The fodmap diet was first introduced in 1999 in Australia and the idea of reducing fodmaps in the diet to treat the symptoms of functional bowel problems like IBS is now spreading around the world.
Read on to find out how this diet could help you and the basic principles behind its introduction.
The low fodmap diet was developed by researchers of the gastroenterology department at Monash University in Melbourne Australia to help people with functional bowel disorders like irritable bowel syndrome.
The word FODMAP is an acronym which stands for:
These are all types of sugars which are found in many kinds of foods. They are short chain carbohydrates.
Most starches in our diet are long chain carbohydrates meaning that they are composed of many sugars linked together. Fodmaps only have one or two sugars and so are 'short chain'. The sugars are split into two groups:
As you can see from the groups above these sugars are either only partially absorbed or not absorbed at all in the small intestine where other foodstuffs are absorbed. Poor absorption is normal and anybody can have symptoms. For example many people suffer from excess gas when they eat beans!
Some people with irritable bowel syndrome and other bowel problems seem to be extra sensitive to the effects of these sugars and suffer more symptoms than other people.
When these special sugars are not absorbed in the small intestine they pass into the large intestine where they meet the bacteria living there which causes them to ferment and produce gas.
This can cause the inside of intestine to distend causing pain and bloating. In people with IBS this could be because the nerves in their large intestine are over sensitive.
They also cause fluid to be drawn into the gut which can contribute to diarrhea.
It has been found that some people produce more methane which slows down the gut and some people produce more hydrogen which speeds up the gut.
In one study, people with IBS have been shown to produce more hydrogen than healthy people, thanks to the fermentation by bacteria in their colon. This difference was much more pronounced when they were given a high fodmap diet. The IBS sufferers had a range of gastrointestinal symptoms and lethargy, whereas the healthy people only had increased gas.
The higher fodmap diet did not change the amount of methane produced by the IBS sufferers.
Lactose malabsorption or intolerance can be tested for using the lactose hydrogen breath test. Lactose intolerance is common throughout the world as in fact it is normal for adults to have problems digesting milk which was not designed for them!
Northern Europeans are the odd ones out as they retain the enzyme lactase, which babies are born with, into adulthood.
Fructose malabsorption can be tested for using the fructose hydrogen breath test.
Tests are also available for sorbitol sensitivity.
These tests can be done in the doctors office or in some countries home testing kits are available.
Many people suffer from digestive problems and if you are sensitive to fodmaps then you will have bloating, pain, gas, constipation or diarrhea. So anybody with these symptoms could benefit from a diet low in fodmaps but you must check first with your doctor that your symptoms are not being caused by anything more worrying.
This diet was first formulated with irritable bowel syndrome sufferers in mind and it has been shown that 50-75% of people with IBS see a reduction in symptoms if they reduce fodmaps in their diet.
This applies whether your symptoms are predominantly diarrhea or constipation.
If you suffer from bacterial overgrowth in the small intestine (SIBO) you could also benefit.
Studies have also shown a benefit to people with inflammatory bowel disease.
People who suffer from Gastroesophageal Reflux Disease and acid reflux.
The above foods are relatively high in fodmaps and are the main foods to watch out for. There are other foods which have moderate amounts or low amounts but it is the overall load which counts and some people can tolerate more than others. This is partly to do with heredity and ethnicity.
Usually foods in the fructans, polyol and GOS groups have to be restricted but not always those in the fructose and lactose groups.
N.B. High Fructose means that there is a more fructose than glucose in the food. People with IBS do not seem to react to glucose.
Be aware that many processed foods like carbonated drinks, sauces, condiments, stock cubes, processed meats and basically anything made in a factory often contain fructose sugars, particularly high fructose corn syrup as it is cheaper than other sugars.
Some processed foods now also have prebiotics like inulin and fructo-oligosaccharides (FOS) added.
Read all the labels of processed foods carefully.
It may be daunting to think about following this diet and sometimes it can seem like a game of strategy as there are so many foods to exclude or reduce.
I know this only too well as my mother cannot tolerate onions or any food from that family. This is the commonest fodmap intolerance and it makes things difficult when eating out as so many recipes start with "take one onion". At family gatherings we always have to make extra onion and garlic free versions of dishes. "We don't mind Mum!".
So where to start. Well you are safe with all meats, fish, eggs, tempeh and tofu so that takes care of protein. Oils and fats are low in fodmaps although some people find that they get gut symptoms if they have too much fat.
For some areas of your diet you will need to go shopping for some alternative products.
Get prepared and see below for things to include on your grocery list:
The above list of fodmap diet friendly foods is not exhaustive as Monash University is testing new foods all the time.
It can be tough to get flavor into your food without the help of onions and garlic but unfortunately they are the number one foods to avoid if you have a problem with fodmaps.
Here are some tips to help you prepare tasty low fodmap food:
This diet can be quite complicated as initially large groups of food need to be excluded and then re-introducing during a monitoring phase. For this reason it is recommended that your progress is assessed by a qualified dietitian who is trained to help with this type of diet.
Yes and no. A strict low fodmap diet should only be followed for 6-8 weeks. During this time all the different high fodmap foods should be excluded from your diet to see if it helps.
As foods high in
fodmaps are common across the main food groups, the diet cannot be
followed strictly for too long. This is because there is a danger of
malnutrition. For example some people have developed low vitamin D
levels on this diet. Talk to your dietitian about supplementation.
Foods should be re-introduced one at a time and symptoms monitored. Most people find that after the strict phase of the diet their symptoms calm down and in the long term they only need to exclude some of the high fodmap foods.
Often they can eat small quantities of these or even whole groups. Each person has to find their own tolerance levels.
If the fodmap diet is going to work for you then if you follow the strict restriction phase to the letter you should start to feel the benefit right away.
When you move to the maintenance phase you will have a period of trial and error until you find your individual diet.
If you have symptoms that you think might be helped by the low fodmap diet then first get a proper diagnosis of your problem. If you have a diagnosis of IBS or SIBO then a trial period will tell you if you are likely to be helped by this diet.
The dilemma is that many high fodmap foods are also prebiotic foods which are good at feeding the friendly bacteria in our guts. By reducing them in our diets we can reduce our symptoms but it could be that we are not doing the good bacteria in our intestines any favors. We may be treating the symptoms but are we treating the cause?
Research is on going and more needs to be known about the normal composition of the healthy gut. This could point the way to help for some people. If we could re-balance our gut flora perhaps some of us could tolerate more fodmaps. This is only a theory at the moment.
Australia has introduced a government backed 'Fodmap Friendly' food labelling system which hopefully may spread to other countries around the world.
New information is coming out all the time as the Monash University tests more foods in their lab. More information and help can be found by downloading the Monash University low fodmap smartphone app.
This includes a food guide, traffic light system, recipes and shopping list.
The fodmap diet is not a cure and it can be difficult to follow but many people are motivated to comply with the restrictions it places on their lifestyle by being rewarded with a calm and well behaved gut!
DiarrheaNurse hopes this quick guide to the low fodmap diet has been useful and that you will find relief from your symptoms.
Discover what this common problem is all about.
Get an overview of IBS and find out if you might be suffering from this widespread condition.
Do you have heartburn? Do you have an overactive bladder? You could have IBS. Find out about more symptoms here.
There are many different solutions available today. Find one to suit you!
Garlic By Dubravko Sorić SoraZG on Flickr [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons
Leek By Mgmoscatello (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons
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