Recently, patients have been asking about the FODMAP diet. Typically, this food method is often recommended to relieve chronic digestive complaints such as gas, bloating, diarrhea, constipation, and abdominal pain. FODMAP is an acronym for Fermentable Oligo-, Di-, and Mono-saccharides And Polyols. This is a diet that limits, but does not eliminate, foods that contain:
• Sugar alcohols (polyols)
These compounds in food are poorly absorbed and rapidly fermented by GI bacteria, leading to increased water and gas in the GI tract, which then leads to GI tract distention that causes changes in GI motility, bloating, discomfort and flatulence.
To assess your tolerance for these compounds, eliminate foods high in FODMAPs for 6-8 weeks and then gradually reintroduce foods to identify bothersome foods. Reintroduce one food every four days with a 2-week break between symptom causing foods. The goal is to identify the threshold at which you are able to consume FODMAP containing foods without causing negative GI symptoms.
In order to follow the initial FODMAP process, an individual must be able to identify which foods are to be avoided during the 6-8 weeks of elimination. Foods that contain lactose should be avoided. Lactose is a carbohydrate found in cows, sheep’s and goat milk. Foods such as yogurt, ice cream, milk, and ricotta and cottage cheeses should be limited.
Fructose is a carbohydrate found in fruit, honey, high-fructose corn syrup (HFCS), and agave syrup, but not all fructose containing foods need to be limited on a low FODMAPs diet. Fructose malabsorption is similar to lactose intolerance, in that fructose is not completely digested in the GI tract due to the lack of an enzyme, but unlike lactose intolerance the absorption of fructose is dependent on another carbohydrate, glucose. Therefore, fructose containing foods with a 1:1 ratio of fructose to glucose are generally well tolerated on the FODMAPs diet. Foods such as apples, pears, and mangoes will likely trigger abdominal symptoms because these fruits have excess fructose compared with glucose. Try to avoid fruits such as apples, pears, cherries, raspberries, peaches, watermelon, orange juice, and blackberries.
Fructans are carbohydrates that are completely malabsorbed because the intestine lacks an enzyme to break their fructose- fructose bond; thus leading to symptoms of bloating and gas. Foods that contain fructans include wheat, onions and garlic.
Galactans are carbohydrates are malabsorbed for the same reason as fructans; the intestine does not have the enzyme needed to break down galactans. Examples of galactans include beans and lentils.
Lastly, Polyols are also known as sugar alcohols. They are found naturally in some fruits and vegetables and added as sweeteners to sugar-free gums, mints, cough drops, and medications. Sugar alcohols have varying effects on the bowel. When trying to limit sugar alcohols, look at ingredient lists for the following: sorbitol, xylitol, mannitol and maltitol.
Following a low FODMAP diet can be a challenge without the help of a FODMAP knowledgeable dietitian. As with any diet change, be sure to discuss whether the low FODMAP diet is appropriate for you with your health practitioner.
For further explanation as to which foods should be limited and which foods are suitable for a FODMAP diet please reference the various resources listed below.