"Are you ready to fall back into love with your food frenemy?"
A word of caution:
The following post roughly explains how the Low FODMAP diet works. If you have been diagnosed with IBS I encourage you to work with your gastroenterologist and/or registered dietitian and try the Low FODMAP diet. If you have not been diagnosed with IBS, but suspect you are suffering from it please see your doctor or gastroenterologist. Many serious illnesses such as colon cancer, chrons and celiac disease begin with IBS-like symptoms.
The Low Fodmap diet was developed by Monash University back in 2005. It is the most recognized and effective therapy for IBS to date. Recent scientific studies have shown that thanks to the diet, symptoms can be reduced by up to 70% in people suffering from IBS. If you haven't done so already, please read up on what FODMAPs are and why FODMAPs trigger IBS symptoms so that you know what the Low FODMAP diet is aiming at.
The Low FODMAP diet is a short-term dietary program, the aim of which is to help test common dietary triggers. Since these are different for everyone, understanding your personal IBS symptom triggers enable you to follow a less restrictive and more nutritionally balanced diet in the long run. In short: Once you know which foods don't agree with you and you only have to restrict those. Following the low FODMAP diet also aims at figuring out whether your IBS is caused by FODMAPS or not. Not everyone wit IBS improves on the low FODMAP diet and it's important to understand whether you are among the 1/4 of IBS sufferers who do not experience symptom improvement and thus need other IBS therapies.
The low FODMAP diet step-by-step
The low FODMAP diet is a 3-phase approach that consists of the Elimination phase, the Challenge/Reintroduction phase and the Personalisation phase. Whist on the diet, I recommend you keep a diary of what you eat and how and when it comes out fo your body and how you feel symptom-wise. This will not only help you describe your symptoms in connection to the foods you eat better but also help you see connections. What's more important, it helps your dietitian or gastroenterologist understand your symptoms and give both of you a better picture of your baseline symptoms. This information is particularly important once you enter into the second phase of the diet.
Step One: Eliminate
When someone is talking about the Low FODMAP diet they are often referring to this first phase. But keep in mind, the diet is, in fact, a whole system. In this first phase, all high FODMAP trigger foods are removed from your diet for about 2 to 6 weeks. It is important that you strictly follow the diet at this point. Yes, it's not fun to restrict yourself this much. But believe me, after you have most probably experienced much pain from the symptoms for a long time, giving up on some foods for such a brief period of time is setting you up for a mostly pain-free future. By restricting the trigger foods, your digestive organs are finally allowed to relax and recover. But best of all, your IBS symptoms reduce! For most people, the change the diet brings is quite immediate and the relief from years of suffering might come as fast as a few days into the diet or about after a week.
During this first phase, it is also important to consider external triggers for IBS symptoms such as stress, sleep quality and other health concerns. Try to minimize these triggers as much as possible so that your body is allowed to rest and find its new "normal".
For this first phase, I find it best to work with a dietitian or gastroenterologist who can help you navigate the diet, your response to it and can help determine whether you have any co-occurring or underlying issues such as SIBO or other food allergies.
Step Two: Challenge and Reintroduction
During the second phase of the low FODMAP diet, it is time to systematically reintroduce moderate and high FODMAP foods back into your diet. In this phase, you challenge your digestive system by testing how you react to the various FODMAP groups, one at a time. So while you are following the elimination diet of phase one, you start adding one test food of one FODMAP group into your daily diet and increase the amount over 3 days. Once this is completed, you return to the base diet for a few days until eventual IBS symptoms subside so that you can start testing the next FODMAP group with a clean slate. Should a food trigger IBS symptoms you can try it again about 6 months later and see how you react then. This is what is the reintroduction part of this second phase.
Throughout this second phase which can take anywhere from about 6 weeks up to two months, it is important that you document your digestive reactions to the "challenge" foods. This will help you discover what FODMAP groups trigger your IBS symptoms and which foods do so in particular. The goal is to lay down the basics for your very personal tolerance level roadmap so that you can eat as broadly as possible without triggering painful IBS symptoms.
The amazing and very encouraging thing about this phase is that you learn so much about your body that you didn't know and no doctor could ever tell you. Not only do you learn about what you can tolerate but you also find out that even though some foods might trigger symptoms in certain amounts, they don't do so in smaller amounts. This knowledge is very empowering as it enables you to control your IBS symptoms whilst enjoying as many foods as possible. This is the moment you will start falling back in love with food.
Step Three: Personalisation
After the first two phases of the low FODMAP diet, it's on to the rest of your life. The aim is to now relax dietary restrictions so that you can include as many foods as possible in your daily diet. What you end up with is your very personal long-term FODMAP diet. FODMAP foods that you tolerated well in phase two now become the basis of your diet whilst poorly tolerated foods and FODMAPS are restricted to the level that they will not trigger symptoms. Key in this phase is that you don't only stick to the well-tolerated foods but keep re-introducing foods you didn't tolerate well, in order to see if there are portion sizes you can tolerate. In this way, you are able to eat as balanced a diet as possible whilst controlling IBS symptoms.
There will be foods that you simply can't tolerate but I recommend you still keep trying them out from time to time to see if your tolerance changes. As for the rest, it's now time to make the most of your new personalised diet and integrate it into your daily life as it fits you best. And most of all, it's time to savor your new-found freedom to enjoy food without the painful consequences.
As many IBS sufferers who are navigating life on the personalised low FODMAP diet have experienced, dietary needs can change over time. This means your sensitivity to FODMAPS can change as you grow older. This means that over time you might be able to add items you didn't tolerate back into your diet.
On the downside, you might also experience times when your personalised diet just isn't working anymore. This might be due to changed tolerance levels, your deviation from the initially established tolerance portion sizes or external factors such as stress, lack of sleep, health issues, etc. When this happens make sure to check your portion size is accurate and that you didn't fall into the trap of FODMAP stacking. Also, check the labels of foods that you eat regularly because companies frequently change ingredients without communicating it. Moreover, you absolutely need to deal with external stress factors such as your daily workload, sleep, physical health and anything else that might have changed since you started out on the low FODMAP diet. Find some "me-time" and build physical activity into your weekly schedule.
If all of these measures don't help and you can't find out what is wrong with your digestion, go back to phase one and stick to the elimination diet until your symptoms calm down. Then go through phase two to phase three again to figure out where changes in your tolerance levels have occurred. Should you find that going back on the elimination diet does not lead to symptom relief, go see a doctor as there might be an underlying health issue that mimics IBS symptoms.
For an extensive list of high fodmap foods to avoid or limit in this phase (red and orange foods) refer to the Monash University FODMAP Diet App and the FODMAP Friendly App. Apart from the guidance of your dietitian, these are by far the most helpful tools when navigating the low FODMAP diet.
A great resource for everything FODMAP related is the Monash FODMAP blog and RDN and IBS expert Kate Scarlata's blog "A Digestive Peace of Mind".
Also check out alittlebityummy.com and fodmapeveryday.com for incredible amounts of resources and recipes to get you started.
There are so many more great blogs and websites around the FODMAP diet out there. Just search yourself through the vastness of the internet and you will meet so many incredible IBS conquerers who share their experience with the world!
Gibson PR (2017) Evidence for the low FODMAP diet in IBS. Elsevier
Halmos, E.P. et al.: A diet low in FODMAPs reduces symptoms of irritable bowel syndrome.
Various articles of Monash University, https://www.monashfodmap.com/ibs-central/i-have-ibs/starting-the-low-fodmap-diet/.