The Low FODMAP Diet
A modified low FODMAP Diet is the last stage of the low FODMAP diet. FODMAPs are short chain carbohydrates (sugars) that are naturally present in a wide range of fruit, vegetables, cereals, grains, dairy products, legumes and pulses. These FODMAPs are poorly absorbed in our small intestines where they draw water into our bowels. Next, the FODMAPs are fermented by our gut bacteria in our large intestines where they create gas, which triggers unpleasant GI symptoms, particularly in those with IBS or irritable bowel syndrome. You can get a crash course on the low FODMAP diet here.
The low FODMAP diet is broken down into three distinct phases: elimination, reintroduction, and then a modified low FODMAP diet. The elimination phase is the initial two to eight-week phase of the diet where the goal is to significantly reduce or completely resolve your IBS symptoms through lowering the amount of FODMAPs you consume. This is achieved by removing all high FODMAP foods from your diet and instead focusing on eating low FODMAP foods. The Monash App, Casa de Sante App and the Stanford Low FODMAP Food List are great resources for identifying what foods and serving sizes are considered high FODMAP. Reading labels is also an important component of sticking to a low FODMAP diet, as processed and packaged foods are often laden with hidden high FODMAP ingredients. Once your IBS symptoms are under control you can then progress to the reintroduction phase with the guidance of your dietitian. Here, each FODMAP is tested separately and you work towards identifying how much of each you can consume before symptoms are triggered.
What is a A Modified Low FODMAP Diet?
The introduction of a modified low FODMAP diet is the most exciting, rewarding and final phase of the low FODMAP diet! It’s the “woohoo, I’m almost there” phase! Now that you have a good understanding of what high FODMAP foods trigger your gastrointestinal symptoms, the low FODMAP diet can be tailored to suit your long-term health needs and food preferences. Here’s where you get a say!
The goal of a modified Low FODMAP Diet is to keep your symptoms under control while incorporating a range of low and high (!) FODMAP foods in your daily diet. Initially, this can be tricky, as it requires you to discover what high FODMAP food combinations you can eat and how often, before they send you for the loo or have you bent over in stomach agony. Then you can settle into your new food routine while maintaining symptom control and good gut health. But wait , why the need for high FODMAP foods at all?
Our gut bacteria loves high FODMAP foods like, well, a fat kid loves cake as the saying goes. FODMAPs often act like prebiotics (the food for the good bacteria) and have a positive effect on our gut and overall health and wellbeing. This means restricting FODMAPs long term could actually have a negative impact on your overall health. Food variety is also very important for maintaining good health and ensuring we are getting a nutritionally balanced diet, as each food possess unique nutritional qualities.
The low FODMAP diet is also restrictive and can be pretty socially isolating. Just think of all the potential trigger foods present at a birthday party, potluck dinner, movie outing etc.! You’ve put in the hard yards. Now, with your new-found freedom, you will be able to enjoy a wider range of foods at these events, feeling more ‘normal’ and less deprived.
So, what does the a modified Low FODMAP Diet actually involve?
Based on results from the individual high FODMAP trials during the reintroduction stage, consider moving forward to challenging foods with multiple FODMAPs. Some examples include:
- Fructans and Fructose: Jerusalem artichoke, watermelon
- Fructose and Sorbitol:apple
- Fructans and Sorbitol:plum, prunes
- Fructans/GOS and Mannitol:snow peas
- GOS and Mannitol: butternut squash
Keep in mind that if you did not tolerate a specific FODMAP category during the initial reintroduction (for example, fructose), then avoid trialling foods that contain that type of FODMAP when testing combinations.
Next, test more than one high FODMAP food at a time to assess your threshold. Here, you are figuring out the overall load your body tolerates, so the foods do not necessarily need to come from different FODMAP categories, although they can. For example, you could experiment with a wheat-based pizza (fructans) topped with marinara sauce containing onion and garlic (fructans).
Based on the results of these combination challenges, along with the findings from the reintroduction phase, you can begin to establish your modified FODMAP diet. If you know you can handle foods with fructose and lactose well then focus on consuming foods from those FODMAP categories. However, if you do not respond well to fructans and GOS then limit or avoid foods from those FODMAP categories. Don’t be disheartened if this is the case, as there a range of equally delicious certified low FODMAP alternatives. A great example is replacing onion/garlic (raw or powdered) with FODMAP-friendly spices. It’s important you continue to check in on your symptoms over time and make small tweaks when needed as the gut microbiome is in a constant state of flux.
Overall, it is likely you will remain on some version of the modification phase for life to maintain good symptom control. If possible, it is a good idea to work with a dietitian during the initial part of this phase, who can ensure your long-term modified low FODMAP Diet is nutritionally balanced and that you are getting enough fibre and prebiotic foods.