Does the low-FODMAP diet work with Intuitive Eating? (February 2022)
By Carrie Dennett, MPH, RDN
As a dietitian who works with clients who want to learn Intuitive Eating and clients who want to manage symptoms of irritable bowel syndrome (IBS) with a low-FODMAP diet—and some who want to do both—a question I hear a lot is, “Can you follow a rules-based food plan and practice Intuitive Eating?”
Truthfully, there aren’t many diets you can use from an Intuitive Eating perspective. Unfortunately, this doesn’t stop many weight loss diets—especially those that brand themselves as “not a diet”—from claiming they use Intuitive Eating. That’s some major co-opting, given that the authors of the book “Intuitive Eating” (and creators of the Intuitive Eating model itself) dietitians Evelyn Tribole and Elyse Resch are quite clear that any plan that promotes weight loss is not compatible with Intuitive Eating.
One exception is when the diet, based on solid evidence, can prevent, treat or help manage a specifical medical condition. It’s a common misconception that medical nutrition therapy is not compatible with Intuitive Eating, but, again, the authors/creators are quite clear that the two things are compatible. One example is the low-FODMAP diet for management of IBS symptoms.
What is IBS…and FODMAPs?
IBS is a chronic disorder of gut-brain interaction that affects up to 1 in 10 Americans. Unlike bowel disorders such as celiac disease and inflammatory bowel disease (Crohn’s disease and ulcerative colitis), IBS does not cause damage. However, IBS symptoms—typically recurrent abdominal pain, diarrhea or constipation, often accompanied by bloating—can be uncomfortable and distressing and interfere with quality of life.
FODMAPs—or fermentable oligosaccharides, disaccharides, monosaccharides and polyols—are a collection of carbohydrates that aren’t absorbed properly in the gut, which can trigger symptoms in people with IBS. Research demonstrates that many people with IBS see a reduction in symptoms with the low-FODMAP diet, which includes a brief elimination phase in which all high-FODMAP foods are avoided, then a structured challenge phase in which these foods are systematically reintroduced. This helps each individual learn which FODMAPs trigger their symptoms, and which don’t.
Because of the elimination phase, the low-FODMAP diet is not recommended for people with IBS who also have a current or past history of eating disorder behaviors. Instead, they should seek other therapies to manage their symptoms, such as medication or gut-directed hypnotherapy.
When one of my IBS clients also has a history of chronic dieting that they’re trying to leave behind, there can be a lot of fear that the low-FODMAP diet is going to put them back into restriction mode. However, while the elimination phase is restrictive, the diet as a whole can ultimately increase food freedom. In fact, I see that as the diet’s goal.
Finding Food Freedom
Part of Intuitive Eating is tuning into how foods make you feel physically. This calls for experimenting, and the low-FODMAP diet is a big experiment, although one with evidence to back it up, unlike some elimination diets. For example, one person with IBS might find that lactose (the D in FODMAP) and sorbitol (one of the Ps) trigger their symptoms, while another person might find that it’s the fructans (one of the Os) in garlic, onions and wheat.
If you have no clear idea which foods are making your IBS symptoms worse, and the low-FODMAP diet allows you to identify the actual triggers in a systematic way, that expands your food world. Maybe you thought you couldn’t eat beans, but it turns out you always ate them with onions and garlic, and it’s the onions and garlic that trigger your symptoms. That allows you to freely enjoy beans again—just seasoned differently. Maybe you were avoiding even low-FODMAP foods because you didn’t fully understand what FODMAPs are or which foods are high in them.
You may also find that your symptoms are less about the food than you thought. One of my clients was able to completely tolerate most of the FODMAP groups during the challenge phase, and, in a roundabout way, realized that red wine, while low in FODMAPs, may be the culprit for many of his symptoms.
Another client discovered that only fructans triggered mild IBS symptoms, and that it was the extreme stress of her job in healthcare that was triggering severe symptom flares. She told me, “And all this time I thought it was just the food to blame.” This brought her true food freedom plus clarity about her need to cultivate meaningful ways to cope with the stress in her life.
Yet another client had been avoiding dairy foods (lactose) and wheat for many years, but only saw partial resolution of her diarrhea. After completing her FODMAP challenges, she discovered that she had actually “outgrown” her intolerance to wheat and dairy, and that avoiding onions and garlic completely resolved her symptoms.
Increasing food Satisfaction
When you know which foods trigger symptoms, and which don’t, not only does this expand your food world—because you’re not erroneously avoiding certain foods—but it can enhance food satisfaction. You can freely partake in your “OK” foods without worry, and if a food you love is symptom-triggering, you can still choose to enjoy it carefully from time to time when any subsequent symptoms will be less inconvenient. (While unmanaged IBS can adversely affect quality of life, it’s not actually damaging the body, unlike some other digestive disorders, such as celiac disease, which requires totally lifelong avoidance of even trace amounts of gluten.)
When my clients exercise this option, they find that they are able to savor the food mindfully, without falling prey to the “last supper” phenomenon—eating as much as they can of the food because who knows when they will have it again—because they are eating with attunement. This means balancing their desire for the food with their desire to keep symptoms at a level that feels manageable for them at that time.
In my experience, navigating the elimination and challenge phases of the diet carefully can be challenging—I’ve had many clients come to me for help after trying it on their own—especially when someone knows they need to proceed carefully to avoid falling down the restriction rabbit hole. That’s why working with a registered dietitian who is experienced with IBS and the low-FODMAP diet and has at least some knowledge and training in Intuitive Eating or disordered eating can be extremely valuable.
If you are thinking of trying the low-FODMAP diet on your own, first, be sure that you actually have IBS. Self-diagnosing digestive concerns isn’t a good idea, as there is some symptom overlap between different conditions. Second, turn to a reputable information source, as there are many lists of high- and low-FODMAP foods out there, and some (including some posted on hospital or medical center websites) may not be current. Monash University (www.monashfodmap.com), which is the leading source of FODMAP research, does update their food lists as they test and retest foods for FODMAP content. Registered dietitians Kate Scarlata (katescarlata.com) and Patsy Catos (ibsfree.net) keep up with current research and offer a wealth of resources on their websites. I’ve also found fodmapeveryday.com to be a reputable resource.