Thursday, 27 August 2015

What to do if the low FODMAP diet doesn’t work for you?

By Lucy Taylor (Accredited Practising Dietitian)

The low FODMAP diet has been shown to improve gastrointestinal symptoms in 3 out of 4 people with Irritable Bowel Syndrome (IBS), meaning a small percentage of people with this condition do not respond to the diet. So what should you do if you think you’re a ‘non-responder’? 

Before dismissing the low FODMAP diet approach, it’s important firstly to ensure you’ve strictly adhered to the low FODMAP diet for at least 2 (and up to 6) weeks, ideally under the supervision of a dietitian specialised in using the diet. Use the app or booklet to double-check the FODMAP content of foods you’re eating and ask your dietitian to check your diet for hidden sources of FODMAPs. A specialist dietitian can also help to identify additional dietary triggers that may be aggravating your symptoms, such as caffeine, alcohol and/or spicy foods.

If you’re still experiencing no improvement in your symptoms, it might be worth returning to your Gastroenterologist for further investigations, or seeing a Dietitian who can investigate other dietary triggers, such as naturally occurring food chemicals (salicylates, amines and glutamates) that may be responsible for triggering IBS symptoms in a small proportion of people.

Aside from the low FODMAP diet, your Gastroenterologist or Dietitian may be able to advise you on the use of other therapies, including:

 - GUT-DIRECTED HYPNOTHERAPY, which has been shown to be as effective as a low FODMAP diet in reducing IBS symptoms. 

PEPPERMINT OIL SUPPLEMENTS, which have been shown to reduce IBS symptoms and abdominal pain. Peppermint oil supplements are recommended as a safe and effective, short-term IBS treatment.

Trialling a strain-specific PROBIOTIC SUPPLEMENT.

LIFESTYLE approaches to help you manage stress, including meditation, counselling and/or exercise.

[1] Peters S, Yao CK, Shepard S, Philpott H, Yelland G, Muir J.G., Gibson P.R. Su1369 Gut-Directed Hypnotherapy and a Low FODMAP Diet Are Similarly Efficacious in Patients With Irritable Bowel Syndrome: A Randomised Controlled Non-Inferiority Trial. Gastroenterology 2015: 148(4) Supp 1, 487-488

[2] Tuck CJ, Muir JG, Barrett JS, Gibson PR. Fermentable oligosaccharides, disaccharides, monosaccharides and polyols: role in irritable bowel syndrome. Exp Rev Gastroenterol Hepatol 2014:1-16.

[3] Khanna, R, MacDonald, J.K, Levesque, B.G. (2014). Peppermint oil for the treatment of irritable bowel syndrome: a systematic review and meta-analysis. J Clin Gastroenterol, 48(6):505-12 


  1. Hello I am so delighted I located your blog, I really located you by mistake, while I was watching on google for something else, Anyways I am here now and could just like to say thank for a tremendous post and a all round entertaining website. Please do keep up the great work.
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  2. Replies
    1. Hi tworosellas, thank you for your query regarding an old blog of ours from 2015. SIBO brings many issues, particularly diagnosis. There is no accurate, noninvasive way of diagnosing SIBO. Our low FODMAP diet has also not been studied in the context of SIBO so that is why we didn't cover it in this blog. Breath tests for lactulose have been demonstrated conclusively to be unreliable. Glucose breath tests will only find SIBO in the minority. You bring up a good point though and I have added SIBO to our list of upcoming blogs to be published. Watch this space. Kind regards, Jaci Barrett

  3. I have a question regarding the SIBO testing because you are mentioning just the breath tests: what about the test during a gastroscopy when some stomach liquid is taken and send to a lab? I thought that this is the best method to test SIBO ?

  4. Culturing of jejunal aspirate is the gold standard method for determining SIBO but it is rarely done due to complexity and cost