Anyone who suffers from Irritable Bowel Syndrome (IBS) will know how difficult it can be. With cramps, bloating, and even navigating which foods you should and shouldn't eat. There's no real 'cure', so it really is a case of managing symptoms and seeing what works for you.
Which is where the low FODMAP method comes in. It was created by a team at Monash University in Australia as a treatment for IBS. The NHS has found it reduces symptoms in around 70% of IBS sufferers. But with it being a tricky process at first, it's definitely not something you should try on your own without guidance from a medical expert.
What are FODMAPs?
FODMAPs are ‘Fermentable Oligo-saccharides, Di-saccharides, Mono-saccharides, And, Polyols’. A real mouthful!
In layman’s terms, they’re particular carbs that are poorly digested by the body, causing a flare up of digestive difficulties in some sensitive people. A low FODMAP diet simply means cutting these carbs out - at least for a while - to alleviate symptoms, and help the gut mend. It's a potential way to figure out which foods are problematic and which foods reduce symptoms.
A wide range of foods have been defined as high in FODMAPS. This includes wheat, rye, barley, chickpeas, kidney beans, mushrooms, nuts, apples, onions and cauliflower. (A full list of the foods is available on the Monash University website.
Sounds daunting, but try not to panic! It might seem like a lot of foods are off limits, but there are five different types of FODMAP and, while some people are sensitive to all five, many only have problems with one or two.
Alix Woods, nutritionist at Quest Nutra Pharma explains: “You may find you tolerate some high FODMAP foods perfectly fine and not others, which is why the process of reintroducing is so important. It’s not a blanket list for everyone, forever.”
What is a FODMAP diet?
“Think about a low FODMAP diet as a treatment rather than a lifestyle diet,” says Alix. “It’s a short term plan to treat a specific problem. At the beginning it can feel very restrictive so it’s good to remember it’s not forever.”
For this reason, and to make sure you understand and benefit from the results, it’s vital to go through the process with a trained professional.
“There are a fair number of foods that you need to cut out initially - sometimes quite surprising ones like onions and garlic,” says Alix. “But there are always alternatives and so you need a professional to create a plan that’s specifically tailored to you.
“The last thing you need if you’ve been having long-term digestive problems is to add to any nutritional deficiencies by cutting out major food groups,” she adds.
Is the low FODMAP diet right for you?
If you have IBS symptoms, the first thing to do is go to your GP to rule out any other conditions before you embark on any new diet or treatment. “Your GP will be able to test for things such as Crohn’s or coeliac disease,” says Alix. “It’s important to rule out serious conditions that may need different medical intervention.
“You might also be advised to modify your diet for a few weeks to see if simple lifestyle changes help.”
Once other issues have been ruled you, and you have an IBS diagnosis, you can get to work finding out how the condition manifests for you, and how you can get on top of it. There are apps and how-to's online that can help you follow, track and stay on top of the FODMAP diet, but ask for a referral to a registered dietician before you try anything.
How the Low FODMAP diet works
The first stage is restriction - removing the full spectrum of high FODMAP foods from your diet. “It seems like a long list but for everything there is an alternative,” reassures Alix. “Things are generally good now with plenty of options like nut milks and gluten-free products.”
You cut out these foods for four to eight weeks but, says Alix, “you should start to feel an improvement almost immediately. Most people find that if they’ve been really uncomfortable, removing these hard-to-digest foods really helps within a day or two.”
The idea of going without these foods for a few weeks is so the damage in your gut, caused by symptoms such as bloating and constipation, can heal. “I also add some supplements at this stage, such as a good probiotic, to help the mending,” says Alix. “But that’s very dependent on each individual’s situation.”
Once you’re feeling more comfortable, and under your dietitian's instruction, the next stage is to reintroduce foods one at a time to see if you’re reactive.
“Do this with very small amounts,” advises Alix. “I would have, say, a teaspoon of oats and just see how my body reacted to that. If it seems fine, have a larger amount. Usually if they’re a problem food you’ll react immediately and you can put it on your ‘no’ list.”
The food diary
It can be tedious to keep a food diet for weeks but to enable you to have the widest variety of foods after you finish your low FODMAP diet, it’s essential.
“It’s so important to keep a food and symptoms diary,” says Alix. “Because it’s only by looking back that I can see the pattern of what you’ve eaten and how you’ve reacted immediately or a few hours later. That means we can really tailor your diet in the future so you don’t have to have these horrible symptoms and you can still eat plenty of foods you like.”
Getting back to normal
Once you’ve reintroduced all the foods that you tolerate well back into your diet, you can go back to eating more or less as normal. Working with your dietician, you’ll have created a list of foods that cause your IBS symptoms and it’s up to you to eat what makes you feel good and avoid what doesn’t.
“Nothing is forever,” says Alix. “And your body changes over time so you might need to do the low FODMAP diet again in a few months or years, to recalibrate.”
The beauty of the low FODMAP approach is that by giving you information, it gives you power.
“I’m really passionate about the way it helps people know themselves,” says Alix. “It’s difficult but so empowering.”
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