Over the past several years, there has been increasing interest in the international digestive disorders community in the low-FODMAP diet for controlling gastrointestinal symptoms. It was first developed in the late 1990s by Susan Shepherd, PhD, Peter Gibson, MD, and Jacqueline Barrett, PhD of Monash University in Australia. At first, it was mostly known in that region of the world, but as promising peer-reviewed evidence for its effectiveness in reducing symptoms for many people with IBS has accumulated over time, IBS professionals in other countries and continents have begun to take notice, and in some cases, recommend the diet to their patients. While there have been many types of IBS diets suggested by various sources over the years, to date, the low-FODMAP diet is reportedly the only one with this level of peer-reviewed evidence thus far.
Given this development, there has been an explosion of blogs, books and other resources in various countries that are devoted to the topic. Recently, IBS Impact was invited to review one of the newest books, The Everything Guide to the Low-FODMAP Diet: A Healthy Plan for Managing IBS and Other Digestive Disorders by Barbara Bolen, PhD and Kathleen Bradley, CPC (Adams Media: 2014).
Dr. Bolen is a psychologist and health coach in private practice in the Long Island region of New York, and a health writer with particular interest and experience in IBS and other GI conditions. For many years, she has been the IBS Guide for About.com. She is also the author of Breaking the Bonds of Irritable Bowel Syndrome: A Psychological Approach to Regaining Control of Your Life (New Harbinger Publications: 2000) based on cognitive behavioral therapy techniques shown to be effective for many people with IBS. She is co-author, with Jeffrey D. Roberts, of IBS Chat: Real Life Stories and Solutions (iUniverse: 2007). Ms. Bradley is a recipe developer, consultant, and certified professional coach whose writing has appeared in various health, food, and cooking publications. She has also disclosed on the book’s website and for related media articles that she is a person with IBS who has successfully reduced her symptoms with the low-FODMAP diet.
The Everything Guide to the Low-FODMAP Diet is 288 pages long. Similar to Dr. Bolen’s About.com blog, it is written in a scientifically accurate but non-technical language that is easily accessible to most readers who may not have a scientific background. Throughout the book, points or common questions considered particularly important are set off from the main text in shaded boxes to catch the reader’s attention. The table of contents and index are clearly laid out to make it easy to find specific topics quickly, and the fonts are relatively readable, with the section headings throughout the book in a larger, bolder typeface than the rest of the text.
The first chapter includes a brief overview of the digestion process and the nature of IBS and a fuller discussion of the meaning of the acronym FODMAP, what foods fall into each of the categories, how some or all of them, according to research, may cause increased symptoms for many people with IBS, and the theory behind removing or reducing them in one’s diet. The authors mention hydrogen breath testing, for which some researchers have disputed the level of accuracy, SIBO (small intestine bacterial overgrowth), which appears to coexist with some cases of IBS, but is still controversial as to how it relates to IBS, “leaky gut,” which is similarly still debated, and fiber, which, for many years, doctors considered a first recommendation for IBS, but many people with IBS report actually exacerbates their symptoms.
The second chapter of the book briefly covers the differences between IBS and food allergies or genetic food intolerances, celiac disease, and non-celiac gluten sensitivity, other common types of treatment and management strategies commonly recommended for IBS, low-FODMAP for other types of digestive disorders, the pros and cons of partially following the diet if one feels one cannot stick to the full elimination of high-FODMAPs, and advice for using low-FODMAPs with children. Here, the authors caution that it is especially important to have medical supervision to ensure the child’s proper growth and development. Further discussion of youth-related issues can be found later in the book, including how to involve the child in the diet and alert other adults who may interact with the child. such as relatives, or staff at school or other activities. The authors add another caution that low-FODMAP research specifically on children and youth is less plentiful and established than with adults.
The third and fourth chapters cover preparation for and the actual phases of the diet, including shopping, accommodating the dietary preferences of others in the same household who may not need or wish to join in following a low-FODMAP diet, lists of low-FODMAP and high FODMAP foods in each category, elimination of foods, tips to increase success, step by step suggestions for the challenge phase in which one reintroduces individual foods gradually to test level of tolerance, and other possibilities and suggestions if the diet does not help.
Unsurprisingly, given Dr. Bolen’s background as a psychologist, the authors helpfully address possible emotional frustrations about IBS symptoms or restrictions on perhaps enjoyable foods, or possible slip-ups with the diet. They devote the entire fifth chapter to common sense practicalities of living on a low-FODMAP diet, such as eating out in restaurants or others’ homes, traveling, discussing the diet and/or IBS with others, minimizing extra impact of the diet on one’s food budget, the additional challenges of being a vegetarian on a low-FODMAP diet, which may restrict many traditional vegetarian staples, and as previously mentioned, children and low-FODMAPs.
Chapters 6-16 contain 150 low-FODMAP recipes in the categories of Breakfast, Lunch, Soups, Sauces, dressings and rubs, Pasta, Beef, pork and poultry, Fish and shellfish, Vegetarian sides, salads and mains, Desserts, Snacks and Drinks. They appear to be relatively simple to prepare, and the authors state that they attempted to use easily available low-FODMAP ingredients. When appropriate, the recipes include basic nutritional information, definitions, or FODMAP-specific details. The book’s appendices include a sample menu plan, the authors’ sources, a standard U.S.-metric conversion chart for international readers to use when trying the recipes in the book, as well as a page of selected other resources for IBS and low-FODMAPs.
Overall, the information in The Everything Guide to the Low-FODMAP Diet appears to be scientifically accurate, balanced and up-to-date as of its publication date of 2014. The advice is generally consistent with the multidisciplinary, biopsychosocial approach advocated by functional GI experts. The authors are careful to emphasize that, as always, readers with IBS, or those shopping and cooking for family members with IBS, should consult their own physicians and/or dietitians experienced in the low-FODMAP approach to ensure proper diagnosis of IBS and/or another GI disorder, and that the diet is an appropriate and nutritionally balanced option for a given individual’s situation and any other medical needs. The authors also state correctly that, like every other existing IBS intervention, individual responses to the diet, if any, will vary, as will the particular foods or amounts to which specific people with IBS are or are not apparently sensitive. While this approach has been helpful to many, it is a management strategy, not a cure, and it is impossible for Monash University or any other research lab to analyze every food or every product brand available in every country and circumstance at any given time. Research and information on this topic will continue to evolve in the future. The Monash researchers themselves emphasize, and Dr. Bolen and Ms. Bradley repeat, that total elimination of all high-FODMAP foods is not recommended as a lifetime diet, as many are nutritious foods. The elimination phase is simply meant to assist people in identifying scientifically what their individual sensitivities and tolerances might be to various FODMAP components, so that they can design personal eating patterns that have a high chance of reducing their own IBS symptoms.
The Everything Guide to the Low-FODMAP Diet covers a great deal of varied information on this particular management option and its practical and social aspects in a very readable and understandable format. IBS Impact encourages blog readers who are considering the low-FODMAP diet to obtain a copy, which appears to be readily available in both paperback and Kindle e-book formats. We agree with the authors that if one chooses to try the diet, it should be in consultation with one’s own health care providers. This book is not intended as a comprehensive resource on IBS in general, so the explanations of what IBS is and the range of current treatments and areas of research are very brief. Readers who are relatively new to IBS should be aware of this, and not consider the book their only source of information. We encourage people with IBS and their families to continue to read and learn widely from reputable, scientifically accurate sources, such as the ones listed in the “Additional Resources” section of the book, Dr. Bolen’s About.com blog, the authors’ Everything Low-FODMAP website, Monash University’s own low-FODMAP pages and links, and the many IBS-related links on this blog, the various pages of IBS Impact’s main website, and IBS Impact’s social media
Although IBS Impact received a copy of this book from Dr Bolen for our reference, we receive no funding for this review or for any sales of the book. The observations and phrasing expressed here are original, independent, and not dictated in any way by either of the authors or any publicist. As with all of the information on this blog, our main website and social media, it is provided in the interest of scientifically accurate public awareness and advocacy, and assisting blog readers dealing with IBS to make informed choices for themselves or their families.