Harmonizing Health: Integrating the Low FODMAP and Mediterranean Diets

If you’re navigating the challenges of IBS, you understand that the struggle goes beyond just gut symptoms—it's about reclaiming your overall health, vitality, and the pleasure of eating and socialising with friends and family.

In this week’s blog we explore the benefits of combining the low FODMAP diet, specifically designed to alleviate IBS symptoms, with the renowned Mediterranean diet. This pairing not only offers a path to digestive comfort but also brings substantial benefits for cardiovascular health, metabolic function, and longevity.

Here in Australia, we’re blessed with a climate and a food culture that perfectly complement the Mediterranean diet. Our abundance of fresh, local produce means that making healthy AND delicious meals is easy. Whether it’s a vibrant salad dressed with local olive oil or a hearty dish of grilled fish and vegetables, the Mediterranean diet’s flavours feel right at home here.

But it’s not just about what’s on the plate. The Mediterranean lifestyle emphasizes the importance of community, relaxation, and enjoying the simple pleasures of life, exactly what we need to improve quality of life.

Join us as we explore how combining these two powerful dietary approaches can lead to a calmer gut, improved health, and a happier you.

What is the low FODMAP diet?

The low FODMAP diet is a science backed diet developed by researchers at Monash University that has repeatedly been shown to help improve symptoms in at least 70% of people with IBS.

The first stage of the diet involves greatly reducing the levels of rapidly fermented short chain carbohydrates in the diet. Indeed, FODMAP is an acronym for fermentable oligosaccharides, disaccharides, monosaccharides and poylols.

These carbohydrates can cause problems for people with IBS, either because they are malabsorbed and draw water into the gut, or they are rapidly fermented by gut bacteria to produce gas which stretches the intestines. This gas isn’t a problem for most people, but people with IBS have what is called ‘visceral sensitivity’. The nerves around their intestines are very sensitive, meaning that this stretching causes pain signals to be sent to the brain. The brain can then also send signals back to the gut that affects the way it moves and functions leading to diarrhoea or constipation, or even a combination of the two.

FODMAPs are found in a wide range of food from dairy (which contains lactose, a disaccharide) to wheat (which contains fructan, an ologoasccahrode), some fruit (which contain fructose, a monosaccharide), some vegetables (which can contain a variety of FODMAPS), beans and pulses (which contain galacto-oilgosaccharides) and some artificial sweeteners (which contain polyols).

Before you worry that there is nothing left to eat, take heart from the fact that it is the low FODMAP diet, not the no FODMAP diet. Most foods have a low FODMAP serving size although this can be very small. One exception is raw garlic.

The low FODMAP diet is best thought of as a process. Whilst the first stage – elimination involves sticking to a low FODMAP diet. The subsequent stages – reintroduction and personalisation allow individuals to identify their particular FODMAP triggers and to reintroduce foods that they can tolerate. This provides a greater variety of foods to enjoy.

What is the Mediterranean Dietary Pattern?

The Mediterranean Diet is recommended for chronic low-grade inflammation-related diseases because of its anti-inflammatory properties, derived predominantly from olive oil and phenolic compounds found in plant foods. It has been proven to reduce the risk of cardiovascular disease. It also supports healthy blood sugar levels, blood pressure and cholesterol, lowering your risk of metabolic syndrome. It may also help lower long term cancer risk.

These is some evidence that it can also help improve IBS symptoms. A small trial published earlier this year showed that it led to lower IBS symptoms at the end of a 6 week intervention compared to controls, with 83% of participants on the diet showing at least a ‘minimal clinically important difference’ in symptoms compared to only 37% of controls. It also led to reduced depression scores and improved quality of life.

The diet has features typical of many cultures around the Mediterranean Sea in the mid-20th Century. It is perhaps closet to the diet of the Greek Island of Crete in that era. It predates ultra-processed packaged food, but it is not an ancient diet. For example, capsicum, eggplant and tomatoes are key components of the diet, but these only came to Europe in the 16th Century.

The key components of the diet are plenty of plant-based foods, especially leafy greens and colourful fruits and vegetables; fat from extra virgin olive oil (EVOO), nuts and oily fish; wholegrains, especially sourdough bread; limited red meat (once a week to once a fortnight) and protein from fermented dairy plus legumes, pulses and seafood; with the addition of a splash of traditionally made vinegar.

The diet is flavoursome, and involves liberal use of garlic, onions and herbs.

The individual elements offer powerful health benefits. but it is the combination together that makes this diet so healthy and tasty.

The leafy greens provide nitrates which are converted into nitric oxide by stomach acid, Nitric oxide relaxes blood vessels lowering the risk of high blood pressure and heart disease.

The EVOO has benefits on its own as a monosaturated fat that helps to reduce harmful cholesterol levels, but it also has synergistic effects when combined with other components of the diet.

When EVOO is used for cooking vegetables, particularly red ones, it releases powerful antioxidants and ant-inflammatory compounds like polyphenols, including flavonoids and many others. EVOO also helps with absorption of fat-soluble vitamins and carotenoids and the beneficial compounds in green leafy vegetables. Fresh herbs including oregano and parsley enhance this effect.

The garlic and onions contain sulphur compounds that have cancer preventative effects.

The diet is about a healthy lifestyle that promotes longevity, not just food. Eating together with family and friends is a key element and helps to build connections. It also often includes a restorative afternoon nap and the activity associated with growing your own vegetables and herbs.

How to combine the two

Clearly there are strong benefits of both diets, but there are also some tensions between the two. If you are already a fodmapper, mention of the beans and pulses, and onions and garlic, key components of the Mediterranean Diet may make you nervous.

We take you through the different food groups to illustrate how you can combine the two diets.

Protein Sources

Meat, chicken, eggs, fish and seafood are all free of FODMAPs. Simply swap red meat for seafood and limit chicken and eggs to one serve per day to meet the Mediterranean Diet guidelines. Try to have fish at least three times a week.

Fermented dairy is beneficial, and you should aim for one serve a day.

Milk contains the FODMAP lactose, this is reduced somewhat by fermentation. However, a low FODMAP serving size of Greek yoghurt is still only one tablespoon, so opt for lactose-free yoghurt instead. Choose one with live Lactobacillus and Bifidobacteria cultures.

Legumes and pulses have huge health benefits and are a great source of soluble fibre and phytochemicals along with protein. We have written about their health benefits here. They are a key component of the Mediterranean diet, but they do contain FODMAPs.

Stick to canned, rinsed and drained beans, chickpeas and pulses. The FODMAPS leach into the water in the can. Aim for at least three serves per week. The low FODMAP serving sizes and protein content are in the table.

Extra Virgin Olive Oil and Traditional Vinegar

These two elements are Mediterranean Diet staples.

Olive oil doesn’t contain any FODMAPS at all. Opt for extra virgin olive oil and around 3 tablespoons per day. We’ve written about its heath benefits in depth here.

It contains healthy fats and plant compounds with a myriad of effects. It can help improve cardiovascular health, brain health and blood sugar control. It also has effects on the gut microbiome and reduces inflammation and oxidative stress.

We’ve also covered the health benefits of traditionally made vinegars.

These do contain some FODMAPs but there are generous low FODMAP serving sizes.  You can consume 2 tablespoons (42g) per meal of red wine vinegar. There is a little more fructose in balsamic vinegar linked to its sweeter flavour. The low FODMAP serving size for balsamic vinegar is 1 tablespoon (21g) per meal.

Splash a combination of the EVOO and vinegar over main and side salads every day. Here is one of our favourite colourful salads:

Ingredients (serves 1):

• 40g feta cheese

• 1/8 large cucumber (diced)

• 1 cherry tomato

• 1/4 red pepper

• 3 black olives

• herbs or cos lettuce

• 1 cornichon and 1/4 tspn capers chopped

Method:

Simply combine all ingredients, dress in 1/2 tbsp of olive oil and ¼ tbsp of red wine vinegar, and season with salt and pepper.

Fruit and Vegetables

Aim for three serves of fruit per day. The fructose content of fruits varies, but there are many options with sizeable low FODMAP serving sizes..

My favourites are the berries and citrus. And in line with Mediterranean style living, I have blueberry bushes and citrus trees in the back garden, which I lovingly water each morning.

Have fruit as your dessert if you can to meet Mediterranean Diet guidelines. Dark chocolate is another low FODMAP option, but white and milk chocolate have more lactose. White sugar and maple syrup are low in FODMAPs and you can also ‘sweeten’ with vanilla essence and spices like cinnamon. Honey, agave syrup and all the artificial sweeteners ending in -ol are high in FODMAPs and should be avoided.

Again, aim for at least three serves a day, and a variety of colours.

Our blog on eating the rainbow explains how different colours are associated with different phytochemicals that have unique health benefits.

Adding a salad to the table is an easy way to up vegetable uptake; even small children love sweet salad vegetables.

You can also eat an abundance of just about all herbs.

The alliums, need a special mention. They are a key component of the Mediterranean Diet, and whilst they do contain FODMAPs, there are still some options available to enjoy.

For example, here is a low FODMAP recipe for an Italian Tomato Sauce. It is very versatile. It is the perfect base for a bolognese sauce – simply add 500g of browned minced beef. Alternatively, you can add tuna to the sauce at the end and then bake with pasta. It also works spooned over chicken breasts, which can then be baked.

Ingredients (serves 4):

• 2 tbsp extra virgin olive oil

• 1 whole garlic clove, peeled

• 1 x 400g can of plum tomatoes (a low FODMAP serving size is 100g per meal)

• 1 carrot, grated

• 1 dessert spoon of red wine vinegar (you can swap this and the sugar for 150 ml of red wine)

• 1 dessert spoon of caster sugar

• 1 tsp or dried basil, or 1 tbsp of chopped fresh basil

• 250 ml of low-FODMAP vegetable stock made with as San Elk or Massel Vegetable Stock Powder

• 1/2 tsp ground nutmeg

• 1 bay leaf

• a twist of freshly ground black pepper

  Method:

  Add the oil and whole garlic clove to a large pan and heat gently for a minute, then remove the garlic. This allows the flavour and some of the fat soluble sulphur compounds from the garlic to permeate into the oil. In contrast, the FODMAPs in garlic are water soluble. If the garlic is removed before you add any other elements they won’t leach into the sauce.

  Add the grated carrot and cook for three minutes until softened.

  Add the tin of tomatoes to the pan and break up the tomatoes with your wooden spoon.

  Add the red wine vinegar, caster sugar, bay leaf, nutmeg and black pepper and stir through. Make up the small amount of stock (don’t use too much powder or the sauce becomes too salty).

  Gently simmer for 10 mins, then remove the bay leaf and it’s ready to use.

Nuts and Seeds

Nuts and seeds make great snack options as part of the Mediterranean Diet. You can also sprinkle them on salads and on your breakfast yoghurt. It is recommended to have one or two small servings (1/4 cup) per day.

Nuts are fabulous for heart and brain health. They are packed with fibre, protein, minerals and plant sterols. Despite being high in fat, nuts are considered heart healthy foods. This is largely because they are high in 'good fats' – monounsaturated fats and polyunsaturated fats that help to lower levels of bad cholesterol.

Low FODMAP serving sizes vary a little, and are given in the table.

Seeds have a similar nutrient profile to nuts and are highly nutrient dense. They are great sources of minerals, vitamin E and heart-friendly fats. Seeds are also a great source of both soluble and insoluble fibre for good gut health. Chia seeds rate a particular mention. Whilst they originated in South America, they make a great addition to the Mediterranean Diet. We like to stir them though yoghurt slackened with a little water, leave for a few hours or overnight and top with fruit. Chia seeds are a rich source of non-fermentable fibre that won't cause lots of gas or bloating that can be problematic for people with IBS.

Chia seeds contain both soluble and insoluble fibre. The soluble fibre in chia seeds forms a gel that attracts water during digestion. This bulks up and softens the stool making it very easy to pass. Great if you have constipation.

You Don’t Have to Give up Bread

Yes, that’s right, there are bread options on the low-FODMAP diet:

• Sourdough (white, wholemeal, spelt): 2 slices

• Wholemeal bread: 1 slice

The long proofing time used to make sourdough reduces the fructan content, so this is the best option.

Steer clear of barley, or pumpernickel and other rye-based breads, these are very high in FODMAPs (and gluten). Similarly, breads made from soy flour might be gluten-free, but they also contain FODMAPs.

Brown rice and oats are other great wholegrain alternatives.

Ready to Get Started?

If you are ready to get started, you’ll find that many of the recipes on our recipe page also take the best from both dietary approaches. Also check out our Challenge page for a 10 day meal plan.

Blog written by: Noisy Guts co-founder Dr Mary Webberley. Mary has a background in biology, with two degrees from the University of Cambridge and post-doctoral research experience.