The Low FODMAP Diet: Why Going Solo Can Leave You Miserable And Malnourished
Wednesday, December 06, 2023
Charliejeane Cooke
“Seeking advice is a sign of wisdom, not weakness”
(Catherine Pulsifer)
Worryingly, I recently heard someone mention that they're following the "low FODMAP diet", which, according to them consisted of:
🍗🥩 Plain chicken and beef
🍚🍚 Boiled white rice
🥔🥔 Boiled potatoes
🥦🥦 Cauliflower and broccoli
Well, on the plus side, at least they had some protein, carbs, fibre and veggies! Albeit totally boring and nutritionally inadequate.
... No wonder they were miserable and had lost weight (unintentionally) 😕
❗️Just to be clear -👆that is NOT the low FODMAP diet - they had it all WRONG.
But it's not the person's fault they got it wrong - it's the fault of the people dishing out wrong and confusing information.
Despite their extremely limited diet, they STILL had symptoms!
Even more concerning, they were considering avoiding veggies altogether because of their ongoing wind, bloating and diarrhoea 😧. This is NOT a good idea.
Unfortunately, this is a common scenario – people attempting the so-called low FODMAP diet with incorrect information (or correct nuggets of information but applying them incorrectly). And, with no guidance or support from a Dietitian.
People often don't see any potential for harm - it's like they think, 'it's just food, how can it cause harm'.
But I get it. Because I've even come across a few doctors (who should know better), who were a bit unconcerned about nutrition and food 😮
Just because it's food doesn't mean there are no potential risks.
(- which is why it's annoying with all these cowboys out there!).
As a side note, here's some examples:
- Certain foods and supplements, rich in specific nutrients or compounds, can interact with certain medications.
Take grapefruit, for example, which can increase the amount of simvastatin and atorvastatin in the blood - medicines that lower cholesterol levels. And this increases the risk of side effects. Consequently, it's recommended to avoid grapefruit (the fruit and it's juice) when using these specific medications (1).
Cranberry juice and grapefruit juice can affect warfarin (a medicine to reduce blood clots forming) (1,2).
Foods such as broccoli, spinach, Brussel sprouts, cabbage containing a lot of vitamin K can also affect how warfarin works (2).
Ciprofloxacin, an antibiotic - shouldn't be taken with dairy products or mineral-fortified drinks (1,2).
- Some foods are allergens.
The most common foods include peanuts, tree nuts (such as walnuts, almonds and pecans - peanuts grow under the ground, not on tress!), cow's milk, eggs, shellfish, wheat, soy, sesame (3).
- Food intolerances.
Food intolerances are different from a food allergy - although not fatal, they can be extremely debilitating.
- Food poisoning.
This is when you've eaten food that's been contaminated by bacteria or a virus.
For example, someone hasn't washed their hands before handling food (especially if after using the toilet or they're ill); the food hasn't been stored at the correct temperature; it's not been cooked or reheated thoroughly; or it's been eaten after the "use by date" (4).
- Some foods aren't suitable for various medical conditions.
Some foods aren't suitable for various medical conditions, or they need to be prepared a certain way to ensure they're ok for the person (2). Which is where a Dietitian comes in - to help them know what foods are suitable, and how to make other foods suitable for them so they don't have to completely avoid the food(s).
So, there's more to food than meets the eye!
... And why it's important to be savvy about where you get your food, nutrition and health advice from.
Now, back to the...
The Low FODMAP Diet
A short-term diet which is low in Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols (5) - hence "FODMAPs", because who wants to keep saying that mouthful!
FODMAPs are certain carbohydrates that aren't properly absorbed in the small intestine, so they end up in the large intestine and get fermented by the gut bacteria that naturally live there (6). And this leads to the classic symptoms of IBS.
The low FODMAP diet doesn't cure IBS.
There is NO cure for IBS.
It doesn't work for 100% of people. (Scientific evidence shows at least 86% of people with IBS benefit from using the low FODMAP diet (7,8,9). And it's one of the most scientifically researched diets out there).
But it's got MUCH LESS chance of working when someone tries to do it themselves - DIY's it (10,11,12).
And... There’s research into WHO is BEST suited to deliver the low FODMAP diet, and this evidence is acknowledged in IBS clinical guidelines around the world, including the UK, Canada, the US, Australia, and Italy.
And they all state that the diet should only be given under the supervision of a Dietitian.
This is due to things like:
- The complexity of IBS
- The complexity of the low FODMAP diet
- The potential for nutritional deficiencies
- The knowledge and skills of a qualified Dietitian trained in using the diet
Because heck, some Dietitians don't fully know how to use it - even Dietitians need to be formally trained (and ongoing training to remain up to date).
So, it's no wonder everyone else gets it wrong. (... and then they complain it doesn't work!).
And I can understand why people would think it's ok to do the low FODMAP diet themselves, because...
... I've come across doctors telling their patients to go "Google it";
... nutritionists, Dietitians, and self-proclaimed experts sharing their experiences and tips online.
... And even those with IBS who've successfully followed the low FODMAP diet with a Dietitian and now think they're suitably 'qualified' to teach fellow sufferers like you how to use it - which is 💩 by the way because they're doing you a disservice.
Which leads you to believe that it's an easy, DIY approach.
But it's not.
And it's not suitable for everyone – there are potential hazards. That's why it should only be started if prescribed and supported by a Dietitian.
The low FODMAP diet is a tool. NOT a lifestyle
It's part of a process. NOT for long-term use.
✅ Research has consistently shown that the diet is most SUCCESSFUL, safe, and nutritionally adequate when under the guidance of a Dietitian (5,9,10,12,13).
Ongoing support from a Dietitian throughout the entire process is crucial.
This maximises success. And ensures not only progress through the stages but also guarantees that each stage is nutritionally balanced for you personally, safeguarding your health and wellbeing 💪
✅ So if you want to SAVE yourself the grief and potential harm, avoid dabbling with diets like the low FODMAP Diet... unless it's been prescribed and supported by a Dietitian 👍
Following a personalised, science-backed system that provides clarity, confidence and empowerment is the key to overcoming IBS symptoms and reclaiming your life. And it's only attainable through the IBS Mastery Blueprint™.
References
- NICE. (2023). British National Formulary. Available [online] from: https://bnf.nice.org.uk/interactions/
- Gandy, J. (Ed.). (2019). Manual of dietetic practice. John Wiley & Sons.
- American College of Allergy, Asthma & Immunology. (2023). Food allergy. Available [online from: https://acaai.org/allergies/allergic-conditions/food/
- NHS Inform. (2023). Food poisoning. Available [online from: https://www.nhsinform.scot/illnesses-and-conditions/infections-and-poisoning/food-poisoning/
- Manning, L. P., Yao, C. K., & Biesiekierski, J. R. (2020). Therapy of IBS: Is a low FODMAP diet the answer?. Frontiers in Psychiatry, 11, 865.
- Wang, J., Yang, P., Zhang, L., & Hou, X. (2021). A low-FODMAP diet improves the global symptoms and bowel habits of adult IBS patients: A systematic review and meta-analysis. Frontiers in Nutrition, 8, 683191.
- Nanayakkara, W. S., Skidmore, P. M., O’Brien, L., Wilkinson, T. J., & Gearry, R. B. (2016). Efficacy of the low FODMAP diet for treating irritable bowel syndrome: The evidence to date. Clinical and experimental gastroenterology, 131-142.
- Bellini, M., Tonarelli, S., Nagy, A. G., Pancetti, A., Costa, F., Ricchiuti, A., ... & Rossi, A. (2020). Low FODMAP diet: Evidence, doubts, and hopes. Nutrients, 12(1), 148.
- Whelan, K., & Staudacher, H. (2022). Low FODMAP diet in irritable bowel syndrome: A review of recent clinical trials and meta-analyses. Current Opinion in Clinical Nutrition and Metabolic Care, 25(5), 341-347.
- O'Keeffe, M., & Lomer, M. C. (2017). Who should deliver the low FODMAP diet and what educational methods are optimal: A review. Journal of gastroenterology and hepatology, 32, 23-26.
- NICE. (2017). Irritable bowel syndrome in adults: Diagnosis and management. Clinical guideline [CG61].
- Black, C. J., Staudacher, H. M., & Ford, A. C. (2022). Efficacy of a low FODMAP diet in irritable bowel syndrome: Systematic review and network meta-analysis. Gut, 71(6), 1117-1126.
- Dimidi, E., McArthur, A. J., White, R., Whelan, K., & Lomer, M. C. (2023). Optimizing educational methods for the low FODMAP diet in disorders of gut–brain interaction: A feasibility randomized controlled trial. Neurogastroenterology & Motility, 35(10), e14640.
CharlieJeane Cooke, MSc
Men's IBS & Performance Dietitian
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