How the low-FODMAP diet transformed my health
by Rose Clark If five years ago someone had said I wouldn’t eat a scrap of onion or garlic or my daily Granny Smith, I’d have told them exactly where to stick that apple. But after years of pregnancy-belly, stomach pains and military-like plans for toilet emergencies, I was diagnosed with IBS (Irritable Bowel Syndrome) and put on the low-FODMAP diet, which alleviates symptoms in 70 percent of sufferers. We don’t know why some people get IBS. About 12 percent of people in the UK experience it in any year, and it’s more common in women and people under 50. Contributing factors include infections, stress and genetics, so it’s unsurprising that treatments vary – and it’s usually a lifelong condition. But it’s not all doom and gloom. Could a diet that involves cutting out staples such as bread, milk and lots of fruits and vegetables work for me? What is the low-FODMAP diet? Numerous studies show certain foods exacerbate symptoms in 70–89 percent of IBS sufferers. The low-FODMAP diet cuts out foods containing short-chain carbohydrates for four to eight weeks. These are poorly absorbed by the small intestine, so ferment quickly. That can lead to excess water and gas, resulting in IBS symptoms. FODMAP stands for the types of sugars – Fermentable Oligosaccharides, Dissacharides, Monosaccharides And Polyols. They are found in foods as wide-ranging as pasta, apples and chickpeas. The list of foods off the menu is daunting. How could I make a sauce without onion or garlic? What would I eat for breakfast without lactose or gluten? But within a few weeks of going on the diet, my stomach had deflated and I was virtually pain-free for the first time in years. To begin with there were lots of foods I had to avoid So what can you eat? “Focus on all of the foods you can eat rather than the foods you can’t”, says dietitian Chloe Hall. There are plenty of low-FODMAP foods – meat, fish, eggs, rice and lots of fruit and veg, as well as an ever-growing selection of lactose-free and gluten-free alternatives. “Chives are a great way to add onion flavour… and almost all spices are low-FODMAP. A sprinkling of low-FODMAP nuts or a squeeze of citrus can add flavour. Miso and anchovies can add the best umami punch”, says low-FODMAP blogger and author Emma Hatcher. There is a way to make almost anything FODMAP-friendly. My favourite hacks include finely chopped celery and garlic-infused oil (garlic isn't soluble in oil) as a base for sauces, curries and soups. I make ‘hummus’ using spiced-roast squash and plenty of tahini instead of chickpeas and garlic. Homemade muesli and granola is cheaper and nicer than shop-bought too. I’ve got used to the looks of waiters when I list my dietary requirements, and (mostly) feel less awkward answering a dinner invitation with a thesis of what’s off the menu! Reintroducing FODMAPs Once the elimination process is over, if symptoms have improved, patients reintroduce food groups one at a time to see which foods they’re sensitive to and to what extent they trigger symptoms. The third stage is living on a personalised version of the diet, hopefully symptom-free. I found the reintroduction process tricky. Despite initially thinking I’d be desperate to tuck into dal, apple pie and garlic bread again, I was reluctant to eat anything that might make me feel unwell. Having a dietitian’s advice and trialling one food at a time in small doses over a number of days was key. If your symptoms return, you must wait until they’ve gone before trying another food. Over time, I’ve been able to reintroduce loads of ingredients. I doubt I’ll ever be able to eat a French onion soup, but I can eat lactose in all its delicious forms, as well as leeks, asparagus, peas, artichokes, cauliflower and mushrooms. I’m a vegetarian, but still get enough protein (thank you tofu, eggs, quinoa, nuts and milk). It’s important to keep trying to reintroduce foods, as your tolerance can change over time. “The ultimate goal is to eat and live as freely as possible – the more FODMAPs you can return to your diet without triggering symptoms, the healthier your gut is likely to be”, says Emma Hatcher. Before you start the diet It’s crucial to be diagnosed with IBS by a doctor, and to consult a dietitian, before cutting out FODMAPs. I was referred to a dietitian by my GP. There are also private dietitians with specialist gastrointestinal knowledge. There’s little research on the long-term impacts of being FODMAP-free. Some FODMAPs are prebiotic, so the more you eat, the more good gut bacteria can grow. Studies have linked having a healthy composition of gut microbes to a strong immune system, the body’s metabolic functions and many other aspects of health. “It is essential that people do not follow the diet long term and reintroduce FODMAP-containing foods in a structured manner to improve their microbiome”, says Professor Kevin Whelan, Head of Department of Nutritional Sciences at King’s College London. He also suggests people consider a probiotic supplement, especially one containing the bacteria bifidobacteria, which has been shown to go down on the diet. The low-FODMAP diet isn’t the only way to treat IBS symptoms. The NHS recommends exercise, relaxation, homemade healthy meals and trying probiotics. They also suggest not skipping meals, avoiding spicy, fatty and processed foods and limiting the amount of caffeine, alcohol and fizzy drinks you consume. But if you’ve been diagnosed with IBS and decide to try the FODMAP diet, these recipes will help you to eat well. Life goes on after garlic, believe me. Originally published July 2019