It’s now been two whole years since I started on the low FODMAP diet, a medical diet used to treat IBS symptoms. You would think that one special diet would be enough, but in my case, the strict gluten free diet did not solve everything. Just when I thought I had the whole coeliac thing figured out, I started to get ill again. Daily upset stomach, pains and fatigue. Regular unexplained symptoms that were similar to those of coeliac disease, but which made little sense as I knew I was sticking to the gluten free diet. Apparently, this is not uncommon. ‘20-30 % of coeliac patients on a gluten free diet still have irritable bowel syndrome (IBS) symptoms’, according to one study*, and the low FODMAP diet is now a recommended treatment.
I thought it would be interesting to check in a couple of years down the line, share with others in a similar boat what I have learned, and hopefully hear a few of your experiences too.
It’s a bit like becoming coeliac all over again
When starting on the low FODMAP diet, I had to rethink everything I ate. Go back to squinting at labels, checking everything I put in my mouth against a special ‘FODMAP’ app and being the awkward customer and guest. Initially, the stress of trying to follow the diet seemed to outweigh the benefits of it. It is wearying to have to check every single thing you put in your mouth against a checklist, to say no to delicious foods all the time and cook every single thing from scratch. It takes up a lot of mental space, and even as someone used to doing all of the above for the gluten free diet, it was hard. I wasn’t prepared for quite how upsetting I found it. As someone who was diagnosed with coeliac disease when I was very young, it gave me a new appreciation for how tough it must be to start on the gluten free diet later in life.
You need to cut out healthy foods, too
Counter-intuitively, on the low FODMAP diet you actually cut out a lot of healthy foods (part of the reason it is not intended to be a strict diet for life). Fruits, vegetables, pulses, things that you think you *should* be eating. A lot of these healthy high FODMAP foods were former staples of my diet, and things that I enjoyed eating and cooking with. Onions, garlic, pulses, apples, tinned and dried fruit, milk, yoghurt, mushrooms, sweet potatoes, avocados. I had to empty my cupboards and go back to the drawing board.
Onions and garlic are in EVERYTHING
I mean really, everything. They are staples in pretty much every cuisine, and I find these are the hardest things to avoid. During the strict elimination phase, it made it very difficult to buy any sort of prepared food, or grab something to eat on the go. If you don’t know how to cook from scratch, you’d better learn! Garlic oil + herbs and spices are an ok substitute when you need to add flavour to your cooking. Bizarelly, I also found that apple extract and fruit juice are in a lot of processed gluten free foods, as well as ingredients like xantham gum and psyllium husk, which can irritate the gut.
You need to make sure you are getting enough nutrients
Apart from the fact that dairy is pretty much my favourite food group, I was concerned that in cutting out milk, yoghurt and certain cheeses, I would be losing a lot of calcium. (Coeliacs have a higher than usual propensity to develop osteoporosis, so we need a helluva lot of calcium). I found seeing an NHS dietician crucially helpful for this. She gave me advice on other calcium-rich foods I could eat (e.g. kale, spinach, sardines, fortified orange juice).
Eating Out is difficult, but not impossible
It is hard enough to eat out safely as a coeliac, but avoiding FODMAPS adds a whole other layer of complication. Gluten free options are everywhere, but low FODMAP options are non-existant. Working in Central London, I had gotten used to eating out fairly regularly both for socialising and work (lucky, I know!), so I found it tough to have to start carrying my own food everywhere and constantly be thinking about my next meal.
Soothe Food Supper Club
My favourite discovery was the Soothe Food gluten free and low FODMAP supper club. I had a couple of lovely meals courtesy of Emma, and would definitely recommend it. When I did manage to eat out elsewhere, the safest bets I found were plain steak and chips or a gluten free pizza with low FODMAP toppings. Also, Indian Jain food. I found an Indian restaurant near Oxford Circus which has an onion/garlic-free menu.
No, I’m not trying to lose weight!
Telling people you are following a low FODMAP diet is even more tricky than telling them you eat gluten free. Most people do not know what FODMAPs are (Fermentable, Oligo-, Di-, Mono-saccharides and Polyols), and it is not that easy to explain in layman’s terms. It’s not black and white like ‘I can’t eat gluten’; there are several different types of food you have to avoid / eat reduced amounts of, and you eventually start reintroducing some of these, which can be confusing. Frustratingly, even when I stressed that I was doing the diet for medical reasons because I had been told to by a doctor, some people still assumed I was doing it to lose weight. I hate to be thought of as faddy, and I was kind of offended that they thought I needed to lose weight!
Moderation and balance
Happily, the low FODMAP diet (alongside my permanent strict gluten free diet, obv) combined with some lifestyle changes has worked well for me. Two years on, I feel healthy about 80-90% of the time, which is fantastic. Making some lifestyle changes to reduce stress has also helped, and though I was skeptical at first, I find yoga great for keeping mentally and physically well. I still try to avoid certain trigger foods (onions for one), but I am far from strict with it. Moderation is key. I try to eat low-ish FODMAP at home, so that I can eat more freely and not deny myself when eating out. I also try to avoid eating too many highly processed, rich or fatty foods (e.g. gluten free bread full of gums and thickeners, a full roast dinner) as I find these don’t agree with me, and rarely drink more than a couple of glasses of wine. Touch wood, these things keep me feeling well. I think I’ll probably always have to pay attention to my gut and consider the food I am eating, but ultimately, I’m glad that my issues could be solved (or at least alleviated) with something as simple as food.
Please bear in mind that all of the above is my personal experience. The nature of IBS and gut disorders means that your experience may vary. The FODMAP diet should be undertaken under advisement from a dietician, and it does not work for everyone.
I’d love to hear your thoughts if you have also been on the low FODMAP diet, whether for a year or two or just starting out. Has it worked for you? How do you manage it after the initial elimination period?
Monash University (creators of the low FODMAP diet) – Keep an eye on the research team’s website for the latest updates to the diet. Their app is invaluable for checking which foods you can eat, and getting recipe ideas.
Gut by Giulia Enders – Explores the inner workings of the gut in a fun and accessible way. A very interesting read if you are living with any sort of gut disorder.
Latest FODMAP research – There is some very interesting research being done into the efficacy of the low FODMAP diet at the moment, with findings such as this:
*’20-30 % of coeliac patients on a gluten free diet still have irritable bowel syndrome (IBS) symptoms….Patients with coeliac disease and IBS-symptoms had significant improvement in abdominal symptoms and physical health from a low FODMAP diet for 6 weeks. A gluten free diet with reduced FODMAP content was more effective than a more strict gluten free diet, and should be offered to coeliac patients with refractory IBS-symptoms on a gluten free diet.’ – read abstract here (click ‘Coeliac Disease for the Clinician’ and then look at 16:57 – 17:09)
King’s College, University of London are also conducting research in this area.