Watch Out for Outdated FOMAP Lists
I should mention a quick point about lists of low FODMAPs foods, which is that any list you find on the internet might be wrong, or at the very least out-of-date. This is because the diet is still being researched and improved as I write this, so although it’s been proven to work for many people it’s still a work in progress. Each food is being individually tested in the Monash University laboratory and sometimes retested more specifically – ripe bananas were recently found to be higher in FODMAPs than unripe ones, for example.
So there’s no single, comprehensive list, and the scope of the diet can seem rather daunting. My advice is to a) stick to the lists and resources at the end of this article as they are from the leading FODMAP experts in the world and b) find a dietitian trained in the diet who can guide you through the whole process.
Working with a dietitian has three distinct advantages – it’s much safer than going it alone as you won’t worry about nutritional deficiencies, it’s much more likely to work if you’re choosing the right foods and it’s going to be far easier to stick to the diet if you’ve got a specialist giving you lots of lovely recipes and emotional support.
A Three-Stage Diet
Now, it’s vital to point out that you should not simply avoid all of the high FODMAP foods for the rest of your life – in fact, if you tried to do just that you’d be likely to end up with other problems because your body wouldn’t be getting the nutrients it needs. Instead, the FODMAP diet should be followed via three separate stages.
Stage 1: Restriction
This is where you try to cut right down on your FODMAP intake. Guidelines vary, but it’s generally recommended that this first, strict stage of the diet should be followed for between four and eight weeks while carefully monitoring symptoms for improvements.
Stage 2: Reintroduction
If there has been no improvement in your symptoms after four to eight weeks then, with advice from your dietitian, you may decide to try a different diet as FODMAPs may not be your problem.
If you have seen an improvement then stage 2 of the FODMAP diet is to gradually reintroduce the high FODMAP foods to see which particular foods cause you the most problems and measure what level of FODMAPs in your overall diet your gut can cope with.
Your dietitian will advise on the best way to undergo stage 3 – you could either start gradually with some medium-FODMAP foods, start trying high FODMAP foods straight away or start with some of your favorite foods that you’ve missed.
This may depend on how difficult or easy your symptoms have been to deal with and how mentally strong you are feeling; the safest route is to start with the lower-FODMAP foods and work your way up.
Stage 3: Personalisation
This is an ongoing process where you use the information gathered in stage 2 and continue to refine your eating habits to find the very best diet for you. This diet may not completely eliminate your symptoms, but it should hopefully give you much more control over the IBS while also making sure that you’re not avoiding any foods unnecessarily.
This stage is vital because you need to balance the sensitivities of your IBS with your body’s nutritional needs. Any diet low in dairy could lead to a lack of calcium which is important for the health of bones and teeth. Vitamin b12 may also be lacking.
It’s also important because there’s some evidence that the diet can affect the balance of good and bad bacteria in the gut, what’s known as the “microbiome.” You may have heard of good bugs like bifidobacteria because they’re often found in probiotics, and they’re vital for a properly working gut.
A few studies have shown that a very low FODMAP diet may reduce the number of good bacteria inside the gut which is not ideal. It’s much better to find your tolerance level and search for the foods that particularly upset you as an individual than following a needlessly strict regime.
Finding A Dietitian
Your doctor or gastroenterologist may refer you to a dietitian, but if you’d prefer to find one yourself make sure you look for a registered dietitian (RD) or registered dietitian/nutritionist (RDN), not someone who just uses the term “nutritionist." This is because anyone using the title dietitian is required to be registered with a professional body and will need to be professionally qualified.
However, in many states pretty much anyone can call themselves a “nutritionist,” so it doesn’t tell you anything about their credentials – they might not have any formal training at all.
You can use the Academy of Nutrition and Dietetics “Find an expert” service to search for help near you, either by zip code or by area of expertise (click on “digestive disorders” to see the IBS specialists). A list of FODMAP dietitians is also available on the IBS Free website.
Quick FODMAP Tips
If you’ve decided to give the low FODMAP lifestyle a try then here are a few hints and tips to get you started.
- Don’t change everything at once. When you start the FODMAP diet for IBS, it may feel counter-productive to keep taking your medications or supplements – after all, you want to know whether this diet helps you, not the drugs. But if you make too many changes at once, you won’t have a clue which one is helping you – plus you won’t know which change to cut out immediately if your symptoms get worse.
- Keep an open mind if your symptoms improve. It may be that you are sensitive to FODMAPs, but it could be another aspect of the diet, too. For example, you could have been sensitive to gluten instead, or maybe a diet lower in fiber has helped calm your diarrhea. Work with your dietitian here to identify what’s going on.
- Remember to monitor anything you eat and drink in the first stage of the diet. It’s easy to forget that anything we swallow could contain FODMAPs, but plenty of cough syrups and liquid painkillers have sorbitol in, and diet sodas are only low calorie because they are stuffed full of artificial sweeteners.