What are FODMAPs?
The acronym FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols.
FODMAPs are short chain carbohydrates and sugar alcohols that are poorly digested by the body. They ferment in the large intestine (bowel) during digestion, drawing in water and producing carbon dioxide, hydrogen, and methane gas that causes the intestine to expand. This causes GI symptoms such as bloating and pain that are common in disorders like IBS.
FODMAPs are in some foods naturally or as additives. They include fructose (in fruits and vegetables), fructans (like fructose, found in some vegetables and grains), lactose (dairy), galactans, (legumes), and polyols (artificial sweeteners).
These foods are not necessarily unhealthy products. Some of them contain fructans, inulin, and galactooligosaccharides (GOS), which are healthy prebiotics that help stimulate the growth of beneficial gut bacteria. Many of them are otherwise good for you, but in certain people, eating or drinking them causes gastrointestinal symptoms
Inflammatory bowel disease (IBD): It appears unlikely that a low-FODMAP diet is capable of inducing or maintaining remission in patients with Crohn's disease or ulcerative colitis. Still, a low-FODMAP diet might still be able to help manage symptoms and improve quality of life. People with IBD can also have IBS. When patients with Crohn's or ulcerative colitis in remission are still symptomatic, IBS and FODMAPs could be to blame. During an flare-up of IBD, it stands to reason that one should limit foods that might cause osmotic diarrhea on top of the IBD symptoms. For example, it doesn't make sense to replace fluids during bouts of diarrhea with high FODMAP beverages, such as fruit juice or regular milk. Patients with IBD will want to approach reintroduction of FODMAPs with more caution than other people.
A low FODMAP diet cuts out many common products that contain certain foods. The principle behind the diet is to give the gut a chance to heal, especially if you have GI problems like IBS. People with GI disorders may use this diet as part of their treatment.
Will a low FODMAP diet help IBS or other diseases?
It is believed that a meal plan that includes low FODMAPs also may help ease symptoms from other health conditions, such as:
After your doctor makes the diagnosis of your bowel disease or syndrome, (for example, IBS, IBD, or microscopic colitis), he or she may suggest a low FODMAP diet.
Celiac disease (CD): People with celiac disease are far more likely to have IBS than other people. If you have celiac disease, eat a gluten-free diet, and still experience excess gas, abdominal pain, bloating, diarrhea or constipation, FODMAPs could be to blame. First, though, talk with your doctor to make sure your gluten antibody levels reflect a 100% gluten-free diet and ask an expert in gluten-free eating to review your diet for hidden sources of gluten. Then consider a trial FODMAP-elimination diet to see if your symptoms improve. Be especially watchful of FODMAP ingredients added to boost the fiber content of gluten-free breads and baked goods.
Non-celiac gluten sensitivity (NCGS): A person with NCGS has observed that he or she has a bad reaction to gluten, even though celiac disease has been ruled out. There is no biomarker (specific test) for NCGS. This condition reportedly accounts for over half of the patients seen in celiac specialty clinics. There is some debate about whether the NCGS gastrointestinal symptoms attributed to gluten might really be due to the FODMAPs present in gluten grains.
Small intestinal bacterial overgrowth (SIBO): Healthy people have very few bacteria living in their small intestines. If an overgrowth of bacteria in the small intestine develops, which can happen for a variety of reasons, IBS-like symptoms can occur. Research is ongoing to determine the best ways to diagnose and treat SIBO, and to find out how many people previously diagnosed with IBS actually have SIBO. Firm practice guidelines don't exist yet, but antibiotic treatment shows the most promise. It seems likely that a diet low in rapidly fermentable carbohydrates, such as a low-FODMAP diet, would discourage relapse of SIBO after antibiotic treatment. However, there have been no scientific experiments yet to prove whether this or any other diet is best for people with SIBO.
Gastroesophageal reflux disease (GERD): GERD is a very common condition; a great many people with IBS also have GERD. FODMAPs exert their direct effect in the lower part of the gastrointestinal tract, and FODMAP studies have not looked at GERD symptoms, such as heartburn, directly. Still, many people do report fewer GERD symptoms on the FODMAP-elimination diet. With less excess gas and fluid distending the intestines, perhaps there is less upward pressure on the stomach to encourage reflux. Or perhaps the extra attention to healthy food choices and smaller portions during the low-FODMAP diet reduces reflux.
Symptoms and signs that you may be eating to many high FODMAP foods
FODMAPs are not absorbed well in the small intestine. They increase the amount of fluid in the large intestine (bowel) and they produce more gas.
Symptoms and signs that suggest you may be eating products high in these short chain carbohydrates are:
Since most people
can’t break down FODMAPs, these molecules remain undigested until they reach
your colon. From there, the bacteria in your colon “digest” or ferment these
molecules, which produces gas, and causes digestive symptoms.
The FODMAP diet (also known as “The Low FODMAP Diet”) eliminates foods that are high in these carbohydrates, for anywhere between 2 weeks to 2 months at a time. After the elimination phase is complete, high FODMAP foods are reintroduced one by one to help identify which specific group of carbohydrates are causing symptoms.
Symptoms Caused By High FODMAP Foods
FODMAP intolerances share many of the same symptoms as IBS, such as:
Can You Test For FODMAP Intolerances?
The Hydrogen Breath Test, which measures the amount of hydrogen and methane in your breath produced by gut bacteria, may be helpful for detecting carbohydrate malabsorptions, such as sorbitol, fructose, and lactose. However, the HBT may not produce 100% accurate results, and can only detect the malabsorption of some FODMAPs (for example, it can’t detect fructans). For this reason, it’s not commonly recommended as a diagnostic tool for FODMAP intolerances.
In any case, your body knows best: tracking your meals and symptoms, and dedicating to a low FODMAP diet are the most accurate ways of determining which foods are causing discomfort.
Who Should Follow a Low FODMAP Diet?
As suggested above,
a Low FODMAP diet is most helpful for IBS, but it can also provide relief for
conditions such as SIBO (Small Intestinal Bacterial Overgrowth), and irritable
bowel diseases such as Crohn’s Disease and ulcerative colitis.
Not all people are sensitive to high FODMAP foods— but anyone who regularly experiences the above symptoms may benefit from reducing the FODMAPs in their diet, despite having not received a diagnosis.
Risks For Following The Low FODMAP Diet
Since the FODMAP diet eliminates several foods at once, there is a risk for vitamin and mineral deficiencies, especially if you already have an existing deficiency. For this reason, you may need to take nutritional supplements, which your healthcare practitioner can advise you about.
You may also need to remove the current supplements you take during Phase I (especially fiber supplements, which contain inulin or vitamin tablets sweetened with xylitol and fructose) as many do contain FODMAPs.
The low FODMAP diet isn’t meant to be a long-term plan. It’s designed to give your digestive system a break and identify the specific FODMAPs that are causing your symptoms.
As you can see, a low FODMAP diet can provide powerful results for healing digestive symptoms, and improving your overall health and happiness. In addition to eliminating FODMAPs, it’s also important to regularly eat foods that support gut healing, such as coconut kefir, and Low FODMAP approved green smoothies and bone broth.
High FODMAP Foods (Off Limits on a Low FODMAP Diet)[[PASTING TABLES IS NOT SUPPORTED]]
While all high FODMAP foods should be eliminated on a low FODMAP diet, some people report the most relief by removing onions, garlic, and lentils. This may be helpful to note if you don’t suffer from IBS or IBD, but still experience digestive symptoms after certain meals.
How to Follow a Low FODMAP Diet
There are two
phases for following a low FODMAP diet:
Phase I: Eliminate High FODMAP Foods
Phase II: Reintroduce High FODMAP Foods
Phase I – The Elimination Phase of High FODMAP Foods
High FODMAP foods
are removed for at least two weeks, and up to a few months depending on
severity of symptoms and reactions in the reintroduction phase.
Phase II – The Reintroduction Phase
Once an improvement
in your symptoms is noted, the next step is to reintroduce one high FODMAP food
at a time, from one FODMAP group at a time.
For example, you may introduce disaccharides one week (such as dairy products or grains), and polyols the next week (such as avocados or mushrooms). It’s important to avoid introducing two types of FODMAPs at the same time so you can determine which foods your body is still reacting to (if any).
As mentioned above, most reintroduction phases recommend reintroducing only one FODMAP food per week.
What if You Experience Symptoms During the Reintroduction Phase?
If you experience digestive symptoms during phase II, you can re-test a food from the same group. So, if you tried cheese and your body didn’t react well… You can try another disaccharide food, such as barley, to see if you experience the same symptoms. If you do, you’re considered sensitive to that particular type of carbohydrate and should continue to avoid it. Your healthcare practitioner may also recommend going back to the original elimination phase before reintroducing another group.
It should be noted that the FODMAP diet isn’t a “No” FODMAP diet— it still allows foods that contain traces of FODMAPs in lower amounts. In more extreme cases, it may be recommended to avoid FODMAPs altogether.
Tips for Low FODMAP Diet Success
#1 Create Time in Your Schedule and Make it Realistic
Since the FODMAP diet eliminates several foods at once, it requires dedication for best results. For this reason, it’s best to begin a low FODMAP diet during a time you’re able to have the most control over your diet, and not in a position where you’ll be frequently eating out or under excessive stress.
#2 Read Labels and Avoid Processed Foods
Reading food labels and doing meal prep at home is also important, since high FODMAP ingredients such as onion powder, sugar alcohols, refined sugar, and skim milk powder hide in processed foods, fast foods, and packaged foods.
#3 Keep a Meal and Symptom Journal
Keep track of improvements or worsening of your symptoms after each meal in your phone or in a notebook.
#4 Always Have Low FODMAP Foods on Hand
Keep low FODMAP foods accessible at all times. It can also be helpful to keep a low FODMAP list in your phone so you’re never left guessing what to eat and grocery shop for.
As you can see, a low FODMAP diet can provide powerful results for healing digestive symptoms, and improving your overall health and happiness. In addition to eliminating FODMAPs, it’s also important to regularly eat foods that support gut healing, such as coconut kefir, Low FODMAP approved green smoothies, and bone broth
LOW FOD MAPS FOODS
Vegetables and Legumes
Meats, Poultry and Meat Substitutes
Fish and Seafood
Cereals, Grains, Breads, Biscuits, Pasta, Nuts and Cakes
Condiments, Dips, Sweets, Sweeteners and Spreads
Drinks and Protein Powders
Dairy Foods and Eggs
Cooking ingredients, Herbs and Spices