In our post Metabolic Diet, we discussed how one person food can be another person poisons— this is definitely the case here with FODMAPs Diet.
And when you meet people on the FODMAPs Diet, they refer to every food as high or low in FODMAPs as in Oh, I don’t have garlic cause it’s high in FODMAPs. or I always order lettuce salad cause it’s low in FODMAPs.
To an outsider, the list of foods they refer to as high or low in FODMAPs seems nothing more than a random group of foods with a hidden commonality called FODMAPs.
And somehow understanding what that means gives you the pass to the insider world of FODMAPs and the pain they feel from having to have to live with irritable bowel syndrome (IBS), a common gastrointestinal disorder that affects 10% of the U.S. population each year.
Whether it’s your curiosity that brought you here, or you’ve been ordained by your doctor to improve your IBS and IBD conditions with FODMAPs, the first step in understanding this what people refer to as "really strict" and "life changing" diet is decoding the word FODMAPs.
What is FODMAPs?
The name FODMAP stands for (ready for this?) F-Fermentable O-Oligosaccarides D- Disacharides M-Monsaccharides A-and P-Polyols.
These include lactose (a sugar present in milk), fructose (a form of sugar found in fruits, vegetables, and honey), oligos (fructans and galactans), and polyols (sorbitol and mannitol), sugar alternative that has the taste and texture of sugar in about half the calories.
The FODMAP diet is more properly called the Low FODMAPs diet because the idea is to limit your consumption of these nutrients.
All of these nutrients are in the carbohydrate family; some are sugars (such as lactose and fructose), others are sugar alcohols (such as sorbitol and mannitol), and some are non-digestible fibers (such as fructans and galactans).
Sugar alcohols are also used in more concentrated amounts in food processing to produce sugar-free and diabetic foods.
All occur naturally in whole foods such as fruit, dairy, beans, and grains.
How do FODMAPs affect digestion?
Different FODMAPs present different issues in digestion.
The sugars require specific enzymes for proper digestion and an absence of these enzymes can cause problems.
The sugar alcohols are highly osmotic, meaning that they tend to pull water into the digestive tract from the surrounding tissues.
The fibers serve as food for your gut bacteria, which digest them via a process of fermentation, producing carbon dioxide in the intestines.
All of this is perfectly natural and— although consuming large amounts of these compounds could lead to digestive discomfort for just about anyone—most people don’t have trouble with the amounts encountered in a typical diet.
In fact, some of these nutrients serve beneficial roles, such as acting as probiotics that foster healthy gut bacteria.
Some folks, however, seem to have a lower tolerance for some or all of the FODMAPs.
What that means is in those people, FODMAPs get poorly absorbed in the small intestine where, with the help of bacteria, they ferment.
When they eat more than small amounts of these nutrients, they end up with severe bloating, distention, pain, and all kinds of other miseries.
Fortunately, the solution is fairly simple.
A low FODMAP diet often solves the problem.
The idea behind this diet is that by eliminating foods high in FODMAPs digestion is improved to a normal speed, thereby reducing symptoms.
It's no surprise, FODMAPs diet is used as a treatment for irritable bowel syndrome (IBS) and inflammatory bowel diseases (IBD).
Foods High and Low in FODMAPs?
Foods that are high in FODMAP contain one or more of these compounds.
Foods like garlic, mushrooms, watermelon and nectarine, are some of the foods that are high in FODMAPs Diet.
While these fruits and vegetables are generally part of a healthy balance diet for most people for their high nutrient content, some people with Crohn’s disease and digestive concerns can’t tolerant them.
Their sensitivities towards FODMAPs turn their guts into knots and result in digestive problems and bowel irritation.
For people with sensitive guts, this is could means having excess:
- Painful bloating
Besides the uncomfortable symptoms, IBS causes a significant effect on a patient's quality of life by limiting their food choices during their FODMAP dieting period.
Not only flavoring staples such as garlic and honey are high in FODMAPs and are off limit, a wide selection of fruits and vegetables such as apple, pears and asparagus is also restricted.
Examples of foods high in FODMAPs are:
- High fructose corn syrup (HFCS)
- Dairy products containing lactose
- Fruits like apples, apricots, dates, digs, watermelon
- Vegetables such as artichokes, cauliflower, mushrooms
- Cashews, beans, lentils
- Grains such as wheat, barley, and rye.?
What you can eat is a selection of foods that are low in FODMAPs.
Below is a list of low FODMAPs foods that are recommended and proven effective in relieving IBS symptoms.
Low FODMAPs foods list:
- Dairy: Lactose-free milk, rice milk, almond milk, coconut milk, lactose-free yogurt; hard cheeses such as feta and brie
- Fruit: Bananas, blueberries, cantaloupe, grapefruit, honeydew, kiwi, lemon, lime, oranges and strawberries
- Vegetables: Bamboo shoots, bean sprouts, bok choy, carrots, chives, cucumbers, eggplant, ginger, lettuce, olives, parsnips, potatoes, spring onions and turnips
- Protein: Beef, pork, chicken, fish, eggs and tofu
- Nuts/seeds (limit to 10-15 each): Almonds, macadamia, peanuts, pine nuts and walnuts
- Grain: Oat, oat bran, rice bran, gluten-free pasta, such as rice, corn, quinoa, white rice, corn flour and quinoa
FODMAP diet effectiveness
A study by Richard B Gearry PhD, from the Department of Gastroenterology, Box Hill Hospital, Victoria, Australia, has shown that 50% of IBS patients respond favorably to the FODMAPs diet.
Another source, University of Virginia School of Medicine reported seeing success in 77% of their patients.
Though different studies saw different success rate, across all researches, effectiveness of FODMAPs diet amongst IBS patients is deemed positive.
Studies show that the positive effects of the diet includes less abdominal pain, bloating, and diarrhea. Interestingly this was noted in patients with Crohn’s disease and ulcerative colitis as well.
According to Gearry PhD from Box Hill Hospital, increased adherence to the diet also improves results.
Based on scientific evidence, there is a significant benefit for embracing the FODMAPs diet for some people.
How Does FODMAPs Diet Work?
After identifying your sensitivities towards FODMAPs, speak to a licensed professional to assess whether FODMAPs diet is right for you.
If it is, this section is to provide just a general idea of how it works.
One of the reasons why the low FODMAP diet is so strikingly effective is that it casts a fairly wide net.
It eliminates several categories of compounds which, together, are responsible for a large share of digestive issues.
Initially you avoid ALL the foods on the high FODMAP list for 4-6 weeks to allow for the gastrointestinal tract to heal, and then gradually add single foods back in small amounts to find your sensitivity triggers.
Note that this does not mean you are sensitive to all foods.
It's more likely that you may only be sensitive to one or two of these compounds and not all of them—in which case you’ve eliminated a bunch of foods that weren’t actually a problem for you.
Once things have calmed down in your tummy town, there’s an opportunity to do some further investigation.
You can test your tolerance for different FODMAPs by introducing them one at a time and seeing if symptoms recur.
You might, for example, figure out that beans and grains aren’t a problem for you as long as you stay away from dairy. Or, you might establish that fructose malabsorption is your issue and that, as long as you stick to the low fructose fruits and vegetables, everything else is back on the table. And so on.
If you’d like to learn more, here’s a link to an excellent handout prepared by the University of Arizona Campus Health Service. However, I’d also encourage you to work with a qualified nutrition professional.
Take Home Message
While it may seem a simple case of avoiding the foods listed above, a FODMAP diet should really only be undertaken under the supervision of a registered dietitian, a nutritionist or physician.
Because the diet is restrictive in its food choices, substitutions will need to be made to ensure you get a diet balanced in nutrition, vitamins and minerals.