The struggle is real for individuals living with Irritable Bowel Syndrome (IBS). First of all, digestive symptoms are down right uncomfortable. It’s hard to feel so bloated your pants are going to burst by the end of the day. It’s frustrating to make sure you stay within proximity of a washroom around mealtime. On top of that, it’s hard to be diagnosed with IBS because while symptoms are apparent, nothing really appears to be medically wrong! You might eat one food one day and feel okay, the next day the same food causes you to run straight to the washroom.

​The anxiety, mental challenges and financial stress from taking days off work and spending more money on healthcare add another layer of complexity to this problem. It’s so challenging to find a happy balance between getting enough nutrients, controlling symptoms so that you can have the energy to do things you love and feel comfortable in your own body. 

What is IBS?

Irritable bowel syndrome, or IBS, is a common gastrointestinal disorder that affects 15% of the population. IBS symptoms include abdominal pain, bloating, gas, constipation, and diarrhea. It is unclear what the pathophysiology of IBS is, but research has shown that disturbances in the nerves of intestine may be associated with genetics, changes in the gut after an infection (such as gastroenteritis), and psychosocial factors (e.g. stress, anxiety, depression). 

How is IBS diagnosed?

​As I said, it’s hard to diagnose IBS because, well, there is no single reliable diagnostic test. There are no biochemical, structural or physiological abnormalities in individuals with IBS, despite symptoms. Doctors rely on the patient’s report of symptoms, and conduct a battery of tests to rule out other diseases such as celiac’s disease, bowel cancer, etc. Talk to your doctor and specialist dietitian if you are unsure if you have IBS.

Does the low FODMAP diet actually work? 

​The low FODMAP diet has proven to be a huge game changer for IBS patients. There is strong evidence showing 75% of IBS patients get relief from symptoms by following a low FODMAP diet. That’s right, you can get relief from your IBS symptoms with food! 

What are FODMAPs?

FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols. They are indigestible carbohydrates found it food that make their way to the gut and get fermented by the gut bacteria. While this is a normal and healthy process,  people with IBS have lower tolerance to the amount of FODMAPs they can eat before symptoms are triggered. 

​What does the FODMAP elimination trial look like? 

The low FODMAP diet is a learning diet. That means, it is temporary and its purpose is for learning your individual tolerance and sensitivity to foods. The entire process may take 6 months to complete and is divided into three phases.  
Step 1 – Elimination (2-6 weeks):
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  1. During this stage, you will eliminate all foods high in FODMAPs from the diet to get relief of symptoms.
  2. Having reduced symptoms indicate that FODMAPs were truly the culprit. It's important to note that this phase is only temporary.
  3. While some people find relief within a week of elimination, some people may take up to 6 weeks to fully adjust to the new diet. 
Step 2 – Re-challenge (6-8 weeks): 

​Because FODMAP foods are also healthy foods for your gut bacteria, you need to reintroduce them into your diet and figure out a threshold that works for you. During this stage, 5 individual food challenges are reintroduced in a methodical manner to test your tolerance. These challenges include
  1. Lactose
  2. Fructose
  3. Fructan
  4. Galacto-oligosaccharides
  5. Polyols
Step 3 – Reintroduction (6-8 weeks):
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  • ​By the end of this phase, you will learn from what your personal tolerance is for certain types of food.
  • The goal here is all about increasing the variety in your diet so that you can enjoy your food while minimizing symptoms as much as possible. 

Why you should see a dietitian specializing in IBS before starting the low FODMAP diet

There are many reasons why the low FODMAP diet should be a dietitian-guided process, including successful outcomes and your well-being.
  1. A dietitian can assess if you would be a good candidate for the low FODMAP diet for various reasons. These include proper diagnosis and investigation of the disease, lifestyle, emotional, physiological, and dietary reasons.
  2. A dietitian can  make recommendations to alleviate digestive symptoms in addition to guiding you through the low FODMAP diet.
  3. A dietitian can make sure you are meeting your nutritional needs while being on a restrictive diet. Especially for those with other dietary restrictions and health conditions (such as being a vegan or having diabetes), the risk for poor nutrition quality leading to deficiency is higher. 
  4. A dietitian can help you personalize your low FODMAP diet. You can get answers for what type of easy snacks can you eat? What kind of protein powder or supplements are appropriate? How do you make food taste delicious without using certain ingredients?
  5. A dietitian can guide you through the elimination phase, challenge phase, and reintroduction phase to make the diet work for you long-term so that you can live free of symptoms.