What is the low FODMAP diet and who is it for?

The low FODMAP diet is a relatively new and increasingly used intervention for the management of irritable bowel syndrome, which is a chronic gastrointestinal disorder characterized by abdominal pain and altered bowel habits. It is important that IBS is diagnosed by your GP or specialist to rule out other bowel related conditions with overlapping symptoms. 

Most of the research on low FODMAP diets has been on patients with IBS and is ongoing, but the general scientific consensus is that a low FODMAP diet should be the first dietary approach for treatment of recurrent gastrointestinal issues.

A low FODMAP diet can also be beneficial for managing symptoms for people who have gastrointestinal disorders such as:

• Functional Gastrointestinal Disorder (FGID)

• Small intestinal bacterial overgrowth (SIBO)

• Certain auto-immune conditions

• Inflammatory bowel disease (IBD)

• Other health issues triggered by certain foods.
  

What are FODMAPs???
FODMAPs are a group of short chain carbohydrates that are be poorly digested or absorbed, particularly in people with IBS. They are found in a variety of foods, as well as in some additives.

FODMAP stands for:

Fermentable – broken down by the gut bacteria

Oligosaccharides – oligo= few and saccharides= sugar, thus, a few sugars in a chain.

Disaccharides – di= two, thus, two sugars joined together.

Monosaccharides – mono = one, thus, one sugar molecule.

And

Polyols – sugar alcohols

The FODMAP groups are:

• Fructose eg. apples, pears, dried fruit, honey

• Galactans eg. chickpeas, lentils, beans, soy bean products

• Fructans eg. beetroot, cabbage, onion, garlic, wheat

• Lactose eg. milk, yoghurt, soft cheese, ice cream

• Polyols eg. cauliflower, mushroom, avocado, some artificial sweeteners

How do FODMAPs affect the gut?
As FODMAPs are poorly digested and absorbed, they move through the small intestine to the large intestine, the home of the gut bacteria. Here two things can occur:

1) The bacteria ferment the FODMAPs resulting in gas production

2) They attract water into the bowel, which can lead to diarrhoea in some people

Although FODMAPs are poorly absorbed by everyone, those with IBS may be more sensitive to their presence in the bowel.

How do I start a low FODMAP diet?
When starting a low FODMAP diet, it is recommended that this is done with the guidance of a Dietitian specialising in this area.

Phase 1: Strict low FODMAP diet
The low FODMAP diet usually starts with 4-8 weeks (depending on symptoms) of excluding foods containing a moderate to high amount of FODMAPs.
The aim of this stage is to eliminate all potential cause of IBS symptoms allowing the gut to rest. Your dietitian will help you to decide when you are ready to start the re-introduction phase.

Phase 2: Re-introduction
The FODMAPs diet is not a long term solution. This is because while we are restricting FODMAPs we are also restricting fibre which feeds the beneficial bacteria that reside in our gut. Research has found that over time, a FODMAP diet reduces the diversity of our gut bacteria. A lack of diversity is associated with a less favourable gut bacteria profile and has been linked to various health conditions.

In order to maintain gut bacteria diversity and to maximise variety in the diet, the re-introduction of the various FODMAPs groups is essential. Most people will identify one or two FODMAPs groups that they are sensitive to. It would be extremely rare for someone to be sensitive to all of the FODMAPs groups. Additionally sometimes there is dose response, where people can tolerate a certain amount of a food, and will only get symptoms if they go over this threshold.

Your dietitian will guide you through the types and amounts of FODMAPs to introduce in order to test your tolerance. Once a FODMAP group has been tested and tolerated, it can be included back into the diet on a regular basis.

Adapted FODMAP Diet
Once trigger FODMAPs have been identified, you will know what you can and cannot eat. You can then use this information to formulate your own personalised diet to keep your symptoms to a minimum.

At Results Nutrition Centre, our Registered Dietitians are experienced in gut health and FODMAPs protocols. We work with you to ensure that you feel supported and that your eating is nutritionally balanced during your low FODMAP diet.