1. Why follow a low FODMAP diet?
84% of studies into IBS suggest that food makes IBS symptoms worse (2). A 2013 study suggested that the most likely culprits are carbohydrates which can trigger IBS symptoms (1).
A low FODMAP diet has been seen to give relief in 75% of people who use it (2). Like all dietary interventions, it takes time before you see results. In order to really see the benefit, the FODMAP diet should be followed ideally for 2-6 weeks. No cheating, it's only 2-6 weeks.
To get the best results, treat yourself like an experiment, and track what you eat and how it makes you feel. Pen and paper work just as well as online apps.
However, a great online app to track FODMAP foods is the ‘Montash University FODMAP diet’ app.
Some FODMAP foods may only become problematic at higher quantities. This app, uses a traffic light system so you can see at what quantity a food becomes difficult for an IBS sufferer to tolerate.
This means that you don’t need to eliminate too many foods.
2. What fruit and vegetables are FODMAP foods. Low FODMAP fruit includes, bananas, mixed berries and citrus fruit, kiwi and honeydew melon. Low FODMAP vegetables include bok choy, bamboo shoots, carrots, celery, ginger, green beans, red bell peppers, spinach and tomatoes, these vegetables make good stir fry options. If you like an onion taste (without the onions ) try the green stems of leaks or spring onions. Low FODMAP root vegetables include parsnips, yellow squash, potatoes, sweet potatoes, swede, courgettes which can be enjoy ROASTED or in a SOUP. For flavour include plenty of fresh leafy herbs (4). It is very important to note that IBS symptoms may be exacerbated by including the nightshade vegetables in your diet, these include tomatoes, eggplant, potatoes and bell peppers, which can cause digestive issues, mouth tingling, rashes, hives and in some people may result in a anaphylactic reaction (3). For some people these vegetables can be better tolerated if cooked, but it is worth keeping a food diary to monitor your symptoms. When your IBS symptoms are problematic remember to COOK your vegetables. Raw vegetables including salads may be too hard for you to digested. My turning point was raw broccoli. I have posted about how beneficial broccoli is to women for oestrogen regulation, unfortunately for IBS sufferers the head of a broccoli, particularly raw, is a problem. Raw broccoli, gave me my worst attack, and it was this attack that made me change. This is a lot of information. Remember that very often low FODMAP fruit and vegetables are low carb fruit and veg, it maybe easier to start off by eating above ground vegetables and avoid the cabbage family that includes brussel sprouts, broccoli, fennel and all onions and garlic.
3. How do I remember what fruit I can eat? The easiest way, but not a perfect way… But then what is.. is to remember; High FODMAP fruits are tree fruits i.e. apples, pears, peaches, nectarine, plums, cherry, and apricots. Low FODMAP fruits are berries, citrus fruits, grapes, and honeydew melon (4). Why? Because the high FODMAP fruits contain a sugar molecule called Polyols, studies show that IBS sufferers find these fruits/sugars highly fermentable, possibly causing bloating and flatulence. Once your gut begins to heal, you may be able to tolerate high FODMAP fruit stewed, and then eventually raw. But while you work on healing your gut, avoid tree fruits. Listen to your gut and take note of symptoms, you will begin to understand what works for you.
4. Are meat, poultry and fish low FODMAP? YES… You should be able to enjoy, roasted, sautéed and stir fried, meats, poultry, fish, sea food and eggs, avoiding pre-marinated or processed meats, which may contain onions and garlic. The digestive process begins before we even eat a mouthful of food. The cooking, smelling, looking and thinking about food starts to produce the digestive enzymes we need, take your time, enjoy the process of preparing food. If you struggle with digesting meat, consider whether you are chewing these foods enough. Try and chew each mouthful 20 times, and see if this helps. If you still feel you need support, then with the help of a nutritional therapist, you may for a short period, benefit from digestive enzyme supplementation.
5. Can I eat bread? For people with IBS eating wheat based products may trigger both GI ( gut issues ) and non-GI symptoms such as hives, a runny nose, headaches, asthma, and in some cases, anaphylaxis. You may suffer with Non-Celiac Gluten Sensitivity or it could be a sensitivity to Amylase Trypsin Inhibitors, or ATIs, which is another wheat protein, that triggers symptoms such as brain fog, joint pain, and fatigue (2). For this reason during the 2-6 weeks of a low FODMAP diet it is better to remove wheat based products. Some people may suggest eating gluten-free bread is a good substitution, but I think this complicates things. For 2-6 weeks it is better and less confusing to avoid bread and gluten-free bread, but you should be able to eat rice and oats. Maybe try overnight oats for breakfast with berries and unsalted nuts, YUMM. Don’t despair, if you are a bread lover like me, it's not for ever. Once your gut has healed you may be able to tolerate small portions of sourdough bread. The natural fermentation process decreases the amount of gluten and the natural bacteria in sourdough may make it easier to digest(5).
6. What else can you do? Ask your doctor to run some test
If you are regularly suffering from stomach pain and other distressing symptoms ask your doctor for some tests. Even though 50% of people suffering from IBS do not suffer from celiac disease, it's worth checking.
Test for helicobacter pylori (H. Pylori) a bacteria that when overgrown can cause pain, nausea bloating and burping.
A nutritional therapist can organise a stool test for you, checking for an imbalance in beneficial vs non beneficial bacteria, parasites, SIBO, and H-pylori.
Alternatively, there are some supplements that may ease your symptoms and help to improve your gut health.
The one change I made that dramatically influenced my IBS journey was Kefir, specifically Chuckling Goat kefir. It is packed with beneficial bacteria, and because it is a drink you can start super slow, 1 tablespoon at a time. Goats milk is a A2 protein and can be tolerated by some people who cannot tolerate cows milk, A1. Alternatively, you can buy water kefir.
IBS is a complicated condition with many possible factor to consider. You may feel lots of benefits from trying a low FODMAP diet, but it can feel lonely and confusing when you try to resolve the issues on your own.
If you would like a complementary assessment of your diet so we can begin to put a plan in place, please book a 30 minute complementary assessment either via the website or with me directly
1. Bohn et al 2013, Am J gastroenterol:108, 634-41
2. GI Institute, IBS management: The low FODMAP diet