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The Low FODMAP Diet

What is a Low FODMAP Diet?
FODMAP diet and nutrition or diet therapy

A Low FODMAP Diet is recommended as first-line nutrition or diet therapy for people with digestive sensitivities, including those who suffer from Irritable Bowel Syndrome (IBS). Although foods high in FODMAPs are not the cause of the problem, they can trigger gastrointestinal (GI) symptoms. A Low FODMAP Diet therefore represents a great option for GI symptom reduction and ultimately better quality of life.

 

The premise of a Low FODMAP Diet is to identify and eliminate specific food triggers for each individual, with a keen focus on specific short-chain carbohydrates found in foods and beverages, known as FODMAPs. This is not a passing fad or a trend, but it is a continually evolving nutrition intervention based on scientific findings and progressive research.

 

A Low FODMAP Diet works as follows:

  • The plan begins with a 2- to 6-week trial elimination phase where foods high in FODMAPs are removed from the diet, to help reduce effects of FODMAPs on the gut (e.g., stretching caused by water and gas) that can lead to pain, bloating, and cramping, and help establish the least symptoms possible.
  • After the elimination phase, a FODMAP knowledgeable registered dietitian nutritionist can provide guidance on the re-introduction of FODMAPs, in a step-wise process, to distinguish individual FODMAP triggers and tolerances.
  • The FODMAP expert can then help prepare a customized, well-balanced eating plan that restricts FODMAP triggers, while minimizing food elimination and maximizing nutritional value.

Watch this short video: The Bucket Concept and a Low FODMAP Diet ©2016 The Regents of the University of Michigan. All rights reserved. Used under license by Nestlé.

Is This Diet for Everyone?
FODMAP diet not for everyone

A Low FODMAP Diet is not for everyone and should be used appropriately by the person with food intolerance or digestive sensitivities including Irritable Bowel Syndrome (IBS). Medical direction for people of all ages is important as common symptoms of IBS can also be signs of other more serious medical issues that cannot be overlooked.

 

Who Should Not Follow This Diet?

Individuals dealing with gastrointestinal discomfort including gas, pain and altered bowel movements, should consult with a medical professional first. Although these symptoms are common to IBS, a doctor should either confirm an IBS diagnosis, or rule out other medical conditions (e.g. Celiac Disease, colon cancer, inflammatory bowel disease and ovarian cancer, food allergy). The otherwise healthy individual should also not follow this plan because it may compromise nutritional value of meals eaten and could alter the balance of healthful bacteria in the gut.

 

Who Should Follow This Diet?

Individuals with digestive sensitivities, including those who suffer from IBS, may likely find relief on a Low FODMAP Diet. Often times, people self-diagnose and simply avoid all foods and food categories that give them discomfort, or even fear of discomfort. However, identifying their specific FODMAP triggers can give this person more food options and less anxiety. With the help of a skilled healthcare professional well-versed in the Low FODMAP Diet, this dietary approach can help them find relief and improved quality of life.

Symptoms of Digestive Discomfort
FODMAP symptoms of digestive discomfort

The ABCDE Symptoms of Irritable Bowel Syndrome (IBS)

 

Common symptoms for the person with IBS are easily remembered as found below.

Listed symptoms are not all-inclusive and actual symptoms may vary.

 

Watch a series of short videos: Why do I feel symptoms? ©2016 The Regents of the University of Michigan. All rights reserved. Used under license by Nestlé.

  • Abdominal pain or discomfort
  • Bloating or visible distention
  • Constipation: hard, difficult-to-evacuate, or infrequent stools
  • Diarrhea: loose, watery, or frequent stools
  • Excessive gas

 

How can a Low FODMAP Diet have a positive impact on IBS?

 

  • Clinical evidence supports the Low FODMAP Diet as the first-line dietary approach for people with IBS.
  • The Low FODMAP Diet has been proven to work in 70 percent of sufferers -- and millions of people worldwide – bring their IBS symptoms under control.
  • With the careful guidance of a FODMAP knowledgeable registered dietitian nutritionist, this diet plan can help people target only the food triggers they need to target, maximizing the foods they can eat, the nutritional value they can consume and the quality of life they can achieve.
Balanced Nutrition on a Low FODMAP Diet
FODMAP elimination diet and balanced nutrition

In order to avoid FODMAP triggers and IBS reactions, a Low FODMAP Diet does place restrictions on specific foods consumed. Altering the diet in this way can bring about a risk of nutritional compromise. Working alongside a credentialed FODMAP nutrition expert can help ensure a customized diet to minimize this risk.

 

Watch this short video: Eating a Balanced Diet ©2016 The Regents of the University of Michigan. All rights reserved. Used under license by Nestlé.

Which nutrients are most at risk? How can this risk be lessened?  

  • Fiber – Natural sources of fiber may be limited in this diet because the dietary sources such as fruits, vegetables, grains, beans, nuts and seeds, are also sources of FODMAPs.
    • Careful food re-challenge with the guidance of a FODMAP dietitian expert can help identify the most common triggers in your diet.
    • Low FODMAP fruits, vegetables, grains, beans, nuts and seeds (such as chia seeds, sunflower seeds) are plentiful and should be included in the diet, as tolerated.
  • Calcium and Vitamin D – As milk and milk-based dairy foods are commonly restricted on the Low FODMAP Diet, sources of calcium and vitamin D are limited.
    • Low FODMAP sources of dairy and calcium-fortified non-dairy include lactose free milk, calcium-fortified almond milk as well as leafy green vegetables and should be included in the meal plan, as tolerated.
    • Fatty fish such as salmon, tuna and sardines are great sources of vitamin D.
    • Calcium and vitamin D supplements may also be warranted.
  • Protein -- Adequate protein may be especially important for vegetarians and vegans to obtain as their FODMAP restrictions may likely include dairy, beans, nuts and seeds, which largely make up their dietary protein options.
    • Low FODMAP sources of protein include eggs, nut butters, tempeh and tofu, nuts and seeds, rice protein powders, as tolerated.
    • For non-vegetarians, additional protein sources include fish, chicken, beef, pork and lamb.
    • A Low FODMAP nutrition expert can provide recommendations for additional dietary supplementation or alternative options, as needed.
Sources
  • Academy of Nutrition and Dietetics. Find a Nutrition Expert. Available at http://www.eatright.org/find-an-expert.
  • Barrett, JS, et al. Dietary poorly absorbed, short-chain carbohydrates increase delivery of water and fermentable substrates to the proximal colon. Aliment Pharmacol Ther. 2010;31:874-82.
  • Chey WD, et al. Irritable Bowel Syndrome: A Clinical Review. JAMA. 2015;313:949-58.
  • Gibson, PR, Shepherd SJ. Food Choice as a Key Management Strategy for Functional Gastrointestinal Symptoms. Am J Gastroenterol. 2012;107:657-66.
  • Halmos EP, et al. A Diet Low in FODMAPs Reduces Symptoms of Irritable Bowel Syndrome. Gastroenterol. 2014;146:67-75.
  • Kate Scarlata, RDN, LDN. FODMAP Resources. Available at katescarlata.com.
  • Mansueto P, et al. Role of FODMAPs in Patients with Irritable Bowel Syndrome: A Review. NCP. 2015;30(15):665-82.
  • Monash University Low FODMAP Diet for Irritable Bowel Syndrome. Available at http://www.med.monash.edu/cecs/gastro/fodmap/.
  • Mullin GE, et al. Irritable Bowel Syndrome: Contemporary Nutrition Management Strategies. JPEN. 2014;38:781-99.