FODMAPs is a acronym for those low molecular weight, poorly-absorbed sugars that either retain excess fluid in the gut or are fermented releasing gas.
FODMAPs are present in a large variety of vegetables, fruits and cereals, and can potentially cause pain, bloating and diarrhoea in people with a sensitive gut. This led a team of doctors and dietitians from Monash University in Melbourne, Australia to devised the low FODMAP diet, which aims to restrict these foods to amounts that can be tolerated. Yesterday, the Monash team posted that a low FODMAP diet is for ‘Just 2-6 weeks; it is not a strict diet for life’.
We welcome this statement. While a strict low FODMAP diet can certainly help many people with IBS and other causes of a sensitive gut by reducing fermentation, it is not the sort of diet you should stay on long term.
Both the Monash group and a corresponding team at Kings College, London, have shown that a low FODMAP diet deprives the beneficial bacteria in the gut of essential nutrients and depletes their numbers. Yet we are increasingly being told that so many of the chronic diseases that affect us, obesity, heart attacks, diabetes, rheumatoid arthritis, alzheimers disease and parkinson’s disease, may be due in part to a depleted colonic microbiome (a collective term for the micro-organisms, predominantly bacteria in the gut) and we should all be taking daily doses of probiotics to maintain a healthy gut. Surely we can’t have it both ways?
The thing is that a strict low FODMAP diet is a quick fix. That’s why so many people like it. By eliminating poorly absorbed sugars, it dramatically reduces gas production and retention of fluid in the gut. So at a stroke, bloating and diarrhoea may be abolished. But the long term consequences of remaining on such a restricted diet are uncertain and could be quite dangerous. Both the Monash and Kings College groups advocate that a period of dietary elimination groups must be followed by piecemeal dietary reintroduction.
It is easy to take foods out of the diet, particularly when you feel so much better, but much harder to put some of them back in again especially since depriving the gut of a particular food ingredient can tend to make you more sensitive to it. So many people with a sensitive gut find reintroduction difficult. It seems so counter-intuitive. As soon as you find a solution to your IBS that has been bugging you for years, they tell you to start eating the same foods that may have caused the problem in the first place.
Realising this, Monash and Kings recommend that that reintroduction should be supervised by a dietitian trained in the use of a low FODMAP diet. But this poses a severe logistical problem. IBS affects 15% of the population of the UK, approximately 12 million people, yet there are only about 600 FODMAP trained dietitians.
So most of the people who try a low FODMAP diet would have to resort to unsupervised dietary restriction, risking long term microbial and nutritional depletion. There are also other aspects to consider consider. The symptoms of IBS do not just depend on the type of food that is eaten, they also depend on the bacterial populations that ferment them and the sensitivity of the gut. The modification of gut bacteria is a very active area of research, which has yet to be fully realised. But the sensitivity of the gut, like other physiological variables, will fluctuate according to what is happening in a person’s life. Stress, worry, despair, frustration and depression is likely to make people and their guts more sensitive, whereas relaxation, leading a more balanced life and mindfulness reduces emotional tension and sensitivity.
In ‘Cooking for the Sensitive Gut’, we don’t advocate strict elimination of foods. We want you to eat a healthy, balanced and appetising diet. This is why we encourage you to understand your food, restricting those foods that contain the amounts of FODMAPs and other ingredients that are most likely to be causing symptoms and finding low FODMAP alternative ingredients that are low in FODMAPs wherever possible. It’s more about self help and understanding the portion sizes that are right for you than a strictly supervised elimination and replacement regime.
Even though you have IBS, you can still have a balanced and delicious diet; you just need to know how to prepare it yourself restricting those ingredients that are most likely to irritate a sensitive gut; not just FODMAPs, but fat, hot spices, alcohol and insoluble fibre while at the same time using the mindful art of cooking to relax and gain experience and confidence around food. But the bottom line is the same. Don’t deprive yourself of the foods you like and the people you like to eat them with by going on a strict elimination diet, just understand the foods you like and learn to prepare them in the amounts that keep you well and symptom free. Be confident and in control.
For more information on how to manage your sensitive gut follow the link to the IBS Network