Aidan:
Hello and welcome to episode seven of the Ideal Nutrition Podcast. I am one of your hosts, Aidan Muir, and I am here with my co-host, Leah Higl. And today we’re gonna be talking about FODMAPS and IBS. So the reason we are talking about FODMAPS in relation to IBS is because it’s got about a 50 to 80% success rate in terms of significantly improving symptoms. So it’s one of the frontline kind of strategies we’ve got for dealing with it.
A lot of people will talk about other strategies that should be used first in terms of being other frontline strategies like, for example, as we were talking about mindful eating last kind of episode, doing little things like decreasing caffeine intake, avoiding really high fat foods, avoiding spicy foods, limiting alcohol, all those things should be tried first. But if you’ve tried those and you still get symptoms, FODMAPS is typically the next step. And it’s a bit of a confusing topic, so we really want to cover it. My personal experience with clients, like as I said, that 50 to 80% success rate, that comes from the research.
With diarrhoea, it’s a much higher success rate. With constipation, it’s a lower success rate. With clients who have diarrhoea, I’ve had a nearly 100% success rate. I can’t think of anyone that hasn’t really worked for, but there’s also been other stuff that I’ve done alongside that as well that we’ll probably talk about later or in future episodes as well. With constipation, it seems from what I can tell to be like a 30% success rate. And like when you understand the mechanism, I don’t know how deep we’ll go into the mechanisms, that makes sense, but I suppose I’ll pass it over to you, Leah. You’ll talk about what they are and that’ll kind of set it up for the mechanisms and stuff like that as well.
Leah:
Yeah. So without going into too much depth, because it is quite a nuanced topic and it can be quite complicated, but FODMAPS is basically an acronym that stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. So these are short chain carbohydrates and sugar alcohols that are poorly digested in the gut and they ferment in the large intestine. So what this does is it can draw in water to the intestine and also produce gas. For many people that don’t have IBS or have sensitive guts, this doesn’t cause symptoms.
So it’s a very, it’s like a naturally occurring process that is actually quite beneficial for gut health. But for people who are quite sensitive to FODMAPs and that do have IBS, it can cause a myriad of symptoms. So the most common ones we’ll see changes in your bowel movements. So whether that’s constipation or more so diarrhoea specifically, particularly with drawing that water into the large bowel. So we’ll also see things like excessive bloating and distension. So anyone with IBS is gonna be very familiar with that idea of like just being so distended that it’s painful. So not normally bloated.
So everyone gets a little bit bloated after a large meal or having a big can of baked beans and that’s really normal. But people with IBS, they’re actually going to be impacted like on a daily basis.
Aidan:
For sure. And going into like the mechanisms a little bit and you’ll understand how it makes sense. Like if you think of these as gas producing carbohydrates in for more sensitive people, in some cases, like to be clear, in some cases, some of them are going to produce gas regardless particularly just high fibre foods are gonna do that regardless. But some people are also more prone to this occurring. But if you think of it terms of gas producing, that explains the bloating, that explains that. If you think of it in terms of them drawing water into the bowels as well, that explains the diarrhoea.
So what explains the constipation? Like that’s what is, it’s interesting to me, because like I think about two years, maybe a little bit less into dietetics. I was pretty confident in all my stuff, but like there’s one thing that never really made sense to me, the constipation thing never made sense to me. I remember asking a supervisor in a previous job, shout out to them for making me feel stupid, but they’re like, it’s super well documented, like everybody knows this. And it was basically the explanation is that the gas production kind of compacts the faecal matter, which makes it harder to pass. Right. So that’s how it works for constipation. And when you understand that that’s the mechanism, it’s like, okay, it makes sense why it doesn’t work at that larger percentage of the time.
Why like 30% of time, roughly, that’s my number, that’s not the research-based number, but around 30% of the time, it seems to work for that. That mechanism is nowhere near as strong as the bloating and the diarrhoea kind of stuff, which explains why the success rate is so much higher for the other stuff. So the next thing I wanted to talk through is the gold standard approach to the low FODMAP diet, because even when working with clients and stuff like that, if I have no intentions of doing the gold standard approach, because it is pretty intensive process, I’ll still talk through it.
So the first phase is the elimination phase. You basically avoid all FODMAPs and that’s an oversimplification. It’s called the low FODMAP diet. You don’t have to completely exclude them. You just go to low levels. You can have them in small amounts, but it’s like a traffic light system where it’s kind of like you’ve got those like five or so groups and you’ve got foods within them. Which actually we’re going to touch on that like if you wanted to identify foods you can use something like the Monash Fodmap app where you can just search the foods it’s about $10 for the app and I particularly in years past very opposed to spending money, but like the Monash FODMAP app if you want to FODMAPs you pretty much need this app or Something similar I would get anybody doing the low FODMAP diet or doing anything to do a FODMAPs to get this app because it has
The best database I’m aware of and to the best of my knowledge as I speaking with Leah earlier, I don’t think there is a good database that’s available for free. I was saying in terms of like if somebody put that together, they’d get a lot of traffic to their website. But there’s nothing you can really get for free, which is why they can charge about $10. I think it’s 10 to 15. I think if you’re on iPhone, it’s $15 for the app. That’s why they can do it. But you can literally search foods on that app and it will tell you if they’re high FODMAP or low FODMAP. But because it’s a traffic light system, it’s based on serving sizes.
For example, a ripe banana is often considered high FODMAP. If you had a quarter of a banana, no matter how ripe it is, it’s not gonna cause symptoms. It’s too small of an amount. If you had three bananas, it’s probably going to cause symptoms. That’s the way of looking at it. It’s a traffic light system. So in the elimination phase, phase one, you go low FODMAP. Is there anything you wanna touch on with elimination phase or should I go to the next phase?
Leah:
Just to be wary of resources that aren’t the Monash FODMAP app. There are so many poorly done lists online and so many things that contradict one another. So I just wouldn’t take anything that can get for free online as gospel when it comes to low FODMAP and it’s well worth the 10 or 15 bucks.
Aidan:
100 % and like something that I also want to touch on is like, I don’t think I’m dumb, but it took me about two years to really get my head around FODMAPs in terms of like just being like, is this food high FODMAP? Is this food low FODMAP? Like there was a lot of stuff that came really easily to me, but there’s a lot of stuff that like sometimes it seems like there’s no rhyme or reason. There is a scientific explanation for all of them, but sometimes it feels like there’s no rhyme or reason. So the app is really handy because it’s like, if you were going to do this, anytime you eat, you really need to search. You need to search the ingredients and see if they’re high FODMAP or low FODMAP.
Phase two, the reintroduction phase. So this is where you slowly and systematically reintroduce FODMAPs. Ideally, the elimination phase is done for anywhere between two and six weeks. I typically do four weeks with most of my clients. But ideally, if you’re at phase two, phase one has worked. As in, if you’ve done, say, four weeks of the low FODMAP diet, and you still have pretty bad symptoms, it didn’t work for you. As we said, it’s like 50 to 80% of people it works for. There is people who it doesn’t work for. And if it doesn’t work for you, why would you slowly and systematically reintroduce foods.
This whole process takes at least 10 weeks. You should really just call it after four if it hasn’t worked and just reintroduce stuff as quickly as possible. If it’s worked and you’ve got minimal symptoms, the reintroduction phase is incredibly important. And we’ll talk about why it’s important later, but like it’s a necessary part of the process. So you slowly and systematically reintroduce foods. So week one, you’ll pick one of those groups and day one, you’ll have a small amount. Day two, you’ll have a moderate amount and day three, you’ll have a large amount, assuming you didn’t get symptoms on previous days. And if you got no symptoms from that, you can probably pretty safely conclude that that food or that food group or whatever doesn’t cause symptoms for you. If you did get symptoms from that, you’ve now identified it.
This is pretty much the best way we’ve got of identifying intolerances, so to speak, when it comes to IBS style symptoms. We can’t really do blood tests or anything like that. We do need to do elimination and reintroduction phases. It’s a bit of a grind. Because after that, after you’ve done that reintroduction, you then take that food out and you do a washout phase. So you go back to the complete low FODMAP diet for a couple of days and then you don’t even reintroduce it until the end of the entire process because there is what’s known as FODMAP stacking, which is basically where, let’s call it an iceberg where like the tip of the iceberg is your symptoms, basically, or enough to where you can identify symptoms.
You could have, say a small amount of one FODMAP group and not experience any symptoms. And then you add another amount from another FODMAP group and still not experience symptoms. And then you add a third FODMAP group and that pushes you over above the water and you get symptoms. You would identify the third one, but really the other ones contributed as well. So basically the whole point of this is basically you go low FODMAP so you can 100% accurately identify what causes symptoms.
So much easier for diarrhoea than constipation because diarrhoea you’ll If it’s say lactose, you’ll probably notice symptoms within one hour. If it is something like fructans in wheat, 24 to 48 hours, so it’s a little bit harder. But like with constipation, because like you might not notice it on a day-to-day basis, it becomes a lot harder, which is another challenge to add onto that. And the reintroduction phase can be a little bit more complex than that. I’ve laid it out being like day one, day two, day three. For fructans, because it’s 24 to 48 hours, it’s actually like day one, rest day. Day two, rest day, day three. So it’s more complicated.
So phase three, personalisation. This is the nice neat phase where it’s basically like you figured out what causes your symptoms and then theoretically you can just put it all together and live a great life after that with no symptoms. It’s so much more complicated than that because like say you get to the end of that process and you’re like, okay, these three food groups cause symptoms for me or these three FODMAP groups cause symptoms for me. That sounds fine, but what did I say earlier about like this whole like FODMAP stacking concept?
You’ve got to figure it out from there. You’ve also got to figure out what, how much of certain foods you can tolerate. For example, say you find garlic and onion is a trigger. Maybe you can’t have a lot. Maybe you can have a little without symptoms. It’s finding that balance. And then it’s also playing around in terms of, I say this to a lot of clients, but it’s like, you’re an adult, you can make your own decisions. Or it’s kind of like, you can eat a food and get symptoms. You can make that choice. Everyone makes the joke about people with lactose intolerance, still consuming lactose, like, I don’t know, like you can do what you want at this phase and it’s just figuring it out.
And the last thing to touch on that before going into other stuff as well, I suppose we’re gonna talk about this later, but like stress. Stress plays a role in IBS. What if you can eat a certain amount of one food when you’re not stressed, but when you are stressed, it causes symptoms. So that’s something to think about as well with this whole personalisation phase. After that, you’re really done, but it’s really trial and error based on that.
Leah:
Let’s go through the other considerations. So I know we’ve briefly touched on this, that the FODMAP diet isn’t always the first line approach. And because it is such an intensive process, it takes a lot of time and a lot of working around, that it’s not always the thing that we’ll do first. Particularly if someone has very particular symptoms, like say constipation. Because there’s a low success rate with constipation, a lower success rate with constipation, we’d be looking at other things to solve that issue first that potentially have a higher success rate. So it can depend on the person’s symptoms. It can depend on their current diet. is there anything like other reasons that we can identify this person is having these symptoms outside of, you know, doing a low FODMAP diet?
So if someone, the easy example is lactose. If they’re having a high amount of dairy and they have constant diarrhoea and they kind of, they’ve kind of linked those two in their head. makes sense to just take out lactose before trialing a low FODMAP diet. So we’ll look at that. We’ll look at their general lifestyle and eating behaviours. going back to that mindful eating, so are they eating slowly? Are they chewing their foods well? Are they active? Actually, something I like to look at is like the three F’s before going to FODMAPs and that’s fluids, fibre and fitness. So fluids meaning someone is well hydrated, fitness meaning that someone isn’t too sedentary because that can definitely contribute to gut symptoms and are they having adequate fibre or even are they having too much fibre.
So there is several things we’ll look at before even considering going straight to FODMAPs and outside of that, obviously making sure there’s no other diagnosis there. So something like inflammatory bowel disease and getting tested for celiac or and all of those actual disease diagnosis, we would double check that they’re not there before moving on to the IBS route.
Aidan:
100% because otherwise you’re wasting time to a certain degree where it’s kind of like if you had bowel cancer, inflammatory bowel disease, celiac disease, any of those things and you’re messing around with FODMAPs, it’s not addressing those conditions and you’re potentially making those worse in the meantime like for example celiac disease There’s a strong overlap between the FODMAP group fructans in wheat which if you limit your fructan intake you will be reducing your gluten intake. But you can get by fine on the with IBS if you if you find that to be a trigger and you just go to a low level. It’ll work fine in lot of cases with celiac disease.
You need to completely exclude gluten so if you’re if you’ve never done the test for celiac disease and you feel better when you reduce gluten, but you might still be doing damage to your bowel and stuff like that in the meantime, because even small amounts are doing some form of damage. So it makes sense to address and look at all of these things first. And I’d really try and get onto it as quickly as possible. Even using IBS, there’s a statistic that’s like, takes about seven years to get a diagnosis for the average person. So it’s like, you would want to look at everything else first as quickly as possible. Because if you can get through the other stuff quicker, it gets you to the IBS diagnosis quicker as well.
Aidan:
Totally. And usually it is just one set of blood tests as well to rule most things out. So they’ll typically pick up on inflammatory processes from a blood test to further investigate certain things. But if you don’t have anything that flags in a blood test, then it makes sense to potentially move on to something diet related like FODMAPs as opposed to going down that process even further.
Something I would briefly like to touch on in other considerations is I work with a lot of plant-based people. A lot of plant-based people in my experience have IBS symptoms, but I actually don’t have a huge success when it comes to just utilising the low FODMAP diet in plant-based people because a lot of the time it’s simply because their fibre intake is really, really like wildly high and they’ve not been doing it for that long.
So they’ve gone from a pretty regular diet that’s 25 to 30 grams of fibre a day, which is the recommendations, to potentially up to 70 to 80 grams of fibre a day, and that’s what’s causing the symptoms. So I just say that in general, we’re gonna consider, like you should consider a lot of different avenues or a lot of different things that could be impacting your symptoms before jumping straight to FODMAPs.
Aidan:
So the other things that we’d look at considering as well there’s a few things. One, in terms of what I touched on, in terms of you must reintroduce foods. So, imagine you’ve got horrific symptoms to start off with, because we’re mostly doing this with people who’ve got pretty serious symptoms. If you didn’t have bad symptoms, you wouldn’t really be keen to do a 10 plus week process that involves a lot of thought and involves a lot of effort. So you’ve probably got serious symptoms. So imagine having serious symptoms and then you undertake the low FODMAP diet and say it solves almost all of your symptoms or completely solves it.
You feel great. What is the first thing you wanna do? You would not want to risk reintroducing stuff. You already feel good, like, I don’t know. So like a lot of people who do it by themselves, which is what I’m gonna talk about later as well, don’t wanna reintroduce foods. And there’s downsides to that. One, no brainer, quality of life. Let’s say garlic and onion is a great example. If you don’t eat garlic and onion, it’s very hard to eat out at restaurants and stuff like that. It’s very, very limiting. And that’s just one of so many examples. It really limits you if you’re on a low FODMAP diet. It’s a hard diet to do. Two, just micronutrients and fibre and stuff like that. The more you restrict yourself, the harder it is to get these things in. Three, one thing I often talk about is diversity of plant intake. I really encourage getting greater than 30 different plant-based foods per week. The nature of doing a low FODMAP diet by itself restricts how many plant-based foods you can eat to start off with.
That’s going to make it harder. And a lot of these foods are really great prebiotic sources. Going back to garlic and onion, they’re great prebiotics. Like if you happened to be able to tolerate those, if they weren’t something that was an issue for you, you’d want to reintroduce them from an overall gut health perspective. And there is research backing this up. So like one of the most popular ones for that is 2018 study by Valdez and colleagues. And they concluded that the low FODMAP diet reduced the number of healthy bacteria and diversity of the microbiota and there was particularly reductions in bifidobacterial counts.
As Leah and I were talking about earlier, it’s a difficult one because a lot of people grab onto that and be like, well, diversity of the microbiota is good. Those bacteria, they’re good as well. We don’t want those things to happen. This doesn’t mean the low FODMAP diet is bad for gut health, but it does mean that we observe changes happening very quickly, as in this happens within two to four weeks. I recommend four weeks on low FODMAP diet that therefore means even the duration I recommend it for, these changes are occurring. They change really quickly. The gut microbiota changes quickly, probably in an unfavourable way.
I’m not gonna make that claim that it is unfavourable, but like, I will make the claim that the more diversity you can have, the better. So it makes sense to not stick onto it for longer than necessary.
Leah:
I see a lot of people get stuck in that step one of just the elimination and they don’t do it great, it’s not perfect. They’re not working with a dietician or anyone to do it. And they’ve seen a decrease in symptoms, not a complete, know, their symptoms are completely gone. So they keep trying at this low FODMAP diet for like, I’ve seen years, like I’ve seen someone on it for a couple of years. So if you think like the, over a small period of time, your microbiome can change quite drastically, you know, in four weeks, what’s going to happen to your microbiome in one to two years? So we don’t know that for sure, but it’s likely not going to be great for your symptoms in general.
Aidan:
100%. And that leads into another topic I’m really passionate about. I’ve never seen somebody do the low FODMAP diet well without seeing a dietician. And I’ve looked, like I just haven’t found anybody who’s done that. If you have followed me on social media or anything like that for a decent period of time, you’ve probably figured out that I don’t really shamelessly plug dieticians often.
I don’t even plug my own services that often. I’m just a believer philosophically in just trying to put out good free content and whatever comes from that comes from that. That’s just my overall philosophy and I think that approach works. When it comes to FODMAPS though, I do shamelessly plug dieticians because I’ve never seen somebody do it well without seeing a dietician. I’ve seen a ton of people do it poorly without seeing a dietician. Even dietitians who have issues of IBS probably should see another dietician just for the accountability. It is a hard thing to do. You want somebody else even just to sit down and plan it out and stuff like that. I don’t know. I think it’s a good idea to do that. The next thing that I want to talk about as well is I kind of touched on it being like this gold standard process. And this might be where I kind of diverge from some other dieticians in terms of like, we talked about stress. If you’re stressed, you’re probably going to get IBS symptoms regardless of what you’re eating.
It’s probably going to happen if the stress is bad enough. But a dietitian colleague of mine made a statement that really stood out to me. He has IBS himself and he’s like, when I’m stressed, I’ve got to go low FODMAP. When I’m not stressed, I don’t have to think about it. And he doesn’t get symptoms at all really. It’s just like when he’s stressing, he gets symptoms, he goes low FODMAP, it solves it. So it’s like, you can’t really do that if you’ve never really learned about FODMAPs. If you’ve never taken time to learn about the gold standard process and how to do that, you can’t actually do that.
And then the last thing that I wanted to touch on with all of this is that, or there’s two more things actually. One thing I wanted to touch on was that for athletes, food for thought, you’ve got an important event coming up. Maybe you don’t even have IBS. Maybe you just sometimes you get symptoms or something like that in terms of gut symptoms that could impact your performance. There is an argument to be made for going low FODMAP for 24 to 48 hours leading up to that event. It guarantees that you feel good.
If I’m making, just using powerlifters as an example, if I’m making a meal plan for competition day for a powerlifter, and I have the choice between say, pasta and rice for a meal. Pasta is high FODMAP because it’s high in weight, it’s high in fructans. Rice is low FODMAP. I’m gonna put rice in that meal plan. I’m not gonna tell them, I’m not gonna be like, doing this because low FODMAP. So it’s like, it just minimises chance of bloating or whatever going on. Maybe it doesn’t matter. For some people it does. And that has been studied again for endurance athletes and stuff like that in terms of runners gotten like helping improve those symptoms.
What I think would be kind of interesting is I know we’ve both trialled the low FODMAP diet. So why don’t we just briefly talk about our experience in doing so?
Aidan:
I haven’t tried it.
Leah:
You haven’t? No, no, I seriously you Yes, I’ve tried a lot of other stuff. I haven’t done that. OK, well, I tried it. Yeah. Because I did have some IBS symptoms that I’ve come to learn as anxiety based. And that’s what I should probably focus on. But it was tough. I think I did it for one and a half weeks and I gave up because it was just hard. So if you have all the tools and you know what you’re doing and it’s still really, really difficult, then I think you need a pretty big buy into the process. Your symptoms need to be pretty bad to go through the entire process.
Aidan:
100%. There’s a lot of people I’ve worked with who like, because like, reasons I haven’t tried is one, it’s hard, two, I don’t have symptoms, I’m not going to do something as hard, could risk gut microbiome issues and stuff like that. Like, that’s why I haven’t done it. But like, I’ve always been shocked at some clients who have been so stoked to be doing it. And I’m like, their symptoms must have been bad. Like if this is like an enjoyable experience.
But the last thing as well that I did want to wrap things up on is we’re going to do a podcast in the future on what to do if FODMAPS don’t work. I was going to try and put it into this one, but when I was saying this, I realised it’s going to be way too much. Like it’s such an in-depth topic. So we’re going to do episode nine on that. We’ll leave a gap so it’s not just back to back FODMAPS, because we’re also going to do another kind of, IBS style related podcasts even after that. So that’s going be in the future. So if this is of interest to you, episode nine is where to look for the next one. And apart from that, that will wrap things up for this episode.
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