What to Do When the FODMAP Diet Falls Short

IBS is a complex condition, and FODMAPs are just one piece of the puzzle. If the FODMAP diet hasn't delivered enough relief, don't lose hope. There are other options you can explore.

By Laura Tilt

FODMAP Restriction is not a one-size fits all approach 

FODMAP restriction is effective for a large number of people with IBS, but it's not a universal solution. IBS symptoms can be affected by many factors, and there's no one approach to managing symptoms that works for everyone.   

If you haven't experienced the anticipated improvement on the low FODMAP diet, here are some other options to consider: 

1. Psychological Therapies:

As discussed in week four of this programme, stress and anxiety can be a major trigger for IBS symptoms. If you’ve noticed a link, it’s well worth exploring tools to manage stress and anxiety. You can find some suggestions in week four.  

There are also two types of talking therapy that have been shown to help reduce IBS symptoms.  

Gut-directed cognitive-behavioral therapy (CBT) looks at how thoughts and emotions can impact how your gut functions.

Over several sessions, a therapist will work with you to help you understand how stress and emotions can trigger IBS symptoms, and help you learn tools that can help manage stress and address unhelpful thoughts.  

If you are in the U.K., you can refer yourself for this type of therapy. Click here for more details. CBT can also be delivered by a private therapist. Our recommendation is Dr Sula Winsgassen, a Senior CBT Therapist and Health Psychologist.  

Gut-directed hypnotherapy is a form of hypnotherapy which targets the disrupted communication between the brain and gut.

A session typically begins with a visualisation to calm and relax the mind and body. Suggestions are then made to the subconscious part of the mind around the normalisation of gut function.

Sessions are delivered over 6-12 weeks by a specially trained hypnotherapist. You can access this type of therapy through a digital app called Nerva, or with a specialist gut-directed hypnotherapist. In some areas in the UK, it’s available through the NHS, but this is a limited service.  

2. Medications:

Medications can be used to target specific symptoms such as cramps, diarrhoea or constipation. In some cases, a type of low-dose antidepressant may be beneficial in helping to manage abdominal pain. Speak with your doctor to explore options. 

3. Chat with a Specialist Dietitian:

An IBS-Specialist dietitian can look at your diet, eating habits and symptoms in detail and explore other nutritional approaches. For some people fibre supplements can be helpful. There’s also evidence that a low histamine diet may help a subset of people with IBS.  

4. Speak with your GP:

Other conditions like coeliac disease and inflammatory bowel disease can mimic the symptoms of IBS. These should have been ruled out by your GP before a diagnosis of IBS, but it's worth confirming that they have been.  

About 30% of people with IBS-Diarrhea have bile acid diarrhea, caused by too much bile acid in the large intestine (colon). You can read more about this condition here.  

If you suffer with chronic constipation or emptying your bowels, a visit to a pelvic floor physiotherapist might be helpful.  

Remember, your journey toward managing IBS is unique to you. While the FODMAP diet is a powerful tool, it's not the only option.

By exploring alternative therapies and seeking professional help, you can uncover new avenues to symptom relief.