Bloating is one of the most common gastrointestinal symptoms. It can occur as a sensation of gas stretching the gut, with or without actual distension, when the abdomen is visually swollen. Bloating often results in significant discomfort and/or pain and is a major complaint in many patients with irritable bowel syndrome.
One of the major aims of the low FODMAP diet is to reduce bloating by restricting short chain carbohydrates from the diet that are fermented by gut bacteria. The fermentation process is responsible for the gas release and distension of the gut that leads to bloating.
As we have pointed out previously, the low FODMAP diet should only be followed strictly short term.
The diet should be relaxed long term to ease the burden of following the diet, but more importantly to reintroduce some FODMAPs back into the diet for their potential benefits. This benefit arises from the fermentation of FODMAPs by gut bacteria – the reason we restrict FODMAPs in the first place – but small amounts of FODMAPs are fuel for good bacteria and is likely to be important in long term gut health.
Many people try the reintroduction or rechallenge phase and state they have failed - their symptoms returned on reintroduction of the foods and they went back to a strict low FODMAP diet. This will be necessary for symptom control only in the minority of extremely sensitive individuals. For everyone else, it may be that smaller amounts of FODMAPs need to be trialed, and in fact, the return of symptoms needs to be looked at in a different way.
When you experience symptoms, it is vital that you are tuned in to the severity. Pain and significant discomfort are not OK and you can discuss these outcomes with your treating dietitian who can advise further on future challenges and food trials you may better tolerate. But for many people, the reintroduction of FODMAPs, or FODMAP ingestion when eating, results in gas production and a little bloating. The initial thought is that there has been a reaction and the food should again be removed from the diet, but we ask you to think about it in a different light.
Fermentation and gas production after eating high FODMAP foods is beneficial to the gut. If you experience some gas related symptoms that are tolerable and perhaps just include some mild bloating and flatus, this could be a good sign that you are providing fuel that encourages good bacteria in your gut. Everyone experiences some bloating and flatus and it is important not to immediately consider these as ‘symptoms’ of IBS, rather they should be considered a normal part of healthy digestion (as long as there is no significant discomfort or pain!).
So remember, a little gas is a good thing.