Written by Lisa Kunstler, FodShop Nutritionist, Personal Trainer, and Group Fitness Instructor

Introduction

A low FODMAP diet can be a hard pill to swallow when you have a busy lifestyle and a variety of intolerances to juggle. The role of a FODMAP trained dietitian is to guide you through this process to ensure the low FODMAP diet is both enjoyable and nutritionally adequate.

A prospective study found that most IBS patients were wiling to try a low FODMAP diet however, compliance was low, and most patients highlighted the desire for a dietitian's guidance (Ouytsel et al., 2021). Compliance to the diet is a big concern, with individuals suggesting that the diet is difficult to follow in their every day life (Weynants et al., 2020). 

For these reasons, it is critical, if you are attempting a low FODMAP diet, to seek out the help of an Accredited Practising Dietitian (Australia) or Registered Dietitian (NZ, Canada & USA), to ensure the best possible outcomes for managing your lifestyle and symptoms. 

Three Reasons Why You Need a Dietitian on a Low FODMAP Diet

1. To ensure a nutritionally adequate diet that effectively manages your symptoms

The elimination phase of the low FODMAP diet often restricts key food groups including fruits, vegetables, and dairy, which contain some essential nutrients such as calcium, fibre, iron, vitamins, and minerals. Restricting these nutrients in your diet can have long term effects on your health and affect your gut symptoms even more and hence, it is important that a dietitian is involved to provide you with some low FODMAP alternatives that will meet your nutritional requirements. 

It is also important that the restriction phase is only for a short period of time, as FODMAP foods are essential to the health of the gut microbiome, as they encourage the growth of healthy gut bacteria that will minimise gut symptoms. The timeline of when this happens will depend on the severity of your symptoms and should be discussed with the dietitian. In some cases where symptoms are more mild, a more 'gentle' approach to the diet can be appropriate.

 2. To improve your knowledge and skills

One study showed that those who followed a low FODMAP diet with the guidance of a dietitian had improved symptoms, a lower FODMAP intake, and a better understanding of the diet (Tuck et al., 2020)

The low FODMAP diet is not a one-size-fits-all diet. It needs to be personalised in a way that will suit you and your lifestyle to increase the likelihood of it sticking and working! This can only be done with an evidence-based management plan by a professional, as a lot of the information on the internet is often inaccurate. 

3. To pick up on any red flags 

Throughout your gut health journey, your dietitian may notice some key red flags that sit outside the scope of IBS. These may include blood in stools, fever, or unexplained weight loss, that a dietitian can assess to refer you to a GP, gastroenterologist, or specialist. 

Furthermore, a lack of progress or poor symptom management on a low FODMAP diet despite adherence, may be a sign of other dietary triggers at play. IBS caused by stress or other psychological conditions, may benefit from other treatments, like gut-directed hypnotherapy or working with a psychologist. 

Final Thoughts

If you have been diagnosed with Irritable Bowel Syndrome (IBS), the best plan of action is to get in contact with an Accredited Practising Dietitian (Australia) or Registered Dietitian (NZ, Canada & USA), as such practitioners are experts in the implementation of the FODMAP diet. Many are also Monash University Low FODMAP Diet trained. It is highly recommended that you do not attempt the low FODMAP diet alone, as the chances of successful implementation, adherence, and symptom management are lower.

References

Tuck CJ, Reed DE, Muir JG, et al. Implementation of the low FODMAP diet in functional gastrointestinal symptoms: A real-world experience. Neurogastroenterology & Motility. 2020;32(1):e13730.

Van Ouytsel, P., Szalai, A., Van Gossum, A., Arvanitakis, M., & Louis, H. (2021). Feasibility of a low FODMAPs diet without initial dietician intervention in the management of patients with irritable bowel syndrome: a prospective study. Acta gastro-enterologica Belgica, 84(4), 593–600. https://doi.org/10.51821/84.4.010

Weynants, A., Goossens, L., Genetello, M., De Looze, D., & Van Winckel, M. (2020). The long-term effect and adherence of a low fermentable oligosaccharides disaccharides monosaccharides and polyols (FODMAP) diet in patients with irritable bowel syndrome. Journal of human nutrition and dietetics : the official journal of the British Dietetic Association, 33(2), 159–169. https://doi.org/10.1111/jhn.12706