How to institute the low-FODMAP diet

Abstract

A diet low in poorly absorbed, fermentable, short chain carbohydrates (FODMAPs) is an effective strategy to manage symptoms of irritable bowel syndrome (IBS). The diet has gained traction since its original description in Australia 10 years ago and is now an internationally accepted dietary management strategy for IBS. Randomized controlled trials have raised the profile of the low-FODMAP diet to become a viable first-line therapy for IBS, when implemented under a dietitian's guidance. Importantly, the diagnosis of IBS should be confirmed before commencement of the dietary approach. The skill set of the dietitian is then paramount to the success of the diet. Experience in gastrointestinal disorder management, consideration of symptom types, severity, baseline FODMAP intake, and overall nutritional content and meal pattern are vital in the assessment of the patient. If a strict low-FODMAP diet is deemed necessary, it should only be for an initial period of 4 to 6 weeks. Research suggests that a strict long-term, low-FODMAP diet may negatively impact intestinal microbiome. After the initial strict period, follow up with the dietitian should be conducted to achieve the overall goal—a relaxed FODMAP restriction that enables inclusion of prebiotic FODMAPs while still maintaining symptom relief. The diet will be effective in the vast majority of patients. For those in which it fails, FODMAPs should be reintroduced to the diet, and other dietary (or non-dietary) approaches should be considered.