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Is it all or nothing when it comes to the low FODMAP diet?

31 October 2023

By The Gut Health Doctor Team

Dr Megan Rossi in a lab looking through a microscope

As you may have learned from the low-down on the low FODMAP diet, this can be an effective approach for those suffering with IBS. In fact, there are over 10 clinical trials that support it’s use in the management of IBS. The first of the three stages involves restricting groups of carbohydrates that, while healthy for you, are more likely to trigger unpleasant symptoms for a sensitive gut.

But have you tried to implement the diet yourself and failed? When few of us have time to cook every meal from scratch, the reality of strictly eating low-FODMAP for 4-8 whole weeks can not only be an emotional struggle but a practical one too. Not to mention the fact that our research team from King’s College London and others have shown that when not implemented correctly, under the care of a trained specialist, the diet can not only increase your risk of nutritional deficiencies but also have a negative impact on your gut microbes… and so a vicious gut health cycle ensues.

Need a solution that can allow you to reap low FODMAP benefits but in a more practical (and lower risk) way?

Try Dr Megan Rossi’s FODMAP-Lite approach.

If your IBS doesn’t respond to the first-line diet approaches (e.g. reducing caffeine, alcohol, spicy food etc.) and you don’t have access to a FODMAP-trained healthcare professional, Megan’s FODMAP-Lite approach might be a helpful place to start. In fact, she developed this simplified approach back in 2017 specifically for people like you. The first step is to spend some time becoming familiar with the higher-FODMAP foods so that you can plan to limit these (just for a few weeks) in your meals in advance. This preparation work will help you get the most out of the diet, so rather than jumping straight in, getting to grips with what’s needed beforehand will minimise the burden (and duration) of the plan. Please be aware that if you have a history of an eating disorder then this isn’t for you. It is crucial that you wait to see a healthcare professional before considering restricting anything in your diet.

*This is not a comprehensive list of alternatives, instead it is to give you inspiration. Include all other foods that are not listed on the ‘higher-FODMAP’ column in your diet. Remember this is a modified version, not the full low FODMAP diet.

Follow the FODMAP-Lite approach

Similar to the low FODMAP diet, there are three stages of the FODMAP-lite approach. For the full step-by-step guideance, check-out the IBS chapter and flow diagram in Eat Yourself Healthy (titled ‘Love Your Gut’ in the US and Canada).

STAGE 1: Restriction

Replace higher-FODMAP foods with lower-FODMAP alternatives for 2–6 weeks** alongside 15 minutes per day of the gut-directed yoga flow (see book for full details) or 10 minutes of diaphragmatic breathing.

STAGE 2: Reintroduction

Continue restricting higher-FODMAP foods, as you reintroduce single high-FODMAP test foods***, one at a time using the portion guide in Eat Yourself Healthy.

STAGE 3: Personalisation

Over several months, gradually reintroduce all food up to your tolerance level. While most people manage to reintroduce all foods by 6 months, if you do struggle to reintroduce and meet your diversity goals, it is important to see a registered dietitian who can help troubleshoot. Remember, long term restriction of various plant foods can not only negatively impact your gut microbes, but may make you more senstive to them. This means, when you do have the

** Ensure you are maintaining adequate amounts of fruit, vegetables and wholegrains.

*** TEST FOODS: These are the suspected trigger foods from the higher FODMAP food lists (see book for full details).

Illustration of the stomach containing cells, bacteria and microbes, and a magnifying glass with a yellow tick symbol

Takeaway

Despite the scientific evidence to support the benefit of a low FODMAP diet for IBS, the reality is it can be challenging and risky to implement without the support of a FODMAP-trained healthcare professional. Megan created this modified approach to help offer relief to those who might not have access to personalised support, and to help you get the balance right between what suits you practically, emotionally and physically.

In fact, the full low FODMAP diet is classed as a medical diet and as per the medical guidelines should only be done with the guidance of a FODMAP-trained specialist. This is because the research shows that it can be risky business for your gut and wider health. It’s also worth keeping in mind that the restriction stage (stage 1) should only be done for a maximum of 8 weeks. Reintroduction is vitally important so please don’t cut out all higher-FODMAP foods for good!

If you need personalised support with either diagnosing or managing IBS, including implementing the low FODMAP diet, please reach out to our team of FODMAP-trained specialist registered dietitians at The Gut Health Clinic.