Weight Management Series

In this installment of our Weight Management series and the Low FODMAP Diet Series, my intent is to provide nutrition recommendations to help one achieve a healthy weight.

It is not uncommon to experience mild weight loss during the Low FODMAP Elimination Phase often due to smaller portions and food restrictions, which for some may be desired.

For those struggling to maintain a healthy weight or who want to gain weight, please refer to my article, How to Gain Weight on The Low FODMAP Diet article as a helpful resource.

If you are trying to achieve a lower healthier weight please refer to the article below, How to Lose Weight on the Low FODMAP Diet. It is encouraged to wait until completion of the low FODMAP Eliminate and Challenge Phase before pursing weight reduction for reasons stated below.

How to Lose Weight on the Low FODMAP Diet

The low FODMAP diet is not considered a weight reduction diet, however some experience weight fluctuations as a result of restricting or expanding their food choices. Most dietitians agree that one should not pursue active weight loss during the Low FODMAP Elimination Phase and Challenge Phase.

Why? Both of these diets require attention to detail and prioritization given to new dietary patterns and food choices. Trying to tackle both simultaneously can be very challenging and possibly decreasing your success rate with both goals.

If you have a dual objective of controlling your IBS symptoms and weight loss it is highly recommended to complete the low FODMAP elimination and challenge phase FIRST.

A Dietitian Can Help

Over the past two decades I have worked with thousands of clients seeking weight loss via diet and exercise, weight loss medications, and bariatric surgery. In the past four years my focus has grown to include a specialization in the FODMAP diet and IBS.

As many of us know weight loss and weight maintenance is hard, really hard. Nutrition science continues to evolve in both of these fields and a FODMAP trained RD can help devise a personalized approach and help you along this journey for optimal response.

Despite the dozens of diets available and new weight loss medications obesity remains an epidemic. Even drastic approaches such as bariatric surgery are not fool proof, weight regain happens. The pendulum continues to shift with the various weight loss approaches.

Twenty years ago it was the low fat craze and now the complete opposite Ketogenic diet (a diet very high in dietary fat) is popular – I recommend neither.

Weight loss recommendations vary greatly and unfortunately personal bias sets the tone for many. Dietitians teach evidence based nutrition which often involves making lifestyle changes that are realistic and attainable. The truth of the matter is that fad diets for weight reduction rarely equal long-term weight loss success.

The low FODMAP diet is by no means a fad diet, but rather a science based approach of reducing gastrointestinal symptoms associated with IBS. To find a dietitian near you check out our Registered Dietitian Directory.

So What Can You Do?

Here are some tips that may help you achieve weight loss once you have completed the low FODMAP Elimination and Challenge phases.

Watch Your Portions

Portion control is essential on the low FODMAP diet since larger portions can exceed safe thresholds making a low FODMAP food high FODMAP. Minimizing intake of processed carbohydrates can help trim your waist line since these often lack fiber and contain excessive sugar making it easier to overindulge.

Many of the foods in the low FODMAP Monash app are listed in grams or ounces therefore a digital food scale or even measuring cups and spoons can help bring awareness to appropriate and safe serving sizes.

Eat at Regular Times

Aim for three meals and 1 to 2 snacks during the day while eliminating or greatly reducing late night snacking. Skipping meals and eating large portions can trigger IBS symptoms and contribute to weight gain. Going long periods of time without food can negatively affect the metabolic rate, and in addition set us up to overeat and make poor food choices – low FODMAP or not.

Eating the majority of one’s calorie in the evening and under eating during the day is an all too common eating pattern in those struggling with their weight.

Skipping breakfast and fueling yourself on caffeine all morning is counterproductive in managing both IBS and weight loss. Try to evenly distribute your calories throughout during the day. Big dinners and late night snacking are a recipe for weight gain and unhappy tummies. Bring awareness to why you snack – is this related to is hunger or habit? 1

Stay Hydrated

Drink 64 to 80 ounces of water each day. Adequate hydration can aid in weight loss and improve digestive health. Inadequate fluid and fiber can make IBS-C symptoms worse. Try to have a measurable goal to ensure you are reaching 64 to 80 ounces (2 L to 2.4 L) each day.

For example, I fill up my 32-ounce (960 ml) hydro flask two times every day plus drink additional fluids with meals.

Sleep 7 to 8 Hours a Night

Chronic sleep deprivation contributes to a slower metabolic rate, preference for larger portions, impulsive food behaviors, an increase in the hunger hormone that stimulates appetite and a decrease in the hormone that helps one feel full.

Sleep deprivation can strengthen your cravings for unhealthy snacks and consume extra calories, often greater than 250 calories.

Poor sleep also appears to worsen next day IBS symptoms and those reporting poor sleep quality have higher incidences of IBS. 2 There is also strong evidence of increased sleep disorders among those individuals with IBS versus healthy individuals, which may be a contributing factor in the development of IBS. 3

Eat More Plants

Try to eat the rainbow and add color to your plate. Make an effort to include low FODMAP fruits and vegetables in safe portions with every meal.

Often times fiber intake dips on the low FODMAP elimination diet, work hard on including plant based fibers such as low FODMAP fruits and vegetables, strained and canned chickpeas and lentils, oats, brown rice, quinoa, sweet potatoes, and winter squash (all in low FODMAP amounts, of course).

Fiber helps one stay fuller longer and keeps constipation in check. The low FODMAP diet often limits intake of prebiotic fibers, which play an important role in gut health, consuming safe portion of many of the plant based fibers can help minimize this negative impact. For a list of our favorite low FODMAP prebiotic foods read this article.

Don’t Forget the Protein

I often feel like a protein pusher. For starters proteins do not contain FODMAPs, but watch for high FODMAP ingredients such as garlic and onion that often lurk in the marinades and spice blends used to flavor meats. Most of us meet our protein needs, yet we consume the majority at dinner and often skimp on protein with breakfast and sometimes lunch.

Adequate protein intake at every meal can help minimize the loss of lean muscle mass, which often accompanies rapid weight loss, slightly increases metabolic demands, and lastly, protein makes one feel full longer. 4, 5.

Healthy low FODMAP protein options include chicken, turkey, fish, seafood, lean beef, turkey and chicken sausages (without garlic and onion), lactose free cottage cheese, yogurt, and kefir, strained and canned chickpeas and lentils, tofu, tempeh, and safe protein shakes or powders.

Check out my article Low FODMAP Meal Replacements & Protein Shakes for suggestions.

Have a Plan

The hardest part of any diet change or new eating pattern is meal planning. We can all have good intentions; however, if we do not have a plan of action the likelihood of sticking with a new eating pattern is greatly reduced.

When blood sugar levels are plummeting and time is short we often reach for the easy choice, which is less likely to be the healthy choice and less likely to be low FODMAP. So what can we do… try to always have a plan for your next two meals.

At breakfast you should be thinking about dinner, maybe you need to pull out a food to defrost or stop at the store for a last minute item. Spend time on slow days to meal prep, grocery shop, and plan a few meals in advance.

Take short cuts such as buying precut fruit and vegetable trays or a low FODMAP compliant rotisserie chicken if time is limited. For ideas on how to prepare for changing some of your patterns this article may interest you.

Add Variety

I feel that many of us revert back to our old ways when we get bored or get stuck in a rut. It is important to add new recipes for inspiration and excitement with your new eating habits. (Go to our Recipes page right here at FODMAP Everyday® and use our filter to find what you want). Try to not get overwhelmed which is easy with the overabundance of recipes on the Internet.

Try one new recipe or maybe even a new spice once a week; this is more achievable and will likely result in new foods in your meal rotation. We have a plethora of recipes to try, look for our “kiwi” icon to know that a recipe is Elimination Safe.

Eat Fermented Foods

There is limited evidence to support the use of probiotics for weight loss. Two small clinical studies demonstrated VSL # 3 prevented weight gain despite a significant increase in calories and the strain Lactobacillus rhamnosus CGMCC1.3724 (LPR) resulted in greater weight loss among women.

Unfortunately the LPR probiotic supplement contained FOS and inulin, both high FODMAP ingredients. Both Align and VSL # 3 have proven to be effective at reducing overall IBS symptoms and improved quality of life when taken for greater than eight weeks or longer.

As a RD my approach is often food first, this is not only cheaper but also a little more enjoyable. My top picks include Green Valley Organic Lactose Free Yogurt and Kefir, tempeh (watch ingredients since some contain high FODMAP ingredients), firm tofu, and miso.

Consumption of these live cultures may help maintain the healthy bifida bacteria levels, which can be reduced during the low FODMAP Elimination diet. 6, 7, and 8. Consumption of low FODMAP probiotic rich foods can improve microbial diversity of the gut bacteria which may support a healthy weight.

Exercise

Make time for exercise most days. Find ways to move your body that you enjoy whether that be a walk, jog, swimming laps, aerobic class, yoga, or weight training. Most research suggests a goal of 250 to 300 minutes per week of exercise for healthy weight loss and maintenance.

Exercise can help reduce stress, improve IBS, help manage IBS flare-ups, and improve digestion. Aim for moderate bouts of exercise, since intense exercise can exacerbate IBS symptoms. 9

For ideas on how to start a yoga practice or body movement practice you can read our IBS & Yoga series.

Be Mindful

We live in a culture where everything is done fast, which includes eating. Make an effort to eat meals at a table without distractions such as the TV, your phone, or while reading.

Chew your food twenty times and try to eat slower. Deep breathing before a meal can help you remember to slow down and may decrease stress, which can have a positive impact on your IBS symptoms.

For some helpful ideas on mindfulness, cooking and eating this article IBS and Yoga Series: Kitchen Yoga has some helpful guidance.

Remember to be patient, be kind to yourself, and make yourself a priority as you move through this low FODMAP journey.

  1. Douglas Paddon-Jones Eric Westman Richard D Mattes Robert R Wolfe Arne AstrupMargriet Westerterp-Plantenga. Protein, weight management, and satiety . The American Journal of Clinical Nutrition, Volume 87, Issue 5, 1 May 2008, Pages 1558S-1561S, https://doi.org/10.1093/ajcn/87.5.1558S. Published: 01 May 2008. Accessed 27 June 2018
  2. Leidy HJ1, Clifton PM1, Astrup A1, Wycherley TP1, Westerterp-Plantenga MS1, Luscombe-Marsh ND1, Woods SC1, Mattes RD1. The role of protein in weight loss and maintenance. The American Journal of Clinical Nutrition, Volume 101, Issue 6, 1 June 2015, Pages 1320S–1329S, https://doi.org/10.3945/ajcn.114.084038 . Published: 29 April 2015. Accessed 27 June 2018.
  3. McFarland LV1, Dublin S. Meta-analysis of probiotics for the treatment of irritable bowel syndrome. World J Gastroenterol.2008 May 7;14(17):2650-61.
  4. Marina Sanchez, Christian Darimont, Vicky Drapeau , Shahram Emady-Azar. Effect of Lactobacillus rhamnosus CGMCC1.3724 supplementation on weight loss and maintenance in obese men and women. British Journal of Nutrition . Available at: https://doi.org/10.1017/S0007114513003875. Volume 111, Issue 8 28 April 2014 , pp. 1507-1519
  5. Kristin L. Osterberg, Nabil E. Boutagy, Ryan P. McMillan , Joseph R. Stevens , Madlyn I. Frisard, John W. Kavanaugh Brenda M. Davy, Kevin P. Davy, Matthew W. Hulver. Probiotic supplementation attenuates increases in body mass and fat mass during high‐fat diet in healthy young adults. Obesity A Research Journal. Available at: https://onlinelibrary.wiley.com/doi/full/10.1002/oby.21230 Published: 14 October 2015. Accessed 27 June 2018.

For as long as I can remember, I’ve had “tummy troubles.” Now, let’s be honest. Digestive distress isn’t something fun to bring up at a dinner party or on a date. If you suffer from stomach problems like me, you’ve probably spent most of your life trying to hide it.

As a child, I can remember waiting in the ladies room until I had to go on stage at dance recitals. High school track and field practices were interrupted by perpetual runs to the locker room. My childhood best friend knows just about every public restroom in the western (and now eastern) United States. Bless her!

‘We all poop, we all bloat, we all have diarrhea. It will only become less stigmatized if we become more open about it.’

Kate Scarlata

While my stomach problems were always embarrassing, things became unbearable when I moved to New York City and started a “big girl” job. I had always worked, but for the first time in my life, I couldn’t run to the bathroom. I had meetings, deadlines and responsibilities — and recurrent toilet timeouts were not on the schedule.

When winter arrived, the severity of my symptoms worsened. If you’ve ever experienced an East Coast winter, you know it’s not exactly the time to be surviving on saltines and Pepto-Bismol. Marching to work in frigid weather requires stamina, and I found myself tolerating less and less food. Some days I could barely eat at all, and I’m a girl who likes her food!

As life became less tolerable, and WebMD self-diagnosis only led to neurosis, I finally sought help from a gastroenterologist. My doctor quickly diagnosed IBS, or Irritable Bowel Syndrome. The name was gross and the symptoms grosser, but sadly, they fit the bill: diarrhea, constipation, bloating, indigestion and nausea.

Say it with me, FODMAP (pronounced FAWD-MAP)

According to the National Institute of Diabetes and Digestive and Kidney Diseases, IBS affects about 10-15 percent of adults in the U.S. Of those, only five percent have received a formal diagnosis.

So, I wasn’t alone. But what now?

My doctor had good and bad news. The good? IBS is increasingly treatable with dietary regulation. The bad? There really is no “cure” for the syndrome. It’s all about maintenance. Sigh.

Just before the winter holiday, I visited a nutritionist. I knew I needed to change my diet, but I needed specifics. She explained that a new diet was taking the digestive world by storm (no pun intended) and it had a funny name. As I sat in her office on the verge of tears, I learned for the first time about the Low FODMAP Diet.

The Low FODMAP diet was developed by Monash University researchers in Melbourne, Australia about ten years ago. It is a relatively new way to regulate digestive distress through a three-step elimination, integration and maintenance system.

“So let’s start with the term FODMAP. When we talk about what is a FODMAP, it really is a group of small-chain carbohydrates that are commonly mal-absorbed,” Kate Scarlata, a registered dietitian, low FODMAP educator, author and blogger told NBC BETTER.

FODMAP stands for Fermentable, Oligo-Saccharides, Disaccharides, Mono-saccharides and Polyols. It’s a lot to digest, I know. Stay with me here.

The diet is a way to regulate digestive distress through a three-step process: elimination, integration and maintenance.

Basically, FODMAPS are carbohydrates that draw water into the gut and give us those not-so-friendly tummy symptoms. The Low FODMAP diet is a three-phase diet wherein a patient eliminates “high FODMAP” foods and then slowly works them back in to determine what’s bearable for the gut, and give it an all-encompassing chance to heal.

Dr. Peter Gibson led the research team at Monash University in Melbourne to develop the Low FODMAP diet. His team began testing foods to find gut-irritating commonalities. In the past, IBS had been treated to no avail. But Gibson was determined to find a way for patients to know just what their stomachs could, and mostly could not, tolerate.

“You would recognize foods were causing you a problem, but you wouldn’t recognize correctly which foods cause symptoms, because we eat a lot of varied things in our diet,” Dr. Gibson told BETTER. “What the diet has done is by recognizing the components in the foods, you have the power to know what you can and can’t eat.”

Phase 1: Elimination Implementing

The Low FODMAP Diet works in three phases.

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“The initial phase is an elimination diet,” says Scarlata. “That’s where we remove all the high FODMAP foods from the diet. The patient will follow that for two to six weeks until they feel symptom control.”

Now, this is where things get real. The list of high FODMAP foods that both my nutritionist and Scarlata suggest cutting out is a delicious mile long.

You begin by eliminating gluten, dairy, garlic, onions, soy, beans, apples, avocados, broccoli … you get the picture.

I returned to the nutritionist and nearly cried again, but this time for a different reason: I felt cured.

Needless to say, the elimination portion of the diet isn’t pretty. But at this point, I was desperate to heal.

I was a dedicated, determined Low FODMAP soldier. I carried the lists and tools with me and stuck to my mission through demanding work schedules and holiday parties. I wouldn’t even touch those buttery cookies, or indulge in more than one cocktail (another fun part of the diet.)

Full disclosure, I did not see results right away. I know now that the digestive system, like any body part in bad shape, takes time to heal. In the meantime, I lived on flavorless chicken broth, eggs and gluten free toast. But Scarlata’s popular blog, and the promise of a better gut, kept me going.

The Second Phase: Reintroduction

As winter turned to spring and New Yorkers traded in puffy jackets for rain boots, so too was I stripped of my constant digestive agony.

Yes, I was eating half of the foods I was used to, and, yes, I lost some weight and nearly drove waiters mad, but it was worth it. I felt better. I felt like myself again.

I returned to the nutritionist and nearly cried again, but this time for a different reason. I felt cured.

She quickly warned me that the elimination phase, albeit successful, is not sustainable long-term. And, like she mentioned in the beginning, IBS is truly not ‘curable.’

“FODMAPS are innately healthy foods,” says Scarlata. “There is no reason to restrict them for 85 percent of Americans who do not have IBS or IBS Symptoms. So if you have no problem digesting broccoli, by all means, digest broccoli.”

Thus, I entered the second phase of the diet, re-introduction. I slowly began eating apples, cauliflower and other “high FODMAP” foods. The re-introduction phase is tricky because every person reacts to different food in different ways. I know I’ll never again eat a raw onion or have a milkshake, but for some, the Low FODMAP diet helps to reset the gut in a way that makes foods tolerable again.

So while I felt better and stronger, I realized the true gift I had received here was power. I no longer had to wonder what I could or could not eat. I slowly integrated foods that worked, and avoided others like the kiss of death (here’s looking at you, garlic). I wanted nothing more but to hug my health care professionals.

Kate Scarlata’s gluten free and low-FODMAP blueberry muffins.Kate Scarlata/For a Digestive Peace of Mind

Maintenance Mode: Control Stress and Digest

As I began to feel healthier, I craved more information on this whole gut-health philosophy. Unfortunately for me, there was a theme that kept resurfacing that just couldn’t be ignored: Stress and digestive health are closely related.

“When have a lot of emotional stress, affects our gut, and if you’ve got bad symptoms, that’s going to feed your anxiety,” says Gibson. “It’s a vicious circle going on.”

Those daily stresses about deadlines, bills and relationships directly affect what happens in our stomachs. Both Scarlata and Gibson call this the Gut-Brain Axis.

“The gut-brain axis is very interesting, it’s a bi-directional communication between the gut and the brain,” says Scarlata.

What researchers have found is that the more stressed out we are, the more our symptoms ramp up.

The gut-brain axis is a bi-directional communication between the gut and the brain.

“Irritable bowel syndrome is all about gut-brain axis,” says Gibson. “You can use the brain to influence the sensitivity of the gut. And we have done studies. And we are very interested in gut-directed hypnotherapy. And there is some good evidence that it works.”

It turns out that an important facet of managing gut health is approaching life in a way that reduces stress, in order to ultimately ease digestive distress.

Though hypnotherapy isn’t something I’ve been able to include in my own routine, running has provided an excellent way for me to de-stress. I also know my brain, and stomach, can’t tolerate too much caffeine on those more hectic weeks. Unplugging at the end of the night also sometimes helps me to wake up feeling refreshed instead of nauseous. Once again, it’s all about empowering yourself to know what works, and doesn’t, for you and your symptoms.

Teach me how to FODMAP

Since I discovered the Low FODMAP Diet, my life has changed considerably. If you’re asking yourself if you should try it (or reading this in the bathroom stall), here are a few FODMAP expert tips.

  1. DO find a health professional: “I always recommend people go on the Low FODMAP diet with a dietitian, if possible,” says Gibson. From personal experience, it is much more doable when you have someone to guide you through the ins and outs of FODMAP eating.
  2. DO educate yourself. Scarlata runs a popular Low FODMAP blog and is the author of several books, including a new step-by-step recipe guide due out this fall. And Gibson’s pioneering work is accessible through an app that dictates the various FODMAP content in foods, and helps you steer clear of the scary stuff (no more garlic bread, people.)
  3. DON’T be embarrassed to find a support system. When we go to restaurants now, my boyfriend backs me up by clarifying that I really CAN’T have those onions, “She’s allergic!” he’ll say to the waiter. We’ve looked at the FODMAP lists together, and my friends have them, too. Don’t be embarrassed. You are not alone. “I do feel like we need to talk more about digestive health,” says Scarlata. “We all poop, we all bloat, we all have diarrhea. It will only become less stigmatized if we become more open about it.”
  4. DON’T think drinking Kombucha will magically cure your gut. Probiotics are good bacteria that help to keep our stomachs healthy. Recently, though, they’ve become so mainstream they’ve begun popping up in everything from granola to brownie mix. But experts say don’t be fooled by that fitness blogger you see chugging Kombucha. “A lot of my patients come in sucking down bottles of Kombucha,” says Scarlata. “They often don’t help all patients. It’s probably going to be a very individualized response because we all have our own fingerprint.”

The best part about my FODMAP journey was taking back control of my health. Where I was once ruled by the aftermath of a bad eating day or slice of ice cream cake, I know now that I can turn back to the elimination phase of the FODMAP diet and settle my symptoms. And while I may never be fully “cured” I know there are tools and resources to help me manage the condition.

And experts are seeing progress in the right direction as well. Today, Gibson’s research team at Monash University has worldwide partnerships in FODMAP education and research and THE FODMAP diet app has been downloaded by more than 100,000 people in over 30 countries. Scarlata, who has worked as a dietitian for 30 years, says she, too, is seeing results in treating IBS with the Low FODMAP diet like never before.

“Patients with IBS always knew food bothered them, but we really didn’t have any tools to guide them,” says Scarlata. “For me, it’s just the most rewarding work because finally I have an application that I can provide my patients, and they can completely turn their life around.”

When it comes to my life, it certainly has.

A Low FODMAP Diet

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What Is The Low FODMAP Diet?

FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharide and polyols. These compounds are all types of carbohydrates that can be difficult to digest. Fermentation of them in the gastrointestinal tract can result in bloating, discomfort, and other symptoms.

This is not a weight-loss diet. It was designed for people with irritable bowel syndrome (IBS) and is sometimes recommended for treatment of inflammatory bowel disease. IBS symptoms can include any combination of constipation, diarrhea, gas, bloating, abdominal pain or discomfort, fatigue, and headaches.

FODMAPs include wheat, rye, onions and legumes; lactose (found in soft cheese, yogurt and milk), fructose (as in high-fructose corn syrup), honey and certain fruits, including apples and pears. Artificial sweeteners, such as sorbitol, are also regarded as FODMAPs, and the diet limits fiber. Entirely eliminating these foods allows you to more easily identify which ones bring on your IBS symptoms when you add small amounts back in. The FODMAPs responsible vary from person to person and frequently change over time. The Low FODMAP diet is one of several popular diets reviewed on DrWeil.com.

How Healthy Is The Low FODMAP Diet?

Researchers at Australia’s Monash University developed this diet in 2005. Once all foods containing FODMAPs have been eliminated, they are reintroduced one by one in small amounts to see which ones bring on symptoms. After the troublesome FODMAPs are identified, a new diet that excludes them can be designed by a trained dietician. This process can take from two to six weeks. Because you must work with a dietician, costs will range from $150 to as much as $350 per hour depending on where you live, but the expense may be fully covered by your health insurance plan.

What Can You Eat On The Low FODMAP Diet?

Although the diet initially requires eliminating many foods, you can continue to consume several others: meat, poultry, fish, and eggs, as well as wheat-free grains and flours. You also can eat bananas, berries, oranges and melon, as well as such vegetables as kale, cucumbers and sweet potatoes. Certain dairy foods, including lactose-free products, hard cheeses and mozzarella are also permitted. An app available from Monash University provides recipes and information on FODMAP products from major food brands. It also allows you to check unfamiliar foods to see if they contain FODMAPs.

How Many Calories On A Low FODMAP Diet?

You don’t have to count calories on this diet. Many people shed a few pounds during the elimination phase, but dieticians generally advise against trying to lose weight at that time, or when you’re adding back foods. Afterwards, if you want to lose weight, you can work with your dietician to come up with an eating plan that will help you reduce your caloric intake without triggering symptoms.

What Do Doctors Say?

If you have IBS, your doctor may recommend the FODMAP diet to identify the foods that are causing your symptoms. The diet has been scientifically evaluated and is in widespread use as a treatment for IBS. According to researchers at Monash University, following the low-FODMAP diet results in relief of symptoms in three out of four patients with the disorder. They maintain that the positive effects are long lasting.

Dr. Weil’s Take On The Low FODMAP Diet:

If you have IBS, you may be able to help ease your symptoms by identifying and eliminating any foods that appear to set them off. I also recommend avoiding caffeine (including decaffeinated beverages), tobacco and other stimulants that can irritate the bowels and worsen diarrhea. Avoiding dairy products can also help. Although the FODMAP diet incidentally reduces fiber for those sensitive to certain compounds in fiber foods, others may see benefit from increasing intake of fiber – eating fruits, whole grains and cooked vegetables, sprinkling a tablespoon of freshly ground flaxseed on cereals, soups or salads, and using a psyllium-based fiber supplement if you can’t sufficiently increase your consumption of fiber-rich foods. These are changes you can make on your own. While there is evidence that a low-FODMAP diet can have a positive impact on IBS symptoms, it has not yet been shown whether it works better than other less restrictive diets for IBS.

Sources:
Peter R. Gibson and S.J. Shepherd, “Evidence-based dietary management of functional gastrointestinal symptoms; The FODMAP approach“. Journal of Gastroenterology and Hepatology, February 2010, doi:10.1111/j.1440-1746.2009.06159.x.

Peter R. Gibson, “History of the low FODMAP diet,” Journal of Gastroenterology and Hepatology, March 2017, doi.10.1111/jgh.13685

If you’ve ever suffered from irritable bowl syndrome (IBS), you’ll quite possibly have heard of the low FODMAP diet, which cuts out certain carbohydrates for a period of time to reduce or even eliminate symptoms. IBS is a chronic, relapsing and often life-long condition, and symptoms include abdominal pain, bloating and a change of bowel habit. More than four million people in the UK suffer from IBS and people visit their GP between three to ten times for help. There is a tendency to prescribe medication first to help manage symptoms, and GPs spend 14% of their budget on this. But what about the role of diet in treatment? Research shows that up to 86% of people who follow a low FODMAP diet notice a significant improvement in symptoms.

What are FODMAPs?

The catchy acronym stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols, which are more commonly known as carbohydrates. These can be further divided into five groups called fructans, galacto-oligosaccharides, lactose, excess fructose and polyols. The diet originated in Australia and has been adapted for the UK by researchers at Kings College, London. In essence, FODMAPs are different carbohydrates found in a wide range of foods including onions, garlic, mushrooms, apples, lentils, rye and milk. These sugars are poorly absorbed and pass through the small intestine and enter the colon, where they are fermented by bacteria. Gas is then produced, which stretches the sensitive bowel causing bloating, wind and pain. This can also cause water to move into and out of the colon, causing diarrhoea, constipation or a combination of both. People with IBS are more susceptible to the problems that are associated with this.

How to follow a low FODMAP diet


Under the supervision of a dietitian, high FODMAP foods are eliminated from the diet for six to eight weeks and replaced with suitable alternatives. After this, small amounts of FODMAP foods are gradually re-introduced to find a level of tolerance without the symptoms returning. It is not designed to be a ‘diet for life’ as many high FODMAP foods are important for stimulating the growth of beneficial bacteria in the gut.

It is important to remember not everyone will have a problem with every FODMAP. Some people might have symptoms triggered by one or two types of FODMAPs, whereas others may be sensitive to all five. The reasons for this are unknown, but foods should only be restricted if they contribute to symptoms. The diet is intended to be individualised according to the problematic FODMAP, so it is very important to seek guidance from a dietitian.

High FODMAP foods

This is not a definitive list – please refer to your dietitian or healthcare provider for more information.

FODMAP Type

Fructans

Galacto-oligosaccharides

Lactose

Excess fructose

Polyols

Examples of foods

Wheat Baked beans Animal milks Apples Nectarines
Rye Lentils Custard Pears Peaches
Barley Borlotti beans Ice cream Mangoes Plums
Garlic Chickpeas Condensed milk Watermelon Cauilflower
Leek Soybeans Evaporated milk High-fructose corn syrup Mushrooms
Onion Kidney beans Yogurt Honey Sugar snaps
Lentils Dairy desserts Chewing gum
Chickpeas Confectionery with polyols
Legumes
Cashews
Pistachios

The expert verdict

Does it really work? If IBS is a confirmed diagnosis, the low FODMAP diet can be extremely effective. It is heavily supported by science and if followed correctly, has proven to be effective in significantly reducing symptoms. It can be a challenge to follow at times, but the efforts are well worth the rewards. I tell my clients planning and preparation are key to success.

A word of advice, if you suspect you suffer from IBS, speak with your GP. It is important to exclude coeliac disease and other possible medical conditions first. If IBS is confirmed as the cause of symptoms, then a low FODMAP diet under guidance with a dietitian can definitely be beneficial.

Low FODMAP recipes to try…

Salmon & lemon mini fishcakes
Baked sea bass with lemon caper dressing
Potato salad with anchovies & quail’s eggs
Chocolate crunch & raspberry pots
Gluten-free carrot cake

For more tempting ideas, visit our low FODMAP diet recipe collection.

Emer Delaney BSc (Hons), RD has an honours degree in Human Nutrition and Dietetics from the University of Ulster. She has worked as a dietitian in some of London’s top teaching hospitals and is currently based in Chelsea.

This article was reviewed on 8 August 2018 by nutritionist Kerry Torrens.

Kerry Torrens is a qualified Nutritionist (MBANT) with a post graduate diploma in Personalised Nutrition & Nutritional Therapy. She is a member of the British Association for Nutrition and Lifestyle Medicine (BANT) and a member of the Guild of Food Writers. Over the last 15 years she has been a contributing author to a number of nutritional and cookery publications including BBC Good Food.

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