What is FODMAP? What does it stand for?

FODMAP is an acronym that stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. These are specific types of carbohydrates that can be challenging for some people to digest. Let's delve deeper into what each of these terms means:

• Fermentable: This refers to the process by which gut bacteria break down undigested carbohydrates to produce gases like hydrogen, methane, and carbon dioxide. It's this fermentation process that can lead to bloating, gas, and other digestive discomforts.

• Oligosaccharides: These are complex carbohydrates that consist of 3-10 simple sugars (monosaccharides) linked together. Two main types of oligosaccharides are found in the diet: fructo-oligosaccharides (FOS) and galacto-oligosaccharides (GOS). Common sources include wheat, rye, legumes, and various fruits and vegetables.

• Disaccharides: These are carbohydrates composed of two monosaccharide molecules. The most common disaccharide in our diet is lactose, which is found in milk and dairy products.

• Monosaccharides: These are the simplest form of carbohydrates and include glucose, fructose, and galactose. High-fructose foods include honey, apples, and high-fructose corn syrup.

• Polyols: These are sugar alcohols that are found naturally in some fruits and vegetables and are also used as artificial sweeteners. Examples include sorbitol, mannitol, xylitol, and maltitol. They can be found in foods like apples, pears, stone fruits, and certain artificial sweeteners.

When these specific carbohydrates are poorly absorbed in the small intestine, they travel to the large intestine where they become food for the gut bacteria. The fermentation of these carbohydrates by the bacteria can produce gas, leading to symptoms like bloating, abdominal pain, and altered bowel habits in sensitive individuals. This is why many people with irritable bowel syndrome (IBS) or other digestive issues may benefit from a low FODMAP diet.

What is the Low FODMAP Diet? How does it work?

The Low FODMAP diet is a structured approach designed to help individuals pinpoint and manage foods that exacerbate gastrointestinal symptoms. It comprises three distinct phases:

1. Elimination / Substitution Phase:

• Purpose: To provide immediate relief from gastrointestinal symptoms by removing potential triggers.

• Duration: Typically lasts between 2 to 6 weeks.

• Process: All high FODMAP foods are eliminated from the diet. Instead, one consumes low FODMAP alternatives. It's crucial to note that this phase is temporary, as long-term exclusion of these foods can compromise nutritional intake.

2. Reintroduction Phase:

• Purpose: To methodically identify which FODMAPs, if any, cause symptoms.

• Duration: This can vary depending on the individual but usually spans several weeks.

• Process: Foods from each FODMAP group are reintroduced one at a time, in controlled amounts, while monitoring for symptoms. For instance, if testing for lactose (a disaccharide), one might start with a small amount of milk and gradually increase the quantity over several days, noting any symptoms. If symptoms occur, the amount is reduced or eliminated, and once symptoms resolve, a different FODMAP group is tested.

3. Personalization Phase:

• Purpose: To establish a long-term dietary plan that is both enjoyable and symptom-free.

• Process: Based on the findings from the reintroduction phase, a personalized diet is crafted. This diet will exclude or limit only those FODMAPs that are known triggers, allowing for a broader range of foods than the initial elimination phase. The goal is to have the most varied and nutritionally complete diet possible without triggering symptoms.

By following this structured approach, individuals can gain a clearer understanding of their food triggers and craft a diet that supports their gastrointestinal health without unnecessary restrictions. It's recommended to work with a dietitian to ensure that the diet remains balanced and nutritionally adequate.

How effective is the Low FODMAP diet in treating irritable bowel syndrome (IBS) and other Functional Gastrointestinal Disorders (FGID)?

Irritable bowel syndrome (IBS)

IBS is a common gastrointestinal disorder characterized by a combination of symptoms, including abdominal pain, bloating, and altered bowel habits. The exact cause of IBS remains elusive, but diet and gut bacteria play significant roles in its manifestation.

The Low FODMAP diet has emerged as a leading dietary intervention for IBS:

• Clinical Evidence: A landmark feeding trial found that patients adhering to the Low FODMAP diet experienced a marked reduction in overall gastrointestinal symptoms when compared to those consuming a typical Australian diet.

• Symptom Relief: Multiple randomized controlled trials (RCTs) have underscored the diet's efficacy. Patients following the Low FODMAP regimen consistently report improvements in global IBS symptoms, abdominal pain, and bloating.

• Mechanism: The diet's success may be attributed to the reduction of fermentable substrates available for gut bacteria, thereby decreasing gas production and fluid accumulation in the gut.

Functional Dyspepsia, Functional Constipation, SIBO, and other FGIDs

Functional Gastrointestinal Disorders (FGIDs) encompass a range of conditions characterized by chronic or recurrent symptoms without an identifiable underlying structural or biochemical cause. Among these are Functional Dyspepsia, characterized by upper abdominal discomfort, and Functional Constipation, marked by persistent difficult or infrequent bowel movements.

Preliminary research suggests that the Low FODMAP diet may offer symptom relief for various FGIDs. However, the evidence base is not as robust as that for IBS.

Given the nascent state of research, individuals with FGIDs other than IBS should consult with a gastroenterologist or dietitian before embarking on the Low FODMAP diet. Personalized guidance can ensure the diet's suitability and safety.

In conclusion, while the Low FODMAP diet has proven effective for many IBS sufferers, its role in treating other FGIDs remains an active area of research. As always, individual responses can vary, and professional guidance is paramount.

What are low FODMAP foods?

Low FODMAP foods are those that contain minimal amounts of fermentable carbohydrates that can trigger digestive symptoms in people with irritable bowel syndrome (IBS) and other digestive disorders. Including a variety of low FODMAP foods in your diet can help manage symptoms while ensuring you get the necessary nutrients. Some of the best low FODMAP foods to include in your diet are:

• Dairy: Almond milk, lactose-free milk, rice milk, coconut milk, lactose-free yogurt, and hard cheeses.

• 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 nuts, peanuts, pine nuts, and walnuts.

• Grain: Oats, oat bran, rice bran, gluten-free pasta, quinoa, white rice, and corn flour.

What are high FODMAP foods?

High FODMAP foods are those that contain significant amounts of fermentable carbohydrates and can trigger digestive symptoms in sensitive individuals. If you're following a low FODMAP diet, it's essential to avoid these foods:

• Fructose: Fruits (including apples, mangos, pears, watermelon), honey, high-fructose corn syrup, agave.

• Lactose: Dairy (milk from cows, goats, or sheep), custard, yogurt, ice cream.

• Fructans: Rye and Wheat, asparagus, broccoli, cabbage, onions, garlic.

• Galactans: Legumes, such as beans (including baked beans), lentils, chickpeas, and soybeans.

• Polyols: Sugar alcohols and fruits that have pits or seeds, such as apples, apricots, avocados, cherries, figs, peaches, pears, or plums.

How to get started with the FODMAP diet?

The FODMAP diet is not a one-size-fits-all approach. It's essential to work with a nutritionist or dietitian who can guide you through the process, ensuring you're eliminating the right foods and still meeting your nutritional needs.

Intea Health (inteahealth.com) can assist you in resetting your gut and developing a personalized FODMAP diet-based program tailored to your needs.

Sources:

• Staudacher, H. M., & Whelan, K. (2020). The low FODMAP diet: recent advances in understanding its mechanisms and efficacy in IBS. Nutrients, 12(1), 148. Link

• Dwyer, E. (2018, January 15). The 3 phases of the low FODMAP diet- A blog by Monash FODMAP. Monash FODMAP Blog. Link

• Lomer, M. C. E., Parkes, G. C., & Sanderson, J. D. (2020). Efficacy of a low-FODMAP diet in adult irritable bowel syndrome: a systematic review and meta-analysis. European Journal of Nutrition. Link