Why a low FODMAP diet won't FIX your IBS
If you have IBS, there's a good chance you've become a little scared of food.
Onions make you bloat, so you stop eating onions. Garlic gives you pain, so that's out too. Apples seem to set your stomach off. Before you know it, the list of foods you feel safe eating is getting smaller and smaller.
I see this all the time in my clinic.
Before you know it, the list of foods you feel safe eating is getting smaller and smaller.
Many of my IBS clients come to me having restricted their diets considerably. Some have tried a low-FODMAP diet, found that it helped their symptoms and then become stuck in the elimination phase because they're frightened to reintroduce the foods they've removed.
Others arrive with the results of a commercial food intolerance test telling them that they react to 20, 30 or even 50+ foods, and have unnecessarily removed perfectly nutritious foods as a result.
It's completely understandable. If removing a food makes you feel better, why would you want to put it back in?
But there's a question I always ask: is the problem really the onion, apple or garlic? Or should we be asking WHY your gut is struggling to tolerate those foods in the first place?
Does a low-FODMAP diet help IBS?
Yes, it can.
There is good evidence that a low-FODMAP diet can reduce symptoms such as bloating, abdominal pain and altered bowel habits in some people with IBS.
And sometimes I use FODMAP restriction with my own clients. If you're highly symptomatic and certain foods are clearly making things worse, temporarily reducing them can be a useful way of getting symptoms under better control while we look at the bigger picture.
But here's the important distinction:
Managing your symptoms isn't necessarily the same as understanding what's contributing to them.
If you've discovered that eating onion leaves you painfully bloated, avoiding onion may stop the immediate symptom.
But it doesn't necessarily tell us why you're struggling to tolerate it.
And that's the bit I'm interested in.
How long should you follow a low-FODMAP diet?
A strict low-FODMAP diet isn't intended to be followed indefinitely.
The approach developed by Monash University has three stages: restriction, reintroduction and personalisation. The initial restrictive phase is generally followed for around 2-6 weeks before FODMAP-containing foods are systematically reintroduced to establish individual tolerance.
The long-term goal is not to avoid every high-FODMAP food. It's to achieve the least restrictive diet you can tolerate while maintaining symptom control.
Yet this is where I often see people getting stuck.
Their symptoms improve when they remove certain foods, so understandably they're scared to put them back in.
Months, or sometimes years later, they're still following an unnecessarily restrictive diet.
What happens if you stay on a low-FODMAP diet for too long?
Here's another reason this matters.
Many of the foods people remove on a low-FODMAP diet are foods we'd normally consider incredibly nutritious.
Onions. Garlic. Apples. Legumes. Certain wholegrains. Various fruits and vegetables.
Many of these foods also have prebiotic effects, providing fuel for beneficial bacteria living in the gut.
Research has found that low-FODMAP diets can reduce levels of bacteria such as Bifidobacteria, an important group of beneficial gut bacteria. That doesn't mean following a low-FODMAP diet for a few weeks will “damage your microbiome”, but it does give us another reason not to stay on a highly restrictive version of the diet unnecessarily.
The aim isn't to become brilliant at avoiding FODMAPs.
My aim? To help you ultimately get MORE foods back onto your plate.
What about food intolerance tests for IBS?
This is another route by which I see people ending up with extremely restricted diets.
Commercial food intolerance tests can produce alarming lists of foods that you're supposedly “intolerant” to. In particular, food-specific IgG testing isn't considered a reliable way of diagnosing food intolerance.
Removing dozens of foods based on one of these tests can therefore leave someone unnecessarily frightened of foods that may not be causing their symptoms at all.
That's very different from establishing through a properly structured elimination and reintroduction that a particular food repeatedly triggers symptoms.
If food isn't the whole problem, what else could be contributing to your IBS?
This is where I look beyond individual trigger foods with my clients.
Of course, what you're eating matters. I'll look at the overall quality and variety of your diet, your fibre intake and whether particular foods or eating patterns could be exacerbating your symptoms.
But I'll also look at things such as:
How your digestive system is functioning: constipation, diarrhoea, motility, bloating, reflux and other symptoms can all give us useful information.
Your gut microbiome: what's living in your gut and whether there are factors that may be affecting that ecosystem.
Your medical history: previous gastrointestinal infections or food poisoning, travel, medications and when your symptoms actually began.
Your lifestyle: stress, sleep, movement and other factors can all influence digestive symptoms.
Your life stage: hormones, menstrual changes, perimenopause and age can matter too.
In my practice, I often consider further investigations including comprehensive stool testing which provides useful additional information.
When it comes to managing IBS, the aim is to dig deeper and understand what may be driving your symptoms, rather than continually asking:
"What food should I remove next?"
So, can a low-FODMAP diet fix IBS?
A low-FODMAP diet can be a really useful tool for managing IBS symptoms.
But if you've been stuck on a restrictive diet for months or years, your list of “safe” foods keeps shrinking and you're frightened to reintroduce foods, I think it's time to change the question.
Instead of asking: “What else should I cut out?”
Start asking: “Why is my gut struggling with these foods, and what else could be contributing to my symptoms?”
Because for me, successful gut-health work shouldn't end with an ever-growing list of foods you can't eat.
The goal of working on your gut health should be to expand your diet, not make it smaller.
Struggling with IBS despite changing your diet?
If you're dealing with bloating, abdominal pain, constipation, diarrhoea or food-triggered digestive symptoms and feel like you've tried cutting out everything, I offer a free 30-minute consultation.
We can talk through what's been going on, what you've already tried and whether nutritional therapy could be the right next step for you.
Hi, I'm EmmaI'm Emma Mukasa, a BANT and CNHC Registered Nutritional Therapist and Health Coach specialising in gut health and IBS. I work with clients who are tired of managing their digestive symptoms by continually cutting out more foods. My approach looks beyond individual food triggers to understand the wider factors that may be contributing to your symptoms, with the ultimate aim of helping you eat a more varied diet, not a more restricted one. Ready to talk? Book a FREE 30-minute consultation. |
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