4 reasons why you should think twice before going low FODMAP

why you should think twice before going low FODMAP

If you suffer from digestive issues, you may have come across the low FODMAP diet at one point or another (FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols). The low FODMAP diet has become popular among those suffering from conditions like Irritable Bowel Syndrome (IBS) and the diet basically entails eliminating the five forms of carbohydrates – lactose, fructose, fructans, sugar alcohols, and galactans – then slowly adding them back in to narrow down which foods specifically were the culprits. Proponents of the low FODMAP diet argue that malabsorption of carbohydrates leads to gas, bloating, and issues with motility, therefore, these carbohydrates should be eliminated. Others argue that carbohydrates are not actually the root cause of the discomfort, but rather that this malabsorption is a symptom of something much larger that should be tackled head-on. The following are 4 considerations about going low FODMAP (and other ways symptoms can be alleviated).

1. Low FODMAP is a band-aid, not a fix.

Taking the low FODMAP approach to manage IBS/digestive symptoms is basically the equivalent of telling someone who is lactose intolerant to avoid milk – sure, they might feel a little better when not drinking milk, but the cause of the lactose intolerance was never addressed. Although many with IBS have issues with foods containing FODMAPs, FODMAPs are not the cause of IBS.

IBS is an inflammatory condition – reducing inflammation is the key to finding relief, not only from digestive symptoms, but from other symptoms caused by inflammation as well (such as anxiety, depression, mood swings, brain fog, headaches, heartburn, joint pain, or other inflammatory symptoms). Inflammation is at the root of the problem for many with digestive conditions… not carbohydrates. After the cause of the inflammation is tackled, FODMAPs are often well tolerated by a vast majority of those who had previously experienced digestive discomfort while consuming them.

2. It’s cheap and easy… for the health practitioner.

One of the reasons why the low FODMAP diet is often recommended by doctors and dietitians is because handing someone a piece of paper with instructions for a diet is a whole lot easier than doing the leg-work to get to the root of the problem. Although FODMAPs is somewhat “evidence based,” the studies just confirm that those with certain digestive conditions tend to have problems with some FODMAPs (and, as outlined in the previous point, FODMAPs are not the cause of the condition AND FODMAPs are often tolerated after the true cause is identified and remedied). It also boggles the mind how many practitioners blindly follow the rest of the herd – so few actually do their own research to get real answers and seek out better solutions (i.e. better outcomes) for their patients.

3. It’s difficult to follow.

FODMAPs are in a LOT of foods… even “healthy” foods. Most will likely view the low FODMAP diet as very restrictive and, as I mentioned before, the end results don’t really pay off for all of the effort put in (especially if you have other symptoms). On the low FODMAP diet, you will have to bid adieu to certain fruits (like apples, pears, cherries, raspberries, watermelon, and several others), certain vegetables (onions, garlic, cauliflower, green peppers, mushrooms, asparagus, etc), honey, certain grains (wheat, rye, spelt, etc), beans, legumes, lentils, dairy, and others. Imagine if you had to restrict this stuff for months or years while on a low FODMAP diet… not fun.

4. It doesn’t address other triggers.

Many, many, many IBS sufferers have food and chemical triggers that go way beyond those outlined in the low FODMAP diet. The low FODMAP diet only addresses foods from the perspective of the types and amounts of carbohydrates in them and completely ignores other possible triggers for symptoms. Just about ANY food can trigger IBS symptoms (and everyone has DIFFERENT triggers), so most will likely continue to experience some digestive symptoms (and may even experience worse symptoms) as well as non-digestive symptoms while following the low FODMAP diet.

Another Way

If you suffer from IBS, reducing inflammation should be priority number one. LEAP (which stands for Lifestyle Eating and Performance) is a diet that is completely individualized based on a blood test that identifies which foods and chemicals cause inflammation in YOUR body. Using a blood test (called the Mediator Release Test) to guide the diet helps to take the guesswork out of figuring out your problem foods (especially helpful since symptoms might not start for 3-4 DAYS after eating the offending food) – this means that the diet doesn’t have to be unnecessarily restrictive, making it more manageable to follow, and providing better and quicker results (which go beyond improving digestive health). Once the sources of inflammation are removed, the body can begin to heal.

For more information about LEAP and inflammation, visit http://getwellified.com/services/leap.

34 Responses to 4 reasons why you should think twice before going low FODMAP

  • There is wrong information in this post. You seem to be confusing IBS w/ IBD. IBS is NOT an inflammatory disease. And since there’s no cure for either disease, treating symptoms w/ dietary changes isn’t a “band-aid”, it’s a therapy to reduce symptoms. To say it’s a band-aid implies that you’re avoiding a cure-all when there isn’t one. You should have a better understanding of pathophysiology before you start handing out medical advice.

    • Actually, IBS is an inflammatory condition… there are plenty of studies confirming this. Here are a few that I dug up on a quick PubMed search:

      Chemotactic chemokines are important in the pathogenesis of irritable bowel syndromehttp://www.ncbi.nlm.nih.gov/pubmed/24667736

      Tight junctions and IBS–the link between epithelial permeability, low-grade inflammation, and symptom generation?http://www.ncbi.nlm.nih.gov/pubmed/24548256

      Proinflammatory and anti-inflammatory cytokine profile in pediatric patients with irritable bowel syndromehttp://www.ncbi.nlm.nih.gov/pubmed/25697785

      Cytokine imbalance in irritable bowel syndrome: a systematic review and meta-analysishttp://www.ncbi.nlm.nih.gov/pubmed/24796536

      I did not say that dietary changes are a band-aid; the low FODMAP approach to dietary changes is a band-aid… and one that could become harmful if high FODMAP foods are avoided long-term. Foods high in FODMAPs contain some of the best prebiotics (food sources for good bacteria in the gut) – without sufficient prebiotics in the diet, this could lead to further imbalances in the microbiome over time (if the microbiome isn’t adequately nurtured, this can lead to worse health outcomes in the long-run).

      Those with IBS tend to respond negatively to foods high in FODMAPs because their digestive tracts are much more sensitized – if inflammation is significantly reduced (by removing foods and chemicals that cause inflammation), this sensitization improves, allowing those with IBS to enjoy higher FODMAP foods again. I’ve seen this time and time again in my own practice (so have my colleagues).

      When the focus is shifted to reducing inflammation (by identifying and removing inflammatory triggers, which differ from person to person), other health parameters also tend to improve (since inflammation is linked, in varying degrees, to many chronic health issues). So, the benefits of reducing inflammation are numerous.

    • Sally, you’re right that FODMAPS can help reduce symptoms for someone with IBS as a therapy. I’m not sure how familiar you already are with FODMAPs, but it might interest you to know that even prominent FODMAPs teachers (Patsy Catsos, RD is one of them) note that FODMAPs is not a cure. It manages symptoms (which is very helpful), but does not address the root cause. Why is IBS there in the first place? Addressing the inflammation means aiming for the root causes of IBS (there may be add’l causes for inflammation, so therapy is usually multi-factorial). Amanda correctly pointed out the IBS is an inflammatory condition. FODMAPs are great if they help manage symptoms, but it is more important to address the root causes. Long term FODMAPs can be challenging to manage. Hope this helps.

        • You mentioned to reduce inflammation yet show now way in your post to actually reduce it besides an expensive blood test. Some tips to get at the root besides just slamming a diet would be nice.

          • Hi Kylie, I understand your frustration — you’d like a concrete list of what to eat, what not to eat — the problem is, each person responds to foods differently… that’s why I recommend MRT testing and going through the LEAP protocol – it’s the most effective way to reduce inflammation that’s currently available. This post was mainly intended for folks who are fed up with generic food lists that only produce so-so results and for people who may not be aware that there are more personalized options out there that can be of much more benefit on many more levels. I stand by my position on this as I’ve worked with many people utilizing MRT/LEAP who felt such a night and day difference in a matter of weeks. Yes, the test may seem pricey, but it’s sooooo worth it.

  • Hi Everyone,

    I’m just learning about FODMAPs. I first implemented the “diet” to deal with a submandibular issue and it lessened the pain while I was awaiting surgery because HIGH FODMAP foods were causing the gland to work OVERTIME! After the surgery I stopped the diet. My diet was already limited though….no grains and no dairy for at least 5 years. Well, I’m back on the diet again. This time I was having so much bloating that it was causing bladder issues because my intestines were pushing on my bladder! But, my understanding of the FODMAP Diet is that it should be followed for a short time period (perhaps 8 weeks) and then foods should be slowly added back. Also, there is no way to remove all the foods that fall within the categories of what FODMAP stands for, so you aren’t really avoiding all, just taking them in at a lower amount…then after 8 weeks we are to increase the amount. I think the problem arose for me because I was overdoing the HIGH FODMAP foods thinking I was doing such a healthy thing for my body. Like eating a clove of raw garlic everyday and a whole avocado and lots of almonds and honey in place of sugar and half of a seedless watermelon because of its hydration, using beans in place of meat (I think I became reactive to meats because I would always season them with garlic and onion.) Well, these are just a few of my personal examples. So when I add the HIGH FODMAP foods back to my diet…I will do so slowly and in smaller quantities. Going on the low FODMAP diet has expanded my diet tremendously, based on what I was eating before of only fruits, veggies, nuts and seeds! Also, this is the most affordable way for me to discover the trigger foods. I have battled digestive issues knowingly for 15 years. Learning what foods cause me pain will be a great benefit. Reducing inflammation will allow my body to heal!

  • We need to exercise extreme caution when completely eliminating entire food groups, when, as mentioned above, other causes can be over-looked. In my time as a Nutritional Medicine practitioner, I have learned the value of getting to the cause of a problem (if it is possible – and is not always!) and treating that as a primary concern. There is wisdom in this web-site because inflammation is a cause of many many problems in health. FODMAPS contain so many essential nutrients that care must be exercised to avoid deficiencies occurring. Thanks Amanda, food for thought!

  • I am wondering if the author of this has IBS. The low FodMap diet has been a life saver for some of us. It is also shown to relieve migraines and may help fibromyagia.
    However how bad can it be, it includes plenty of meat, eggs and vegetables you can still have and even some fruits and things like dark chocolate and peanut butter. Also cheese with 0 grams of sugar which is easy enough to find and sweet and white potatoes.
    It’s best to concentrate on what you can have than what you cannot and many find they only have a few triggers after being on it for a while, not to mention blessed relief.
    Not one but two different board certified doctors diagnosed it and recommended low Fodmap.
    This problem is horrible and discouraging enough without someone slamming one of the only things that gives many of us relief.

    • Thanks for the comment – I’m glad that you found something that worked for you. Unfortunately, many of the folks that come to me with IBS have tried low FODMAP first with minimal relief. Many docs who recommend low FODMAPs do so because they don’t know what else to tell their patients – they know that some people find relief, so it’s worth a shot, right? My issue is with one-size-fits-all diets in general as nutrition really needs to be individualized. And I also still stand by my statement of low FODMAP acting as a band-aid – even if you find relief with removing high FODMAP foods, the diet doesn’t address the underlying reasons for why your body is having issues with FODMAPs to begin with. In my experience, a lot of other healing work needs to take place aside from removing foods that set off symptoms. Many people stop as soon as symptoms are alleviated but fail to do the other work that is necessary, which often leads to more and more issues down the road (kind of like when you’re prescribed a course of antibiotics for an infection but don’t finish the entire bottle because your symptoms disappeared a couple days in – it’s almost guaranteed that the infection will return). Hope that gives you a better understanding of where I’m coming from. 🙂

    • Hi, has anyone had much success with low fodmap treating chronic migraine?

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