“Help… I don’t think it’s working!” Your guide to troubleshooting the low FODMAP diet

Although the low FODMAP diet can be greatly helpful in addressing a range of gut-related health concerns, like anything, it is not a ‘one size fits all’ approach. However, the good news is that there are multiple approaches you can take to troubleshooting your gut symptoms! Today on the blog, we will discuss why the low FODMAP diet may not work, how you can troubleshoot, and alternative strategies to try.

Why does the low FODMAP diet not ‘work’ for everyone?

With this question, it is important to consider what we mean by the diet not ‘working’. Following a low FODMAP diet is one (very important) piece of the IBS symptom relief puzzle, but it is important to manage your expectations about what you hope to achieve through following the diet – from elimination to reintroduction phases. Done properly, the low FODMAP diet should involve some ‘short-term pain for long-term pain relief’. Although the low FODMAP diet works to reduce physical discomfort, there can be a fair amount of ‘pain’ involved in wrapping your head around the diet and its many complexities. Just like the diet is complex, there are also multiple reasons why the diet may not ‘work’ in terms of symptom relief. Let’s run through a few of the contenders.

Have you actually been diagnosed with IBS?

Irritable Bowel Syndrome (IBS) is a condition that affects the functioning of the bowel. FODMAPs are types of sugars (short-chain carbohydrates) that can trigger the uncomfortable digestive systems of IBS. However, the symptoms of IBS are not ‘unique’ – they align identically to other gut conditions which can make a diagnosis of IBS difficult. If you suspect that you may have IBS, it is important to first seek medical advice to ensure that your symptoms aren’t caused by any other serious gut conditions such as Inflammatory Bowel Disease (IBD), coeliac disease or even bowel cancer. A doctor may complete a full medical check-up, blood tests, including blood tests to screen for coeliac disease, stool tests, and if further testing is needed, an investigation of the bowel lining by inserting a small tube (sigmoidoscopy) or of the small bowel via a colonoscopy. If your symptoms are caused by a different health condition, you are essentially using the ‘wrong key to open the door’, which will more than likely not lead to symptom relief.

Are you FODMAP stacking?

FODMAP stacking refers to how individual FODMAPs can ‘add up’ in the gut and cause symptoms. Think of FODMAP stacking like loose change – in isolation, loose change doesn’t necessarily make a difference, but when added all together, it might buy you something (in this case, unfortunately it may buy you physical discomfort!). It is challenging to develop a specific guideline for FODMAP stacking, as everyone with IBS has varying levels of tolerance. However, the FODMAP Friendly App (Android or Apple) can help you calculate portion sizes and monitor FODMAP stacking.

Eating out and eating high FODMAP foods without knowing

Unless you cook all of your meals at home, unfortunately it is impossible to have full knowledge of what you’re eating, and you could be eating high FODMAP foods without knowing. If you are experiencing flare ups after eating out, you may like to consider how you can manage this (it may not be as simple as deciding not to eat out, but perhaps reducing it to special occasions).

Non-compliance

There are no shortcuts in the low FODMAP diet. Depending on your tolerance, sometimes even a teaspoon of a FODMAP-containing food is enough to cause discomfort in some people. This is why in the initial phase of the low FODMAP diet, complete commitment for a short period of time is much more helpful than half-hearted commitment for longer.

There are a few other unassuming and often hidden gut irritants that may make your IBS symptoms worse. Here are some foods/beverages to look out for:
Carbonated beverages
Adding more air or bubbles to an already gassy and bloated digestive tract may result in more pain.

Caffeine
For those with IBS-D (diarrhoea), caffeine may exacerbate symptoms because it increases the stress hormone, cortisol, which increases gut motility and can lead to cramping and diarrhoea.

Alcohol
Also affects gut motility in various ways at different points of the digestive tract.  Alcohol slows digestion, keeping food in your stomach longer which can increase ‘transit time’ and increase fermentation processes, producing gas and which may cause further discomfort.
Fatty foods
Such as deep-fried goods, pizza and cream may induce abdominal pain, abdominal distension, gas and bloating to a greater extent in people with IBS.

Spicy foods
Hot and spicy foods typically containing chilli can be tolerated by some people with IBS yet cause digestive upset in others.

You’re on the low FODMAP diet for weight loss

The low FODMAP diet is NOT meant to restrict calories and NOT intended to result in weight loss. The diet focusses on swapping and omitting specific foods or large quantities to reduce FODMAP intake rather than energy intake. FODMAP-trained Dietitians typically discourage pursuing active weight loss during the low FODMAP elimination & challenge phases. Why? Following a low FODMAP diet and losing weight are tasks that require a great deal of attention to dietary patterns and food choices. Tackling both at the same time may decrease your success in achieving either goal. Remember, SMART goals are those that are specific, measurable, attainable, relevant, and timely.

Troubleshooting the low FODMAP diet

Not all is lost – just as there are plenty of reasons why the diet may not be working, there are plenty of troubleshooting strategies for you to make the low FODMAP protocol work for you.

See a FODMAP-trained Dietitian

A FODMAP-trained Dietitian is a great person to have on your team. A Dietitian can perform a full patient assessment, including a symptom assessment and diet. They will be able to answer all of your FODMAP questions, and help you choose the best course of action when it comes to the way in which you’d like to implement the diet. Also, there is greater risk of nutritional inadequacy when eating low FODMAP which could lead to nutritional deficiencies in the long term. Dietitians will help ensure that you are meeting all of the nutritional requirements when eating low FODMAP.

When you try to embark on the low FODMAP diet yourself, it can be very easy to make mistakes and feel discouraged. A Dietitian will equip you with the knowledge and tools you need to succeed through the three phases.

Download the FODMAP Friendly App (Android or Apple)

It is one thing to know what FODMAPs stand for, and another to know what they actually are. Have a look at reputable websites such as our FODMAP Friendly blog with multiple posts explaining the different letters that make up ‘FODMAPs’. Another great resource is the FODMAP Friendly App, which will help you discern the FODMAP content of foods.  Also, be sure to clue up by familiarising yourself with any FODMAP Friendly certified products at your local supermarket. You may want to set aside a few hours for your first shopping trip to spend time reading ingredients lists for high FODMAP-containing ingredients such as garlic or onion.
By knowing what FODMAPs are and which foods are low and high in FODMAPs, you will be better able to make a list of your favourite low FODMAP foods and plan your meals around that. The more you know, the easier the process will be!  For more options of low FODMAP foods download the FODMAP Friendly App, available for Apple /iPhones and Android.

Don’t forget the non-diet IBS symptom relief strategies

While diet can often prevent or ease symptoms, stress is a major driver of symptom onset and severity. High stress can interfere with even the best dietary strategies. When it comes to stress management, any behaviours you implement to manage your stress levels can help control your emotional response to IBS. You may like to consider taking up some gentle physical activity. Regular exercise can aid in stress reduction by stimulating the release of endorphins, leading to a greater sense of calm and well-being. Consider low impact exercise such as walking, yoga, light cycling, tai chi, or swimming – all activities which can help reduce stress and improve fitness. You can even type in ‘yoga for IBS’ on Google and retrieve a range of IBS-specific yoga flows! Meditation is another great stress management strategy to add to your toolkit, and again there are many wonderful free resources online to refer to when building this habit.

In Summary

The low FODMAP diet will not ‘work’ for everyone, but there are plenty of factors to determine whether you’re following the protocol properly, or whether you need to follow it at all to relieve physical discomfort. Working with a FODMAP-trained Dietitian will help you personally troubleshoot your experience, and provide you with all of the resources you need through your IBS journey.

Written by: Charlotte Barber (Student Nutritionist)
Reviewed by: Kiarra Martindale (Accredited Practising Dietitian)