Breaking down how we approach the Low FODMAP Diet at Alyssa Lavy Nutrition & Wellness and what to expect throughout the process!
Perhaps you have just been diagnosed with IBS, and your doctor has recommended that you seek nutrition counseling to help manage symptoms. We couldn’t agree more with your doctor; making changes to your diet—not only what you eat, but also how and when—can play a huge role in symptom management.
At Alyssa Lavy Nutrition & Wellness, we are specialists in GI disorders and particularly in the low FODMAP diet. FODMAP is an acronym that stands for fermentable oligo-, di-, mono-saccharides and polyols. What a mouthful! What are these things, you may ask? These are highly fermentable, short-chain carbohydrates found in foods. It is important to know that this does not refer to all carbohydrates – just those that are highly fermentable. As our bacteria ferment these carbohydrates, gas is created as a byproduct. Additionally, some FODMAPs have an osmotic effect. For those with IBS, this fermentation – coupled with visceral hypersensitivity (basically, a fancy way of saying that you may be a bit more sensitive) and possibly the type of bacteria present, can lead to diarrhea, bloating, distention, urgency, cramping, excessive gas production and/or constipation. The low FODMAP diet aims to determine which of these carbohydrates someone is sensitive to, which ultimately will allow this person to limit only those foods in the diet and reduce IBS symptoms. The diet is not intended to be a forever diet, and, in fact, our goal is to be able to liberalize your diet as much as possible and for you to be able to eat and enjoy the foods you love in a way that feels (and tastes) best for you!
As they sometimes say on TV, “do not try this one at home!” At least, in this case, we suggest not trying this without the help of a specialist to guide you. Why? There are a few reasons:
Not everyone is an appropriate candidate for the low FODMAP diet and not everyone may need a full low FODMAP diet. Working with a specialist ensures that you only start this intervention if it is appropriate for you - and it can be modified for your needs, as well.
This diet is highly nuanced and it was developed to be dietitian-led . At Alyssa Lavy Nutrition & Wellness, we often work with people who have tried the low FODMAP diet on their own with no improvement, only to find that the diet was not carried out correctly (which is understandable – the diet truly is very nuanced!)
It is important to ensure that you are meeting your nutrient needs, especially when embarking on an elimination diet. Too often, people focus heavily on cutting out certain foods and do not consider how to include different nutrients in their diet.
There are many other dietary and non-dietary factors that can trigger IBS symptoms – working with a specialist allows you to determine your individual triggers (dietary or otherwise) so that you can ultimately enjoy a more liberalized, improved quality of life. Additionally, this can potentially lead to other helpful referrals to other specialists that may be necessary for your treatment.
Because this diet is restrictive and there is a lot at play when considering how different FODMAPs affect you, it is highly recommended that you work with a dietitian throughout the entirety of the protocol so that it is done properly, efficiently and, at the end, you can walk away knowing what you are triggered by and what you can safely tolerate. So, what can you expect on the low FODMAP diet? First, we will take the time to learn more about you – including your medical history, labs, past procedures/tests, lifestyle, food preferences. Basically, we want to assess whether the low FODMAP diet is appropriate for you (and whether it is necessary) and then have all of the information to assist you with making this process low stress and full of foods that you love.
The low FODMAP diet is a three-phase diet. We often see that people linger in the elimination phase long-term or mistakenly think that the diet is solely comprised of the elimination phase – and that is simply not true. The elimination phase is just one phase – the initial phase - of the diet. Each of the phases are briefly outlined below:
1) The Elimination Phase: In the first phase of the low FODMAP diet, all foods that are high FODMAP are eliminated from the diet for up to 6 weeks. If your symptoms improve with strict elimination of these foods, it would likely be determined that you are sensitive to FODMAPs. If your symptoms do not improve during this time, we “abort mission” and work together to determine other possible triggers. It is important to note that portions play an important role in the low FODMAP diet – so there are many foods that are allowed in *some* portion but not other portions. Working with a professional can help you to keep as much variety in your diet as possible!
2) The Reintroduction Phase: If your symptoms have improved, we will then move on to the reintroduction phase. In this phase, we will systematically reintroduce each FODMAP, gradually increasing the portion of the FODMAP food over the course of a few days. Throughout the entire reintroduction phase, we will monitor your symptoms and reactions to each FODMAP. When the reintroduction phase is over, we will have a clear understanding of what triggers your IBS symptoms. This phase is time-consuming but it is also so important to do this correctly so that your diet can ultimately become as liberalized as possible in the long-term.
3) The Maintenance Phase: In this phase, we will aim to increase the variety of foods in your diet by reincorporating well tolerated FODMAPs and limiting those that were not well tolerated. Ideally, we don’t want to cut things out of your diet permanently; we want to be able to include all foods and be more mindful of quantity for those foods that have been proven to cause symptoms. This phase is more long-term and requires some counseling initially to ensure that you are liberalizing your diet and continuing to manage your symptoms.
What are some of the ways that we help to support you while you’re following a low FODMAP diet at Alyssa Lavy Nutrition & Wellness? By learning your lifestyle and your food preferences, we can provide you with shopping guides and personalized meal/snack suggestions and recipes curated for you so that you don’t miss out on any of your favorite foods. We also make sure to include options suitable for your lifestyle – meaning convenience options, meal delivery options and/or recipes, depending on what would work best for you! Also included are our favorite resources, so that you can utilize helpful apps, websites and cookbooks, depending on your preferences. Additionally, we are available for our clients to provide support as needed between sessions, because you are not going through this process alone when you work with us!
If you're interested in learning more about how we can support you at Alyssa Lavy Nutrition and Wellness, click here to schedule your complimentary discovery call!
This article was written by Amy Schwarz, MS, RD, CDN