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Update on the Low FODMAP Diet for IBS
A Three Phase Approach
The low FODMAP diet was created by researchers at Monash University in Australia in the 2000s. It is a temporary approach aimed at establishing an individual’s tolerance to different families of FODMAPs in order to control digestive symptoms without sacrificing balance and food variety. The low FODMAP diet has three phases: elimination, reintroduction, and personalization.
The first phase, which lasts two to six weeks, involves eliminating high-FODMAP foods from the diet in order to achieve a marked decrease in gastrointestinal symptoms. In the event that there is no improvement in symptoms at the end of the first phase, it is recommended to discontinue the low FODMAP diet and to try alternative approaches.
The second phase aims to reintroduce each of the FODMAP families in order to measure an individual’s tolerance. Specifically, according to Monash University’s protocol, tests are performed by increasing amounts of a food containing a single family of FODMAPs to assess whether this family triggers gastrointestinal symptoms. It is important to maintain a low FODMAP diet during this phase to avoid distorting the results of the reintroduction tests.
The third phase consists of reintegrating the tolerated foods, depending on the results obtained in the reintroduction phase. Since an individual’s tolerance can vary in the long term, it may be useful to repeat some tests in the future to re-evaluate one’s tolerance.
The low FODMAP diet has been shown to be effective in reducing the severity of gastrointestinal symptoms of IBS and improving the quality of life of people with IBS in at least 50% of cases. In the studies that have been done, despite the restrictions imposed by the low-FODMAP diet, no dietary deficiencies were observed in people with IBS who followed this diet along with personalized support from a Registered Dietitian.
The Low FODMAP Diet, Not Only for IBS
The low FODMAP diet may also sometimes be recommended for conditions other than IBS, such as for people with inflammatory bowel disease (IBD), or for athletes who have exertional digestive symptoms.
A significant proportion of people with IBD (ulcerative colitis and Crohn’s disease) have gastrointestinal symptoms, even if their disease is in remission. A few short-term studies have shown that a low FODMAP diet can help reduce digestive symptoms in people with IBD and improve their quality of life.
More than 50% of endurance athletes suffer from digestive symptoms during an endurance event such as a marathon or triathlon. During prolonged and intense exercise, the rate of digestion is reduced, which can lead to carbohydrate malabsorption. In addition, there is less oxygen available to the gastrointestinal system, which can create damage and inflammation in the intestines. A high FODMAP intake can cause symptoms during exercise in some individuals who generally tolerate these types of sugars well when at rest. A few studies have observed a significant decrease in symptoms in endurance athletes who have followed a low-FODMAP diet for a short time. In some cases, it may therefore be useful to adopt a low FODMAP diet before prolonged and intense sports activity. On the other hand, there are several other factors to consider to help limit digestive disorders during exercise. Indeed, it is important to ensure optimal hydration and train your intestines to tolerate carbohydrates during exercise.
Author
Kathryn holds a Bachelor Degree in Nutrition as well as a Bachelor and a Master Degree in Kinesiology, all from Laval University. She is a Registered Dietitian and active member of the Ordre professionnel des Diététistes Nutritionnistes du Québec (ODNQ) and of the American Academy of Nutrition and Dietetics. She holds the Monash University's certification for the FODMAP diet and IBS, and has considerable clinical experience in that area. She is also an accomplished athlete, having ran track and cross-country at a national level. Kathryn specializes in sports nutrition, weight loss, diabetes, as well as heart and gastrointestinal health.
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