Navigating the Low FODMAP Diet During Eating Disorder Recovery

Disclaimer: This topic is geared towards RD’s working within the ED population as this therapeutic diet is high risk and should not be attempted unless under the advisement and direction of a nutrition professional.

The low FODMAP diet and its relevance for individuals dealing with eating disorders (ED) and gastrointestinal (GI) issues is due to the large prevalence of GI issues within the ED population. This subject is close to my heart, as I, too, experienced the challenges of managing IBS during my recovery from binge eating disorder. So how do we help ED patients find relief from their GI symptoms while safeguarding their recovery and preventing relapse?

Why Does This Matter?

GI issues frequently accompany eating disorders and may worsen during ED recovery. A study examining a sample size of 100+ females with an ED found that 98% of those patients had a functional gut disorder, with 50% having IBS. Additionally, around 23% of people with GI issues engage in disordered eating practices, and 90% of IBS sufferers avoid specific foods to alleviate symptoms. Striking a balance between food freedom and symptom management is essential in these cases.

Understanding FODMAPs

Before we dive into the low FODMAP diet, it's essential to grasp what FODMAPs are. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These are short-chain carbohydrates that can ferment in the gut.

The FODMAP Process

FODMAPs cannot be broken down or absorbed in the small intestine. As they reach the large intestine, they trigger water absorption, leading to fermentation by gut bacteria. This fermentation produces gases and fatty acids, causing discomfort for individuals with IBS.

The Five Problematic FODMAP Groups

FODMAPs can be broken down into five main groups: fructans, fructose, galactans, lactose, and polyols. Let's delve deeper into each group.

Fructans

Fructans are found in various foods, including wheat, garlic, onions, broccoli, and cauliflower. They are non-digestible and can be problematic for people with IBS.

Fructose

Fructose is the fermentable sugar in fruits, honey, and high fructose corn syrup, and it may be an issue for some IBS patients.

Galactooligosaccharides (GOS)

GOS, also known as galactans, are the fermentable sugars in legumes such as beans, chickpeas, lentils, and soy. Like fructans, GOS are non-digestible and can trigger symptoms in individuals with IBS.

Lactose

Lactose is the fermentable sugar found in milk and dairy products. Not all IBS patients are lactose intolerant, and the lactose content varies among different dairy products.

Polyols

Polyols are sugar alcohols, often ending in "-ol." They occur naturally in some fruits and vegetables and are also used as artificial sweeteners. It's worth noting that not all substances ending in "-ol" are polyols.

The Low FODMAP Diet

The low FODMAP diet is a therapeutic approach that temporarily restricts these five FODMAP groups. This restriction aims to provide relief from uncomfortable IBS symptoms, allowing the gut lining to heal and restoring a balanced gut flora. The diet typically consists of three phases:

1. The Elimination Phase: Lasting 2-6 weeks, this phase focuses on resetting and improving GI symptoms by avoiding all high FODMAP foods. During this phase, it's often more beneficial to concentrate on foods patients can eat rather than those they can't.

2. The Challenge or Reintroduction Phase: Taking 6-8 weeks, this phase aims to identify specific trigger foods or FODMAP groups through systematic reintroduction. This process can be complex and needs close monitoring.

3. The Personalization Phase: After identifying trigger foods, the focus shifts to long-term maintenance and expanding dietary variety.

FODMAP Stacking

FODMAP stacking occurs when multiple "low" FODMAP foods are consumed together, creating a "high" FODMAP meal. This often happens with foods that have a portion control for FODMAPs, such as blueberries with trace FODMAP content.

Pros and Cons of the Low FODMAP Diet for the ED Population

Pros:

• Evidence-based treatment for IBS, reducing symptoms in 75% of individuals.

• Provides a structured approach with a clear end date.

• Identifies specific food triggers and expands dietary variety.

• Allows the reintroduction of previously feared foods.

• Enhances quality of life through increased food flexibility.

Cons:

• May lead to prolonged restrictive diets without professional guidance.

• Can increase anxiety around food and social settings.

• May mask disordered eating behaviors.

• Increases time spent thinking about food.

• Poses challenges for dining out or social situations involving food.

• Existing dietary restrictions, such as vegan or vegetarian diets or food allergies, can risk nutritional deficiencies.

• May lead to a negative relationship with food and eating disorder relapse.

Patient Scenarios

Individuals with eating disorders and GI issues may have different scenarios:

1. Patient 1: Started with GI issues, leading to restricting suspected trigger foods, eventually resulting in an eating disorder.

2. Patient 2: Initially restricted foods, leading to an eating disorder, which subsequently caused GI issues.

3. Patient 3: Predominantly an eating disorder client in recovery, then started experiencing GI issues, leading to limiting or eliminating suspected trigger foods and causing relapse.

Final Thoughts

In working with eating disorder patients experiencing GI disturbances, close monitoring and expert guidance from a dietitian are essential to prevent relapse. Balancing GI symptom management and ED recovery is a delicate process, and the low FODMAP diet can be a valuable tool when used thoughtfully and under the guidance of professionals. The ultimate goal is to help individuals with eating disorders enjoy a pleasurable, comfortable, and nutritious relationship with food.