Stop Doing Low FODMAP This Way
Why you should be combining it with other gut supportive therapies.
Adhering to a diet is difficult enough. Adhering to a diet, thinking you’re doing everything right, when you’re actually not, is even more heartbreaking to find out. Using diet to improve your digestive health often involves some sort of food elimination, better described as elimination diets. Elimination diets should be like war, you get in, and get out as fast as possible.
I’ve previously written How Good Carbs Go Bad, in which we discuss the seemingly controversial idea that plant foods and fiber could make your gut issues worse. Many of these fibers we discussed fall under the category of high FODMAP foods. FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) are fermentable carbohydrates that are poorly absorbed in the small intestine. Great, who cares? Because, we have trillions of bacteria living within our large intestine, meaning if FODMAPs are poorly absorbed in the small intestine, these sugars make their way to the large intestine still intact, ready for our gut bugs to ferment them. Excess fermentation means you get symptoms of gas, bloating, belly pain, constipation, diarrhea, painful urination, etc.
The clinical application of low FODMAP has tremendous benefits, and people often choose it with the right intentions, looking to fix their gut health. Let’s discuss why you might choose low FODMAP, why you may end up sticking to it long term, and the best approach to take when using it.
The Typical Approach
The Low FODMAP diet is often firstline nutritional therapy for those with IBS, SIBO, or endurance competitions. This is an incredibly restrictive way of eating, and should not be the diet you follow year-round. All too often, I see people following “elimination diets” as their normal way of eating. Why is this a problem? Long-term adherence to a low FODMAP diet has been associated with micronutrient deficiencies in some studies (1). Let’s also not forget the obvious reason: they just aren’t fun to follow. Trying to go out to eat with friends or date night with your significant other turns into you obsessing over the menu, or just skipping the experience altogether.
Then why do some stick with low FODMAP long term? There’s a totally logical reason: they feel better eating that way. Any time they try to eat off-plan, they feel like they have a setback. Two things come to mind when I think about this. One, for some, the idea of a “setback” is actually a totally normal phenomenon. Say you go to an all-you-can-eat sushi restaurant, and the chef talks you into having rolls you’ve never tried. You get up from the table and realize you are very full. You think, “Oh gosh I’m so bloated I can’t believe this is happening I’m never eating like this again!” When in reality that “bloating” is just because your belly is full. Two, and more importantly, they still have disturbances in their gut microbiome and/or immune system that are causing these food reactions.
How could this happen if they eliminated all the harmful foods? Sometimes, diet alone can’t fix your gut issues. If your gut issues are a result of food poisoning, diet isn’t going to kill off that bad bug that caused you to vomit your entire dinner. If you’re suffering from Small Intestinal Bacterial Overgrowth (SIBO), diet alone isn’t going to get rid of the problem either. You need to implement strategies other than diet changes to support your gut, more on this later.
The Preferred Approach
While low FODMAP works well, it should not be used in isolation. Rather, it should be one of several tools that a clinician uses to improve your gut health. Combined with other gut-supportive therapies such as probiotics, digestive enzymes, gut-friendly herbs, immunoglobulins, and herbal antimicrobials, low FODMAP can have a tremendously synergistic effect.
With regard to the micronutrient deficiencies, I always recommend people seek out the assistance of a dietitian or another healthcare provider who has experience working with the diet for multiple reasons. One, your low FODMAP diet will look different than someone else’s, so you can’t just take any PDF off the internet and go with that. Two, based on the foods you eliminate, you’ll have to pay greater attention to supplementation or including other foods that are rich in the vitamins and minerals you eliminated. Three, the reintroduction phase can be the most difficult part.
The reintroduction phase is where many people lose discipline. You struggle to know what foods you should add back in, how many foods should be added in, after how long should each food get added back in. It’s just crazy. This is why many people resort to either the “just add back in everything approach”, or the “well I’m feeling better so I think I’ll just stick to this way of eating long term.” You just did all that hard work of sticking to the diet, now is the time for you to reap the rewards and see how much progress you’ve made with your gut!
Now, if you realized after following the diet that you don’t miss eating certain foods at all, say gluten or dairy, you don’t have to add them back in. I think it’s more of an issue when people follow the diet, restrict themselves to only eating a handful of foods, and then continue to only eat those 5–7 foods for months and sometimes years on end. I don’t believe we have enough long-term data on people who eat like that in a traditional western environment.
If you interested in implementing low FODMAP, feel like you continue to have several food sensitives despite being on low FODMAP for months, or you’re unsure how to use the other gut therapies we talked about, head on over to The HIVE Natural Health Center, where our functional medicine practitioner can help support you along your gut health journey.
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As always, Trust in Your Gut.
Disclaimer: The contents of this article are for educational purposes only, and are not intended to diagnose or treat any condition. Do not apply any of the information in this article without first speaking with your doctor.
References
- Bellini M, Tonarelli S, Nagy AG, et al. Low FODMAP Diet: Evidence, Doubts, and Hopes. Nutrients. 2020;12(1):148. Published 2020 Jan 4. doi:10.3390/nu12010148
