In this episode of Inside Knowledge, Anna Mapson takes on the Low FODMAP Diet, a potential game-changer for those with Irritable Bowel Syndrome (IBS).

What you'll learn:

1. What Are FODMAPs? And why do they affect your digestion?

2. The Low FODMAP Diet Phases - elimination, reintroduction, and establishing a new long-term diet.

3. Who Should and Shouldn't Try the Low FODMAP Diet? caution for those with a history of eating disorders and the need for a holistic approach to digestive health.

4. Tips for Getting Started - practical tips, like focusing on naturally low FODMAP foods and planning meals in advance.

5. The Complexity of FODMAPs why individual responses vary.

6. Considerations Beyond FODMAPs - other food based triggers for IBS

Stay tuned for the next episode where I'll go deeper into the intricate process of reintroducing FODMAPs.

Remember, always consult a healthcare professional before making significant dietary changes.

Links

• https://www.goodnessme-nutrition.com/fodmap/a-beginners-guide-to-the-low-fodmap-diet/
• https://www.goodnessme-nutrition.com/ibs/when-the-low-fodmap-diet-doesnt-work/

Why is it so hard to follow the FODMAP

diet, especially when there is so

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much information available online?

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Actually, the more information there

is, it can make it more confusing.

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The low FODMAP diet was developed

to help people with IBS.

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And most research shows it helps

about three out of four people

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better manage digestive symptoms.

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But it is not an intuitive diet to follow

on your own and it can be very confusing.

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So this is what I'm going

to be talking about in this

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episode of The Inside Knowledge.

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You'll learn what are FODMAPs,

when to try this diet and

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when not to, and how to start.

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And you'll also find out some of my

top tips on making the guidelines

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as easy as possible to follow.

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And welcome to episode 17 of the

Inside Knowledge for People with

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I B S, with me, Anna Mapson.

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Today we are going to dive into

the low FODMAP diet for I B Ss.

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I want to explain to you what it

is, how to do it, and whether it

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could be a good option for you.

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It's been developed specifically

for people with I B s and around

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75 percent of people will see

some kind of benefit from it.

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Now, if you have never heard of the low

FODMAP diet, it's basically an acronym.

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It stands for Fermentable

Oligosaccharides, Disaccharides,

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Monosaccharides and polyols.

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Those are the various letters and they

are each different types of starch.

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They're basically short chain

carbohydrates which are found in food.

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They can't be well digested

by humans and they're often

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broken down by our gut bacteria.

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This is a good thing.

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We want to feed our good beneficial

bacteria, but for some people with IBS

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these particular carbohydrates can draw

water into the bowel which creates loose

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stools or Because of the fermentation

process it can create excessive gas.

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So if you've never thought about what

these foods might actually involve Let us

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just go through a list of them and see.

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So oligosaccharides, this includes

two key subsections, really.

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There's galacto oligosaccharides,

which is often found in nuts and

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seeds, beans and lentils, almonds,

chickpeas, those are all high goss foods.

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And then also in that first

oligosaccharides, we've got, uh, fructans.

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And these are long chains of fructose

modules that are linked together.

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This is found in foods like wheat,

onions, garlic, grapefruit, courgette.

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If you haven't listened to my episode

about gluten and fructans, I did mention

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a bit about that last week, episode 16.

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So you go back and listen to a summary

of fructans but just as an example,

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those are some of the foods included

in the oligosaccharide category.

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Then we've got the D, the

disaccharides, that's lactose,

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which is found in dairy foods.

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The monosaccharides, that's a single

saccharide, and the disaccharide,

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obviously two saccharides stuck together.

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Um, but this includes fructose in,

so monosaccharides category includes

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fructose, which is in tomatoes, mango.

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red pepper, grapes, and

some stone fruits as well.

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And then we've got the and for the

A, and then the P is polyols, which

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includes sorbitol, xylitol, mannitol.

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Sorbitol foods include

sweet corn, avocado, um,

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blackberries, and white cabbage.

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And the mannitol section includes

butternut squash, cauliflower,

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mushrooms, celery, and fennel.

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So What you might see from this

list of foods I've just Drawn out is

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that they're all healthy good foods.

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Like these are not food you want to

restrict long term So the process of

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the low FODMAP diet is not to restrict

these foods in the long term the way

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you approach the diet is to Follow

this low FODMAP elimination phase for

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somewhere between two to six weeks.

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This is to see if you feel better

without these fermentable carbohydrates.

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So if you feel better, you get less

bloating, maybe less diarrhea, less gas.

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That's a good sign and it

means you can continue.

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The reason it's up to six weeks is that

sometimes people find it takes a little

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bit longer to see improvements and you

probably would want to go up to at least

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two weeks and I find sometimes if you

have a bit of a slip up and you eat

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something high FODMAP you didn't realize.

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You might want to do another week,

or you might want to do a little

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bit more in order just just to

help you get a good baseline.

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That's what the first phase is all about.

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Establishing a good baseline and

reminding yourself of what good

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digestion should actually feel like.

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Then the important bit, the most

important bit that most people don't

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get to is the reintroduction phase.

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You wanna do a careful reintroduction of

higher FODMAP foods whilst monitoring.

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All your symptoms.

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This phase can take a really long time

because there is a specific way to

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do it with suggested extended periods

of reintroduction and increasing

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amounts and you need a bit of time

in between each trial to wash out

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and make sure that you are resetting.

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Most people do not go

through this process.

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Properly and they say I tried the low

FODMAP diet didn't work and I still

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don't know what my triggers are and that's

because of the reintroduction phase.

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Anyway, the final phase is your new

diet, which is a longer term eating plan.

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So including as many of the high FODMAP

foods as you can manage and excluding

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anything that triggered your symptoms

during that reintroduction phase.

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So who should not be

doing the low FODMAP diet?

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Well, firstly, if you haven't actually

got a diagnosis of IBS, I don't suggest

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starting with this low FODMAP diet.

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It's not the first thing that I would

try anyway, because it is complicated.

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, the first thing to do would be to

go to your doctor and understand if

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there's any medical tests you need and

make sure you get checked out before

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launching into a restrictive diet.

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If you haven't looked at the...

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Basics yet.

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I would also start there.

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If you haven't yet addressed, how

you're eating, looking at slowing

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down to eat, chewing, all the basics,

spacing out your meals, making sure

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you're getting a good nourished diet

full of protein, fats and carbs.

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Maybe if you haven't looked at other

factors that can really influence

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digestion, like alcohol intake,

caffeine intake, whether you've

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got sleep, is there any medication

that's upsetting your digestion?

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How is stress affecting you?

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These are all things I would start

with first, because these are like

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the baseline things that you can

do without the restrictive diet.

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And then the other time I would be very

cautious of starting a low FODMAP diet is

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if you have a history of disordered eating

or diagnosed eating disorder, if you have.

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an existing eating disorder, then you

should be working with somebody who

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understands your condition anyway.

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But if you have maybe a history of an

eating disorder, like it was in your

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teens and now you're in your 40s, there

is still a chance that following lots

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of diet rules could be quite triggering.

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And so, I think it's worth investigating,

maybe if you have a therapist talking

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that through, if you have a practitioner

you work with in terms of nutrition,

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making sure they fully understand

how that eating disorder has affected

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your current approach to eating.

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Because if you're following a lot of

rules, sometimes it can bring back some

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of those thoughts about controlling.

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If you've now listened to this

and thought, actually I do want

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to give it a go, it's worth a try,

here are some tips to get started.

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First of all, I would Start by

thinking about what you can eat.

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So really focusing on foods that you can

eat freely that are low FODMAP foods.

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These include things like rocket,

spinach, green beans, collard

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greens, olives, parsnips, papaya,

rhubarb, kiwi, green bananas.

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Oranges.

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You can eat lots of these as

well as things like potatoes.

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Protein does not have any of these

starches in it, so you can eat as

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much meat, fish, eggs as you like.

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and the low FODMAP diet is not a

caloric restrictive diet, so it's

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not meant for you to lose weight.

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The important thing is that you don't

get too hungry because that can also.

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Triggered IBS symptoms sometimes,

so you want to make sure that

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you know what you can eat lots of

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And then the next step is to identify

which foods are allowed in moderate

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amounts but You can't eat too much of

them, so you can have a small amount.

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This would be things like, a quarter of

an avocado is okay, but when you get to

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half an avocado, that becomes high FODMAP.

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This is why the diet is highly confusing.

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You will read blogs that say, Yes,

you can eat peppers, peppers are fine.

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Then you'll read another blog

that says, Don't eat peppers.

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They are high FODMAP.

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And this is because bell peppers,

there are different colors.

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There's red, yellow, orange, and green.

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And each of them has a different FODMAP

rating for the size of the portion that

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is allowable under the diet guidelines.

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So for example, with red peppers, you

can only have about 40 grams before it

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tips into a higher, moderate FODMAP.

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Whereas with green peppers, you can

have up to like 60 or 70 grams, I think.

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Before it becomes higher FODMAP.

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So you can have a lot more for

your portion because of the

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amount of fructose in the fruit.

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So it is all dependent on portion

sizing, and this is why it's good

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to understand what you can eat

lots of without worrying too much.

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And then what foods you

can eat in small portions.

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The other thing to know is that

this diet is not gluten free.

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It is not dairy free, but it does.

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Limit your intake of wheat due to the

high fructans and milk and high lactose

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foods such as yogurt and creamy cheeses.

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So you can have around 40 grams of hard

cheese, for example, which is not too bad

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a portion if you want to have a sandwich

or if you want to grate some cheese

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on your dinner or something like that.

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It's doable, but it's not.

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a huge portion.

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So if you're used to eating a

lot of cheese, you may find this,

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you know, just understanding what

40 grams of cheese looks like.

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And then my last tip on getting started

would be to make a plan of two to

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three versions in your head or on some

paper of breakfast, lunch and dinner.

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You want to know two to three things

that you can eat for breakfast.

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Maybe a nice weekend one that might

be a bit more tasty and time consuming

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and something else that's really

quick that you know you can prepare

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the night before or that you can do

quickly in the morning before work

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or taking the kids out, whatever.

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And then do the same for your lunch

and your dinner so that you've

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just got a couple of options that

you Understand how to make them

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and you understand what to do.

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The final thing to remember in terms

of like quick tips for getting going

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is that this phase of restriction

is only for two to three weeks.

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It is not forever.

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If you can just get through this week,

the first week is probably the hardest.

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And once you've established.

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A little bit of a routine,

you'll feel a bit more confident.

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I'm going to record a part two of

this podcast, specifically about the

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reintroduction phase, because that is

one of the most tricky parts of the diet,

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and I want to give it sufficient time.

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But, whilst you're in this low

FODMAP phase, the first bit, where

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you're just cutting everything out,

a couple of things to help you.

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One would be...

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Thinking about FODMAP stacking.

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If you have more than one portion of

a moderate FODMAP in a meal, and you

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add it to another portion of another

moderate FODMAP meal, it could make it a

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high FODMAP meal without you realising.

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So, as an example, two

tablespoons of apple is about

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moderately high for sorbitol.

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The same as a quarter of an

avocado, or half an avocado, might

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be moderately high with sorbitol.

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If you're adding these together in

the same meal, you could end up with a

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higher FODMAP meal without realising it.

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So this is one of the traps that

people can fall into, is putting a meal

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together including lots of small or

moderate portions that actually then

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will add up to be a higher FODMAP meal.

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This is where keeping as much

diversity in your diet as possible

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is really, really helpful.

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You also need to be aware that some foods

do contain more than one type of FODMAP.

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So, like apples, I just mentioned, have

got sorbitol and fructose, and cashew

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nuts have got gauze and fructans.

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And this can make it more confusing

when you're trying to work out

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what you've actually eaten that

might have triggered your symptoms.

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You must also remember

that you are not a machine.

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You may not react to foods in

the same way that a machine did

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when the foods were classified

in terms of their FODMAP content.

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The Monash University in Australia

is where the FODMAP diet was created,

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and the way they measure the amount of

FODMAPs in food is by some standardized

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processes that shows the amount of sugar

in grams per hundred grams, and they look

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at the particular sugars, like fructose

and lactose and that sort of thing.

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And whilst they do try and pick a

selection of foods, like I think they

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have five different supermarkets or

five green grocers and they pool it

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all together, or they might, you know,

choose the main brands that are available

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on the market, they are choosing

things that are from the Australian

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market mostly, and there can be some

difference in when the food was picked.

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So if we think about tomatoes, they can

taste completely different if they are

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slightly underripe and they've been kept

in the fridge or if they've been out

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in the sun, getting all ripe and juicy.

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It depends on the variety that's used.

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It depends on the climate

that the food was grown in.

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The season that the food was grown

in, whether it was force grown

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under polytunnels or naturally

grown because it's the season.

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How long the food has been

stored before it was tested.

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So all of these things you can see

can affect the potential to have

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higher FODMAPs in a food that may be

classified as low to moderate FODMAP,

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but may still give you a reaction.

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And that is because You can't

standardize everything that you eat

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and compare it to something that has

been tested in a lab in Australia.

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Now that doesn't mean it's not accurate.

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They have done so much work into

how these FODMAPs affect your gut

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and what particular cutoff point is

thought to induce symptoms in people.

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So there is so much

research behind this diet.

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However, It may be an individual

response to a certain food that

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could still trigger your symptoms.

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And this is down to individual

genetics, your own digestive processes,

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maybe other health conditions, your

mental state when you're eating.

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All of these things could have some

impact on your ability to digest your

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food and that's why there is some trial

and error expected in the low FODMAP even

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if you follow the diet to the letter.

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It is not an exact science, and I know

that can feel very frustrating when

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you are trying so hard, but you're

not seeing any of the improvement.

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The other thing to remember is

that it might not be FODMAPs in

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the food that is the issue for you.

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There are other kind of triggers in

foods that can set off IBS like symptoms,

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including histamine, salicylates, which

is in things like oranges, berries,

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sweet potato, broccoli, almonds, and tea.

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Alcohol intake, that can be a real

trigger if you are drinking a lot of

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alcohol alongside the low FODMAP diet.

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Sometimes dairy, and it can be like a

dairy allergy that's been undiagnosed,

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or maybe you just can't even tolerate

small portions of the lactose.

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it could be a problem

with gluten intolerance.

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Other things in foods like soy and

corn or other allergens that are known

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to be a problem for people like eggs.

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And this is where the sulfur content of

food may be an issue for some people.

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So if you find that things like

onions and garlic and processed

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meats, that kind of thing, are all

triggering for you, consider whether

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sulfur might be a problem as well.

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I just listed those things out, that's

not an exhaustive list of other things

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that could, but it's a Common list of

things that I will cycle through in

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my mind when working with somebody who

says the low FODMAP diet doesn't work.

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Other issues that are worth

considering, if you feel like the

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low FODMAP diet doesn't work for

you, is to think about gut bacteria.

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This is really important because these

are the things that are helping to

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break down the fiber in your diet.

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If you have a lack of the beneficial

bacteria, or you have an overgrowth

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of pathogenic or like bad bacteria,

or maybe some particular strains

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are overgrowing out of control

in your small or large intestine.

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These can affect your ability to

process fibres and you may find

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you're reacting significantly

to carbohydrates in your food.

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Then the last two things that you

should be aware of is maybe you've got

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a problem with gut motility, so that

migrating motor complex that comes

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to sweep out your small intestine.

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That should be happening.

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And if it doesn't, it may lead to

an increase in bacteria overgrowing

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in your small intestine that can

impair your digestive enzymes.

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So motility in terms of fast transit

time or a slow transit time can really

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affect your ability to digest the

food and can lead to IBS symptoms.

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So whether you've got fast or slow

transit time, some of that, yes, is

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affected by diet, but it might also be

affected by nervous system issues, by,

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a lack of maybe movement if you're not

actually doing any exercise, that can

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lead to slow digestion, for example.

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And then finally, the visceral

hypersensitivity that's so common, so

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that gut brain connection, thinking

about your gut's nervous system, you

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may be experiencing heightened sensation

of pain, , and Experiencing more

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sensations of gas and movement within

your body than other people could.

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And it might not have anything

to do with the FODMAP, so it

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might be almost like your gut's

nervous system, that is the key.

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And in that case, you should work

on your vagus nerve, um, other

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nerve system support in terms

of managing anxiety and stress.

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And also be aware of how hypervigilant

you are, which can be a bit of a

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conundrum when you are doing this diet

in order to focus on your symptoms.

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And yet, if you're someone who's sort of

symptom obsessed, it can be pretty tricky.

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I'm going to leave it

here for this episode.

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The next episode will all be about

how to do that reintroduction, what

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you'd be looking for, what kind of

things you can do in order to know

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whether FODMAPs are your trigger and

if they are which particular ones.

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So do join me next time for a bit more

on the FODMAP reintroduction process.

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See you then.

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Goodbye.