Aidan
00:00:09 – 00:00:46
Hello and welcome to Episode 7 of The Ideal Nutrition Podcast. I am one of your hosts, Aidan Muir. And I’m here with my co-host, Leah Higl. And today we’re gonna be talking about FODMAPs and IBS. So the reason we’re 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 in last kind of episode,
Aidan
00:00:46 – 00:01:17
and 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. Um, 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 is the lowest success rate. With the kind of diarrhoea I’ve had a nearly 100% success rate.
Aidan
00:01:17 – 00:01:45
I can’t think of anyone it 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 when you understand the mechanism and I don’t know how deep will go into the mechanisms that make sense. But I suppose, I’ll pass it over to you, Leah. You’ll talk about what they are, and they kind of set it up for the mechanisms and stuff like that as well.
Leah
00:01:45 – 00:02:29
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 like a naturally occurring process that is actually quite beneficial for gut health.
Leah
00:02:29 – 00:03:14
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 will see changes in your bowel movement. So whether that’s constipation or also 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 going to 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 on a daily basis.
Aidan
00:03:14 – 00:03:39
For sure and going into the mechanism is a little bit and you’ll understand how it makes sense. 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 going to produce gas regardless, particularly high fibre foods are gonna do that regardless. But some people are also more prone to this occurring. But if you think of it in terms of gas-producing, that explains the bloating. That explains that.
Aidan
00:03:39 – 00:04:15
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 interesting to me because I think about two years, maybe a little bit less into dietetics. That’s pretty confident in all my stuff. But like, there’s one thing that never really made sense for 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 she was like “they’re like, super well documented, like everybody knows this,” and basically the explanation is that the gas production kind of compacts the fecal matter which makes it harder to pass.
Leah
00:04:15 – 00:04:15
Right!
Aidan
00:04:15 – 00:04:44
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 the time. Roughly, that’s my number. That’s not the research-based number, around 30% of the time, it seems to work for that. That mechanism is nowhere near as strong as the bloating and the diarrhea kind of stuff. Which explains why the success rate is so much higher for the other stuff. The next thing I want to talk through is
Aidan
00:04:44 – 00:05:27
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 a pretty intensive process. Um, I’ll still talk through it. So, the first phase is the elimination phase. You, basically, avoid all FODMAPs. 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, um 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
Aidan
00:05:27 – 00:05:47
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 the Monash FODMAP app, if you want to do FODMAPs, you pretty much need this app or something similar. I would get anybody doing the low-FODMAP diet or doing anything to FODMAPs to get this app because it has
Aidan
00:05:47 – 00:06:23
the best database I’m aware of. And to the best of my knowledge, as I was 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-$15. I think if you’re an iPhone is $15. Yeah, that’s why they can do it. Um, but you can literally search foods on that app, and it will tell you if they 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
Aidan
00:06:23 – 00:06:40
a quarter of a banana, no matter how right it is, it’s not going to 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 the traffic light system. So in the elimination phase, phase one, you go low FODMAP. Anything you want to touch on the elimination phase or should go to the next phase.
Leah
00:06:40 – 00:06:59
Just that, 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 you can get for free online as gospel when it comes to low FODMAP. And it’s well worth the 10 or 15 bucks.
Aidan
00:06:59 – 00:07:34
100%. And 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? There was a lot of stuff that came really easily to me. But there’s a lot of stuff that, like it’s 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 really need to search like you need to search the ingredients and see if there is high FODMAP or low FODMAP. Um, phase two,
Aidan
00:07:34 – 00:08:21
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 in a 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 who works for, there are people who 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,
Aidan
00:08:22 – 00:08:43
the reintroduction phase is incredibly important, and we’ll talk about why it’s important later. But 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 have a large amount, assuming you didn’t get symptoms on previous days. And
Aidan
00:08:44 – 00:09:20
if you’ve 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 intolerance is 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 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
Aidan
00:09:20 – 00:09:55
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 had a third FODMAP group, and that pushes you over above the water and you get symptoms. You’d identify the third one,
Aidan
00:09:56 – 00:10:17
but really the other ones contributed as well. So, basically, the point of this is basically you go low FODMAPs, so you can 100% accurately identify what causes symptoms. So much easier for diarrhoea than constipation. Because diarrhoea if it’s lactose, you’ll probably notice symptoms within one hour. If it is something like fructans in wheat, 24 to 48 hours is a little bit harder.
Aidan
00:10:17 – 00:11:01
But like with constipation because you might not notice it on a day to day basis, that becomes a lot harder, which is another challenge to add on to that. And the reintroduction phase can be a little bit more complex than that. I laid it out being like day one day, two day 3, 4. 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 – personalization. This is a 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 so you get to the end of the process. And you’re like, OK, these three food groups cause symptoms for me or these three FODMAP groups cause symptoms for me.
Aidan
00:11:01 – 00:11:35
That sounds fine. But what did I say earlier about, like this whole, like FODMAP starting concept? You’ve got to figure it out from there. You’ve also got to figure out how much of certain foods you can tolerate, for example, so you find garlic and onion is a trigger. Maybe you can 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, it’s like you’re an adult, you can make your own decisions or it’s kind of like you can eat your food and get symptoms. You can make that choice. Everyone makes a joke about people with lactose intolerance still consuming lactose, like,
Aidan
00:11:35 – 00:12:01
I don’t know, like you can do what you want at this phase, and it’s just figuring out. And the last thing to touch on that before going into other stuff as well, I suppose, we’re going to talk about this later, 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 personalization phase. After that, you’re really done but it’s really trial and error based on that.
Leah
00:12:02 – 00:12:44
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 you know someone has very particular symptoms like, say, constipation. Because there’s a low success rate with constipation, 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. So,
Leah
00:12:44 – 00:13:29
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 the easy example is lactose. If they’re having a high amount of dairy and they have constant diarrhoea and they kind of linked those two in their head, it makes sense to just take out lactose before trialling a low FODMAP diet. So we’ll look at that. We’ll, look at their general lifestyle and eating behaviours. So going back to that mindful eating. So are they eating slowly? Are they chewing their foods well? Are they active? Um, actually, something I like to look at is like the three Fs before going to FODMAPs. And that’s fluids, fibre and fitness. So fluids meaning someone is well hydrated.
Leah
00:13:30 – 00:14:06
Fitness, meaning that someone isn’t too sedentary ’cause it can definitely contribute to gut symptoms. And are they having adequate fibre or even are they having too much fibre? So, there are several things will look out before even considering going straight to FODMAPs. Um, 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
00:14:06 – 00:14:45
100% because I’ve always just wasting time to a certain degree where it’s kind of like if you had bowel cancer, inflammatory bowel disease, ceoliac 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, ceoliac disease, there’s a strong overlap between the FODMAP group fructans in wheat . If you limit your fructan intake, you will be reducing your gluten intake, but you can get by fine with IBS. If you find that to be a trigger and just go to a low level, it’ll work fine in a lot of cases. With coeliac disease you need to completely exclude gluten. So,
Aidan
00:14:45 – 00:15:20
if you’ve never done the test for ceoliac disease and you feel better when you reduce gluten but you might still be doing damage to your balance 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 really try and get onto it as quickly as possible. Even with IBS there’s a statistic that’s like it takes about seven years to get a diagnosis for the average person. So it’s like you would wanna 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.
Leah
00:15:20 – 00:15:59
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, you know, inflammatory processes from a blood test to further investigate. You know, certain things. But if you don’t have anything that flags and a blood test, then it makes sense to potentially move on to something diet related, like FODMAPs as opposed to, you know, going down that process even further. Something I would briefly 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.
Leah
00:15:59 – 00:16:42
But, you know, I actually don’t have a huge success when it comes to just use 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, you know, 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 going to consider, uh, 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
00:16:43 – 00:17:17
So, the other things that we look at considering as well there is 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 have got pretty serious symptoms. Like, 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 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 them, and you feel great.
Aidan
00:17:17 – 00:17:55
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 going to talk about later as well. Um, don’t want to reintroduce foods. And there’s downsides that. One no-brainer is quality of life. Let’s say garlic and onion, it’s 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 in a low FODMAP diet, it’s a hard diet to do. Um, two. Just micronutrients and fibre and stuff like that. The more you restrict yourself, the harder it is to get these things in.
Aidan
00:17:55 – 00:18:26
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 that’s a lot of these foods are really great prebiotic sources going back to garlic and onion. They’re great probiotics. 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
Aidan
00:18:26 – 00:19:01
there is research backing this up. So, like one of the most popular ones for that is 2018 study that concluded, a low FODMAP diet reduced the number of healthy bacteria and diversity of the microbiota. And there was particular reductions in bifidobacterial counts. As Leah and I were talking about earlier, it’s a difficult one because like a lot of people grab onto that and be like, well, diversity of the microbiota is good. Those bacteria that they’re good as well, like, 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
Aidan
00:19:01 – 00:19:29
very quickly, as this happens within 2 to 4 weeks. I recommend four weeks on a 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 going to 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 necessarily.
Leah
00:19:29 – 00:20:10
I see a lot of people get stuck in that step one of just the elimination and they don’t do it great. That’s not perfect. They’re not working with the dietitian or anyone to do it. And they’ve seen a decrease in symptoms, but not a complete, you know, their symptoms aren’t 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 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 1 to 2 years? Um, so we don’t know that for sure, but it’s likely not going to be great for your symptoms in general.
Aidan
00:20:10 – 00:20:53
100%. And that leads into another topic I’m really passionate about. I’ve never seen somebody did a low FODMAP diet well without seeing a dietitian, 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 dietitians often. I don’t even plug my own services that often. I’m just a believer philosophically and 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, so I do shamelessly plug dietitians because I’ve never seen somebody do it well without seeing a dietitian. I’ve seen a ton of people do it poorly without seeing a dietitian.
Aidan
00:20:54 – 00:21:35
I, even… even dietitians who have issues with IBS probably should see another dietitian 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, like 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 a kind of touch on it being like this gold standard process. And this might be where I kind of diverged from some other dietitians in terms of, like, we talked about stress. If you’re stressed, you’re probably gonna get IBS symptoms regardless of what you’re eating, like 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.
Aidan
00:21:36 – 00:22:07
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 you stress and get 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… oh, there’s two more things, actually. One thing I want to touch on was that
Speaker 1
00:22:07 – 00:22:29
for athletes. Food for thought. You’ve got an important event coming up. Maybe you don’t even have IBS. Maybe just sometimes you get symptoms or something like that. Um, in terms of got symptoms that could impact your performance, there isn’t going 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,
Aidan
00:22:29 – 00:22:54
and I have the choice between, say, pasta and rice for a meal. Pasta is high FODMAP because it’s high in wheat, it’s high in fructans. Rice is low FODMAP. I’m gonna put rice on that meal plan. I’m not gonna tell them. I’m not gonna be like we’re doing this because the FODMAP is, 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 demonstrated for endurance athletes and stuff like that in terms of runners gotten helping improve those symptoms.
Leah
00:22:54 – 00:23:02
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
00:23:02 – 00:23:06
I haven’t tried it, I’ve tried a lot of other stuff.
Leah
00:23:06 – 00:23:43
Okay, well, I tried it. Because I did have some IBS symptoms that, you know, I’ve come to learn is anxiety based. And that’s my… what I should probably focus on. Um, but it was tough. I did try to do it as a vegan, I think, which makes it a lot tougher in terms of like that FODMAP stacking like that’s really easy to kind of go just overboard on the FODMAP stacking. Um, but it was tough. I think I did it for 1.5 weeks and I gave up because it was just hard. Like, so if you think, you know, if you have all the tools and you know what you’re doing
Leah
00:23:43 – 00:23:52
and it’s still really, really difficult. Then, you know, I think you need a pretty big buy into the process, like, your symptoms need to be pretty bad, so you’ll go through the entire process.
Aidan
00:23:52 – 00:24:08
100%. And there’s a lot of people I’ve worked with who, like, ’cause like, reasons I haven’t tried as one is hard to. I don’t have symptoms. I’m not going to do something. It’s 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 like that who have been so stoked to be doing it.
Aidan
00:24:08 – 00:24:33
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 gonna try and put it into this one, but when I was planning this, I realize it’s gonna be way too much, like, it’s such an in-depth topic. So we’re gonna do episode nine on that will leave a gap, so it’s not just back to back FODMAPs because we’re also gonna do another kind of,
Aidan
00:24:33 – 00:24:52
um, IBS related podcast, even after that. So that’s gonna be in the future. So if this interests you, Episode nine is where to look for the next one. And apart from that, that will wrap things up for this episode. Thank you for listening. Follow or subscribe wherever you get your podcast. And we also encourage telling your friends about it or anybody else about it. If you like this podcast too.