deciding if the low FODMAP diet is right for you.
What Foods contain FODMAPS?
FODMAPS are commonly found in many foods we eat. Below are a few examples of foods from each FODMAP category:
• Fructo-Oligosaccharies (FOS): Garlic, onion, leek, artichokes, wheat, rye, barley
• Galacto-Oligosaccharides (GOS): Baked Beans, kidney beans, lentils, chickpeas, legumes
Lactose: Milk, cheese, ice-cream, yoghurt, custard, cream
Excess Fructose: Apples, mangoes, pear, honey, watermelon, high fructose corn syrup
Polyols: Avocados, cherries, pears, nectarines, prunes, plums, mushrooms, cauliflower
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Diagnosed with IBS? What Happens Next?
Once your doctor have excluded all other conditions and makes the diagnosis of IBS, you may wish to go ahead and trial the low FODMAP Diet.
A low FODMAP diet can be confusing and may lead to a restrictive diet. If you are planning to undertake the low FODMAP diet, we recommend that you see an Accredited Practising Dietitian who is specialises in this area for specialist guidance. If you are intending on undertaking this diet on your own, ensure that you are referring to evidence-based information that is kept up-to-date so you can achieve the best results.
Children who requires a low FODMAP diet will highly benefit from the support of a Paediatric Dietitian who is experienced in this area. Children are actively growing and have different nutritional needs so it is important to ensure that their diet remains adequately balanced whilst undertaking any dietary exclusions.
Should the low FODMAP diet be undertaken correctly, it could be your ticket to life again. My clients often start to see an improvement in symptoms within a few days. Many can confidently say goodbye to those agonising symptoms and stop living the emotional rollercoaster of IBS.
Charlyn is a Specialist IBS & FODMAP Dietitian with experience working with chlidren and adults.
The Low FODMAP Diet
The low FODMAP diet consist of 3 phases.
Phase 1 – Elimination
The Elimination phase involves the restriction of high FODMAP foods for a short duration to calm your gut and reset it back to baseline. It is important to note that the low FODMAP diet is only recommended to be undertaken for a short duration, usually between 2 to 6 weeks. It should not go longer than 8 weeks and it is certainly not a diet for life. Research has shown that remaining on this phase long-term can affect your gut microbiome and increase the risk of nutritional deficiencies.
Your dietitian will help you to identify suitable alternatives on the low FODMAP diet and ensure that your diet remains nutritionally balanced during this phase. Once your symptoms have improved and you feel better, it is time to proceed on to the Reintroduction Phase.
Phase 2 – Reintroduction
Phase 2 is the Challenge Phase or Reintroduction Phase. It involves a systematic approach to reintroducing high FODMAP foods gradually in specific quantities to test your tolerance threshold. This stage is a learning phase where you will be discovering more about your body and figuring out what you can and cannot tolerate, and how much you can comfortably consume without any triggering a major reaction.
The average length of the Reintroduction Phase is normally 8-12 weeks but it depends on the individual. You are in control of this phase so you can proceed through the challenges at your own pace. You may experience setbacks from time to time or may like to take a break from the challenges if you are travelling. The goal is to accurately work out your threshold for each FODMAP group so we can move on to Phase 3, the Customisation Phase.
Phase 2 is an important but often neglected step. FODmappers often slip into a comfort zone after achieving symptom relief on the first phase as they are anxious about the symptoms returning again. This is completely understandable! If this is you, we encourage you to think about the long-term benefits of identifying your triggers. More to come about this in the next section…
Phase 3 – Customisation
Once you have undertaken the challenges during Phase 2, you will gain more clarity into your trigger foods and individual thresholds for each FODMAP group. Your Dietitian will help you to work out which groups can be safely consumed without causing reactions and customise a diet that suits your lifestyle. It is important to note that the threshold for FODMAP tolerance will vary between individuals.
The final step involves introducing non-trigger foods back into your diet gradually. By reintroducing well-tolerated FODMAP foods, you will be able to enjoy a wider variety of food to keep your gut microbes happy and maintain a nutritionally balanced diet for general health benefits. By progressing through the different phases, you will be able to gain more control and be able to live a full life that is no longer bound by IBS symptoms.
• The low FODMAP diet is a highly effective treatment for the management of Irritable Bowel Syndrome.
• The Elimination Phase is only to be undertaken for 4 to 6 weeks. It is not the intended diet for life.
• While the initial phases may seem challenging, it does get easier with time. We promise!
• Once the Reintroduction Phase is complete, you will understand your personal threshold for each FODMAP group. We will help you to interpret the results of the challenges and provide guidance on introducing variety back into your diet whilst maintaining adequate symptom control.
Charlyn is Perth’s Leading FODMAP & IBS Nutrition Expert. She is an Accredited Practising Dietitian and Monash Certified FODMAP Dietitian with a mission to offer an empowering solution for a common but yet silent problem. She will hold your hand through every step of the process.
from the heart
“The freedom that comes with the knowledge of controlling your IBS is liberating. I want that for you”
Charlyn Ooi, Founder