Step 3: Personalisation - Why is it important?

Let’s talk about why moving on to Step 3 - Personalisation of the FODMAP diet is important for you!

To quickly recap, below are the three steps of the FODMAP diet and their main purposes:

It is no surprise if you experience symptom relief during Step 1, whereby you are only consuming foods in their low FODMAP serving size. Whilst it is tempting to remain in this step of the diet, studies have actually found that symptom relief can still be achieved in the Personalisation step (1-3). Moving on to Personalisation is also essential and beneficial for the following reasons:

More variety: There are plenty of foods that can be found in each type of FODMAP subgroup, meaning you are also bringing back a lot more food options and varieties if you reintroduce foods containing the type of FODMAP you can tolerate. The more options, the more flavours and creativity in your meals!

For example, if you find out that you are tolerable to excess fructose, you can include a lot more fruits and vegetables in your personal FODMAP diet (e.g. strawberries, mangoes, grapes, broccoli stalks, red capsicum) rather than having to keep avoiding these (or restricting the amount of consumption) like you did in Step 1.

Nutritional adequacy: Over-restriction of FODMAPs may reduce your intake of nutrients such as calcium, iron, dietary fibre, vitamins and protein (especially if not followed under the guidance of a FODMAP trained dietitian). On the other hand, being able to include a broader variety of food groups allows you to consume more types of vitamins, minerals and other nutrients in your diet. In turn, this strategy helps you achieve and/or maintain nutritional adequacy.

Prebiotic intake: GOS and fructans (oligosaccharides) are prebiotic fibres, meaning they act as nutrients for the ‘good’ bacteria in the gut. Studies have found that prebiotic intake is reduced in short-term, during the low FODMAP step of the diet. If you found out that you tolerate these during the Reintroduction step, they should be included in your diet as well. A study in 2021 found that bifidobacteria (a type of bacteria found in the gut) did not change between baseline and long-term in IBS patients who completed all three steps of the FODMAP diet (1), which may be attributed to the reintroduction of these prebiotics according to authors.

In fact, we encourage including prebiotic-containing foods in their low FODMAP serving size in your personalised diet for a healthy gut. Some options include:

Quality of life and social health: Being able to include a broader variety of foods gives you more flexibility and in turn, enjoyment when you eat out or make your own food at home with friends and family. More food enjoyment means less stress and possibly better symptom control!

So when can I move on to the Personalisation step?

You should proceed to the Personalisation step if you have worked out the FODMAP subgroups that you can and cannot tolerate during the Reintroduction step.

Just like with the first two steps of the FODMAP diet, the Personalisation step should be worked through with a FODMAP trained dietitian, to monitor nutritional adequacy, troubleshoot any abnormal findings and ensure you have the relevant knowledge and skills to manage your very own version of the FODMAP diet going forward.

Click here for the Monash FODMAP trained Dietitian Directory.

Tips

• Filters in the Monash FODMAP app allows the Food Guide to indicate which FODMAP you can and cannot tolerate based on your individual sensitivities. When filters are enabled, a green or red traffic light is displayed for serving sizes that you can or cannot tolerate, respectively. (Click here for step-by-step instructions in the ‘Filters’ section)
• Some symptoms are normal. For example, a small amount of bloating or flatulence is a normal part of a healthy bowel. A FODMAP diet should reduce symptoms to a tolerable level, but not eliminate them.
• Stress can also exacerbate IBS symptoms. Non-diet approaches targeting stress or anxiety may be considered (e.g. light exercise, yoga, gut-directed hypnotherapy) if psychological factors are associated with your symptoms.
• FODMAP tolerance can change over time. Repeating FODMAP challenges of poorly tolerated FODMAPs may be necessary as FODMAP tolerance can change over time.
• If your IBS flares, you may need to follow a lower FODMAP diet for a short time. Once your symptoms settle you can return to your personalised FODMAP diet.
• Non-diet strategies may also be helpful such as
  • Probiotics
  • fibre supplements
  • herbal therapies (e.g. STW-5 and peppermint oil capsules)
  • lactase (trial if intolerant to lactose)
  • heat packs
  • psychological therapies (e.g. gut-directed hypnotherapy, stress management)
  • Speak to your FODMAP trained dietitian to see how these non-diet strategies can help with symptom management.

References:

1. Staudacher HM, Rossi M, Kaminski T, Dimidi E, Ralph FSE, Wilson B, et al. Long‐term personalized low FODMAP diet improves symptoms and maintains luminal Bifidobacteria abundance in irritable bowel syndrome. Neurogastroenterology & Motility. 2021 Aug 24;34(4).
2. O’Keeffe M, Jansen C, Martin L, Williams M, Seamark L, Staudacher HM, et al. Long-term impact of the low-FODMAP diet on gastrointestinal symptoms, dietary intake, patient acceptability, and healthcare utilization in irritable bowel syndrome. Neurogastroenterology & Motility. 2017 Jul 14;30(1):e13154.
3. Bellini M, Tonarelli S, Barracca F, Morganti R, Pancetti A, Bertani L, et al. A Low-FODMAP Diet for Irritable Bowel Syndrome: Some Answers to the Doubts from a Long-Term Follow-Up. Nutrients [Internet]. 2020 Aug 7;12(8). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468924/