Today, I need to get something off my chest. I am never one to offend those in the gut health community and although I have Crohn’s myself, this website is very much about all different approaches to gut health and aims to support those with a variety of different conditions. However, since I have started offering nutrition consultations one word is coming up again and again: FODMAP.
Let’s go back to the beginning…
Now I’ve known about FODMAP for a good few years or so- I was introduced to the concept by the lovely Samantha who runs The Gut Health Empire. When we first met, Samantha was extremely well informed on all things FODMAP; she even tracked down the testing team in Australia which confirmed she was indeed intolerant to FODMAP. That’s dedication!
However, years later and Sam is no longer alone. Somewhere along the line- somewhere in between that conversation where Sam explained what the hell FODMAP stood for and today- FODMAP has exploded. No longer something that was adopted by a minority who felt it made a real difference to their health but instead by anyone who turned up to their GP with a stomach ache and decided to ‘give it a go’.
The Big Issue
Herein lies the problem. A low FODMAP diet is not something you ‘have a go at’- you have a ‘go’ at drinking less alcohol or eating kale (and if you’re anything like me, your attempts might not last very long). If your knowledge of food and nutrition is limited, you don’t have a ‘go’at a complex diet that you can’t pronounce and was originally done with the support of fully qualified dietitians. If you do, well then, it can only end badly…
After taking this to my social followers, I found some interesting insight. The first was Nicola, a gluten free blogger who was reviewing my nutrition services. Nicola explained she struggled with IBS and in her own words “had been trying to do a low FODMAP diet but not very successfully. Fruits and veg are limited”. A quick glance at her food diary confirmed this: they weren’t limited, they were non-existent and her diet pretty much revolved around gluten free aisle alternatives.This is no slight on Nicola as she seemed genuinely surprised when I didn’t think low FODMAP diet was right for her. Now, this concerned me for several reasons…
- I am no FODMAP expert but there are plenty of fruit and veg that are suitable- bananas, grapes, green beans, carrot, cucumber, lettuce, tomato. The list goes on. Not that this is Nicola’s fault in the slightest: since at it’s simplest the diet explains that fruit sugars are difficult to digest and it might be easier to think we should avoid them altogether. This is where expert guidance comes in.
- Nicola then revealed she had her gallbladder removed. Now straight away I was aware that diarrhea is often caused by this operation– not because of an issue with the short chain carbohydrates that FODMAP sufferers find but because of bile regulation. One glance at her diet meant I could also see it was very low in omega 3, which would help anti-inflammation and she needed some enzyme support for digestion. Now, you tell me, why Nicola would need to be prescribed a low FODMAP diet by her doctor?
- Nicola seemed quite surprised that I wasn’t recommending low FODMAP diet being a gut health nutritionist. This is where the message has got badly wrong: low FODMAP diets should be a last resort for those with gut issues not the definite statement on gut issues. You wouldn’t expect a doctor to treat everyone exactly the same if they had a headache- it would depend completely on that person’s circumstances. My thoughts when looking at someone’s diet is always: what goodness can we add into it? what can we maybe cut down on? How can we help you with nutritional deficiencies? Far more rationale than an extreme diet.
One Size Fits All
What tends to happen in medical communities is when one person latches on to an idea, they all do. Around a year ago, I shared what I felt, was a really useful blog post- a non-biased scientifcally supported overview to all the different diets out there for gut health- with the IBS Network. Their response? ‘Sorry, we only support content about the low FODMAP diet’. No suggestion of supporting the individual, keeping a food diary or elimination diets.
It is thought that at the very least 10% of the population have IBS (some estimates go as high as 20%) That means the IBS Network is seriously suggesting that 6.25 million people in the UK follow the same diet? That’s 6 times the number of people on Slimming World- where on earth are we going to get all the dietitians for that?
We’re not of course. And that’s the problem. Doctors, being fed up of not knowing what to say to IBS patients have too latched on to this. Fellow blogger Charlotte has chatted to me for a long time about her struggles with FODMAP. She was told to follow it but, without proper support, she found the whole process actually gave her more anxiety about food and made her feel worse. When asked what support she was given, she replied ‘I was given LOW FODMAP” on a post it note and the doctor told me to try it. ‘ A recipe for disaster waiting to happen.
Now before we go any further- I am aware that there are plenty of people who do find a low FODMAP diet beneficial for them and I don’t want this article to be completely unbalanced. In the interest of research, I chatted to Tania fromWhen Tania Talks who responded to my shoutout on twitter. She explained that she has been following the principles of the diet for years after finding out about it from The Allergy Free From Show. She explained she welcomes it becoming mainstream but does explain she felt confident in tackling the diet as both herself and her mother were well versed in understanding allergies and nutrition. There are some bloggers who share amazing low FODMAP recipes such as The Zebra Pit for example.
It is perhaps a mixed blessing then that there are more products emerging than ever before for those on a FODMAP diet. On the one hand, companies like Fodify foods and Bay’s kitchen have emerged. I haven’t tried their food personally but they appear to be run by sufferers who have found restricting FODMAP foods has made a great deal of difference to their life with IBS and want to help others.
This is admirable and largely what started the surge of gluten-free products we now have on our shelves. It started off with good intentions but now I regularly have to explain to people who have bought me ‘gluten free ketchup’ or ‘dairy free potato crisps’ that they’re paying for a label. One can only hope that the FODMAP movement does not follow suit.
What concerns me most is not the number of people who will be on the FODMAP diet in the near future, but the number which will attempt it. Will we see those ‘having a bit less FODMAPS’ or ‘low FODMAPS days’ becoming the new meat free Monday? If you are reading this and you are struggling with IBS, I would always encourage you to go back to basics. Keep a food diary. See a specialist and as always: make sure other conditions are ruled out. Work on your stress. Add in plenty of gut health foods. Consider intolerance testing. All of these things will be a hell of less stressful than going straight to the low FODMAP diet. If you are reading this and you’ve tried it all- gluten free, dairy free, sugar free, preservative free, flavour free, and you’re still not getting anywhere then ask to see a NHS dietician who can guide you through the process.
Our guts are a complicated thing and vitally important to our overall health. It’s thought that everything from our bacteria to our enzyme levels is unique to us. There may be at least 6 million people with IBS in the UK but if two of them had a conversation, I could bet their experiences would be different. Some people have diarhea. Others constipation. Some have excessive bloating. Others wind. Some have low energy levels. Others have all sorts of deficiencies. If we acknowledge that IBS is far reaching and varies widely, it only makes sense to acknowledge that when it comes to diet, one size cannot and absolutely should not fit all.