The importance of seeing a dietitian before starting the FODMAP diet

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Jimmy Lee - Research Dietitian, 15 October 2021

“Dietitians have a defined and recognisable body of knowledge and utilise scientific principles and methods in the study of nutrition and dietetics, applying these results to influence the wider environment affecting food intake and eating behaviour.” – Dietitians Association of Australia Board 2013, revised 2015

Following a low FODMAP diet, especially if you need to juggle other commitments in your daily routine, may seem challenging at first. However, with the guidance and assistance from a FODMAP trained dietitian, a FODMAP diet can be both enjoyable and nutritionally adequate. We have summarised the top 5 reasons on why it is essential to see a dietitian before commencing on the 3 step FODMAP diet

1. To ensure that your diet is nutritionally adequate

One of the major reasons to see a dietitian is to ensure that your FODMAP diet in the following weeks is not nutritionally compromised. During the restriction step, over-restrictions of certain food groups (such as dairy, fruit and vegetables) may reduce your intake of calcium, iron, dietary fibre, vitamins, or even protein, which can be avoided by seeing a dietitian. They will determine low FODMAP alternatives that you can enjoy during your diet, whilst ensuring your nutritional status is maintained and your diet is personalised to your needs. 

Reintroducing FODMAPs is beneficial from a nutrient adequacy perspective, as well as for the health of the gut microbiome, where they behave as prebiotics, stimulating the growth of beneficial gut bacteria. Therefore, it is important for patients to progress from restricting FODMAPs to bringing back some FODMAPs in a tolerable amount during the re-introduction step. You can read more about the importance of receiving a follow-up consultation from a dietitian via one of our blog posts.

2. To tailor your FODMAP diet according to your symptom severity

It is important to understand that the level of FODMAP restriction depends on the type, severity and duration of your symptoms. A dietitian is a clinically trained health practitioner who can thoroughly assess your nutritional status, before tailoring the FODMAP diet to your symptoms. For example, you may benefit from a ‘simplified’ or ‘gentle’ approach to the FODMAP diet if you only have mild symptoms. A dietitian may also wish to expand the diet to include more lower FODMAP serves during the restriction step of the FODMAP diet, to optimise nutrition adequacy.

3. To increase your knowledge and management skills during your FODMAP diet journey

A recent study has found that those with IBS who received guidance from a dietitian when following the FODMAP diet resulted in:

-A lower total FODMAP intake

-A better understanding of how to follow the FODMAP diet

-A better symptom response to the diet (1)

In another study, patients reported that receiving written information and dietetic support helped them to adhere to and benefit from the diet (2). Visiting a FODMAP trained dietitian for personalised educational advice and strategies helps to ensure that the diet works best for you. This is important because a diet should not be a one-size-fits-all regime. In addition, many patients may browse on the internet for generalised FODMAP advice, but the accuracy of this information is questionable. An evidence-based management plan should be developed by a trained dietitian, based on your background and conditions, to optimise adherence and effectiveness of the diet as you progress down the track. 

4. To troubleshoot any abnormal findings during your journey

There are many other gastrointestinal symptoms that indicate more severe gut conditions outside of IBS. These are known as ‘red flags’, and they include, but are not limited to: unexplained weight loss, rectal bleeding and fever. If there are any ‘red flags’ present, the dietitian can identify these symptoms and ensure that you get referred to a gastroenterologist, GP or specialist for further investigation of your condition. 

If your IBS symptoms were caused by stress or other psychological conditions, you may benefit from alternative non-diet approaches, such as cognitive behavioural therapy. A dietitian can assess the appropriateness of this therapy and if necessary, refer you to a psychologist with an understanding of IBS.

Some patients may not receive an adequate response from a low FODMAP diet despite adhering to a FODMAP diet well. One of the possible solutions is to identify whether there are other dietary triggers that need to be avoided, such as caffeine, alcohol and fat. 

5. To make your FODMAP diet enjoyable!

Last but not least, a dietitian is here to ensure that following a FODMAP diet is enjoyable and appropriate to your lifestyle and daily schedule. For example, if you are busy working with a family to take care of, a dietitian can share with you how to purchase low FODMAP food products when shopping at the supermarket. He or she may also discuss with you ways to prepare low FODMAP meals and snacks amidst your busy routine. After all, being able to enjoy your FODMAP diet is one of the best ways to keep symptoms at bay for the long run! Why not check out our recipe index for some inspirational ideas to get you started on creating healthy and delicious low FODMAP snacks? 

If you would like to seek the guidance of a dietitian before starting the FODMAP diet, our Dietitians Directory is a great index for you to find a local dietitian who is Monash FODMAP trained. From Australia to America, our directory covers over 800 dietitians in over 49 different countries. 

References:

1. 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.

2. de Roest RH, Dobbs BR, Chapman BA, et al. The low FODMAP diet improves gastrointestinal symptoms in patients with irritable bowel syndrome: a prospective study. Int J Clin Pract. 2013;67(9):895-903.


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