Digestive Disorders

Low-FODMAP Diet Basics

With the increasing popularity of the low-FODMAP diet, you may be wondering whether it’s right for your patients. While this elimination diet can provide many benefits and symptom relief for those with digestive disorders such as irritable bowel syndrome (IBS), it isn’t appropriate for every patient. For those who find that the low-FODMAP diet helps with their IBS symptoms, RDs can help guide patients on how to implement the diet and share helpful resources with them.

What Does the Diet Entail?
FODMAP is an acronym that stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. FODMAPs are fermentable short-chain carbohydrates that are poorly absorbed and/or have an osmotic effect in the gut. Common foods high in FODMAPs include onions, garlic, apples, mushrooms, cauliflower, wheat, milk, yogurt, and honey.

The low-FODMAP diet is a three-phase elimination diet that has been shown to reduce symptoms and symptom severity and improve quality of life in people diagnosed with IBS.

Who Should Follow the Diet?
The low-FODMAP diet may be appropriate for patients diagnosed with IBS who currently eat a high-FODMAP diet and experience symptoms, and those with inflammatory bowel disease with quiescent symptoms.

Other patients would most benefit from a simplified low-FODMAP diet, in which they only restrict very high–FODMAP foods they frequently consume. This type of low-FODMAP diet is more appropriate for patients who aren’t likely to comply with a strict diet, older adults, and pediatric patients.

Patients who have a history of eating disorders, disordered dieting, or orthorexia, or those whose diets aren’t thought to trigger IBS symptoms, may benefit from nondiet therapies such as cognitive behavioral therapy or gut-directed hypnotherapy rather than a strict eating pattern.

Implementing the Diet
The low-FODMAP diet can feel immensely restrictive for patients, but RDs can help make the diet more doable. Encourage patients to continue eating a variety of low-FODMAP fruits, vegetables, grains, and proteins to ensure overall nutritional adequacy. Also recommend they keep track of their symptoms with a food and symptom journal. This can especially come in handy when reintroducing foods into their diet.

When following a restrictive eating pattern, it’s usually necessary to cook at home more often. Provide suggestions based on patients’ cooking abilities. If they’re a skilled cook, it may be easier for them to prepare meals that are low in FODMAPs but high in flavor. Patients who aren’t culinarily inclined or short on time may benefit from convenient low-FODMAP food products such as those made by Fody Foods or Casa de Santé. RDs also can help patients develop strategies for different away-from-home situations, from packing low-FODMAP snacks for travel to bringing a low-FODMAP dish to a holiday party.

Finally, remind patients that the elimination phase isn’t for life and that they may be able to introduce some foods back into their diets. Guide them gently into the reintroduction phase after the elimination phase.

Resources for Patients
The Monash University FODMAP Diet app is available for iPhones and Androids for $8. It helps patients and practitioners identify which foods are low- or high-FODMAP and which FODMAPs they contain.

Organizations such as the International Foundation for Gastrointestinal Disorders provide resources and support for patients.

RDs who have FODMAP-focused blogs and websites that provide evidence-based information and low-FODMAP recipes include Stephanie Clairmont; For a Digestive Piece of Mind; Tamara Duker Freuman, MS, RD, CDN; The Spicy RD; and Judge Nutrition & Wellness.

FODMAP Everyday, A Little Bit Yummy, FODMAP Life, and Everyday Nutrition also provide low-FODMAP recipes and resources for patients.

Resources for RDs
If you’re interested in learning more about the low-FODMAP diet to better serve patients, several options are available.

Monash University provides a comprehensive online training course called The Low FODMAP Diet for IBS. Dietitian-created self-trainings include Kate Scarlata’s, RDN, LDN, CEU course called Irritable Bowel Syndrome: FODMAPs, Fat, Fiber and Flora, Second Edition and The IBS-Free FODMAP Practice Kit for RDNs by Patsy Catsos, MS, RDN, LD.

Finding a Low-FODMAP Dietitian
If you think your patients would benefit from the low-FODMAP diet but don’t feel comfortable counseling them, you can refer them to other RDs. There are several RDs who specialize in digestive disorders and are knowledgeable of the low-FODMAP diet. Directories such as Monash University’s FODMAP Dietitian Directory, Scarlata’s FODMAP Registered Dietitian Registry, and the FODMAP Everyday Registered Dietitian Directory can make it easy to find an RD who specializes in the low-FODMAP diet.

— Alena Kharlamenko, MS, RD, CDN, is the founder of Alena Menko Nutrition, a food and nutrition blog where she publishes healthful, plant-forward recipes and makes nutrition approachable with easily digestible information. She’s also a Monash FODMAP-Trained Dietitian. You can find her on Instagram @thebalancedbite or on Facebook @AlenaMenkoNutrition.

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