The Simplified Low FODMAP Diet
Did you know that there is more than one way to do the low FODMAP diet? The low FODMAP diet involves removing certain fermentable carbohydrates from the diet for several weeks and then slowly reintroducing these foods to tolerable levels. It has shown great success in treating many individuals with irritable bowel syndrome (IBS), but can be very difficult to follow because it typically involves removing many dietary staples, including some wheat products, beans, milk, apples, pears, onions, garlic, and cauliflower. However, the simplified low FODMAP diet is another way to approach the diet that involves minimizing the number of foods that you need to restrict short-term. I wanted to bring attention to this approach because it isn’t as well known as the full low FODMAP elimination diet, and yet it can also be effective in controlling gut symptoms, such as bloating and abdominal pain, for people with IBS.
I learned about this method last year when I completed online training for the low FODMAP diet by Monash University in Australia,1 which is where gastroenterologist, Peter Gibson, and dietitian, Sue Shepherd, created this diet. The low FODMAP diet should be adapted to suit different people based on each individual’s lifestyle, nutritional status, and symptom severity. Not everyone can, or needs to, do the full elimination diet. I get that, it may just not be the right time for you now and that’s OK. This article will focus on exactly what the simplified low FODMAP diet is, who it’s for, and what it looks like.
Low FODMAP diet
As an example, Thomas has been experiencing a lot of bloating, abdominal pain, and diarrhea after meals over the past year. He goes to see a gastroenterologist who diagnoses him with IBS and recommends that he try the low FODMAP diet. What does that mean? It means strictly avoiding all high FODMAP foods for two to six weeks, and then monitoring to see if his gut symptoms improve. If symptoms improve, he can move on to the reintroduction phase and, if they don’t, then he should consider other diet and lifestyle strategies. The long list of foods to avoid with this diet is overwhelming for Thomas at first glance, especially because he isn’t sure what to substitute or replace for his usual and favourite foods.
It is well known that the low FODMAP elimination diet is associated with an improvement in gut symptoms in up to 80% of people with IBS.2,3,4FODMAPs can trigger gut symptoms in people with IBS, but not all types of FODMAPs cause symptoms in those who are affected. The goal is to figure out which particular FODMAP groups are triggering symptoms, and then work on liberalizing the diet as much as possible, while keeping gut symptoms under control. I have never met anyone who has to avoid all high FODMAP groups long-term, and the chance of this happening is very unlikely. For someone in Thomas’ situation, this is good news.
Simplified Low FODMAP diet
The simplified low FODMAP diet involves fewer dietary restrictions than the full elimination diet. It is appropriate for people with mild symptoms of IBS who may be eating a lot of high FODMAP foods or for people who are unable or unlikely to comply with a strict elimination diet. It may also be appropriate for people at higher risk of malnutrition, such as older adults and children.
In the simplified approach, you only need to avoid frequently consumed high FODMAP foods that you suspect to be major triggers. For example, if you eat a large quantity of beans (high FODMAP) at lunch every day, and experience a lot of bloating and abdominal pain, then you could focus on simply cutting out beans for two to six weeks and monitor to see if your gut symptoms improve. If there is an improvement in gut symptoms, then you could reintroduce beans and include small and controlled amounts back into your diet to figure out what portion you can tolerate, and how often you can enjoy them (e.g., ½ cup every second day instead of 1 cup every day). Let’s look at two scenarios to put this into practice.
Scenario 1
Walter has decided to eat more plant-based foods this year and has started to eat vegetarian meals more often. He is now regularly snacking on pistachios, experimenting with vegan cashew ‘cheese’ sauces, and is making vegetarian chili with chickpeas and soups with lentils every week. Unfortunately, he has noticed that he is often uncomfortable after meals, experiencing more bloating and abdominal pain than he ever remembered having before. He books an appointment to see a dietitian, who suggests a simplified low FODMAP diet for two to six weeks. The dietitian advises him to snack on walnuts instead of pistachios, to enjoy peanut sauce instead of cashew sauce, to use crumbled extra-firm tofu to replace chickpeas in his chili, and to use edamame instead of lentils in his soup. Rather than cut out all high FODMAP foods, his simplified low FODMAP diet for the short-term would involve just removing beans, cashews, and pistachios.
After two weeks, Walter has noticed that he’s feeling a lot better. He experiences only mild bloating once a week and the abdominal pain is gone. He works with the dietitian to re-challenge these foods back into his diet and learns that he can tolerate ¼ cup cashews per serving and enjoy ½ cup of chickpeas or lentils every second day. This is enough to keep his symptoms under control and he can continue to enjoy a plant-based diet.
Scenario 2
Lisa has decided to eat less white sugar this year and has begun to eat sugar-free yogurt and put honey in her tea three times a day. Instead of snacking on treats in the office, she is eating dried mangoes from home and chewing xylitol-sweetened gum throughout the day. After making these changes, she starts to notice that her bowel movements are getting loose and she now experiences moderate bloating and diarrhea a few times a week. She goes to see the dietitian who recognizes that she is eating a lot of high FODMAP foods (honey, mangoes, sugar-free yogurt, xylitol-sweetened gum). The dietitian recommends the simplified low FODMAP diet approach for two to six weeks, which Lisa is keen to try. Lisa starts to feel better after she stops chewing gum, replaces the dried mango with an orange, and replaces the honey in her tea with 100% maple syrup. Lisa’s simplified low FODMAP diet for the short term would involve temporarily removing just mangoes, honey, yogurt, and xylitol from her diet.
Conclusion
The full low FODMAP elimination diet isn’t for everybody, and there is a simplified approach to the diet that is endorsed by the creators of the low FODMAP diet at Monash University. If you have IBS, particularly if you have mild symptoms, and you don’t feel that you can or want to do the full elimination diet, then this approach may work very well for you. A dietitian with expertise in this area can help you figure out what the simplified low FODMAP diet would look like for you after completing a full nutrition assessment and diet history. When it comes to the low FODMAP diet, I’ve seen it help many individuals get their gut symptoms under control, and this is just one more way to do it!