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Update on the Low FODMAP Diet for IBS
Other considerations
It is not recommended to follow a low FODMAP diet in the long term, as it is too restrictive. People are generally not intolerant to all families of FODMAPs. The purpose of the diet is to identify problematic foods so that all other foods can be reintroduced and unnecessary restrictions can be avoided. Some studies suggest that following a long-term low FODMAP diet can alter the gut microbiota. However, according to a recent meta-analysis of studies including 403 participants, the effects of a low FODMAP diet on the colon microbiota of people with IBS appear to be specific to bifidobacteria, with no consistent impact on other measures of microbiota health, including diversity, fecal short-chain fatty acid concentrations, and fecal pH. Nevertheless, to optimize one’s health, diet variety is essential.
Adherence to the low FODMAP diet is a major obstacle for many people. A more targeted, less restrictive approach, called the “Gentle FODMAP Approach”, is recommended for people for whom the low FODMAP diet could affect their nutritional status, such as children, the elderly, and people with an eating disorder. It consists of restricting the largest sources of FODMAPs in their diet, in a personalized way.
The Canadian and American gastroenterology associations recommend that people who want to follow the low FODMAP diet be accompanied by a Registered Dietitian specialized in gastrointestinal diseases and who are familiar with the FODMAP approach, given the complexity of this dietary approach. Too often, people obtain a list of high-FODMAP foods to avoid, but don’t know that they only need to restrict these foods temporarily and reintroduce them afterwards, or don’t know how to do the reintroduction tests. However, not everyone has access to a Registered Dietitian who specializes in the low FODMAP diet.
FODMAP Wizard
To address this, we have created a ‘FODMAP Wizard’ in the form of a mobile app, for people who need to follow the FODMAP protocol but cannot access – or cannot afford – a Registered Dietitian who has been trained in this protocol.
The Wizard guides users step-by-step through the three phases of the protocol. Each step is explained in detail through video clips recorded by expert Registered Dietitians. In addition, users have access at all times to a peer support group moderated by Registered Dietitians, where they can find reliable answers to their questions about protocol and diet. The Wizard has an adaptive algorithm that determines the quantities of reintroduction tests based on user-reported symptoms. Following the instructions, the Wizard automatically generates a personalized table showing the amount that can be freely consumed for hundreds of foods, as well as recipes suitable for one’s individual tolerances as determined by the Wizard for each user.
The Wizard was recently the subject of an independent clinical study conducted by the University of Montreal Hospital Research Centre (CRCHUM), which demonstrated its effectiveness.
Conclusion
In conclusion, the low FODMAP diet has been shown to be clinically relevant for people with IBS, as it can greatly help reduce their digestive symptoms and improve their quality of life. We offer low-FODMAP meal plans and recipes, as well as personalized consultations with Registered Dietitians who are specialized with the FODMAP approach.
Sources
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Barrett et coll (2010). Dietary poorly absorbed, short-chain carbohydrates increase delivery of water and fermentable substrates to the proximal colon. Aliment Pharmacol Ther;31(8):874-82.
Van Lanen, de Bree et Greyling (2021). Efficacy of a low-FODMAP diet in adult irritable bowel syndrome: a systematic review and meta-analysis. Eur J Nutr;60(6):3505-22.
Dionne et coll (2018). A Systematic Review and Meta-Analysis Evaluating the Efficacy of a Gluten-Free Diet and a Low FODMAPs Diet in Treating Symptoms of Irritable Bowel Syndrome. Am J Gastroenterol;113(9):1290-300.
Black, Staudacher et Ford (2021). Efficacy of a low FODMAP diet in irritable bowel syndrome: Systematic review and network meta-analysis. Gut;10:2021–325214.
Halmos et coll (2014) A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology; 146:67–75.e5.
Wang et coll (2021) A Low-FODMAP Diet improves the global symptoms and bowel habits of adult IBS patients: a systematic review and meta-analysis. Front Nutr; 8:683191.
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Gibson et coll. (2022) Diet as a therapeutic tool in chronic gastrointestinal disorders: Lessons from the FODMAP journey. JGHF; 37(4): 644-52.
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Jiang et coll (2021). Therapeutic implications of diet in inflammatory bowel disease and related immune-mediated inflammatory diseases. Nutrients;13(3):1-17.
Devrim-Lanpir, Hill et Knechtle (2021). Efficacy of popular diets applied by endurance athletes on sports performance: beneficial or detrimental ? A narrative review. Nutrients;13(2):1-40.
So, Loughman et Staudacher (2022). Effects of a low FODMAP diet on the colonic microbiome in irritable bowel syndrome: a systematic review with meta-analysis. The American Journal of Clinical Nutrition;116 (4) 4: 943–952.
Halmos et Gibson (2019). Controversies and reality of the FODMAP diet for patients with irritable bowel syndrome. JGH Open;34(7):1134-42.
Moayyedi et coll (2019). Canadian Association of gastroenterology clinical practice guideline for the management of irritable bowel syndrome (IBS). J Can Assoc Gastroenterol;2(1):6-29.
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Laforce et coll (2022). Diète FODMAP via une plateforme Web : impact sur la qualité de vie et les symptômes physiques et psychologiques des gens atteints du syndrome de l’intestin irritable. Faculté de médecine de l’Université de Montréal – Thèses et mémoires.
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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