FODMAP | the flaw of the LOW FODMAP diet

For years, we have known that food choices can drastically impact health symptoms. So, it's no surprise that diets are continuously developed for different health conditions or symptoms. Yet, the question remains: should you be eating for your specific condition by following strict dietary guidelines?

This brings up the Low-FODMAP Diet (aka low fermentable oligo-, di-, and monosaccharide and polyol), a dietary intervention with a strict reduction of indigestible short-chain carbohydrates that feed the bacteria in your gut.

Since the conception of the Low-FODMAP Diet, there has been a lot of research to understand whether it works – especially for symptoms associated with Irritable Bowel Syndrome (IBS). The research has been quite positive and demonstrates that the Low-FODMAP Diet does, in fact, have a lot of benefit.^{1 2}  However, the studies carried out did not consider the downfalls of this diet, such as an increased risk of nutritional inadequacy and fostering disordered eating, in addition to impacting your gut microbiome in a negative way.^{3 4}

This is why I strongly disagree with the long-term use of the Low-FODMAP Diet and I want to outline the reasons why it is not a true solution for IBS.

It might sound easy to avoid foods on the High–FODMAP list, except that a number of foods suggested for elimination help nurture the healthy bacteria that protects your digestive system and increases nutrition absorption.

To compound the problem, some of the allowable foods are full of refined starch and sugar that feeds unhealthy bacteria, yeasts and parasites, in addition to simply not being health promoting.

For instance, according to the Low-FODMAP protocol, you can consume the following inflammatory items which damage your gut health: aspartame, Acesulfame K, saccharine, sugar, corn (even corn chips!), rice (including Rice Krispies!), oatmeal, wheat (1 piece of bread per day), spelt (sourdough, though it is stated not to consume fermented foods), icing Sugar, golden syrup, peanuts, potato (including potato chips!), popcorn, beer, vodka, gin, whiskey, wine, coffee and most forms of dairy.

In my years of experience helping clients transform their digestive health, all of these suggestions are very hard on the gut and I feel they should be completely removed when dealing with a digestive issue. My clients' bowel function almost always improves by removing grains, refined carbohydrates, dairy and alcohol.

Looking at the list of foods to avoid while on the Low-FODMAP Diet – asking you to avoid a lot of beneficial, healthy, fermented foods (i.e. sauerkraut) when you are permitted to drink various forms of alcohol, consume yogurt and glutinous, sourdough bread and eat mouldy cheese (i.e Brie) – do you see the problem here?

Some of the other healthy ‘gut’ foods removed on the Low-FODMAP Diet include: onion, garlic, artichoke, asparagus, avocado, cauliflower, celery, falafel, fermented cabbage (eg. sauerkraut), leek bulb, mushrooms, peas and pickled vegetables. All of these foods are very healthy, containing fibre, nutrients and antioxidants.

The healthy foods on the ‘NO’ list of the Low-FODMAP Diet do not necessarily cause digestive symptoms unless you are specifically allergic or intolerant to one of them. When you restrict healthy Low-FODMAP foods, you starve your gut bacteria, including the good and healthy ones. ^{3 6} It's true that symptoms, such as bloating and gas, are relieved by as much as 70%, though I think there is much better way to deal with underlying causes of IBS and relieve your symptoms permanently.

In the long-term, the Low-FODMAP protocol is very unhealthy and has a detrimental impact on your healthy gut microbiome.^{4 5} Following the Low-FODMAP protocol has you, literally, starving the good bacteria while promoting unhealthy bacteria, yeast and parasites because you're eating refined grains, sugar, alcohol and mouldy food!

You will see that pre-biotic food is healthy to consume, and even encouraged (unless you have a specific intolerance), because it feeds beneficial bacteria to rebalance your microbiome.^{6 7} Think of taking probiotics as the equivalent of planting seeds in your garden. Taking pre-biotics, by contrast, is like watering the seeds that are already there, so that they grow and flourish. Additionally, because all pre-biotics contain dietary fibre they are so important for detoxification – binding toxins and helping to eliminate them in stool. Not enough fibre in your diet can lead to mild constipation and toxin re-absorption. Take note however, that you may need to test out different fibres and pre-biotics in order to find the ones that works best for you.

On a final note, the inappropriate use of the Low-FODMAP Diet, or its use long-term, carries the risk of nutritional inadequacy because it eliminates healthy, whole foods from your diet. In addition, the restriction of foods and an obsessive focus on food choices can cause, or trigger, disordered eating behaviours, having long-term impact on your mental health.

Instead of following a super-strict Low-FODMAP Diet, here's my suggestion for what to do if you have digestive problems:

The food you consume must be tailored to YOUR needs. I do not believe in Die-Its. I believe in Live-Its that are designed to consider your symptoms and health needs. A better strategy and first step in healing digestive issues is to test foods to figure out your unique intolerances through the Elimination Protocol and removing refined carbohydrates such as sugar, gluten and difficult-to-digest foods (such as dairy and corn).

These recommendations can be found in my first book, Meals That Heal Inflammation.

References

1. O’Keeffe M., Jansen C., Martin L., Williams M., Seamark L., Staudacher H., Irving P., Whelan K., Lomer M. “Long-term impact of the low-FODMAP Diet on gastrointestinal symptoms, dietary intake, patient acceptability, and healthcare utilization in irritable bowel syndrome”. Neurogastroenterology & Motility. 2017. 30(1): https://www.ncbi.nlm.nih.gov/pubmed/28707437
2. Gibson P., Shepherd S. “Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach”. J Gastroenterol Hepatol. (2010); 25: 252-258. http://www.ncbi.nlm.nih.gov/pubmed/20136989
3. Muir P., Gibson P. “Controversies and recent developments of the low-FODMAP Diet”. Gastroenterol Hepatol. 2017; 13(1): 36-45. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5390324/
4. Rao SS, Yu S, Fedewa A (2015). "Systematic review: dietary fibre and FODMAP-restricted diet in the management of constipation and irritable bowel syndrome". Aliment. Pharmacol. Ther. 41 (12): 1256–70. doi:10.1111/apt.13167. PMID 25903636.
5. Heiman ML, Greenway FL (2016). "A healthy gastrointestinal microbiome is dependent on dietary diversity". Mol Metab (Review). 5 (5): 317–320. doi:10.1016/j.molmet.2016.02.005. PMC 4837298 PMID 27110483
6. Brouns F., Delzenne N., Gibson G. “The dietary fibers – FODMAPs controversy”. Cereal Food World. 2017; 62(3): 98-103. https://aaccipublications.aaccnet.org/doi/pdf/10.1094/CFW-62-3-0098
7. Slavin J. “Fiber and prebiotics: mechanisms and health benefits”. Nutrients. (2013); 5: 1417-1435. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705355/