FODMAP threshold

If cutting out all FODMAPs is risky in terms of wiping out the good gut bacteria in an attempt to keep the windy consequences of nastier gut bacteria under control, is it reasonable to cut FODMAPs down progressively using a ‘top down’ approach? In this blog I will explore the idea of using a progressive approach to finding what I call your ‘FODMAP threshold’, where you eat as much FODMAP containing food as possible whilst remaining symptom free.

The evidence based approach to dietary management of Irritable Bowel Syndrome (IBS) is the low FODMAP diet, originally ‘invented’ and investigated at Monash University in Melbourne Australia, but now recognised and embraced around the world. While known to be extremely effective for overcoming IBS symptoms in 80 – 85% of IBS sufferers who trial the diet, a low FODMAP diet is challenging to follow and does decrease the viability of healthy gut bacteria.

While there is little published evidence to support the use of a more progressive approach to reducing FODMAPs, there are many practical advantages and some anecdotal evidence that a progressive or ‘top down’ approach could be useful, and sometimes preferable to a low FODMAP diet. A progressive approach to managing FODMAPs could be worth considering if any of the following points resonate with you:

  • If you have tried a low FODMAP diet and found it too difficult to follow
  • If you have other dietary limitations that would prevent you from complying with a low FODMAP diet for 2 – 6 weeks
  • If your symptoms are not severe enough to be classified as IBS but impact on your quality of life – perhaps wind, bloating, abdominal pain, diarrhoea or flatulence
  • If you don’t feel the need to understand exactly which FODMAP might be most problematic, and are just happy if the symptoms go away
  • If you are considering a low FODMAP diet trial but you need to ‘test the water’ first.

If you do trial a progressive approach to lowering FODMAPS some of the barriers you might need to overcome include:

  • Deciding which FODMAPs to decrease and by how much
  • Understanding which FODMAPs are most problematic for you
  • Knowing which dietary changes helped the most in symptom reduction
  • Learning how much FODMAP load you can manage before symptoms are triggered.

The above points are not intended to influence you one way or the other in deciding which approach to use for finding your ‘FODMAP threshold’. The main point is that if a low FODMAP diet trial is not for you, there are other ways you can go about finding your own ‘FODMAP threshold’. Of course, having a Dietitian on hand to step you through the process might not be a bad idea. Please contact me directly to arrange an online diet assessment or Skype consultation.

Blogged by Kerith Duncanson – July 2015

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