Some of you may have heard of the Low FODMAP diet already. It certainly has a funny sounding name that does nothing to explain what it really is. It’s a phased diet developed at Monash University in Australia that includes the following phases: elimination, challenge, personalization, and liberalization. The word itself is an acronym standing for Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols. That means carbohydrates and fibers (fiber is essentially a carbohydrate that we can’t digest) that ferment in the bowel and may cause some people GI discomfort.
Who is most affected by FODMAPs?
Many of the people affected by such carbohydrates are those with increased visceral sensitivity due to Irritable Bowel Syndrome (IBS) which is a functional gut condition that is not life threatening. Other folks with Irritable Bowel Disease (IBD) can also benefit from the protocol to help with comfort and recover from flares, but IBD is a medical condition that can be life threatening.
Why FODMAPs irritate the gut
Carbohydrates that fall into those categories include lactose (disaccharide), fructan and galacto-oligosaccharide, also called GOS for short (oligosaccharide), fructose (monosaccharide), and sorbitol and mannitol (both polyols). Those carbohydrates are found in healthful foods which makes identifying food triggers surprising and frustrating at the same time. Some foods contain high concentrations of those types of carbohydrates in a typical serving.
For the disaccharide lactose, if the body doesn’t have enough lactase enzyme to break down the disaccharide into monosaccharides of galactose and glucose to be absorbed in the small bowel, the lactose travels through the small bowel intact. Once in the colon, our gut bacteria consume it and cause gas, bloating and sometimes diarrhea or constipation. If the FODMAP is a fiber or a polyol, it can travel through the gut intact and the same thing occurs. Fructose is a monosaccharide which should be easily absorbed as it’s in the most basic form of a carbohydrate. What makes this interesting is that when fructose is present in a ratio in excess of glucose, our bodies use a different, less efficient shuttle system in the absorption process which creates a bottleneck in the small bowel. Once this happens, fluids are drawn into the small bowel to dilute the load causing bloating, pain and bowel changes. Fun times.
How the phases work
High FODMAP foods are limited or avoided for about 2 weeks to test if elimination improves symptoms such as gas, bloating/cramping, diarrhea and/or constipation. Once it is determined that symptoms are actually food related, each FODMAP category is systematically reintroduced (aka challenged) using foods containing only that FODMAP type. Symptoms are tracked during this period to identify tolerance levels of each FODMAP type. Following that is personalization, which uses the information gleaned from the challenge phase. Foods are added back into the eating pattern that have not shown to cause symptoms. Once some foods have been added and enjoyed, we look to add combinations of FODMAP types, all the while finding what tips and tricks can help the client have a varied eating pattern to attain optimal health while maintaining more comfortable days than uncomfortable days.
So, there you have it! That’s the Low FODMAP diet in a nutshell. Full disclosure: it’s not a cure all and it takes effort. Due to the complexity of the diet and drawbacks of remaining in the elimination phase for too long, this process really should include a qualified Registered Dietitian for constant assessment. Apps can be helpful too, but not a replacement for professional guidance. Sometimes it is ineffective and other non-diet alternatives should be explored. If you have been diagnosed with IBS or IBD and are thinking about trying the Low FODMAP diet to increase comfort, get in touch. It sounds very complicated (it kind of is), but I can help guide you through it every step of the way and help find alternatives should it not be the best option for you.