The low FODMAP diet should NOT be the first thing you do for IBS
So you’ve been diagnosed with IBS, now what?
It is common for a diagnosis of irritable bowel syndrome (IBS) to be followed by a recommendation to try the low FODMAP diet. This recommendation is often made out of great intentions, because the low FODMAP has been shown to improve symptoms for around 70% of those with IBS, which is better than many medications on the market…
But here’s the catch:
These results are only shown under the care of a registered dietitian who is qualified and trained to guide you through this diet… AND there is risk that comes with this diet that could leave you in a worse place than you started.
That nice handout your doctor gave you may not include these warnings and tips to get the most of the diet if you do choose to use it… so the goal of this article is to break down when the low FODMAP diet is appropriate, how to get the most from it, and what to do BEFORE you start it.
What is the low FODMAP diet?
The low FODMAP diet is a three-phase diet protocol where FODMAPs (fermentable carbohydrates) are eliminated for 4-6 weeks, each FODMAP group is challenged to test tolerance, and then FODMAPs are built back into the diet based on challenge results.
FODMAPs are short-chained carbohydrates that are more gas-causing and have an osmotic action in the gut, pulling water in to contribute to diarrhea, bloating, and cramps.
For those without IBS, you may not notice the impact of these foods, but for those with IBS these symptoms that can intense and painful. This is why the diet can work for so many.
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When the low FODMAP diet is appropriate
It may sound like this diet would be the obvious choice for anyone with IBS since these foods can trigger symptoms, but the truth is that these won’t be triggers for everyone because IBS looks different for each person.
How to know this diet is a good recommendation:
If you notice you have symptoms related to foods you eat. It can help to start tracking symptom patterns and if you notice that you feel worse a few hours after meals, FODMAPs could be part of that picture.
If you don’t have a history of an eating disorder. Phase 1 of this diet is very restrictive and can trigger eating disorder relapse, so it’s not the best option for those with either an active or recovered eating disorder.
If you are being guided by a dietitian. More to come on this later, but know that this diet is more complex than a piece of paper or an app can fully prepare you for.
If you are eating enough and meeting your nutrition needs. More on this to come in what to do BEFORE.
If you have IBS-D, post infectious IBS, pain, or bloating. The diet has been shown to reduce symptoms for these symptoms more than others, including constipation. You can still use this diet for your IBS if you have constipation, but you’ll want to improve the constipation or have a plan ready for that before you begin as this may make your constipation worse.
How to get the most out of the low FODMAP diet
I know so far I have communicated more warning over the diet than excitement, so this is where that shifts.
The low FODMAP diet is highly effective for reducing symptoms and can be used with success to reduce flares and find confidence with meals again. For many, this diet will actually expand your diet because you’ll know what feels good in your body versus eliminating more and more due to fear.
If you are moving forward with the low FODMAP diet, here are a few tips to get the most from it:
Have a dietitian in your corner. I am repeating this because it’s so important to have a knowledgeable guide as you go through this approach. A dietitian can help determine if the diet will actually be helpful for you, meet your nutrition needs with modifications and swaps as you eliminate foods, and go through the challenge and personalization phases properly. Not all dietitians are trained in the low FODMAP diet and IBS, so be sure to vet that out before you start with someone.
Use reliable resources to help you through it. FODMAP measures in foods continue to change and be updated, so if you’re using an outdated handout or list online, you may find yourself confused and without the relief you’re hoping for. The most trusted sources online are the Monash University Low FODMAP Diet App and the FODMAP Friendly App.
Make swaps versus only eliminating foods. FODMAPs are found in many incredible foods, including fruits, vegetables, grains, nuts, and seeds! If you eliminate these foods that you’re already eating, you may find gaps in your diet. So instead you want to replace them with lower FODMAP alternatives that will meet your needs.
Don’t skip the challenge phase. It’s tempting to stay in the elimination phase of the diet if you’re feeling better. But this can leave you stuck in your diet options and leave gaps in your overall nutrition. You’ll also find that your confidence is low in elimination because you don’t know with certainty which FODMAPs are triggers. During the challenge phase, you’ll learn your personal triggers and your tolerance levels so you can expand your diet and still feel great.
What to do BEFORE starting the diet
This section is truly the reason for writing this entire article. The low FODMAP diet can be a great option, but it shouldn’t be the first thing you do.
Why?
There are more triggers than food.
There are more triggers in foods than FODMAPs
You’ll have better results if you find stability in your routines and diet first
You’ll have better challenge results if you’re using more tools than diet alone
You may not even need the diet, which will save you time and energy
I hear way too often that the low FODMAP diet either didn’t work or that someone got stuck in elimination for way too long, because they were recommended it too early in their IBS management journey.
Here are the things you’ll want to do BEFORE you start a low FODMAP diet:
Make sure you’re eating enough, balancing meals, and eating consistent meals versus being sporadic in your eating.
Improve sleep quantity and sleep quality.
Establish routines around toileting that help your body relax and tune into cues.
Improve hydration.
Reduce top irritants and stimulants (for diarrhea).
Establish a consistent movement practice that feels good in your body.
Build awareness around stress and build in habits that support nervous system regulation.
You may be thinking “but how do I actually do all of those things?”
….that would take a full book to go through, so it’s more than a blog will cover. The reason is that each thing I mentioned above will look different based on where you begin with your symptoms and current habits, and how your body is responding to the changes you are making.
You can work with a dietitian on this to personalize recommendations to your needs, which is what our team does if you’re looking. You can also consider the MASTER Method Membership for a lower cost, virtual option that will guide you through these steps and all phases of the low FODMAP diet, if it ends up being what you need.
Are you frustrated with your IBS symptoms? Do you desire to be confident in your food choices? Do you want to have a healthier relationship with your body and diet? Are you ready to take control of your IBS?
