Episode 3: Why FODMAPS Matter (or Doesn’t Matter)
In today’s episode, Team Gut Girls explain how fermentable carbohydrates called FODMAPs (oligosaccharides, disaccharides like lactose, monosaccharides like excess fructose, and polyols) can worsen bloating, pain, distension, diarrhea, and urgency by drawing water into the colon and fueling bacterial fermentation, especially in IBS and visceral hypersensitivity.
They review evidence originating at Monash University showing symptom and quality-of-life improvements, note limited bloating-only trials, and compare low FODMAP to the stricter Specific Carbohydrate Diet. They debunk myths that low FODMAP must be permanent, that FODMAPs are bad for everyone, or that it “cures” bloating, emphasizing short-term, guided use with reintroduction and personalization to identify thresholds. They discuss risks (constipation, weight loss, nutrient gaps, disordered eating) and recommend practitioner/dietitian support, tracking, and using reliable resources like the Monash app.
00:00 Bloating and FODMAPs
02:11 What FODMAP Means
03:24 Why FODMAPs Cause Symptoms
05:40 FODMAP Categories
09:07 Low FODMAP vs SCD
13:23 Myths and Misconceptions
15:30 Safety and Risks
25:14 Three Diet Phases
26:32 Restriction Phase
27:25 Reintroduction Strategy
30:50 Personalization and Whole Picture
32:25 Evidence and Guidelines
34:11 Talking to Your Practitioner
36:55 Final Recap and Outro
Resource Links
If you’re curious whether FODMAPs are contributing to your bloating, one of the most evidence-based tools available is the Monash University Low FODMAP Diet App. Monash researchers developed the original Low FODMAP protocol, and their app can help you identify trigger foods, track symptoms, and navigate the elimination and reintroduction phases with much more confidence.
https://www.monashfodmap.com/ibs-central/i-have-ibs/get-the-app
https://www.monashfodmap.com/blog
Team Gut Girls Episode Three: Why FODMAPS Matters or Doesn’t Matter
Dr. Whitney Baxter, ND: [00:00:00] Welcome back to The Gut Girls Podcast. This is Dr. Whitney, and I’m joined with Dr. Christina and Dominique. On today’s episode, we wanna dive into something you’re likely familiar with when it comes to bloating. Food intolerance is in fiber in a diet you may have heard of a whole bunch of times the low FODMAP diet.
So as practitioners who focus in a GI space, a gastrointestinal space, we hear a lot of cues from our patients and even our friends that FOD maps or fibers may be contributing to their bloating. So, such as this, I’m adding in more fiber, but I’m so uncomfortable. I eat a lot of healthy fruits and vegetables.
I feel like I’m doing all the right things. I exercise, but I’m still so bloated at the end of the day, or I’ve read about or have been recommended, the low FODMAP diet for my bloating or irritable bowel syndrome. Is this the best advice? So we [00:01:00] always want to break down when to consider this. Have to clue into this being a cause of your bloating and how to talk to your healthcare practitioners about the low FODMAP diet.
Okay, so first I wanna start with an overview of this diet and how it’s used for patients with bloating or irritable bowel syndrome. A lot of studies with low FODMAPs fermentable fibers in general are done on individuals with irritable bowel syndrome, so that’s just something to keep in mind. It often also presents with uncomfortable bloating and distension.
Some articles and meta-analysis also mentioned that there hasn’t been a lot of. Specific bloating only and low FODMAP trials. So we’ll just keep that in mind for this.
Dr.Dominique Vanier, ND: So as the gut girls, we hear about this all the time and we always wanna talk to you about the
Dr. Whitney Baxter, ND: how’s and the why’s so you can understand if this is being recommended to you, especially because it is quite a restrictive dietary approach to bloating.[00:02:00]
And if you’re a practitioner listening today, when someone comes to you and asks about this, or if you’ve read about it and you’d like to recommend it, how to best set your patients up for success. Okay, so the obvious, what does it stand for? So, fodmap,, fermentable, oligosaccharides, saccharides, monosaccharides, and polyols.
So what the heck does this mean? These are short chain carbohydrates and sugars that are either poorly absorbed in our guts or in completely broken down by the enzymes in our intestine, and not always fully absorbed for our own nutritional value. Instead, once they hit that large intestine, the colon to our microbiome, they act as fuel.
There are a diverse group of sugars that act on different areas of the diagnos digestive tract. So there’s different ways that they’ll get either absorbed or malabsorbed and they can create different symptoms in different individuals. So that’s where when we break down this diet [00:03:00] into its components and kind of teach you what each.
Type of fiber or sugar is doing in your gut. You can start to see that some will trigger people differently than others. So, for example, a disaccharide that you have likely heard about this is lactose. So it’s a two sugar component that can just get malabsorbed in a lot of us and cause symptoms.
So FODMAPs actually serve as ideal nutrients for these bacteria. In the small intestine where bacterial population is quite low, there’s minimal gas production. And then once it hits that colon, that’s where they’re being fermented. So it’s like similar to making bubbles during the fer fermentation of grapes into champagne, for example.
Some FB maps have osmotic properties too. Remember that? Fun one from chemistry, grade 11 chemistry, I think. So it’s going to draw in water to that colon. So the gas buildup plus this osmotic flow of fluids into our [00:04:00] intestine essentially stretches the colon, the colon, which can make significantly more uncomfortable for especially those with visceral hypersensitivity.
So that heightened sensation of pain, those with IBS or a disorder of gut brain interaction, which you should tune into that episode, we’ll dive into that a little bit more. But that can be quite uncomfortable for a lot of people. Even if you don’t have visceral hypersensitivity, you might just notice bloating and dissension if you’re eating a lot of these types of fibers.
So this low FODMAP diet is helpful because it’s eliminating that osmotic draw, that fermentable fiber type into these individual’s diets. What can, which can trigger symptoms, particularly those with IBS diarrhea predominant. It’s also gonna help those with visceral hypersensitivity, like I mentioned.
It is just gonna be relieving. And I’m always curious how things all started. So if you look [00:05:00] way back, 20 2008 there, it’s when it started at the Monash University, they developed this research and they noticed that it improved symptoms in those with IBS. And 75% of individuals. So that was quite significant.
And then the research has really taken off since then. There’s a whole lot more randomized control trials, especially in the past 10 years with this diet all over the world. Okay, so symptoms improved, pain, discomfort, improved bloating, distension. So that physical expansion of bloating, it noted that improved people’s quality of life.
So we are really excited about this. Okay, let’s break down each category and we’re gonna bring in doctors, Christina and Dominique to take us through these and then we’ll take you into some myths. Things we hear on social media, things our patients ask us about, our friends ask us about. We really want you to walk away with a better understanding of if this diet is appropriate [00:06:00] for you, for your bloating and how to ask your doctor about it.
Okay, so the first one’s obvious. They’re fermentable, they’re feeding or microbiome. Let’s dive into the next one, the oligosaccharides. Christina, can you walk us through that one?
Dr. Christina Carew, ND: Yeah, so this is gonna be a bit challenging , as someone who’s a consumer. ’cause these aren’t really labeled very well often on your packaging.
So you’re looking for food products. That have fructans in them. So on the label, what you’re gonna see are things like wheat, raw onion, garlic and then the, those are sort of the fructans. And then there’s galacto oligosaccharides, which are like beans and pulses, so things like lentils. And these are more poorly digested and fermented by the colon, so it means.
Similar to what Dr. Whitney led us to understand is like that those, when they reach the bacteria, they become more fermented, creating more gas and more bloating, art distension.
Dr. Whitney Baxter, ND: Yes, you made a good point. [00:07:00] They’re not always labeled, which be really, really, really handy. And that’s why we’ll talk about, it’s so important to be working with a practitioner or a dietician who really understands this diet to help you walk you through each of the categories. And Dr. Dominique, it’s joined by her sweetie pie Mason, can you walk us through the deck?
Dr.Dominique Vanier, ND: He’s a little sick today, so if you hear like, what sounds like a dragon breathing, it’s sucks. This little guy. Okay, so the, the most known example of disaccharides is gonna be the lactose which is a fodmap. But so you can see you can see this malabsorption happen in some sensitive individuals.
And that’s gonna trigger. You know, abdominal discomfort. And they don’t exactly tolerate like what with the issue is that they’re not actually tolerating this malabsorbed lactose. And interestingly, most of us actually have some sort of lactose intolerance. So what that. Actually means is the enzyme to break down the sugar is gonna decrease over time.
[00:08:00] And that leaves the whole sugar to hit the gut and then feed bacteria. And so we can see things like urgency diarrhea often more like loose stool or on the looser end. And then sometimes pain discomfort, like I mentioned there.
Dr. Whitney Baxter, ND: Yeah, so that’s where, if you’ve heard of lactase enzyme, you can take that lactate. You can take that as a supplement in that it’s the enzyme, so it helps you break down that disaccharide sugar lactose. Okay, so the monosaccharides, these are glucose fructose fructose can cause malabsorption in excess.
So honey mango, delicious things. Mm-hmm. And there’s like, there’s a helper to help it get absorbed into our intestine. So due to this, it kind of, it also gets smell absorbed and then hits the gut and causes a feeding frenzy and some symptoms. Then finally, the polyols, which are our sugar alcohols. You’ll see these unpackaging, sorbitol, manitol, malitol, xylitol, isomalt.
There’s a number of them. We’re gonna [00:09:00] dive into this in another podcast, so I’m gonna leave this one for now. Be sure to tune in for that one. And then Christina, can you walk us through the difference between the low FODMAP diet and the specific carbohydrate diet? Because a lot of people have heard of both, or they kind of get confused by the two.
Dr. Christina Carew, ND: Yeah, so I would say definitely a lot of patients come in and they maybe have heard of low FODMAPs or their gastro has told ’em about low FODMAPs, but then they start researching it and there’s also another diet called the SCD Diet or specific Carbohydrate Diet, and it looks kind of similar. And so then as you’re trying to pick out foods, sometimes you’re gonna start seeing some foods that are crossing between both of these groups and some that are very divergent.
And I would say the most challenging thing of low FODMAPs is there isn’t just one resource and there isn’t great, at least now still great searching. So you’ll like type in the food and you type in low FODMAP and you get all kinds of different answers about it. [00:10:00] And so when we think about these two diets, they both limit foods that are fermentable by bacteria.
And they are specific around symptoms of gas, bloating, diarrhea, dysbiosis, and inflammation. So that’s sort of like the goal is very similar. The low FODMAPs is more selective restrictions. So, one of the things that you’ll see in, in Monash or some of the online directories or resources is there’s like a green side and a red side, or a go side and a stop side.
And the ones that are more in the green are ones that shouldn’t cause most people with these types of bacteria to have more fermentation and ones in the red could cause them. Now, not all red foods cause all people problems, part of the issue. But the low FODMAPs diet allows a lot more carbs than the other SCD diet.
So they’ll allow rice, potatoes, oats, fruits, and veggies, some of them. And the goal of lowfat. Which we’ll talk about in a few [00:11:00] minutes, is more like a very short term diet to reduce fermentation load while something else is going on. The SED diet is much stricter, so it’s no grains, no starches, no processed sugars, no lactose no potatoes, no rice, no packaged food.
So it’s like really cutting a big chunk of that category out. And the intention behind it by being very specific on carbohydrates, is that there. Using carbohydrates as a tool in which they’re going to create more change in the ecosystem. And so this tends to be like a longer term diet. It’s trying to change or modify the microbiome.
And it’s often used sometimes in more extreme cases of IBD, which would be like Crohn’s or ulcerative colitis. And there’s, as. Whitney mentioned lots of studies on these diets. This one in particular, some mixed reviews. I definitely have some patients that said this was world changing for them but not for [00:12:00] everyone.
And it’s very hard to do these restricted diets for very long ’cause it makes it feel like you can never eat with friends, go out anywhere because you have so many restrictions and needs.
Dr.Dominique Vanier, ND: I think you brought up a good point there, which we can talk about a little bit later, Christina, but is you’re gonna see different information depending on what resource you look at.
So like the consistency of information isn’t really there as it relates to prob, maybe more so the Low FODMAP Diet Pro probably ’cause that one’s I think a little bit more known. But that’s definitely one of the challenges in addition to sticking to these diets. On their own. At least that’s what I’ve noticed from, from talking to patients about this many times.
Dr. Whitney Baxter, ND: Yeah. And another thing too is you brought up, it does feel better to eliminate these foods. If you have like gas bloating and then you take away all the foods that are causing these things, you’re gonna feel so much better. And [00:13:00] we’ll talk about this, actually, I myth number one, we’ll kind of break this down, but.
It’s risky, and then you run into a point you might not even notice, like, oh yeah, I am. I’m not saying yes to random social plans, or I’m really fixated on my grocery list and my shopping list and what I can eat. So it’s good to catch that before it happens.
Dr.Dominique Vanier, ND: Mm-hmm. Mm-hmm.
Dr. Whitney Baxter, ND: We wanna dive into some myths that we’ve heard or people ask us questions about.
So, kind of jumping into what we were just talking about is myth number one. You have to stay on a low FOD map forever to keep feeling better.
Dr.Dominique Vanier, ND: I can chat about that. So this is definitely not a forever diet and you know, there’s no, there’s no specific like time frame in which people are supposed to stick to it, but there’s kind of like a ref, a reference point.
So like a month, maybe two months, , like I said, there’s no typical protocol. It’s supposed to be like a strict [00:14:00] elimination. And one other point is like, if somebody doesn’t see improvement almost right away with a low FODMAP diet, then the research says that there’s not really a point in sticking to it either.
The goal really is to see if this works. Also hope that you have the right diagnosis. ’cause if it’s not like to IVS or like a similar disorder of gut brain interaction, then you’re totally off the mark. But the goal is to have the least restrictive diet that controls the symptoms.
And then also a very specific like reintroduction plan too, because somebody’s not gonna be sensitive to every single low FODMAP food. So the goal is to figure out. Which ones are they still sensitive to? Can we control the system? And then kind of move on from there with the goal of like expanding somebody’s diet so that they don’t feel so restricted.
Dr. Christina Carew, ND: And one thing to add to that would be like sometimes some of the foods that are higher FODMAPs foods may also be triggering you for another completely different reason. And so like wheat for instance, you may have a gluten sensitivity or you may even be celiac. [00:15:00] And when you take the wheat out, you feel much better.
But it’s not because it’s. High FODMAPs, it might be because it’s triggering something completely different. Same thing with lactose or dairy. And so also being mindful that just because you get a check mark with, yeah, this food really bothers me. It doesn’t necessarily mean that the diagnosis is correct.
Maybe it wasn’t considered
Dr. Whitney Baxter, ND: the gut’s complex. It’s so fun to navigate. Is this diet always safe for everybody? Christina?
Dr. Christina Carew, ND: Yeah, I would say one of the big things that I see in my clinical practice is that people who have very restrictive diets often have constipation, and some of that is that a lot of the fiber or bulking material.
I mean, coming out of their diet sometimes slows down the transit time and also they inadvertently tend to eat bit ma a bit [00:16:00] less. And so if you are already a constipation prone patient, this may worsen. And so it’s really important that your practitioner is also helping you with things that can keep that transit system moving because that.
Alone can cause more bloating, which you’ve heard that in a previous podcast. And if not, go back and listen to that one. What other things? Well, certainly we want to be mindful of someone’s weight because we’re cutting out a lot of calories by taking some of these foods out. And not everyone is prone to just like replacing those with other foods.
Sometimes they’ll just leave them off. The table. And so instead of having, you know, their meat with their veggies and their carbs, they might just move to just eating meat. Which is a solution to meeting the low fo mats, but not a solution to making sure you have good energy and can result in weight loss.
And so if you’re already quite thin this can make things way, way worse. And then also people that already have a complex. Eating relationship with food. People are [00:17:00] worried about. Different things already. So they’re worried about lectins or seed oils or things that are going, or people in their house have allergies and so they already can’t eat fish or nuts or things that are already going on.
And then we load a really restricted diet on top of that. It can not only make you feel crazy. But then people sometimes just stop eating because it’s just easier. It’s not making all of those decisions. And then subsequently, when it comes to putting back foods in, sort of had Dr. Whitney refer to, if you suddenly feel better it’s gonna be really hard for your brain to comprehend that I can eat this food again.
Dr. Whitney Baxter, ND: Yeah, it’s always good to talk to your doctor. Prior, especially with restriction, restricting any type of food, even if you’re noticing a pattern with it. And we’ll talk to you about this at the end, like how to bring this to your doctor. Hey, like, yeah, garlic and onions are really flaring me up. But there’s so much [00:18:00] research behind this low FODMAP diet and over and over and over again it said like guided is the best.
People had way more success. They’re able to find specific triggers. It might just be lactose, it might be lactose plus beans if you’re eating that in certain quantities. So there’s a lot of nuance to this. So there are risks.
Dr. Christina Carew, ND: Another myth
Dr. Whitney Baxter, ND: hearing about whenever we hear about a restrictive diet.
Oh, well if that works, then FODMAPs are bad for everybody. And it, they’re not like they’re fermentable and we need fermentation. We love our gut microbiome. We wanna fuel them. They produce byproducts that really help our brain, our moods, like our cardiovascular system. So many things. So they’re found in so many healthy foods that we don’t want you to restrict for a long period of time.
They’re not inherently harmful. It’s not like they’re hitting the gut and causing damage, which can be like, when I was young, that’s what I thought lactose intolerance meant. I [00:19:00] thought that dairy was just damaging my gut. So it’s important to teach you about this stuff, of course, but also understand that they’re not bad.
We want them. So it’s a targeted tool. It’s a trial. It’s short term. It’s not a universal rule, and it can impair nutrient intake too. So it’s not just starving our good microbes. There’s some sources of, for example, fructans that can be fortified with RB vitamins, folic acid and iron. So wheat, starch bread, breakfast cereals and sources of lactose.
For some individuals, it’s their main source of calcium or a large part of their calcium. So if they’re not lactose intolerant, they might not need to restrict their dairy. That’s where a dietician can really help you see what other sources of calcium or iron you can get. Where you can get these pieces from.
But that’s something to keep in mind too, is they’re not inherently bad. We need those nutrients and they’re fueling our beneficial microbes. [00:20:00] I. Yeah, I think I talked about the next myth. So we’ll go to myth number three. Does low FODMAP cure bloating? Dominique,
Dr.Dominique Vanier, ND: I feel like if it was this easy then everybody with bloating would be on the low FODMAP diet, and we would’ve moved on from this topic a long time ago.
So it, and I think it, it speaks to it, it can, yes, it can reduce. Bloating and abdominal pain. But it’s more like symptom management rather than an actual cure. And so we have some research that shows that FODMAPs are going to increase this intestinal water and colon gas. Both in healthy individuals and in those with IBS, it’s just those with IBS are gonna respond differently.
And so we’ve talked a lot about things like visceral hypersensitivity, even like low grade inflammation at the gut. While such as like pro-inflammatory cytokines, we know that the people with IBS and similar conditions are kind of like a special subset, sub subsect of of the population. So they respond differently.
[00:21:00] What’s really important is that personalization. Matters like as it relates to diet and also kind of the question behind do we even need to do this diet? Because I think diets tend to be more difficult for patients in general, rather than just being able to have the freedom and flexibility to eat what they want to.
So as it relates to your question, and Whitney, like bloating is just, it’s complex. It really is. And ’cause there’s multiple mechanisms that are happening. And there’s other factors too that are like beyond digestion. So like how somebody was sleeping, how they’re feeling, their, like psychosocial state, how they exercise their antibiotic history.
There’s a lot of things, medication use. If they’re, like the week before their menstrual, you know, their menstrual cycle, like where, where are they in their menstrual cycle? Did they just ovulate, et cetera. So yeah, so we, we talk about all those things, but the myth, this is a good one because no bond map does not cure bloating.
Dr. Whitney Baxter, ND: It can give your gut a break, which is nice, and then you can find out exactly what’s causing your bloating and eat the [00:22:00] fruits again. Which is great. I loved this myth because we think about, yeah, these FODMAPs are fueling our microbiome. So is it a dangerous diet? Is it permanently wiping out our good species?
And in reality, short term restriction did find that it was impacting some beneficial bacteria. But again, it’s usually meant for short term elimination. So again, to reiterate, it’s not for long term because we do want these species, so it’s a shift in the microbiome while you’re restricting. But it’s not going to be permanent, especially if you start reintroducing things.
It’s kind of like over Christmas holiday. I know my microbiome changes and I feel very different and I crave different, like more sugar and more heavier foods, but our microbiome’s dynamic so we can fuel it again properly. Which is really exciting. So I found some things in the research. There was a systemic systematic review in the colon microbiome following [00:23:00] a FODMAP restriction.
There were nine different studies and there was a consistent reduction in the abundance of our good bifidobacteria species. But as the reintroduction happened, there were no consistent long-term impacts and there was no change to microbial diversity or short-chain fatty acids, which is what helps our brain and the rest of our body.
So that was, that was really exciting. Any other myths that you two have heard about or wanna talk about before we dive into the specifics of the diet?
Dr. Christina Carew, ND: I don’t know if it’s a myth, but sometimes people sell it like it’s easy and it certainly isn’t. It’s and so I think sometimes trip to the physician’s office, they’ll just be like, oh, do low fo maps, and sort of like send someone on their way and you could Google forever and find something about every single food.
And so. If someone is trying a LOW FODMAPS diet, think about just picking one source of your [00:24:00] guidance, whether that’s Monash or something else, and be mindful of you’re going to get conflicting information, but just believe whatever it is that you’ve started out with. Because it can be really challenging and lots of times patients come in having eaten almost nothing ’cause they just can’t figure out what to eat.
Dr.Dominique Vanier, ND: Another point too is like for people that have been on a diet like this, that’s a restrictive diet. Whether it’s low FODMAP or another one like that doesn’t mean that there has been long-term damage, right? Because we can shift our microbiome within days of changing our diet for the better or for the worse.
So there’s a lot of like promise and hope there, right? I think, you know, back to Christina’s point is these diets are not for everybody and they are complicated. And there should be like, there should be an exit strategy. Really.
Dr. Whitney Baxter, ND: Totally.
Dr.Dominique Vanier, ND: Yeah.
Dr. Whitney Baxter, ND: Yeah. That’s outlined prior to starting here. This is the plan for sure.
This is what it’s gonna look like, and as we’ll see as we’ll dive into each part of the diet. There’s a range, and Dom, you mentioned this [00:25:00] earlier, there’s there’s a range of how long each phase is because it’s gonna look different for each person, but like looking at that from a broader perspective is way more approachable.
Then
Dr.Dominique Vanier, ND: here you go. Here’s your red list. Don’t eat these. Okay. Let’s get into the specifics
Dr. Whitney Baxter, ND: of this diet because it’s not just here’s your red list. Don’t eat these things. There are options. There are, there’s three phases. That’s what it, that’s how it’s presented in the research and the Monash University, that’s their guidelines.
So there’s the restriction phase. Reintroduction and then personalization. Really the goal is finding your triggers in that personalization and reintroduction phase. And again, for best results. Dietician led, there’s education, there’s meal plans, there’s apps available. Of course, there’s structured follow-ups, so I would like to follow up with you in three to four weeks.
Please check in with me if you’re noticing any [00:26:00] changes or. Like you have a plan with your practitioner. There’s tracking of symptoms and over and over and over again. I see that this isn’t always accessible or offered to people like we talked about. It’s just given and then they have no plan. So I know I’ll see a lot of patients come in and say, oh yeah, I’ve tried a fod, low FODMAP diet didn’t work, or didn’t notice any difference.
I’m like, okay, well what was the plan? What did you do? What did you cut off? Where did you get hung up? So let’s dive into this. Domin, can you take us through the restriction phase?
Dr.Dominique Vanier, ND: Yeah. And I will also give a caveat that like there’s different to make it more confusing, there’s like a low FODMAP mini version.
There’s a full low FOD version, so the restriction. Like by definition is you’re cutting out like all of, all of the FODMAPs. Typically for could be four to eight weeks, it could be less. The goal is to be as really as strict as possible [00:27:00] to then to be able to evaluate whether this is like.
A clinically relevant diet for the person. And then and then, you know, and again, then we’ve got discussion about the next steps after that. So the restriction phases is, I would say like probably the, could be the most straightforward one and probably the shortest phase out of all of them. You know, followed by the reintroduction, which can take a lot longer.
Okay.
Dr. Christina Carew, ND: Yeah, so the reintroduction phase is really about gradually introducing those foods that you eliminated to figure out if. Any of those are in fact foods that are triggering for you. And it, it shouldn’t be a case where all of them are necessarily triggering for you. Even someone who’s getting fermentation will find that some of the foods on the list are totally fine.
And so. I always say like, start with the food that you miss the most or the one that you love the most. Because that always feels good to be able to eat that again and try not to eat it [00:28:00] with something else. Inevitably people try things like pizza where there’s like cheese and wheat, and so we wanna try to isolate it a little bit so that we’re able to see what happens.
And so in an isolation of introducing a food, you might introduce it. You might start slow because you’re hesitant around it, but really sometimes it’s like a bigger dose you need to make to see if you have a more of an impact. So eating like a slice of apple may be very different than eating a full apple.
And so I always say aim for the amount that you would like. To be able to eat. I have a patient who loved apple pie and she’s two apples is the equivalent of the amount of apples I like in my apple pie. And so two apples was her goal. And so she could eat one apple, but she couldn’t eat two.
And so that was really interesting, right? So Con told us there was still some more work to do, but but she was able to eat some. And then you wanna track what you’ve what you see as symptoms. And your practitioner should give you some idea of what [00:29:00] those symptoms might be that they should watch out for.
It could be everything from bloating and digestive to, you know, not sleeping very well, or getting a immune system reaction, like getting really tired. Then also how long it lasts. So introduce the food, you know, do I notice anything that day? Do I notice it the next day? I actually felt, okay, okay, maybe I can try another food.
That one might be on my safe list. Now, how do you guys do it? I.
Dr. Whitney Baxter, ND: Exactly the same. What do you miss the most? Let’s start there. I’ll go like category by category two, and depending on what they were eating before, like if they were eating a ton of beans or if they’re eating a ton of the fructose categories, we’ll just say, okay, like maybe microdose it.
Just do a little bit, see how you tolerate it, and then slowly work up, work up to like that, two apples in your pie and see what your personal threshold is.
Dr.Dominique Vanier, ND: Yeah. Yeah, that’s, yeah, it’s basically the same, right? It’s so I do [00:30:00] three days in a row, small amount, medium amount, large amount. Especially as it relates to like how things are divided by like the Monash resource that you mentioned earlier.
And then they have to recording, I think like the recording and monitoring of symptoms is also really important. I was totally subjective that the patient does. But it’s like. Sometimes not always just digestive stuff happening. Like, it, it, you know, I get them to look at like their energy, their sleep.
Because we know that you’re the digestive system and especially like hyperpermeability that can happen is is related to other systems.
Dr. Whitney Baxter, ND: Yeah, that’s a good reminder. I have a patient right now who it’s sleep. It was impacting their sleep and. Such a specific thing, but when we really started to peel back all the layers we’re like, oh, that’s what’s happening in your body.
So yeah, that’s a good point to make. So this final phase, and again, like all of these phases can take various amounts of time. There was one study that found actually two, it two weeks for the [00:31:00] elimination phase is like where you should see a benefit, but oftentimes people can’t get follow up until four to six weeks.
So it depends on when you can see your practitioner. So it is important to kind of be your own advocate and do your tracking and see what, how your body’s responding. It might just take two weeks, it might take four. So this final phase is really just pulling it all together, eating normally again as best as you can.
Maybe knowing okay, two apples is too much. I can do an apple, I can do an apple and a half. I can do an apple, but I can’t have cheese with my apple, or I can have a little bit of cheese. So it’s really, it’s empowering because you can start to piece things together and you don’t feel as restrictive.
It’s confusing and it can change what, what else is going on in your life. But we’re never just giving a low FODMAP diet with these three phases. We’re looking at you as an individual. We’re calming the heightened. Sensation to pain or that visceral hypersensitivity. We’re [00:32:00] talking about meal timing and how to eat slowly and more mindfully.
What’s your exercise? What’s your lifestyle? What’s going on in your body otherwise? So we’re during this huge low FODMAP process. We’re working on all the things. So this personalization phase is really when it should start to all come together, which is exciting. There’s a light at the end of the tunnel, so it can be great.
And there’s lots of research. So it’s been evaluated in many randomized control trials with humans, which we love. It’s supporting its effectiveness. There’s meta-analysis from all over the world with the low FODMAP diet showing that restriction phase can significantly improve. Again, it’s a lot in IBS, but it can improve IBS severity compared to those controlled diets.
So we’re really excited about that. It’s coming up a lot in the guidelines. The American Gastroenterology Association recommends a low FODMAP trial or just food intolerances as a [00:33:00] cause to bloating after ruling out constipation. So we always wanna start with that because adding in a low fo map on top of that, like Christina mentioned, it might just make it worse or it’s not really fixing the problem.
But they are recommending this as an approach. And there are other guidelines. So the British Dietetic Association has this guideline called the traditional dietary advice, and, there’s a bit more to it, which I liked. Like they’re talking about how caffeine can be a real gut trigger, lots of alcohol, lots of high fat foods.
So they’re talking to their patient about this. They’re ruling out lactose intolerance. So it’s not as restrictive as this low FODMAP trial. It’s a little bit more comprehensive. But the low FODMAP when compared to this approach did just show improvements quicker. Of course we’re taking out all those things that are flaring you up.
So that’s something to keep in mind, but it’s not as restrictive. So we’re really just looking at you as an individual, your [00:34:00] medical history and what would be more appropriate. So those are the guidelines. And so overall we like this diet. So we’re gonna just talk about some practical takeaways.
As a reminder. So first, always speak with your doctor or if you have a registered dietician, that’s awesome, start prior to starting this diet. It’s always better when it’s supported. You’ll feel better feeling supported through this process. It’s not appropriate for everyone. There are some contraindications and some safety things we want to think about.
So if you already have a restricted diet, if you have below optimal or low body mass index, you have low weight, unexplained weight loss, you already have a restricted diet for some reason, or you have a history of disordered eating or a relationship with food you wanna talk to your doctor about that prior to starting something like this.
But when it is [00:35:00] appropriate, it is really effective. It can greatly improve the pain, and it really just empowers you to know what that trigger is, which is always really exciting. So how can we talk to, we can how? How can we talk to our listeners about how to talk to their practitioner?
Dr. Christina Carew, ND: I would say one of the things that your practitioner may or may not be familiar with thought map, so always bringing in something that you can show or share can be helpful because they may not listen just because they’re unfamiliar and it could be. Starting with, are you familiar with the low on that side?
Do you think this could be a helpful thing for me because I’m noticing more bloating and discomfort after meals. So I would say qualify first that your practitioner does understand it. Because you might just get a no, simply because someone has no idea what you’re talking about.
Another way could be like if you are recommended a low FODMAPs [00:36:00] diet from your gastroenterologist or dietician or medical practitioner, nurse practitioner I would specifically ask them if there are some resources that they could provide them with, or do they work with someone that could help them help you in the guidance of the process?
Do they work with a naturopath or a dietician or. Nutritionist that could help. Because as you’ve probably learned, it’s super nuanced and you definitely want someone to ask all those weird questions so that you don’t feel alone as you’re participating in this.
Dr. Whitney Baxter, ND: And we’ll add some resources to.
With those podcasts. We mentioned Monash a few times. They’ve, that’s kind of where it all started and they’ve got this great app. They’ve got really nice printable PDFs, tracking forms, recipes like blogs that are always updated. So it’s just so informative. So there’s lots of tools that you can use. Okay.
So let’s review our low FODMAPS. They are [00:37:00] fermentable carbs that get fermented by your gut bacteria, and they can draw water into the colon. So with that, they can trigger some bloating, distension, maybe some discomfort. So while they’re malabsorbed by many individuals, these symptoms occur predominantly in individuals with irritable bowel syndrome disorders of a gut brain interaction, or just like a heightened visceral hypersensitivity.
This diet is a short-term protocol. It’s often a test to see if this is what’s triggering your bloating and a little bit of a treatment. And then we can find your specific triggers, which is always exciting. And please, as always, talk to your doctor before initiating everything. Anything you hear about.
It’s not safe for everyone. It can be a great approach, but it’s better when it’s supported. So thank you for listening to this episode on FODMAPs. We hope to have busted some myths and made this approach to bloating more clear, because better gut health changes everything.
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