The Low FODMAP diet - for most people, this is an unheard diet. For those struggling with Irritable Bowel Syndrome (or IBS), however, the Low FODMAP diet can be extremely helpful in determining food triggers for their digestive symptoms, which can range from diarrhea, constipation, bloating, excessive gas, and/or abdominal pain. Statistics show that anywhere from 13-20% of Canadians are affected by IBS, and the incidence of IBS worldwide is fairly similar, as well. Considering these numbers, it is easy to see why the use of the Low FODMAP diet growing in popularity.
For those of you not familiar with the diet, here’s a quick run down - FODMAP stands for Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols. If this still doesn’t makes sense to you (and it’s okay if it doesn’t), these components are small, poorly absorbed and fermentable carbohydrates that are found in a wide variety of foods. As these components are poorly absorbed and fermented by the bacteria in our gut, they can create bloating, gas, diarrhea and/or constipation in sensitive individuals.
The Low FODMAP diet has three phases - an elimination phase in which all of these potentially offending FODMAP components are removed, followed by a re-challenge phase where each FODMAP subgroup is systematically added back into the diet to identify triggers. The final stage is called the adapted FODMAP phase in which only FODMAP foods which cause symptoms are restricted or limited to tolerable portions (this is different for everyone). The final goal of this diet is to have good symptom control and to have the least restrictive diet as possible.
If you’d like to learn more about the Low FODMAP diet, there are plenty of excellent resources and information online (or better yet, talk with a FODMAP trained Registered Dietitian for more info).
WHAT I LEARNED DOING THE LOW FODMAP DIET...
While I do not struggle with IBS, I did have the pleasure of helping a loved one through the diet. By helping, I mean doing all the meal planning, grocery shopping, as well as, partaking in many, many low FODMAP meals. And yes, the nutrition nerd in me did enjoy it, in the sense that it was a fantastic learning opportunity for me as a dietitian but let me tell you, it was no easy task.
Curious about my experience? Check out the 10 things I learned about going through the elimination phase of the Low FODMAP diet:
1. HAVE A GOOD UNDERSTANDING OF THE DIET BEFORE YOU START
The Low FODMAP diet can be pretty overwhelming in the beginning. Admittedly, there is a pretty big list of foods that are not allowed on the diet (or only allowed in small serving sizes). It can be hard to know where to start. There are times when it seems that everything you usually eat isn’t allowed on this diet, and it can be pretty discouraging. That being said, this diet is not impossible. With a little planning and prep work, this diet is doable (and very worth it for the majority of people).
It’s definitely a good idea to give yourself some time to learn a little about the diet before you delve into it. Arm yourself by finding some reputable and up-to-date low FODMAP resources, food lists and recipes. This way you’ll be setting yourself up to succeed.
If you are able, making time to meet with a FODMAP-trained Registered Dietitian (RD) can help you ease your way into the elimination phase of the diet with confidence and with a greater understanding of the diet protocol. The dietitian can also help individualize the diet to your specific needs, especially if you have other nutrition concerns.
2. PLANNING IS KEY
I believe that planning is key to obtaining good nutrition, no matter your nutrition goals or needs. This is especially true for those wanting to try the Low FODMAP diet. If you are struggling with IBS and considering the Low FODMAP diet, your best chance at success is planning out your meals for the entire time you’re on the diet. This means sitting down, perhaps once a week (or twice a week if you want to break up your meal planning into smaller segments) and planning your meals. Working with a limited diet can be challenging and it’s not something that can be left to last minute. I don’t think I could have done this process without taking the time to plan out our meals ahead of time.
I also found it helpful to keep my previous meal plans, so that if there were times when I was feeling rather uninspired to plan a whole new set of meals (which totally happens!), I would have some older meal plans to fall back on.
3. GARLIC AND ONIONS ARE IN EVERYTHING
Both garlic and onions contain fructans, a type of oligosaccharide (the O in FODMAP) and they are restricted on the Low FODMAP diet. Now let me tell you, garlic and onions are in everything - like everything. It doesn’t even matter the quantity, if garlic or onion is on the ingredients list, they are out.
What’s more is that in Canada garlic and onions don’t need to be listed separately and can be included under the generic terms “spices” and “seasonings” on the ingredients list of a food package. Frustrating, isn't it? This means that a lot of pre-made foods, spice mixes and condiments don’t make the cut on the Low FODMAP diet. This poses another challenge to meal planning.
When I learned there would be no garlic on the Low FODMAP diet, my immediate thought was that there cannot be life without garlic (am I right?). I mean, I use garlic in most of my cooking and if a recipe calls for one clove, I use at least 4. To my surprise, however, I learned there is life without garlic. I hardly missed it and when I needed some garlic in a recipes, I used a garlic-infused oil (which is allowed on the diet). For the most part, however, I was okay without it. I know, I know, who would have thought?
4. GROCERY SHOPPING TAKES A LOT LONGER
Not only are garlic and onions restricted on the low FODMAP diet, there are a number of other foods that are potential gut offenders to those with IBS. This turns grocery shopping into quite the experience, at least in the beginning while you are learning to identify safe foods. Don’t be discouraged though, it does get easier. As time goes on, you become more efficient at spotting high FODMAP ingredients on food labels and grocery shopping gets easier. Still, in the beginning give yourself a little extra time to get your shopping done and if you usually shop with kids, leave them at home.
Truth be told, there are some foods that you won’t be able to find store bought alternatives for. I found it nearly impossible to find pasta sauce, curry pastes or certain pre-made soups without FODMAP ingredients. While in some areas of the world they are lucky enough to have specific brands that make low FODMAP food products, in my neck of the woods we just aren’t that lucky (although you now can order some online).
5. YOU MAY NEED TO GET CREATIVE IN THE KITCHEN
Building on to my last point - there are some food items that you just can’t find a pre-made alternative for, which means that you may just have to get creative in the kitchen. During the elimination phase of the low FODMAP diet, I found myself making more things from scratch. It got me thinking about food and cooking in a completely different way.
If this thought scares you a bit, don’t let it. You may be surprised what you can come up with. Sometimes all a recipes needs to take it from high to low FODMAP are a few tweaks. It could simply be replacing the onions with the green tips of green onions or chives, or changing up a high FODMAP vegetable like shiitake mushrooms with lower FODMAP oyster mushrooms. If you’re someone who isn’t super confident in the kitchen, not to worry. There are some fantastic low FODMAP cookbooks and online recipes available.
On a related note - if you are not able to prepare you own meals whether it's because of limited cooking skills or due to a work schedule that has you eating out frequently, consult with a FODMAP trained Registered Dietitian who can create an 'simplified' low FODMAP elimination plan which takes into consideration your individual needs while also restricting the high FODMAP foods that you are most likely to eat.
6. IT CAN BE EXHAUSTING
While going through the low FODMAP diet elimination (and re-challenge) phase, I definitely experienced a little fatigue, particularly with meal planning. As food is part of our life everyday, multiple times a day, it felt like I was always thinking about food and it was tiring.
What helped me was keeping a record of low FODMAP recipes and meals that we had tried (and liked!) so that when my creativity and motivation was lacking with meal planning, I could just pull them out and not think too hard. Also stocking my pantry with some low FODMAP snacks and easy meal ideas helped when I had to make food decisions on the fly.
7. THE MONASH AND FODMAP FRIENDLY APPS SAVED MY BUTT
Do yourself a favour, before you start the low FODMAP diet, download the Monash FODMAP and FODMAP Friendly appS. These apps are beyond useful. Truth be told, I’m not one who spends too much money on apps in general but these are worth the money. If you are hesitant to buy both apps and only want to purchase one, I’d recommend getting the Monash app. The Monash app uses a handy traffic light system to identify the FODMAP content in foods - green is low FODMAP (ok to eat), amber is medium (limit intake) and red is high (do not eat!). Personally, I really like this set up.
While there are some discrepancies between the two apps (which is a little frustrating, I know), overall they are helpful in learning which foods are safe and they are super handy to use when out and about. It was definitely great to be able to pull out my phone while grocery shopping to check if foods were high or low FODMAP, especially in the beginning of this whole process when I hadn’t yet committed food items to memory.
The apps will also tell you about acceptable serving sizes of low FODMAP foods because too much of a low FODMAP food can easily become high FODMAP. If you are using the Monash FODMAP app, I recommend you take a close look at the serving sizes. Don’t just eat any ‘green’ food freely, as what you think is a serving may not be the serving size being referred to. For example, Brussels sprouts are a green (low FODMAP) food but upon closer inspection the Monash app informs you know that only two Brussels sprouts are low FODMAP, any more than that are considered high FODMAP. I don’t know about you but as a lover of Brussels sprouts, two just doesn’t seem like a serving to me.
Also, you should be aware that sometimes food gets re-tested and its FODMAP status will change. For example, ripe bananas - when I started the diet a whole ripe banana was considered low FODMAP, however, it was re-tested and found that only ⅓ of a ripe banana (the one with the brown spots) is low in FODMAPs. The great thing about these apps are that they are constantly being updated, so if you have the apps you will have the most up-to-date info.
8. HAVING ONLINE SUPPORT IS VERY HELPFUL
Online support, specifically low FODMAP dedicated Facebook groups, were really helpful, even for me as a dietitian. These groups are a great way to learn new FODMAP recipes, get questions answered, and even to sharpen FODMAP spotting skills on food labels (as often times people will post food labels asking if the product is safe). Overall these groups are pretty helpful and because they are moderated by Registered Dietitians who are familiar with the Low FODMAP Diet, the information is credible. Even if inaccurate info was being discussed, I found the RDs were able to spot it and step in to provide more correct info fairly quickly.
9. EATING OUT IS TRICKY
While not impossible, eating out while on the low FODMAP diet is a bit tricky. Being on the low FODMAP diet took all the spontaneity out of eating out. The simple fact is that if it’s made in a restaurant it’s really hard to control for high FODMAP ingredients.
If we were to be out during meal time, I found we really had to plan where (or if) there were any suitable restaurants for us. My advice is to always have a plan and ditch any spontaneity when it comes to eating out. If need be, bring snacks and meals with you if heading out for the day.
Before our family's experience with the Low FODMAP diet, we would often have a weekly ‘fun family meal’ (aka the "I don't want to cook meal") which usually consisted of pizza, burgers or other foods you may not suspect a dietitian would eat. This had to change. We could no longer order our "family favourites" because, unfortunately, they all contained a number of high FODMAP or unknown ingredients. Instead, we had our ‘fun family meal’ at home, as this way we could control the ingredients. Truth be told, I think we did a great job keeping the food low FODMAP and enjoyable for the whole family. We made nachos, burgers, tacos, ribs (and more) - all low FODMAP.
10. NOT ALL 'LOW FODMAP' LABELED RECIPES ONLINE ARE LOW FODMAP
Like most people searching for new recipes these days my go-to place is the internet. While the internet can be a great place to find information, it can also be a place with lots of misinformation. I found that in my online searches for low FODMAP recipes there were quite a few recipes labeled as low FODMAP that contained high FODMAP ingredients (like garlic!). So, this is just a word of caution. If you are unfamiliar with the low FODMAP diet and if the source is questionable, double check whether or not all the ingredients are indeed low FODMAP.
If you are new to the Low FODMAP diet, here’s a great place to start researching low FODMAP recipes: Monash Low FODMAP Recipe Index
And for good measure, I’ve got a bonus tidbit that I learned….
11. YOU’LL PROBABLY MAKE SOME MISTAKES
You may make some mistakes along the way (ok, you probably will). And you know what? That’s okay. Don’t be too hard on yourself if you eat a high FODMAP ingredient by accident. It happens. The good thing is that you don’t have to start the elimination diet right from the beginning again. If this happens, take a deep breath and be okay with it. Take care of yourself and give your body what it needs in the moment - whether that’s some calming peppermint, a hot water bottle or whatever you’ve found that soothes your symptoms. Remember, stress and anxiety are no good for IBS.
Even I made a few mistakes. One busy day, trying to feed the family I missed the garlic in the dill pickles. Okay, these were actually garlic dill pickles. Let that sink in. I somehow overlooked the garlic in the garlic dill pickles (ones that we had purchased before starting the FODMAP diet). It’s embarrassing to admit but we all do make mistakes.
So there you have it, the 10 things (plus a bonus!) that I learned while implementing the low FODMAP diet in my household. My parting words for those of you with IBS who are considering the low FODMAP diet is that, for the majority of people, this diet process is worth it. It may seem a bit tricky at first but with the right guidance (like from an experienced Registered Dietitian), a few key resources and some patience it could be the answer to getting digestive relief.
Have you ever tried the low FODMAP elimination diet? Are you doing it as we speak? Tell me what you’ve learned from doing it. What key piece of advice would you give someone else contemplating it?