“By failing to prepare, you are preparing to fail” – Benjamin Franklin.
The guy’s got a point. The low FODMAP diet (LFD) is no walk in the park, so being organized and prepared are essential to success. This article is all about what to do before starting the elimination phase of the LFD.
1. Talk to a doctor about your symptoms
I know, I sound like a broken record on this blog, but… it’s really important to discuss your gut issues with a doctor. The symptoms of IBS overlap with other more serious conditions like inflammatory bowel disease, celiac disease and bowel cancer so you should be assessed by either your family doc or a gastroenterologist who specializes in digestive disorders.
Certain “red flag” symptoms should be assessed promptly by a health care provider:
- blood in stool
- unexplained weight loss
- family history of celiac disease, inflammatory bowel disease, bowel cancer
- symptoms getting persistently worse
- waking in the night to have a bowel movement
Getting the right diagnosis means you can develop the right action plan. The low FODMAP diet won’t be nearly as effective if you have a gut condition other than IBS. Sure, it may help a bit, but a treatment should always match the condition for the best results.
2. Consider working with a Monash trained dietitian
Dietitians are more than just the food police who hand out pre-made meal plans and recipes. We’re highly educated and intensively trained nutrition experts who treat health conditions with evidence-based medical nutrition therapy (MNT) and coaching.
Monash FODMAP trained dietitians go a step further and complete Monash University’s training designed specifically for dietitians, so they know all the ins and outs of the low FODMAP diet. They also have expertise in alternative interventions for IBS like other dietary strategies, supplements, fibre therapy, and can advise on non-diet interventions.
How can a Monash trained dietitian help you?
- Assess your diet, lifestyle and gut symptoms.
- Create an intervention plan that’s individualized for you.
- Determine whether the low FODMAP diet is the best option for you.
- Help you avoid nutrient deficiencies.
- Troubleshoot any problems or barriers that arise.
- Provide actionable resources.
- Offer tips and tricks you can’t find online.
- Coach you through low motivation.
- Help you change your eating behaviours and habits.
- Be your cheerleader!
If you’re looking for a dietitian in your area, check out Monash’s directory of Monash trained dietitians.
3. Follow healthy gut habits first
Healthy gut habits are dietary and lifestyle strategies that can help reduce IBS symptoms. Some are grounded in healthy eating principles, others are aimed at minimizing common gut irritants and a few target general health.
Key healthy gut habits:
- Follow general healthy eating guidelines.
- Don’t skip meals. Some research has found a link between IBS symptoms and irregular eating, though this doesn’t necessarily mean irregular eating causes IBS symptoms (2,3,4). That being said, I think we can all agree not eating for long stretches makes people more prone to overeating when they finally sit down for a meal. Large meals can increase your fodmap load and send a lot of material into the gut, thus contributing to bloating and distension.
- Limit your coffee intake. If you suspect caffeine is a symptom trigger, then oust it from your diet. Coffee stimulates motility of the colon in 29% of people, with the effect being felt in 4-30 minutes after ingestion (5). This explains why some people find that coffee promotes BMs (6). But in folks with IBS-D and M, stimulation of the colon may make diarrhea worse.
- Limit spicy food made with chili. After consuming spicy food containing hot capsaicin (ie red hot chili peppers, jalapenos), people with IBS tend to experience worsening abdominal pain and quicker gut transit time (7).
- Eat less high fat food like fried foods, fast food, and desserts. Similar to spicy food, fat can speed up gut motility and exacerbate abdominal pain (8,9,10).
- Drink a minimum of 8 cups of fluid per day. Believe it or not, there is no recommendation on how much fluid people with IBS should drink (11). Expert consensus suggests minimum of 2 litres per day (12).
- Eat slowly and chew thoroughly. Digestion starts in the mouth where your teeth pulverize food and enzymes in your saliva begin breaking down starches.
- Be physically active every day. You don’t need to crush it to benefit – a 30 minute brisk walk will do (13, 14).
- Minimize stress with stress management techniques. Various techniques may be helpful, including meditation (15), yoga (16), mindfulness (17).
If you want to read more about healthy gut habits and how to implement them, check out my blog titled 11 ways to relieve IBS symptoms without the low FODMAP diet.
4. Refer to credible sources of information
When you’re scouring the internet for IBS tips, recipes, meal plans, etc, it’s easy to get lost down rabbit holes that lead to dubious, non-evidence based advice. And it can be hard to differentiate between credible vs. sketchy.
Here are a few questions to consider when evaluating the credibility of a source:
- Who’s the author and what are their credentials?
- Is the author being paid to write the article? And if so, do you feel it was a balanced piece or heavily biased? Some websites/blogs by credible sources make their money from ads, affiliate links, and sponsored posts. People gotta eat! Fodmap Everyday is an example of a site that discloses its partnerships with integrity (in my opinion).
- Does anything in the info seem too good to be true? This is a huge red flag. There are no silver bullets in health my friend.
- Are there references in the article that support the statements?
- When was the article written? It may be a totally reliable piece of info but science sometimes evolves quickly and FODMAP content in foods can change, so look for recent and/or updated articles.
To make things simple for you, I compiled a list of credible sources:
- Bad Gut (Canadian Society of Intestinal Research)
- Canadian Digestive Health Foundation
- Monash University. These guys developed the low FODMAP diet so I think they know what they’re doing.
- Fodmap Everyday. This website is run by a team of dietitians writing informative articles and posting tons of recipes.
- Websites by Monash trained dietitians. Here are a few big names (they’re kind of my heroes): Audrey Inouye (Canada), Andrea Hardy (Canada), Kate Scarlata (US), Kristen Jackson (England), Joanna Baker (Australia)
5. Pick the right date to start the elimination phase
Do yourself a massive favour and don’t plan to start the low FODMAP diet just before Christmas or when you have a long vacation scheduled.
The LFD takes roughly 12-16 weeks and can be a bit tricky, so you need time and focus to do it properly. If you have a major event in the middle of the diet you may not be able to follow the guidelines which will influence your symptoms and prolong the diet. It may also throw you off track entirely, forcing you to start it all over again another time – not fun.
It’s also wise to avoid starting the LFD when you expect to be more stressed, like moving house or starting a new job. The mental and emotional strain could kick off symptoms and skew your results.
Pick a date in your calendar when you have the time, energy and motivation to embark on a journey of digestive discovery. Getting it right the first time means finding relief quicker!
6. Keep a food and symptom diary BEFORE starting the elimination phase
A food and symptom diary is no Dear Diary angsty teen manifesto. You’re writing about your funky bowels rather than your crush.
For at least 7-14 consecutive days before you start the low FODMAP diet, keep a record of your gut symptoms and bowel movements. Rate the intensity of each symptom and use the Bristol Stool Chart to document your bowel movements. This establishes a baseline of your typical symptoms for comparison with your symptoms after the elimination phase.
Record your food and fluid intake so you’ll be able to identify any foods, fluids or eating habits that may be contributing to your symptoms. Since other lifestyle factors like stress, exercise and medications can influence symptoms, it’s also useful to keep track of these.
Read more about how to keep an effective food and symptom journal that helps you get answers about your triggers
In summary, if you want to do the low FODMAP diet right, these 6 things will set you up for success:
- Talk to a doctor about your symptoms.
- Consider working with a Monash trained dietitian.
- Follow healthy gut habits first.
- Refer to credible sources of information.
- Pick the right date for the elimination phase.
- Keep a food and symptom diary before starting the elimination phase.
As always, if you have any questions, pop them in the comment section below 🙂
xoAndrea, RD
