The Low FODMAP Diet

Written by Julia Mor: “Julia Mor is a nutritionist working in healthcare and currently diving deep into the world of nutrition and behaviour with an MSC at Bournemouth University. She has a soft spot for exploring how gut health ties into our mental well-being and a particular interest in inflammatory bowel disease (IBD).”

 

The low FODMAP diet has become a widely studied elimination diet, particularly renowned for its effectiveness in managing symptoms associated with irritable bowel syndrome (IBS) and other gastrointestinal (GI) disorders. FODMAP, an acronym for Fermentable, Oligo-, Di-, Mono-saccharides And Polyols, encompasses specific types of carbohydrates believed to trigger GI symptoms. These short-chain carbohydrates are highly fermentable, undergoing chemical transformations in the GI system and exhibiting poor absorption during digestion. Upon reaching the colon, bacteria ferment these sugars, generating gas and chemicals that can stretch the colon walls, leading to symptoms like abdominal bloating, distension, cramping, pain, and alterations in bowel habits, especially prevalent among IBS patients. It’s important to note that FODMAPs aren’t inherently harmful but may exacerbate GI symptoms in individuals with sensitive GI tracts.

The inception of the Low FODMAP diet roughly a decade ago by Australian researchers at Monash University marked a significant milestone in the management of IBS-related symptoms. Comprising three phases – Elimination, Reintroduction, and Personalization – this diet approach has demonstrated efficacy in symptom alleviation.

During the Elimination phase lasting 2-4 weeks, all FODMAPs are removed from the diet. If symptoms notably improve during this phase, patients proceed to the Reintroduction phase, wherein FODMAP groups are reintroduced one at a time, while monitoring for symptom recurrence. Once trigger FODMAPs are identified, patients may avoid these foods while still consuming other FODMAPs to maintain nutritional diversity. Adherence to this personalized Low FODMAP plan doesn’t cure IBS but can effectively manage symptoms and enhance quality of life.

Navigating the extensive list of dietary restrictions and recommendations can be overwhelming for many patients, underscoring the value of guidance from experienced dietitians during the elimination and reintroduction phases.

Eliminating restricting FODMAPs from the diet can significantly alleviate symptoms of IBS and other functional GI diseases, particularly in individuals who perceive a connection between their food intake and GI symptoms (van Lanen et al. 2021) The Low FODMAP diet can be used in isolation or alongside medications for IBS treatment, with improvements commonly observed in bloating, abdominal pain, fatigue, bowel movements, and overall quality of life.

While predominantly studied in the context of IBS, the Low FODMAP diet is increasingly utilized for other GI conditions due to overlapping symptomatology. In cases where symptoms persist, the diet may complement treatment for conditions such as inflammatory bowel disease, celiac disease, and small intestinal bacterial overgrowth (Eswaran 2021)

Collaboration with GI healthcare providers and dietitians specializing in GI conditions enhances the likelihood of success with this elimination diet strategy. However, it’s important to recognize that the Low FODMAP diet may not be suitable for everyone, particularly individuals with a history of eating disorders, those with complex medical histories.

 

Reference list

Bellini, M., Tonarelli, S., Nagy, A. G., Pancetti, A., Costa, F., Ricchiuti, A., de Bortoli, N., Mosca, M., Marchi, S. and Rossi, A., 2020. Low FODMAP Diet: Evidence, Doubts, and Hopes. Nutrients [online], 12 (1), 148. Available from: https://www.mdpi.com/2072-6643/12/1/148.

Eswaran, S., 2021. Low-FODMAP Diet [online]. American College of Gastroenterology. Available from: https://gi.org/topics/low-fodmap-diet/.

Gibson, P. R., 2017. History of the low FODMAP diet. Journal of Gastroenterology and Hepatology, 32 (S1), 5–7.

Harvard Health Publishing, 2014. Try a FODMAPs diet to manage irritable bowel syndrome [online]. Harvard Health. Available from: https://www.health.harvard.edu/diseases-and-conditions/a-new-diet-to-manage-irritable-bowel-syndrome.

LDN, E. G., MLA, RD, 2020. The lowdown on the low-FODMAP diet [online]. Harvard Health Blog. Available from: https://www.health.harvard.edu/blog/the-lowdown-on-the-low-fodmap-diet-2020072720662.

Monash University, 2019. Low FODMAP Diet | IBS Research at Monash University

van Lanen, A.-S., de Bree, A. and Greyling, A., 2021. Efficacy of a low-FODMAP diet in adult irritable bowel syndrome: a systematic review and meta-analysis. European Journal of Nutrition [online], 60 (6). Available from: https://pubmed.ncbi.nlm.nih.gov/33585949/.

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