FODMAPs and the Low Fodmap diet: Why and When?
Is FODMAP a Familiar Acronym?
If you've been diagnosed with IBS (Irritable Bowel Syndrome) or SIBO (Small Intestinal Bacterial Overgrowth), you've likely encountered the term FODMAPs before. The acronym stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols. Now that’s a mouthful!
These are short-chain carbohydrates and sugar alcohols found in certain foods and notorious for exacerbating gut symptoms, because of their high fermentable factor. This explains why, for many, adopting a low FODMAP diet becomes a key to symptom management.
Why the Low FODMAP Diet?
The Low FODMAP Diet is a therapeutic approach designed to alleviate symptoms related to the consumption of highly fermentable sugars in foods. These symptoms include bloating, gas, burping or belching, abdominal pain, and altered bowel habits such as constipation and diarrhea, which can be particularly distressing for those with IBS.
The diet involves restricting or minimizing the intake of foods high in FODMAPs (which are listed below), with the goal of reducing fermentation and symptomatic effects in the gut. It is important to understand that the diet does NOT treat anything in particular, but rather gives a break to the digestive system and temporarily reduces inflammation in the gut.
Who Should Consider the Low FODMAP Diet?
This diet is primarily recommended for individuals diagnosed with IBS and/or SIBO, as it has shown significant effectiveness in managing symptoms. However, it's crucial to consult with a health professional whether it be a nutritionist, dietician, or informed doctor before embarking on the Low FODMAP Diet to ensure that it is the right timing for you and the appropriate diet.
How Long Should You Follow the Low FODMAP Diet?
This is where it gets tricky. People tend to stay on it for way too long, simply because they feel better. But that can become problematic (more on this below). The Low FODMAP Diet is typically implemented in two phases. The first phase is the elimination phase, lasting around 2-8 weeks, during which high-FODMAP foods are strictly avoided.
The second phase is the reintroduction phase, where specific FODMAP groups are reintroduced one at a time to identify individual tolerances. This phase helps customize the diet to the individual, allowing for a more varied and sustainable long-term eating plan.
The Two Phases of the FODMAP Diet
Contrary to common belief, the low FODMAP diet is not a forever diet but a phased approach. Reducing FODMAPs is only half the process! So, to recap:
1. Eliminate High FODMAP Foods (Temporarily!)
Temporary elimination of high FODMAP foods. This phase, lasting between two to eight weeks, offers a rest for your digestive system from potential IBS-aggravating foods.
2. Gradual Reintroduction of FODMAPs
Following the elimination phase, FODMAPs are reintroduced methodically, one type of sugar at a time. This process allows to unveil which FODMAPs trigger or alleviate symptoms. Unexpected sensitivities might emerge — lentils, for instance. The goal is to find your own individual threshold for each group and food, and you might find that you can have half a cup of lentils just fine but anything over that amount triggers your gut. All tolerable FODMAPs can be gradually incorporated into daily eating.
FODMAP-Containing Foods List
There are plenty of Fodmap foods lists online. I think it can get quite confusing for people so I usually recommend using an App for this, such as Low FODMAP diet A-Z (free) or the Monash University FODMAP Diet (for a cost).
Here’s a list of the main FODMAP-containing foods grouped by sugar category:
Oligosaccharides (many sugars; longer chains are called Polysaccharides)
Fructans: Wheat, rye, onions, garlic, leeks, shallots, artichokes, asparagus, inulin (a type of fiber), butternut squash,pumpkin, as well as some fruits like watermelon and persimmon.
Galacto-oligosaccharides (GOS): Legumes such as chickpeas, lentils, and kidney beans, as well as certain nuts like cashews.
Disaccharides (double sugars):
Lactose: Milk and dairy products such as cow's milk, yogurt, and soft cheeses.
Monosaccharides (simple sugar):
Fructose: Honey, apples, pears, mangoes, cherries, watermelon, and high-fructose corn syrup.
Polyols (sugar alcohols): beware of artificial sweeteners and “sugar-free” packaged foods
Sorbitol: Apples, pears, stone fruits (e.g., peaches, plums, apricots), and some sugar-free gums and candies.
Mannitol: Mushrooms, cauliflower and butternut squash.
Xylitol: Sugar-free anything (chewing gums, candies, cookies, sauces, ice creams, etc.)
Sensitivity to specific FODMAPs can vary among individuals, and it's recommended to work with a practitioner during the FODMAP elimination and reintroduction phases to identify personal triggers accurately.
Why Not Just Keep Eating Low FODMAP?
While low FODMAP eating seems like a panacea for people with digestive symptoms, it's designed for short-term use only — typically one to two months. I cannot stress this enough: prolonging this restrictive approach may lead to frustration, nutritional deficiencies, and potential negative impacts on gut health. Striking a balance between variety and symptom management is crucial.
Extended low FODMAP eating may result in further gut dysbiosis, fatigue, headaches, constipation, and weakened immunity. Your gut bacteria, essential for overall health, also thrive on a diverse range of foods, including those higher FODMAP foods!
Reintroducing High FODMAP Foods: A Tailored Approach
The reintroduction of higher FODMAP foods involves a strategic process, introducing one category at a time over a week or two. Some may find only a few FODMAPs are problematic, allowing for a more flexible diet.
As you identify well-tolerated and troublesome FODMAPs, you can construct a personalized eating plan. This fosters increased energy, confidence, reduced stress, and a sustainable, healthy approach to eating, tailored to your unique needs.
Completing the FODMAP process results in a calibrated eating plan designed for your body's distinct requirements! Embrace the journey to find your optimal, IBS-friendly eating routine.
Important Considerations:
Consult a practitioner: Before initiating the Low FODMAP Diet, consult with a nutritionist or dietician experienced in gastrointestinal health. They can guide you through the process, ensuring nutritional adequacy and personalized adjustments.
Individual Variation: Tolerance to FODMAPs can vary widely among individuals. The reintroduction phase is critical for identifying personal triggers and establishing a more tailored, sustainable diet.
Nutritional Adequacy: The restriction of certain high-FODMAP foods may result in reduced intake of specific nutrients. Working with a nutritionist helps address potential nutritional gaps and ensures a balanced diet.
Long-Term Sustainability: While the elimination phase is relatively short-term, the goal is to transition to a more liberal, yet FODMAP-conscious diet. Achieving a balance between symptom management and dietary variety is key for long-term success. Once you have addressed the underlying causes for your symptoms, food freedom is such a great reward!
The Low FODMAP Diet is a powerful tool for managing digestive symptoms, especially in those with IBS and SIBO (they are very closely related by the way). However, its success lies in proper implementation, personalized guidance, and a focus on reintroduction for long-term dietary options.