9 Reasons You Shouldn't Do The Low-Fodmap Diet Without A Dietitian
The low-FODMAP diet has gained immense popularity in the last couple of years in the GI community, especially related to conditions such as irritable bowel syndrome (IBS). However, if you’ve ever looked into the low-FODMAP diet by yourself, it can be extremely intimidating & overwhelming. One of the most important things to know about this diet-it is not meant to be a long-term diet. If done incorrectly or for too long, it can lead to an extremely restrictive diet and increased stress (which can also impact your symptoms)!
As a Monash University, low-FODMAP certified dietitian, I know how complicated the low-FODMAP diet can feel for clients at the beginning. This diet has been designed to be a temporary intervention involving three stages (elimination, reintroduction, and personalization). At the end of the low-FODMAP diet, you will be able to further understand your unique dietary triggers! However, the reality for many people who attempt this intervention by themselves is a long-term low-FODMAP diet that typically leads to even more restriction than before. This is one reason why it can be helpful to complete the low-FODMAP diet with the support of a registered dietitian, and there are many more reasons below!
Current research supports dietitian-led low-FODMAP education
Most research related to the low-FODMAP diet has used a dietitian-led model of care and there are numerous successful examples using this model. While a smaller number of studies have examined non-dietitian led interventions, findings from these studies are more mixed. Studies utilizing interventions led by a dietitian found improvements in IBS-related symptoms such as bloating, abdominal pain, and changes in bowel movements.
Clinical guidelines recommend a dietitian-led delivery of the low-FODMAP diet
A number of organizations now specifically recommend dietitian-led delivery of the FODMAP diet. These include guidelines from the British Society of Gastroenterology 2021, the American College of Gastroenterology 2021, the British Dietetic Association 2016 and the NICE Guidelines 2015.
Dietitian-led interventions lead to better patient outcomes
Current research also suggests that patients do better when they follow a low FODMAP under the guidance of a dietitian. Dietitians are specially trained to deliver medical nutrition therapy and dietary interventions, while also working to reduce restrictions in their clients’ diets.
Dietitians can help to identify your unique dietary triggers
Dietitians have a broad understanding of the role that diet plays in the management of IBS symptoms and are able to help patients to identify their individual dietary triggers. Examples of some potential dietary triggers of IBS symptoms include specific types of fiber as well as fat, caffeine and alcohol.
Dietitians can help you find low-FODMAP products within your current FODMAP stage, tolerance level, and budget.
Depending on what stage of the low-FODMAP diet you are in, a dietitian can help guide you in finding low-FODMAP certified or friendly products within your particular budget. Many products that are marketed to reduce bloating or “improve gut health” contain high-FODMAP ingredients that can exacerbate symptoms.
A dietitian can ensure a flexible, tailored approach to your diet
Dietitians can tailor therapeutic diets to meet the needs of an individual. This might involve adjusting the degree of restriction depending on symptom severity, allowing for other nutritional needs (ex. Disordered eating, celiac disease or vegetarian/veganism), and allowing for an individual’s ability and/or willingness to adjust their diet and source, prepare and cook special meals.
A dietitian can help in managing risks associated with restrictive diets
Dietitians can identify and mitigate risks associated with restrictive diets, such as the triggering of disordered eating behaviors. Additionally, a dietitian will be able to screen for any potential disordered eating behaviors and suggest other non-diet related interventions for IBS.
A dietitian can ensure nutritional adequacy in the elimination & reintroduction stages
Unless carefully planned, a low FODMAP diet can compromise intake of a range of micronutrients, including calcium, fiber, B vitamins and iron. A dietitian can ensure that a low FODMAP diet is carefully planned to meet the nutritional needs of each patient, and suggest particular foods to consume if a patient is experiencing certain nutrient-related deficiencies.
A dietitian can aid in designing your diet for the long term
Dietitians can clearly guide patients through Phases 2 and 3 of the diet, known as reintroduction and personalization. Each individual will have different tolerance levels to FODMAP containing foods, and a dietitian can help in suggesting amounts for “challenge foods” to determine an individual's tolerance level. Additionally, a dietitian can ensure these specific dietary triggers are identified in a systematic manner in order to create a minimally restrictive diet for the long-term. In the end, many patients will find that restricting a small number of very high FODMAP foods is sufficient for symptom management.
If you’ve struggled to follow the low-FODMAP diet on your own, and you’re struggling with symptoms of bloating, abdominal pain, and unpredictable bowel movements; you do not have to figure it out alone. A dietitian can help you troubleshoot many of the problems identified above around the low-FODMAP diet, as well as provide specialized support to help you feel confidently in charge of your gut health once and for all!
Click here to schedule a discovery call and learn about the Gut Health Reset program to start your journey to optimal gut health today!
References:
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Ireton-Jones C. The low FODMAP diet: fundamental therapy in the management of irritable bowel syndrome. Curr Opin Clin Nutr Metab Care. 2017;20(5):414-419. doi:10.1097/MCO.0000000000000398
Van Ouytsel P, Szalai A, Van Gossum A, Arvanitakis M, Louis H. Feasibility of a low FODMAPs diet without initial dietician intervention in the management of patients with irritable bowel syndrome: a prospective study. Acta Gastroenterol Belg. 2021;84(4):593-600. doi:10.51821/84.4.010
Vasant DH, Paine PA, Black CJ, et al. British Society of Gastroenterology guidelines on the management of irritable bowel syndrome. Gut. 2021;70(7):1214-1240. doi:10.1136/gutjnl-2021-324598
Chey WD, Hashash JG, Manning L, Chang L. AGA Clinical Practice Update on the Role of Diet in Irritable Bowel Syndrome: Expert Review. Gastroenterology. 2022;162(6):1737-1745.e5. doi:10.1053/j.gastro.2021.12.248
McKenzie YA, Bowyer RK, Leach H, et al. British Dietetic Association systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults (2016 update). J Hum Nutr Diet. 2016;29(5):549-575. doi:10.1111/jhn.12385
Addendum to NICE guideline CG61, irritable bowel syndrome in adults. National Institute for Health and Care Excellence. https://www.nice.org.uk/guidance/cg61/evidence/addendum-pdf-7081259797
Sultan N, Varney JE, Halmos EP, et al. How to Implement the 3-Phase FODMAP Diet Into Gastroenterological Practice. J Neurogastroenterol Motil. 2022;28(3):343-356. doi:10.5056/jnm22035
Bellini M, Tonarelli S, Nagy AG, et al. Low FODMAP Diet: Evidence, Doubts, and Hopes. Nutrients. 2020;12(1):148. Published 2020 Jan 4. doi:10.3390/nu12010148
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Lomer MCE. The low FODMAP diet in clinical practice: where are we and what are the long-term considerations? [published online ahead of print, 2023 Jul 7]. Proc Nutr Soc. 2023;1-11. doi:10.1017/S0029665123003579
Staudacher HM. Nutritional, microbiological and psychosocial implications of the low FODMAP diet. J Gastroenterol Hepatol. 2017;32 Suppl 1:16-19. doi:10.1111/jgh.13688
