If you’ve ever wondered what is a Low Fodmap Diet, let me share how it first entered my sphere. Several years ago my oldest daughter, Isabelle, appeared at my bedside late at night, doubled over with abdominal pain. She’s a tough kid with a high pain threshold, so intuition told me to listen to her tears. I took her to the ER, where they were able to rule out appendicitis, but not shed any light on the cause of her belly ache. In the wake of that experience, I brought her to a pediatric GI specialist who prescribed a Low FODMAP Diet. She spent six weeks on the diet and just as her doctor had predicted (and I had hoped), her symptoms dissipated.
From talking to friends and colleagues, I know my daughter is not alone in her GI discomfort, commonly referred to as Irritable Bowel Syndrome. And while plenty of trendy diets get loads of air time, the low FODMAP diet is backed by science, yet seems to fly under the radar.
So, with that in mind, I reached out to registered dietitian nutritionist and FODMAPs expert, EA Stewart, who kindly took the time to answer my questions about the low FODMAP Diet:
1. What is a Low FODMAP Diet?
A low FODMAP diet temporarily eliminates certain foods that are high in FODMAPs {Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols}, that can contribute to painful IBS symptoms. That’s quite a mouthful, right?
In a nutshell, FODMAPs are short chain carbohydrates {oligosaccharides, fructose, lactose} and sugar alcohols {polyols} that are poorly digested, and may lead to IBS symptoms including gas, bloating, constipation, and diarrhea. It has been shown to provide relief from IBS symptoms in up to 75% of people who try it. Some foods that are high in FODMAPS include milk & yogurt {lactose}; apples and pears {fructose & polyols}; honey {fructose}, wheat, garlic, and onions {oligosaccharides}, and many more. The bad news is that, as you can see, many of these are very nutritious foods, which is why the diet is meant to be temporary. The good news is that there are still a lot of nourishing foods you can eat during the elimination phase of the low FODMAP diet including berries, most citrus fruit and melon, leafy greens, carrots, broccoli, rice, quinoa, oats, most nuts and seeds, firm tofu, and MANY more foods. Also, because FODMAPs are only found in carbohydrate containing foods, all plain meat, poultry, fish, eggs, and vegetable oils are FODMAP free.
2. How does it work to identify food intolerances?
By temporarily removing these fermentable “trigger foods” from their diets, my clients are finally able to feel good again. Without having to deal with constant gas, bloating, diarrhea, and/or constipation, they are able to “start fresh” and SLOWLY add in higher FODMAP foods, one-by-one, to see which foods they tolerate, and which ones they don’t. I find this is really individual for everyone, and most of my clients will be able to add many of the higher FODMAP foods back into their diets-they just may need to consume them in smaller portions, or make sure they don’t eat a meal containing a lot of high FODMAP foods.
3. Who is the low fodmap diet for? Is it appropriate for any age…adults and children?
In my practice I primarily work with adults on a low FODMAP diet, although I did work with one 12 year old girl who had been diagnosed with celiac. She was following the gluten free diet very carefully, but still having a lot of GI symptoms, so I suggested a low FODMAP diet trial, and it helped her a lot. I think a low FODMAP diet challenge is appropriate in children, however I strongly suggest it be done under the guidance of a dietitian who is very knowledgeable of the diet.
4. Can you talk about the different phases of the diet?
The low FODMAP diet has 2 phases-the elimination phase and the reintroduction phase. During the elimination phase, high FODMAP foods are removed from the diet, and replaced with low FODMAP foods. This phase usually lasts 2-6 weeks, and most of my clients are on this phase for at least 4 weeks. After the elimination phase, and assuming they are feeling much better on the low FODMAP diet, we start the re-introduction or challenge phase. During this phase, I have my clients try adding higher FODMAP foods back into their diet, one-by-one. It’s very important to not rush through this phase, and to try and add back in as many high FODMAP foods as possible.
5. How is it that eventually those on the diet can transition back to eating FODMAP foods
Most people are not intolerant to ALL high FODMAP categories of foods. When we reintroduce foods, I usually have my clients add in one group {i.e. lactose or fructose} at a time. By taking out all high FODMAP categories of foods at one time, I am able to get the majority of my clients feeling much better. Then, when we add in foods by category, I am able to pinpoint which category{ies} they don’t tolerate well, and which one’s they are ok with. Also, it’s much easier to pinpoint what foods are problematic/causing symptoms when you’re feeling well, vs when you’re having constant gas, bloating, constipation, and/or diarrhea. Lastly, there is a cumulative effect with FODMAPs. While someone may be fine eating 1 apple over the course of the day, they might not be ok with an apple, cauliflower, and pasta sauce with onion and garlic all in the same day.
6. What do people find most challenging about sticking to the program?
I find that the biggest hurdle when starting the low FODMAP diet, is dealing with anxiety over what to eat. While I encourage my clients to stick to the diet as closely as possible, I also reassure them that this isn’t an “all or nothing” diet. Life happens. If they slip up, there’s no need to start from day one. Also, because we are learning so much about how interconnected the brain and gut are, I focus a lot on stress and anxiety reduction during my coaching sessions. Another common challenge, is getting my client to reintroduce foods after the elimination phase. Because they are {mostly } feeling better, many of my clients are fearful of reintroducing high FODMAP foods. I find the reintroduction phase to be the most challenging, so my recommendations during this phase are 1. Take it slowly-it’s important to try reintroducing higher FODMAP foods, because many of them are nourishing and beneficial for a healthy gut microbiome. 2. “Find Your New Normal”-I tell my clients that EVERYONE experiences digestive discomfort from time-to-time. It’s not realistic to expect to be 100% symptom free. I also suggest planning a 3-day re-set meal plan for those times {i.e. vacation} when they get off track with their diets-follow a 3 day low FODMAP diet that you know you feel good on, before trying to add in higher FODMAP foods again.
7. Do people lose weight on the diet?
Although the diet wasn’t developed to promote weight loss, some of my clients do experience this-sometimes it’s desirable, but more often, it’s not. For someone who would benefit from weight loss, I find that the low FODMAP diet can help by getting them to the point where they feel a lot better, which in turn may lead them to make better food choices, and to exercise more.
8. Can you talk about some of the results you’ve seen with clients on the FODMAP Diet?
I would say my experience has been similar to the results MONASH University has seen, with 3/4 of my clients getting good to excellent results with the Low FODMAP Diet. This is the most rewarding part of what I do, and why I truly love my job. As someone who has dealt with chronic health issues in the past, I can 100% empathize with my clients who have been from doctor-to-doctor, spending lots of time and money, and not feeling any better. I’ve had clients be able to get off medicine {Note: Never stop any medication without your physician’s approval}, be able to go back to work, and simply find a zest for life again that had been missing.
9. Where might someone go for more information/resources on the Low FODMAP Diet? (EA: you can include yourself as a resource and mention some of what you offer).
As I mentioned earlier, there’s a lot of confusion regarding the low FODMAP diet, so it’s important to work with a dietitian or qualified health care provider who has been trained in the low FODMAP diet. I offer one-on-one Low FODMAP/Digestive Health nutrition coaching both virtually, and in-person in San Diego, Low FODMAP meal plans, and have an extensive collection of Low FODMAP recipes on my website, as well as on my Low FODMAP Pinterest Board. Other professionals, and resources I highly recommend include: Monash University {website & app}, Kate Scarlata, RDN, and Patsy Catsos, RDN. For anyone who would prefer to work with a low FODMAP dietitian where they live, Kate and Patsy both have Low FODMAP dietitian referrals on their websites.
