Episode 9 – What to Do if Fodmaps Doesn’t Work

Key Topics Covered

  • The Low FODMAP Diet appears to significantly help 50-86% of people with IBS, depending on the statistics you use. So obviously there is a there is 14-50% of people it does not work for.


  • It is hard to stick to the low FODMAP Diet. Even with good intentions, it can be difficult to implement perfectly right off the bat. The first step is to ensure that it was implemented well, before identifying for sure that it did not help.


  • Being exceptionally high fibre can lead to symptoms regardless of FODMAPs.
  • Same issue with really high food volume.
  • Sometimes people who have high calorie needs but focus on eating “clean” can reduce symptoms just by eating more calorie dense, lower fibre foods.


  • Our gut and brain communicate with each other.
  • If you are constantly stressed out, it is likely going to make symptoms worse.
  • ~40% of people with IBS have diagnosed anxiety.
  • Those with depression are 2x more likely to have IBS than those without depression.
  • SSRIs can be used in the management of constipation due to how serotonin plays a role in nerve function and activity. Blocking serotonin receptors through medications can potentially help diarrhea too.
  • 2015 meta-analysis howed 50% of IBS patients benefit from cognitive behaviour therapy and 70% benefit from gut-directed hypnotherapy.
  • Gut-directed hypnotherapy has significant benefits for ~70% of people with IBS.
Nerva Stats


  • Improving overall gut-health could potentially help.
  • Aim for >30 different plant based foods per week.
  • People with IBS typically have lower levels of butyrate, which is a short chain fatty acid that is produced by healthy bacteria in the gut. A lot of foods that promote the production of butyrate actually happen to be high FODMAP.
  • Slowly increasing fibre intake, if it is significantly below 30g per day could also help in a lot of cases.

Competition Prep for Bodybuilders

  • A lot of bodybuilders, in all categories, struggle with IBS symptoms late in the stages of prep and for as much as 6+ months post-show.
  • RED-S is one of the reasons this can occur. Low energy availability means that there is not as much spare energy to be utlised for digestion.
  • Restriction in food choices during prep also contributes to this. Our bacteria in our gut feed on food choices. If there is not much diversity of intake, there is not a diversity of food for these bacteria. This can lead to a reduction in the diversity of the microbiota.

Eating Disorders

  • ~50% of people with a diagnosed eating disorder have IBS. 98% of people admitted into an eating disorders unit have a functional gastrointestinal disorder (constipation, diarrhea, reflux, bloating, dysphagia).
  • Compensatory approaches such as laxatives and purging could contribute to this.
  • Massive fluctuations in intake with binge eating can also contribute.

Vitamin D

Vitamin D3
  • ~80% of people with vitamin D are deficient in vitamin D. This is in comparison to around ~30% of people without vitamin D (these stats are from Saudi Arabia, not Australia)
  • If you are deficient, supplementing or getting more sunlight is going to help with other stuff, even if it is not guarenteed to help IBS.
  • Surprisingly little research has been done on this so far though.
  • Another study from 2016 put this to the test and got 90 people with IBS and got them to supplement 50,000IU vitamin D every fortnight for 6 months. There was a significant improvement in almost all symptoms, but it did not completely solve the IBS on average.


  • Probiotics featuring Bifidobacteria and Lactobacilii seem to be the most effective at this stage.
  • These bacteria populations are typically low in people with IBS. But there are no real clear cut recommendations because the research is all over the place still.
  • A review by the British Dietetic Association of 29 studies showed 14 different studies had positive results, using 10 different probiotics. So while things look relatively promising they are still kind of inconsistent.
  • Benefits can take up to 3-4 weeks to be noticable. It is recommend to do this as a stand alone treatment to tell if a change in symptoms is secondary to probiotic use or not.

Peppermint Oil

Peppermint Oil
  • Menthol in peppermint oil can cause intestinal muscles to relax and reduce abdominal pain. It can also help to allow trapped gas to pass.
  • the most extensive review of peppermint oil included data from over 800 patients from twelve clinical trials. The review showed IBS symptoms were 44% less common in patients who took peppermint oil group compared to those who took a placebo.
  • Standard dosage is 0.2-0.4ml 3x per day before meals.
  • Peppermint tea does not have the same effect as the peppermint oil – it is not potent enough

Relevant Links/Resources

Studies Mentioned

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