The low FODMAP diet can be a tricky thing. Not only does it involve a lot of planning and preparation, but it requires cutting out quite a few foods. This is especially true during the elimination phase. This kind of restriction can also lead to disordered eating behaviour and fear of food. Most registered dietitians I’ve spoken to agree that the low FODMAP diet has had major impacts on how their patients relate to and behave around food. In today’s post we’ll be talking about a new proposed alternative to a strict low FODMAP diet. It is called the FODMAP Gentle Diet (or simplified low FODMAP diet).
Table of Contents
- Disordered eating and IBS
- What is the FODMAP gentle diet (simplified low FODMAP)?
- FODMAP gentle diet vs. the standard low FODMAP diet
- Who would benefit most from the FODMAP gentle diet?
- What foods to avoid on the FODMAP gentle diet
- Reintroducing foods on the FODMAP gentle diet
Disordered Eating and IBS
Aside from real-life experience talking to our patients, research also shows a relationship between disordered eating, eating disorders and GI conditions. Studies have shown that 23.7% of patients with GI conditions display disordered eating behaviours. This includes meal skipping, food restriction, and/or overeating; in contrast with 10% of the general population – the rates are significantly higher.1 This number specifically represents those with ‘disordered eating’. It doesn’t even account for the individuals who meet the criteria for specific eating disorders. Things like anorexia nervosa, bulimia, or binge eating disorder.
So exactly how common are eating disorders?
Given that so many people live with eating disorders, it is so important to screen all patients prior to implementing any type of diet change.
Eating disorder prevalence is on average 8.4% for women (studies show a range from 3.3% to 18.6%). For men, the average prevalence of eating disorders is 2.2% (studies show a range of 0.8% to 6.5%) and likely higher, as men are commonly misrepresented in eating disorder research.2
As IBS dietitians, myself and my colleagues do our very best to screen our IBS patients to determine if they’re a good fit for an elimination diet. Particularly before suggesting the low FODMAP diet – and quite frankly, not everyone is a great fit. Additionally, even if you’re deemed to be a good fit for the low FODMAP diet, the diet itself can trigger a very rigid mindset around food. In other words – your eating behaviours may not be disordered beforehand, but the diet may “feed into” a disordered eating mindset. Is there another way to manage IBS symptoms without being so restrictive?
Because of all the controversies and challenges of the low FODMAP diet, researchers are now proposing less restrictive alternatives to the low FODMAP diet. This includes a ‘FODMAP gentle’ approach, also called the simplified low FODMAP diet. Curious about exactly what that means and how it differs from the original low FODMAP diet? Let me review the details of this alternative diet for you. Including who would benefit most from the simplified low FODMAP diet, which foods to avoid, and more!
What is the FODMAP gentle diet (simplified low FODMAP)?
The FODMAP gentle diet is a way to remove high FODMAP foods, which are foods that contain highly fermentable carbohydrates. These carbohydrates can contribute to gas production, intestinal stretch, abdominal pain, and poor bowel movements. By reducing the amount of FODMAPs consumed, most patients have a reduction in their IBS symptoms. This approach removes the highest FODMAP foods and can be tailored to the individual following it. It can be based on their lifestyle, food preferences, and what they typically eat day to day.
Typically we think of IBS diets from a ‘top down’ approach. This means that we start VERY strict and then gradually add things back in. To put it simply, the FODMAP gentle approach is the opposite.
It is a ‘bottom up’ approach. Meaning that we start less restrictive and only remove a few of the highest FODMAP foods.
We also want to really assess the diet we’re starting with. Do you eat a lot of one particular high FODMAP food? If so, start with those more common foods and work outward from there.
And don’t worry – you don’t need to guess which foods are highest in FODMAPs. As researchers have already done this for you! We’ve put together a copy of this list for you, which you can download for FREE within this post.
FODMAP gentle diet vs. the standard low FODMAP diet
As you’ve likely guessed by now, the major difference between these two approaches is the degree of restriction. Each of these diets still plays out in the same three phases. These are the elimination phase, the reintroduction phase, and the integration/personalization phase. However, on a standard low FODMAP diet, there are far more foods eliminated during the elimination phase. This can be difficult to implement and may not always be safe.
Less restriction in the diet can also offer more flexibility and tends to help people actually stick to the diet. When things get too difficult, it’s human nature to want to quit, run away, etc. Therefore, the FODMAP gentle diet can often be a better fit for someone who struggles to make BIG diet changes. Particularly with the busy lives we lead these days.
The other big difference between the two approaches is the customized nature of the FODMAP gentle diet. Compared to the standard low FODMAP diet, it involves more customization. It also involves identifying exactly which FODMAPs pop up most in a person’s diet. For example, if I eat garlic A LOT, this might be a great place to start. Rather than eliminating 50+ foods right off the bat (which is what the standard low FODMAP diet typically suggests).
Who would benefit most from the FODMAP gentle diet?
The FODMAP gentle diet is best suited for people who can’t take on a more strict elimination of foods. It is also a great fit for people who experience mild IBS symptoms that are frequently eating a lot of high FODMAP foods. I like to put it this way – if there are a lot of “low hanging fruit”, this approach may be all it takes to notice significant symptom improvement. No strict elimination necessary!
Populations that would benefit most from the FODMAP gentle approach include:
- Individuals with a history of disordered eating or an eating disorder. The FODMAP gentle approach still involves some restriction. So, chat with your healthcare team to determine whether a simplified low FODMAP diet is appropriate for you.
- People who are not cooking for themselves or don’t have a lot of food autonomy
- People at higher risk of malnutrition including elderly individuals or children
- Pregnant people
- People who struggle with complying to strict elimination diets
What foods to avoid on the FODMAP gentle diet
The moment you’ve been waiting for – which foods are the highest in FODMAPs? We’ve put together a comprehensive list that you can easily download for free. Some of the top items include wheat, lactose, onion, garlic, and mushrooms – but that’s just a teaser! Sign up below to get the full list of key foods to eliminate on the FODMAP gentle diet.
While having the list is incredibly helpful, it is recommended to work with an IBS dietitian. They can help to personalize recommendations based on your own intake and lifestyle.
Reintroducing Foods on the FODMAP Gentle Diet
After eliminating some or all of the foods listed in the above table, the goal is that your symptoms improve. If you notice a significant reduction in symptoms, you can move on to reintroducing some of the foods you’ve eliminated. This will help you to better understand your specific symptom triggers. The reintroduction process is the same as the standard low FODMAP diet, just with fewer foods.
On the flip side, if you don’t notice much improvement on a simplified low FODMAP diet, you may benefit from moving into a more strict low FODMAP diet. It is best to do this under the supervision of a registered dietitian. Work with one of our registered dietitians today!
FAQs about the FODMAP gentle diet
The FODMAP gentle diet or simplified low FODMAP diet is a less restrictive version of the popular low FODMAP diet. In this diet, only the very highest FODMAP foods are removed from the diet instead of all high FODMAP foods. Learn more.
Some of the highest FODMAP foods include wheat, onions, garlic, milk, mushrooms, apples, and sugar alcohols. Learn more about a FODMAP gentle diet and which foods to avoid.
Thank-you! I am wondering if this has been or will be reviewed by the Academy of Nutrition and Dietetics. I am an RDN and the Executive Director of the Indiana Academy. I follow the Low Fodmap diet personally but will be sure to share your email and information with colleagues if it has been reviewed and accepted.
Interesting! I’m not sure – it’s the proposed approach outlined by Monash so assuming they’r familiar with it Lorna! I’m a member of DIGID but not part of a working group that’s involved in resource creation or practice guidelines etc. so that’s a great question!