Another study comparing typical healthy eating to a low FODMAP diet for people with IBS showed that significantly more people following a low FODMAP saw improvements in bloating, abdominal pain, and flatulence.
Studies also show that IBS symptoms stay improved for a long time (around 6 months) after reducing FODMAPs and even after reintroducing them. However, people should continue to avoid the FODMAP foods that trigger their symptoms.
Should I consult a healthcare professional before starting a low FODMAP diet?
The low FODMAP diet can be confusing, there are many different foods you need to track and avoid. It is generally recommended you seek advice from a dietitian or a healthcare professional before starting the diet.
A dietician or a healthcare professional can help understand the theory behind the diet, outline suitable foods, and provide you with personalized advice.
If you want to start the diet by yourself, there are many online resources, including the Monash University Low FODMAP app, that can help you along the way.
However, low FODMAP diets are complicated and may affect your nutritional intake, so you should talk to a healthcare professional before getting started.
What are the possible health risks of a low FODMAP diet?
In general, the low FODMAP diet is not recommended as a permanent IBS solution. Some of the possible risks & side-effects of following a restrictive low FODMAP diet include:
1. Nutritional deficiencies
Because a low FODMAP diet cuts out many fruits and vegetables and there is the potential for inadequate nutrient intake.
You may need to take vitamin and mineral supplements while on a low FODMAP diet. In particular, it is important that you get enough calcium, iron, zinc and folate intake, and fiber consumption, even if you’re cutting out common foods like dairy.
Because a low FODMAP can affect a person’s nutritional intake, it’s not generally recommended during pregnancy, for people who are underweight, or for people with eating disorders.
2. Disordered eating
There are also risks of becoming disordered in your eating habits after following a restrictive low FODMAP diet. A recent study of over 200 people with IBS showed that those who closely followed the low FODMAP diet showed eating disorder behaviors.
3. Disrupting healthy gut bacteria
Probiotics are ‘friendly’ bacteria that can improve gut function. Several studies have shown probiotics can improve IBS symptoms such as bloating, pain, and constipation. However, a low FODMAP diet may disrupt your natural gut flora.
One study showed the low FODMAP diet lowered the abundance of ‘good’ bacteria including Bifidobacteria and Lachnospiraceae. So, if you’re planning on completing a low-FODMAP diet, make sure you boost health-promoting bacteria with low FODMAP probiotic foods, such as Lactose-free Kefir or Greek yogurt.
Alternatives to a low-FODMAP diet
If you’re looking for a way to manage your IBS without restricting your diet, there are many management strategies available that might work for you, such as cognitive-behavioral therapy, meditation, or yoga.
Another IBS management option that’s been proven to be as effective as a low-FODMAP diet is gut-directed hypnotherapy.
A recent study indicated that gut-directed hypnotherapy was as effective as the low-FODMAP diet in improving IBS, and was shown to reduce symptoms by up to 70%.
Gut-directed hypnotherapy is a simpler option for many people and can usually calm symptoms within six weeks, without the need for complicated food tracking or diet restrictions.
Can I still go out to eat on a low FODMAP diet?
Many meals contain FODMAPs so eating out on the diet can be challenging. However, if you’re looking for a special meal on the town, there are some things you can do to avoid triggering FODMAP foods. Some tips include:
Café: order your tea or coffee with lactose-free milk or almond milk. Choose sandwiches made with gluten-free bread.
Pub food: choose plain meat, fish or chicken without marinade, and a side of low FODMAP salad or fries.
Asian cuisine: choose fried rice or a stir fry with no onion or garlic. Sushi and sashimi are also acceptable options.
Italian: choose gluten-free pasta and request a sauce that does not contain onion or garlic.
Can I do the low FODMAP diet as a vegetarian?
It is possible to do the low FODMAP diet as a vegetarian, however, it may pose some nutritional challenges as many staple protein sources, like beans and yogurt, are high in FODMAPs.
If you want to try a low FODMAP diet, without giving up important vegetarian protein sources, you may want to include more of these low FODMAP/high protein foods in your diet:
Tempeh
Pecans, pine nuts, walnuts
Eggs
Lactose-free milk
Seeds like chia, flax, hemp, pumpkin
Peanut butter
Can I cook with FODMAP foods and remove them later?
It might seem like a smart solution to cook with onions and garlic then remove them from a sauce or soup later, but this isn’t an effective way to avoid high FODMAPS.
Almost all FODMAPs dissolve in water. So, if you are cooking with high FODMAP foods in a soup or a sauce, the FODMAPs will leach out from the high FODMAP foods into the entire dish. While it may be frustrating, it’s best to avoid cooking with high FODMAP foods entirely while on a low FODMAP diet.
Can a low FODMAP diet be flavorful?
Because a low FODMAP diet restricts onions and garlic, many people might think that diet will mean weeks of boring, flavorless meals.
And yes, while many tasty recipes rely on high FODMAP ingredients, there are also many low FODMAP herbs, spices, and flavorings that can add zest to your dishes. Try including these low FODMAP flavor substitutes:
Chili
Mustard
Saffron
Turmeric
Ginger
Should I start a low FODMAP diet?
Before starting a low FODMAP diet, you should have your doctor confirm you have IBS using the official diagnostic criteria.
Generally, a healthcare professional will check that you experience all three of the following to give you an IBS diagnosis.
Abdominal pain: for at least one day per week in the past three months.
Changes in your stools: either in appearance or frequency.
Long-term symptoms: symptoms must have persisted for more than 6 months.
You may also want to consider whether a low FODMAP diet is right for you and your lifestyle. If you have trouble sticking to complicated diets or don’t want to give up certain foods or social activities that involve food, then you may want to look into alternative IBS treatments.
The Wrap Up
The low FODMAP diet is one of the best diets for improving IBS. This diet removes carbohydrates known to trigger symptoms of IBS then slowly reintroduces them over time. This diet can help you maintain better gut health long-term, however, there are some potential risks and lifestyle issues you may want to consider before getting started. If a restrictive diet isn’t right for you, you may want to try gut-directed hypnotherapy, which has been shown to be as effective as a low FODMAP diet in reducing IBS symptoms. Before starting a low FODMAP diet, talk to a healthcare professional to get an official IBS diagnosis.
References
Canavan, C., West, J. and Card, T., 2014. The epidemiology of irritable bowel syndrome. Clinical epidemiology, 6, p.71. https://www.ncbi.nlm.nih.gov/pmc/articles/pmc3921083/
Saha, L., 2014. Irritable bowel syndrome: pathogenesis, diagnosis, treatment, and evidence-based medicine. World Journal of Gastroenterology: WJG, 20(22), p.6759. https://www.ncbi.nlm.nih.gov/pmc/articles/pmc4051916/
Gibson, P.R. and Shepherd, S.J., 2010. Evidence‐based dietary management of functional gastrointestinal symptoms: the FODMAP approach. Journal of gastroenterology and hepatology, 25(2), pp.252-258. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1440-1746.2009.06149.x
Murray, K., Wilkinson-Smith, V., Hoad, C., Costigan, C., Cox, E., Lam, C., Marciani, L., Gowland, P. and Spiller, R.C., 2014. Differential effects of FODMAPs (fermentable oligo-, di-, mono-saccharides and polyols) on small and large intestinal contents in healthy subjects shown by MRI. The American journal of gastroenterology, 109(1), p.110. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3887576/
Marsh, A., Eslick, E.M. and Eslick, G.D., 2016. Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis. European journal of nutrition, 55(3), pp.897-906. https://link.springer.com/content/pdf/10.1007/s00394-015-0922-1.pdf
Aboutibs.org. 2017.
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