The Low FODMAP Diet
The Low FODMAP Diet is proven to be an effective dietary treatment for the vast majority of people suffering from IBS and IBS-type symptoms. People who suspect they have IBS should firstly speak to their doctor about their symptoms. It is recommended that all people with IBS-like symptoms should be investigated for coeliac disease (gluten must still be consumed in the diet), and any other conditions the doctor feels is relevant to the individual. If irritable bowel syndrome is confirmed, then the low FODMAP diet is recommended for dietary management of symptoms.
There are 2 phases to implementing the Low FODMAP Diet:
- 1. Initially, an 8-week diet trial reducing the intake of foods high in FODMAPs in people with IBS-type symptoms is undertaken. It is recommended that such people commence the diet under the advice of a dietitian, preferably a specialist in gastrointestinal nutrition (see shepherdworks.com.au or daa.asn.au). Dietitians will generally advise the strict removal of foods that are high in FODMAPs during this phase. Dietitians are trained to provide expert nutritional advice, so will also suggest alternative foods to those that are restricted (focusing on what CAN be eaten), to ensure nutritional adequacy.
- 2. After completing 8 weeks on the first phase of FODMAP dietary restriction, it is recommended to return to the specialist dietitian for a review to assess how well symptoms have improved in this phase. If all is going well, the dietitian will then work with the individual on the low FODMAP diet to plan the next steps – ie. work out the TYPE and AMOUNT of FODMAPs that can be tolerated before experiencing symptoms. It is an important step to determine how well a person can tolerate the reintroduction of FODMAPs. As well as seeking to minimise symptoms, it is a goal of the dietitian to ensure that the person obtains maximum variety in their diet. Further, reintroduction of FODMAPs to a level that is comfortably tolerated will enable the individual to benefit from the prebiotic effects of FODMAPs.
The most common outcome of this 2-stage process is that people with IBS-type symptoms will experience minimised symptoms, while tolerating increased variety of foods in an eating plan that is individualised.
There is an ever-growing number of scientific research studies from around the world supporting the fact that reducing FODMAPs in the diet assists in managing the symptoms of IBS4. This is not a fad diet – it is supported by scientific evidence and its use is increasing internationally. . . For example, in a scientific study performed in the UK, the Low FODMAP Diet was proven to be much more effective in relieving symptoms (76% of participants achieved IBS symptom control) than the diet formed by the UK’s National Institute for Health and Clinical Excellence (NICE) (where 54% of participants achieved IBS symptom control).
4 See the following research papers:
- Shepherd SJ, MCE Lomer and Gibson PR Short-Chain Carbohydrates and Functional Gastrointestinal Disorders Am. J. Gastroenterol. 2013;108:707-717
- Gibson PR and Shepherd SJ Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach J. Gastroenterol. Hepatol. 2010; 25:252–258
- Gibson PR and Shepherd SJ Food Choice as a Key Management Strategy for Functional Gastrointestinal Symptoms Am. J. Gastroenterol. 2012; 107:657–666
- Staudacher HM , Lomer MCE , Anderson JL et al. Fermentable carbohydrate restriction impacts on luminal bifi dobacteria and gastrointestinal symptoms in a randomized controlled trial of patients with irritable bowel syndrome . J Nutr 2012 ; 142 : 1510 – 18 .