The Low FODMAP Diet 101 (what you should know)

If you’ve been hanging around with me for a little while now, either through my blog, email letters, or over on social media, you may have noticed I’ve been dropping the F-word quite a bit.

No, not that F-word. (I’m much classier than that ;))

I’m talking about FODMAPs.

Don’t worry…if you’re not sure what that word means you’re most definitely not alone.

In this post I’m giving you a brief overview of the Low FODMAP Diet, what exactly it is and how it works, and what you should know before you begin one.

But first…

What the heck is a FODMAP?

FODMAP is actually an acronym for a group of short-chained carbohydrates (certain sugars and fibres) that are poorly digested and absorbed in the small intestine, and as a result, lead to unpleasant digestive symptoms in some individuals who have a sensitive gut – typically associated with Irritable Bowel Syndrome (IBS) and other gut-related conditions, such as Small Intestinal Overgrowth (SIBO).

These poorly absorbed FODMAPS travel to the colon largely intact where they become food for the microbes (healthy or otherwise) that naturally reside there. As a by-product of this “break-down” or fermentation process, these microbes produce gases that can contribute to bloating, abdominal distension, pain, and cramping.

Furthermore, these undigested FODMAPs also have an osmotic effect, meaning they draw water into the intestines – which can contribute to further bloating and distention. And if you’re somebody who already has fast motility to begin with, this can equate to loose stools and diarrhea.

Overall, this lovely little combo of gas and water can lead to altered and unpredictable bowel motility – both constipation and loose stools.

Enter…

The Low FODMAP Diet as a Tool for IBS Sufferers

The Low FODMAP diet is a dietary regimen that was designed by researchers at Monash University in Australia to help minimize the GI (Gastrointestinal) symptoms associated with IBS.

Research has shown that up to 75% of IBS sufferers experience relief when following a low FODMAP diet.

With up to 15% of the world population suffering from this functional gut disorder and its associated symptoms of bloating, abdominal pain, distension, excess gas, and altered bowel motility (constipation and/or diarrhea), the ramifications of these findings is quite significant.

Although each person’s experience of IBS can greatly differ within the known range of symptoms, for many people it’s a debilitating condition that can severely affect their quality of life.

 

FODMAP stands for:

Fermentable (carbohydrates easily broken down by gut bacteria)

Oligosaccharides (Fructans and Galacto-oligosacchardies aka GOS)

Disaccharides (Lactose)

Monosaccharides (excess fructose)

And

Polyols (sugar alcohols such as sorbitol and mannitol)

As you can see it’s quite a mouthful, so let’s just stick with the acronym, shall we?

 

High FODMAP Foods

Here’s a brief sampling of some high FODMAP foods by their respective categories. It’s important to note that foods can contain more than one group of FODMAPs.

Fructans: wheat, barley, rye, onions, garlic, nectarines, dried figs, inulin (added to many packaged goods)

GOS: legumes, cashews, pistachios

Lactose: milk, yogurt, cottage cheese, ice cream

Excess Fructose: apples, pears, mangos, asparagus, honey, agave nectar, high-fructose corn syrup

Polyols: apples, apricots, blackberries, mushrooms, cauliflower, snow peas, sweeteners like xylitol, sorbitol, and mannitol

 

Low FODMAP Foods

This is by no means a complete list, but some of the foods considered to be low FODMAP include:

Grapes, oranges, blueberries, strawberries, bell peppers, bok choy, carrots, eggplant, most leafy greens, cucumbers, brown and white rice, quinoa, polenta, almond milk, goat cheese, feta, cheddar, lactose-free yogurt, chia seeds, hazelnuts, pumpkin seeds, walnuts, beef, chicken, eggs, fish, firm tofu, tempeh, butter, olive oil, coconut oil, apple cider vinegar, soy sauce, peanut butter, maple syrup, dark chocolate, stevia (w/out inulin, FOS, or chicory root), most spices (except onion and garlic powder), black, green, and white tea, peppermint tea, coffee.

Keep in mind that FODMAPs are a type of carbohydrate, so if the food contains no carbohydrates, such as the case with many animal proteins and pure fats (i.e. oils), it’s safe to assume that it wouldn’t contain any naturally occurring FODMAPs.

 

Size Matters (BIG TIME)

When following this diet it’s not enough to just eat from a list of low FODMAP foods and avoid lists of high FODMAP foods, because in many cases the portion size matters.

Some foods that are considered low FODMAP can quickly become high FODMAP when eaten in larger quantities, just as some foods that are considered high FODMAP can be considered low FODMAP (and enjoyed) in a smaller portion size (i.e. 1 tbsp. vs ½ a cup).

A great reference guide for portion sizes is the Monash University Low FODMAP Diet app that can be downloaded to your smartphone. I highly recommend it as it’s continually being updated with the latest FODMAP research. (see resources below).

 

How the Diet Works (3 Stages)

1) Elimination Phase. For 2 – 6 weeks all high FODMAP foods are restricted. The point of the elimination period is to get GI symptoms under control and to assess whether or not these foods might be contributing to your symptoms.

2) Reintroduction/Re-challenge Phase. Each group and subgroup of high FODMAP foods are methodically tested one at a time and in varying portion sizes to see which ones might be potential culprits. You may discover that you can handle a small serving size of some foods, but a larger quantity triggers symptoms. And it’s not uncommon to find that only 1 or 2 categories of FODMAPs are problematic for you.

3) Personalization Phase. Based on your findings you can customize your diet to your unique needs and preferences. Once you know which foods trigger your symptoms, you can continue to either limit them or modify the portion size to suit yourself. Since FODMAPs have a cumulative effect, you may be able to eat small amounts of your “trigger foods” as long as your total overall FODMAP load is low.

 

What You Should Know Before You Begin

Before jumping into the diet here are some important considerations to be aware of:

It’s a Temporary Diet. After you complete the Elimination phase of the diet, the goal is to only avoid (or reduce) those foods that trigger your symptoms while adding back in all of the others foods that don’t and that you enjoy. It’s not about eliminating all high FODMAP foods forever.

Don’t Equate FODMAPs with Unhealthy. As you likely noticed from the food lists above, many foods high in FODMAPS are actually quite nutritious and considered part of a sustainable healthy diet. Remember, the idea is to find out which foods trigger your symptoms (and in what quantities) and then introduce them back into your diet in a way that you can enjoy them without suffering and having to police every bite.

(Of course there are some that you can ditch for good if you please. I’m *looking* at you high-fructose corn syrup.)

It’s One Piece of the Digestive Health Puzzle. While some people experience a significant reduction in their symptoms when following this diet, there may still be other factors that need to be considered alongside a low FODMAP diet such as overall diet quality, eating behaviours, hydration, stress, intestinal infections, and other potential non-FODMAP food sensitivities.

It’s NOT the First Place to Start. As you’ve likely gathered by now, this diet can be quite restrictive. While a little sacrifice upfront in the short-term can mean long-term freedom and empowerment if you can pinpoint food culprits, there are still many other factors that should be addressed first (i.e. diet, eating habits) that can potentially provide a significant relief in symptoms without having to be so restrictive from the get-go.

Seek Guidance. If you’re seriously considering following this diet fully (as in ALL in), at the very least download the Monash University app as mentioned above. Better yet though, consider working with a Certified Nutritionist or natural health practitioner who is well-versed with this diet and can guide you through each phase while keeping you accountable. 

 

Final Thoughts: Is a Low FODMAP Diet Right for You?

If you suffer from IBS, or another functional gut disorder, and the associated symptoms of abdominal pain, constipation, diarrhea/loose stools, bloating, and/or distention, then it’s definitely worth considering. Although to reiterate the point mentioned above under the list of considerations, it’s definitely not the first place to start.

It also goes without saying that it’s always important to see your medical practitioner first to rule out more serious GI diseases (i.e. Celiac Disease, Inflammatory Bowel Disease) and some gynecological conditions, which can have similar symptoms to IBS.

With that said, individuals with Inflammatory Bowel Disease (i.e. Crohn’s) or Celiac Disease can have IBS-like symptoms occur at the same time, so in conjunction with the standard treatments for these conditions (i.e. a gluten-free diet for Celiac Disease), a low FODMAP diet may provide further relief.

 

Sources/Resources

Monash Low FODMAP Diet app: https://www.monash.edu/medicine/ccs/gastroenterology/fodmap/education/iphone-app

https://aboutibs.org/facts-about-ibs

http://fodmapmonash.blogspot.ca/

 

The 3 Steps to an Effective Elimination Diet (and do you even need to do one?)

These days it seems almost the norm to be eating a “free from” something diet, whether it be dairy, gluten, sugar, or something else.

It seems everywhere you turn someone is promoting their detox program or sugar-free challenge, and while these types of programs definitely have a place, this isn’t quite what I’m talking about here today.

Don’t get me wrong, giving your body a break from less than ideal foods is a great step for igniting new healthy eating habits and patterns, and helps us develop a greater awareness of our food choices – not to mention the side benefits of perhaps feeling lighter, more energized, more clear-headed, and just overall healthier.

Here I’m referring to an Elimination Diet as a therapeutic tool to help you uncover specific food culprits or sensitivities that might be contributing to unpleasant symptoms such as bloating, digestive upset, constipation, loose stools, cramps, IBS, skin problems, and any other imaginable symptom you may be experiencing.

When it comes to food sensitivities it can sometimes be challenging pinpointing exactly what’s causing the issue, because unlike an allergic reaction where the effect is often immediate, sensitivity symptoms can take a bit longer to show up as the culprit travels through the full length of your digestive tract, and only when it reaches a certain point may symptoms appear. This can be highly dependent on your transit time as well, aka how long it takes for food to travel through your digestive tract from chewing it all the way to eliminating it.

An Elimination Diet, in the sense I’m talking about here, is:

  • An opportunity to gather information about foods that might be triggering your symptoms.
  • Short-term: generally anywhere from 2 to 6 weeks depending on the symptoms and the food being eliminated (but it can be shorter or longer).
  • A period to alleviate symptoms and determine food triggers.
  • 3 Steps (discussed in detail below), including a Reintroduction phase and a Personalization Phase, in addition to the Elimination Phase.

But first…

Do You Even Need to Do an Elimination Diet?

It can be really easy to get overly rigid and dogmatic around the idea of elimination diets, and some people take the whole concept a little bit too far.

In fact, just the idea of going on an elimination diet can lead to obsessive thinking about food and feelings of deprivation in some people.

When I work with the women in my programs, the last thing I want to do is impose unnecessary restrictions on their diet. In fact, I want them to be able to enjoy the most varied diet possible while simultaneously being free of nagging and uncomfortable symptoms.

That’s the sweet spot!

But getting to that intersection may require a little short-term restriction in the form of “investigative work” to get to freedom over the long-term.

The good news?

When it comes to food it’s rarely ever so black and white, unless you have a severe food intolerance (i.e. gluten in the case of Celiac Disease) or a severe food allergy that cause reactions in even minute amounts.

What’s Your Starting Point?

For many people, including many of the women that I work with, doing an elimination diet is NOT the first line of defense.

In fact, there are a lot of other changes that can often be made first with respect to diet and eating patterns/habits before taking that route.

For example, when working with women who suffer with IBS, I can help them upgrade their diet significantly and get relief from symptoms without having to go on a full Low-FODMAP diet (which can be quite restrictive).

For many people, it’s a question of quantity and/or quality of the food being eaten.

This can be summarized perfectly by the Bucket Analogy.

For example, if somebody who eats a lot of foods made from wheat (i.e. flour products, bread, cereals) rather than eliminate wheat entirely I may recommend higher quality products such as those made from sourdough or sprouted grain (or even wheat-free options) which can be easier to digest.

Or in the case of somebody who consumes a lot of milk and milk products – perhaps it’s giving up drinking milk as a beverage and instead focusing on quality dairy products like organic kefir, unsweetened yogurt, goat’s cheese, and butter in tolerable amounts.

Believe it or not, some people may even benefit with an elimination period of eliminating foods in general (wrap your head around that one!) because it’s cause for crazy-making and can lead to disordered eating behaviours and obsessive thoughts around food, interfering with other aspects of their life. Obviously this is very individual, but worth mentioning.

Types of Elimination Diets

You might give up one or more of the following, depending on your specific symptoms:

– Foods High in FODMAPs (certain short-chained carbohydrates that are poorly digested/absorbed in the small intestine contributing to IBS symptoms in some people)

– Gluten

– Sugar

– Dairy (Lactose)

– Nightshade Family

– Allergenic Foods (i.e. Seafood, Eggs, Wheat, Cow’s Milk, Soy)

– Gastric Irritants (Coffee, Alcohol)

– Processed Foods/Refined Sugar

Note: The last category is difficult to re-challenge because it can encompass any and all different types of foods. If you eat a lot of wheat, sugar, and dairy, particularly in their processed-form, you’re likely going to notice a significant difference in how you feel if you were to give all of these things up for a period of time – obviously a good enough reason to do it but you won’t necessarily be able to pinpoint the exact culprit (if there’s even one).

It many cases it really is just a question of quantity. The Bucket Analogy (mentioned earlier) is the perfect example of this – when your bucket becomes too full, your symptoms spill out all over place. Lighten your overall load and they start to disappear.

3 Steps to an Effective Elimination Diet

#1 Elimination Phase – After choosing what you’re going to eliminate, you refrain from consuming that food for a set period of time. I usually recommend a period of 2 -6 weeks depending on the food/substance.

Usually we know if there are certain foods or substances that we overconsume in our diets, and we may even suspect a certain food (or food type) is contributing to our symptoms. This is usually a good place to start.

#2 Re-introduction/Re-challenge Phase – This phase can actually be harder than the first step because it requires a bit of strategy. The more foods (or categories of foods) that you gave up, the longer this period will take.

The key here is to be systematic and methodical in your reintroduction.

If you give up a bunch of foods for 30 days and feel great afterwards, but then start reintroducing them all at once, you won’t know which one(s) was causing the issue for you.

You want to test one eliminated food (or family of food) at a time and in varying amounts over a few days to see if you notice any symptoms.

Sidenote: The Low-FODMAP diet is bit trickier in this regard, and I recommend working with a nutritionist who is experienced in this area. Keep in mind though that it’s often not the first place to start for most people.

#3 Personalization Phase  Based on your findings you can customize your diet to your unique needs and preferences. Once you know which foods trigger your symptoms, you can continue to either limit them or modify the portion size to suit yourself. Since food sensitivities usually have a cumulative effect, you may be able to eat small amounts of your “trigger foods” as long as your total overall load is low (i.e. refer back to the Bucket Analogy).

There you have it!

Have any questions?

Put them in the comments below and I’ll do my best to answer them!