If you haven't read last weeks installment - When a low FODMAP diet doesn't work, Part 1 - click here to read it first.
If you achieved an inadequate response to a low FODMAP diet, you may need to consider whether the treatment was sufficiently targeted to the underlying cause your IBS symptoms. A number of pathophysiological abnormalities account for IBS symptoms. These include:
One important point here is that these physiological abnormalities (or causes of IBS) are probably not all present in all patients. For instance, some patients’ symptoms may be primarily due to the presence of visceral hypersensitivity, while others may experience symptoms due to problems with motility.
But why do we care about what causes IBS symptoms? The reason is that different therapies target different physiological processes. For instance, certain drugs may target gastrointestinal motility by speeding up or slowing down transit through the gut; psychological therapies may help to reduce stress and anxiety which may otherwise trigger symptoms, and probiotics may alter the gut microbiota. When it comes to the low FODMAP diet, this therapy is thought to primarily target visceral hypersensitivity. That is, reducing FODMAP intake reduces gas and water movement into the intestine, which in turn reduces stretching of the intestinal wall, and this limits the exaggerated sensations of pain and bloating which characterises IBS in some people.
So if you have responded poorly to a low FODMAP diet, it may be worth chatting to your doctor or dietitian about other therapies which may more specifically target the underlying cause of your IBS symptoms. Other therapies to consider include:
But remember, it is best to try one therapy at a time, so you can see what is working.
Need more help? Seek the assistance of a Monash FODMAP Trained Dietitian.