What is the low FODMAP diet and how can it help people with gut issues?

For sufferers of irritable bowel syndrome (IBS), the low FODMAP diet has been recognised as a way to alleviate and manage digestive symptoms.

And with one in seven people – 15 per cent of the world’s population – affected by IBS, the low FODMAP diet can be a saviour.

But what exactly are FODMAPs? They are a collection of short-chain carbohydrates (sugars) that the gut can’t properly absorb and trigger symptoms in people with IBS, such as abdominal pain, bloating, flatulence, irregular bowel movements and fatigue.

FODMAPs, which is an acronym of Fermentable, Oligosaccharides, Disaccharides, Monosaccharides and Polyols, are naturally present in many foods and food additives.

It is now widely recognised that the best way to alleviate IBS symptoms is to avoid foods that contain FODMAPs, and modern technology is helping those affected to navigate what they eat with ease.

Researchers at Monash University have developed the FODMAP Diet app which allows users to search for a range of foods that can be identified as IBS triggers.

The app lists food items by a traffic light system and by serving sizes: red foods are high in FODMAPs and should be avoided; orange foods are moderate in FODMAPs and may be tolerated by some people; and green foods are low in FODMAPs and safe for consumption.

Dr Jane Muir, a nutrition researcher who leads the FODMAP team at Monash University, said the low FODMAP diet is “not a quick fix or fad diet”.

“It is a therapeutic diet to help people who suffer from gastrointestinal symptoms associated with a common gastrointestinal disorder called IBS,” she said.

Dr Muir also said the low FODMAP diet is not a diet for life, but rather best described as “a learning diet” and broken up into three key steps.

The first step involves following a low FODMAP diet for 2-6 weeks, where high FODMAP foods are swapped for low FODMAP alternatives. The second step is a ‘reintroduction’ phase over the course of 6-8 weeks where one FODMAP sugar at a time is reintroduced into the diet, allowing you to recognise which FODMAPs trigger symptoms. Step three involves personalising your diet, where you can expand your diet to include FODMAPs that are well tolerated and limit the FODMAPS that you do not tolerate well.

Dr Muir said a dietitian plays an important role in the implementation of the FODMAP diet.

“A dietitian will make sure that your diet is nutritionally adequate while following the FODMAP program. They will check for any problems that may require you to be referred back to your GP. They will also help determine how strict the diet needs to be; it is not a one-size-fits-all diet,” she said.

The importance of accurate diagnosis

Joanna Baker, an accredited practising dietitian and founder of Everyday Nutrition, said while the low FODMAP diet is typically suitable for people with IBS symptoms, it is important to see a doctor first and get screened for the symptoms.

“IBS type symptoms… are not dangerous and management is purely about getting symptoms settled and improving quality of life. However, these abdominal symptoms can also be triggered by more sinister medical conditions like coeliac disease, IBD or even cancers. Since these conditions do cause serious health complications and have specific medical or dietary treatments, it’s imperative for people to see their doctor first,” she said.

The next step would be to see a dietitian who can address dietary changes that can help with managing the symptoms, Ms Baker said.

“When I see someone, I am looking at the types of symptoms they get, what they have tried successfully or unsuccessfully in the past, the foods that they are currently eating, the foods they suspect are problematic for them and their medical history. It’s really a combination of all of these aspects that I use to determine if a low FODMAP diet is the right approach.”

When navigating a low FODMAP diet or managing a long-term dietary requirement, it can be easy for others to have the misconception that you are being a ‘fussy eater’. To overcome this, Ms Baker said it helps to talk about it openly to family and friends.

“I think it’s good to have an elevator speech ready to go. It needs to be short, brief and to the point. Something like: ‘My doctor has put me on a special diet to see if it helps with my gut symptoms. Right now, it seems to be working really well and I’m making a lot of progress’. I think once you say that your doctor has recommended it, it makes a big difference,” she said.

‘I can enjoy my favourite foods again’

Jennifer Graham first went on a low FODMAP diet in January 2016 after travelling in Vietnam and becoming ill.

When she returned to Australia, doctors concluded she had a parasite and was put on a strong course of medication. Unfortunately, this made her symptoms worse and leaving the house became difficult.

“It seemed that the only foods I could stomach were rice and plain chicken broth. Food had become my enemy. I lost over 15kgs and had too many tests to count before the doctors finally diagnosed it as IBS,” she said.

“It was recommended that I try the low FODMAP diet, alongside my other treatments, to help relieve my symptoms.”

Once her symptoms were better managed, Ms Graham slowly reintroduced some moderate and high FODMAP foods back into her diet.

“This stage of the diet is really important to be able to identify your own personal food triggers. For example, I know I definitely have to stay away from garlic, onion and honey but I can have generous serves of wheat bread and avocado (which become high FODMAP at a certain serving size). This has made it easier to be able to enjoy my favourite foods again and eat out without feeling ill,” she said.

Ms Graham has used several tools to guide her low FODMAP journey. She consulted with a dietitian, used FODMAP-friendly apps and found support in social media groups where she connects with other ‘fodmappers’.

She also started a blog called Fussy Fodmapper where she shares low FODMAP shops, dining venues, products and recipes.

For Ms Graham, going on a low FODMAP diet has been life-changing.

“The best outcome of doing a low FODMAP diet is that I can leave the house again. In the beginning, I was too anxious to go anywhere in case I needed the toilet in a hurry. Now I feel much more comfortable in living my life again.”

For more information on symptoms of IBS, such as stomach gurgling noises, check out this resource by the Centre for Gastrointestinal Health.