In the 90’s, Dr. Sue Shepherd developed a form of fructose malabsorption diet. Subsequently, a team at Monash University, led by Professor Peter Gibson and including Dr. Shepherd and others, developed the low FODMAP diet.
Through their research, they found that limiting dietary FODMAPs can be an effective treatment for people with symptoms of IBS. Other researchers and Registered Dietitians across the world have also been able to prove the effectiveness of this diet. Aside from IBS (which I suffer from), there are other gastrointestinal, and inflammatory disorders and diseases that can also be treated naturally whilst sticking to a low-FODMAP diet. The facts below are what I have learned from Dr. Shepherd, Monash University and several other FODMAPs experts.
1) FODMAPs are…
- Fermentable – rapidly broken down by bacteria in the bowel
- Oligosaccharides – fructans and galactooligosaccharides (GOS)
- Disaccharides – lactose
- Monosaccharides – excess fructose and…
- Polyols – sugar alcohols – sorbitol, mannitol, maltitol, xylitol, polydextrose, and isomalt
2) FODMAPs are poorly absorbed in the small bowel.
3) Multiple types of FODMAPs are usually present in most meals.
4) Fructans are most likely the most common FODMAP to cause symptoms of IBS (Dr. Sue Shepherd).
5) If your symptoms improve after following the Low-FODMAP diet for 2-6 weeks, it is recommended to slowly rechallenge one FODMAP group at a time to understand your “FODMAP threshold”. You will challenge a total of 10 FODMAPs, and once you know your FODMAP triggers and threshold, you will move on to reintroducing FODMAPs into your diet for a modified low-FODMAP diet.
6) On the Low-FODMAP diet, wheat is only a problem ingredient when consumed as a wheat-based carbohydrate food like cereal, breads, or pasta.
7) A low-FODMAP diet is not a gluten-free diet. You are reducing the amount of WHEAT in your diet. When you are on the low-FODMAP diet you can have oats and small amounts of wheat, barley and rye.
8) A fructan is a polymer of fructose molecules. Fructans with a short chain length are known as fructooligosaccharides. Fructans can be found in foods such as agave, artichokes, asparagus, leeks, garlic, onions (including spring onions), yacon, jícama, and wheat.
9) When bacteria in the large intestine receive molecules not absorbed in the small bowel, they break these molecules down quickly. This produces hydrogen, carbon dioxide and methane gases – otherwise known as unpleasant times for people like us!
10) A lactose-free diet is not a dairy-free diet. Lactose is present in most dairy products. The Low-FODMAP diet can benefit those who suffer from lactose intolerance by helping them to reduce lactose intake.
11) The acronym FODMAPs stands for:
Fermentable, Oligosaccharides (Fructans and Galacto-oligosaccharides (GOS), Disaccharides (Lactose), Monosaccharides (excess Fructose) and Polyols (Sorbitol, Mannitol, Maltitol, Xylitol and Isomalt)
12) The low-FODMAP diet is not meant to be a forever thing – it’s meant to be an investigative tool:
- 1st phase – follow this Elimination Phase by strictly negating all FODMAPs for 2 to 6 weeks.
- 2nd phase or Rechallenge Phase – detect personal triggers by reintroducing one FODMAP category at a time, one food at a time. There are 10 total rechallenges.
After the 2nd phase, FODMAPs that do not trigger symptoms can be a part of a regular diet, and some may still be limited but far better tolerated. It is important for all to enjoy a varied diet in order to reap the benefits of various nutrients and minerals.
13) The low-FODMAP diet has been proven to help ease IBS symptoms by way of food as
medicine. If a patient decides to take medications, they run the risk of side effects and might only cure some symptoms. The low-FODMAP diet does not work for everyone, however, taking the natural route with food first may be the healthiest option for most IBS sufferers. The diet works for around 75% of people who craefully follow diet protocol.
14) Fructans are seen as the most common FODMAP to cause symptoms of IBS and they are found in several different types of foods, both natural and processed.
15) The low-FODMAP diet is not a gluten-free diet but it does list gluten-free foods, as most are wheat-free (not all gluten comes from wheat). And, just because something is free of gluten and wheat, does not mean it is free of FODMAPs (make sure you read all food labels to ensure no high-FODMAP foods exist)! Wheat is only a problem when consumed as a wheat-based carbohydrate food (like breads, cereals, pastas, crackers, cakes, cookies, pastries etc.).
16) Fructose malabsorption is defined as the incomplete absorption of fructose in the small intestine, followed by the delivery of fructose to the distal small bowel and colon, where it contributes to rapid fermentation and resultant abdominal bloating. A hydrogen breath test can detect fructose malabsorption.
17) Firm, less-ripe fruit tends to contain more fructose. In order to not overload the GI tract with
sugar, it is suggested to have one serving of fruit per meal. Some fruits like avocados and cherries are OK on the low-FODMAP diet but also come with limitations.
18) Properly reading food labels will help to ensure success with the low-FODMAP diet. Ingredients are listed in descending order of weight with the highest amounts listed first. FODMAPs can be an issue only when consumed regularly and in significant amounts. If a high FODMAP food is listed on an ingredient list but present in small amounts (such as less than 5%) then there probably shouldn’t be an issue and would be “suitable” to consume.
19) If you love garlic or onions eating out can be hard but at home, you don’t have to suffer without the taste. You can sauté onions or garlic for about two minutes -be sure to remove either or before you eat your dish. Garlic-infused oil is a very easy way to add some garlic flavor and Asafoetida powder (choose a wheat-free version) can be used as a replacement for onions or garlic. Use it sparingly as it is very strong in smell and taste.
20) Adding too much fiber can aggravate IBS symptoms and sometimes a person may need to increase or decrease fiber intake for the best symptom management. The low-FODMAP diet does exclude many high-fiber foods, however the following are low-FODMAP and can be a great daily natural boost of fiber: oat bran, rice bran, oatmeal, quinoa, strawberries, blueberries, oranges, 1/4 cup canned lentils or chickpeas (must be drained rinsed), baked potatoes, quinoa flakes or brown rice cereals (check labels). Consider not having too much fiber at any one time and slowly increase as you aim to improve your digestive health. A fiber intake of 25-30g per day is recommended for people with IBS, but please consult with your FODMAP-trained nutritionist so they can help you to slowly add in fiber.
11) It is strongly advised to keep a Food & Symptom Diary while on the low-FODMAP diet. This will help you to better understand your food triggers and work through the re-introduction phase with a Certified Nutritional Consultant or Registered Dietitian.
12) Fats and oils are generally low in FODMAPs, however, fatty foods can actually slow down and inhibit digestion and gut motility. Choose leaner proteins like fish, chicken or turkey, stay away from heavy sauces, and limit oils or fats like butter and olive oil to one tablespoon