FODMAP– you’re either completely bewildered by this word or you know that its an acronym for a group of food compounds that commonly trigger digestive discomfort. For many people with Irritable Bowel Syndrome (IBS), a low FODMAP diet can provide huge relief.
FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. These compounds are found in all sorts of foods, everywhere, making it very hard for people to work out what they might be reacting to. For those with IBS, it can sometimes feel like everything and anything you eat can cause symptoms! Knowing where these compounds are found, and how to systematically avoid them, can be a very empowering process, even if it can feel overwhelming at first!
Key food sources of FODMAPs
Oligosaccharides: fructo-oligosaccharides/fructans in grains and vegetables and galacto-oligosaccharides/galactans found in legumes.
Disaccharides: eg. lactose in some dairy products
Monosaccharides: eg. fructose in fruits (some fruits more than others)
Polyols: eg. sorbitol, a sweetener, found in sweetened foods and also in some fruits and vegetables.
(nb. This is NOT a comprehensive detailed list! But it gives you a general idea of where these compounds are found)
The key here is the word “fermentable”- these little short-chain carbohydrates and sugar alcohols can ‘ferment’ in the gut, creating gas, which then presses on the intestinal walls and can cause pain and bloating. They also draw more water into the intestines, which can create discomfort, urgency, increased frequency and diarrhoea. Because they are poorly absorbed, they linger in the digestive tract and for those who are sensitive, cause many digestive problems.
Like most things that concern bodies and people, its not black and white!
- Many people react to some groups of FODMAPs (eg. fructose and lactose), and not others.
- You may react to one food that contains a FODMAP but not another, even in the same group (eg. you’re ok with kidney beans but not chickpeas).
- You may have a tolerance limit, eg. you can have half a cup of soy milk but a whole cup makes you fart like crazy!
Your practitioner will be able to help you set up a diet plan to first eliminate all FODMAPs for a specific period (at least 2 weeks), and then start to reintroduce specific FODMAPs once your symptoms have resolved, one group at a time, which will help determine which are your problem foods. It’s important to record symptoms along the way. Like any elimination diet, it’s really important to know what you CAN eat as much as what you can’t!
For these reasons, the low FODMAP diet is really just the beginning, and individual testing will still provide more specific information to help take some of the detective work out of figuring out the way your body responds to FODMAP foods.
Is a life without FODMAP foods the answer, or just a step along the path to digestive wellness? Like any exclusionary diet, we would always hope that reducing or avoiding reactive foods is a short-term measure. Taking away these ‘triggers’ allows the body to heal, rebalance, build strength and robustness. In the case of a FODMAP intolerance, especially for those with IBS, this could indicate that there is a further need for balancing of the gut bacteria, strengthening of digestive processes (enzyme and bile output), healing tissues lining the gut, or calming of the nervous system of the gut. Naturopathically, there are many supportive measures that can be employed to speed this process along!
FODMAPs aren’t bad! It cannot be stressed enough that FODMAPs aren’t a problem ordinarily. In fact, they are a really important part of our diet and provide prebiotics and fibre which is beneficial for all sorts of reasons, not least for improving our microbiome (read here for more on what that means). People with healthy robust digestive systems don’t react to FODMAP foods usually, so the key, as always, is in restoring proper function.
FODMAP intolerance may specifically be a sign of Small Intestinal Bacterial Overgrowth (SIBO – more on that coming up in a few weeks). FODMAPs can be metabolised by bacteria in the bowel, but when such bacteria are in the wrong place (eg. the small intestine), symptoms can be uncomfortable to say the least. If we think of FODMAPs as ‘food’ for our gut bacteria, then we want to make sure we have the right bacteria, and in the right place, otherwise we are feeding a bad situation and encouraging it to get worse!
As with all food reactions, information is power, and the first step to improvement.