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Low Fodmap Diet- Beginner’s Guide

Updated on December 28, 2019
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Varsha is an enthusiastic writer who loves to do extensive research on topics of interest.

FODMAP is an acronym that refers to carbohydrates commonly found in our diets. The letters stand for “fermentable oligo-, di-, monosaccharides and polyols.”

What distinguishes FODMAP carbohydrates from others is that the small intestine, in some people, has a harder time digesting it.1

As a result, these undigested carbohydrates remain in the digestive tract and are transported to the large intestine (colon), where bacteria ferment them, which produces gas; they also have a tendency to attract excess fluid.

Most people, it seems, aren’t great at digesting FODMAPs, but that often doesn’t cause real damage to their systems, and they feel fine.

However, for many others, fermentation in the large intestine causes painful gas, bloating, diarrhoea, and other uncomfortable symptoms.2,3

The big picture of a low FODMAP plan is quite easy: By limiting the amount of FODMAP in food, the amount of fermentation and fluid in the large intestine decreases, and, so do the unpleasant symptoms they cause in people with a sensitive gut.4

A pilot study done in Australia found that a low FODMAP diet improved symptoms 74 per cent of the sixty-two IBS and patients with fructose malabsorption who followed it.

Since then, researchers have carried out some larger and more rigorous research, and the results are consistent: About three out of four people with IBS who follow a low-FODMAP diet seem to reverse their studies symptoms.

FODMAP and inflammatory bowel diseases like Crohn’s disease and ulcerative colitis

For people suffering from inflammatory bowel diseases, the main goals are reversing inflammation and healing gut damage, and, depending on the severity of their condition, medication or even surgery may be necessary.5

People with IBD have a higher chance of experiencing gut symptoms such as gas, bloating, and diarrhoea – which may occur in IBS.

In fact, 57 percent of patients with Crohn’s remission and 33 percent of patients with ulcerative colitis remission experience symptoms similar to IBS the week before surveyed by Swedish researchers, according to a study published in American Journal of Gastroenterology.

Another study found that when people with IBD (both Crohn and colitis) who experience symptoms such as IBS underwent a low FODMAP diet, more than half felt an overall improvement.4

Those who experience bloating, abdominal pain, and diarrhoea are more likely to improve, while people with symptoms such as constipation and nausea are less likely.6,7

FODMAP and celiac disease

According to Celiac Disease Foundation, 20 percent of people with an autoimmune response to gluten continue to experience digestive symptoms while undergoing a gluten-free diet.8

This means that these people must go through the frustration of feeling unwell, getting a diagnosis, following a strict diet in hopes of recovery and still feel tormented by their symptoms.

But there’s also the chance for overlap—a person with celiac disease may also have IBS or another digestive disorder.9

If you are among 20 percent of people with diagnosed celiac disease who do not feel better with a gluten-free diet, I encourage you to see a doctor to explore the possibility that you might have other conditions. And depending on the results of those tests, you can also benefit from a low FODMAP plan.

Source

FODMAPS Explained

To really understand what a low-FODMAP plan entails, you have to get to know the letters that make up the FODMAP acronym. Here’s what each one means.

F- The F in FODMAP stands for fermentable. This applies to all of the carbohydrates you need to avoid in the FODMAP plan.

O- The O in FODMAP stands for oligosaccharides, which are carbohydrates made up of short chains of sugar molecules.

There are two classes of fermentable oligosaccharides that we talk about when it comes to the low-FODMAP diet:

• Fructo-oligosaccharides (FOS), or fructans, are chains of fructose sugar molecules (also known as fruit sugar) strung together. They’re found in

  • apples
  • pears
  • mango
  • watermelon
  • cherries
  • fruit juice
  • honey
  • agave
  • high-fructose corn syrup
  • wheat
  • rye
  • onions
  • garlic

• Galacto-oligosaccharides (GOS) are galactose sugar molecules strung together. They’re found in

  • non-canned lentils
  • noncanned garbanzo beans (chickpeas)
  • hummus
  • kidney beans
  • pinto beans
  • peas
  • whole soybeans

D- The D in FODMAP stands for disaccharides, which are carbohydrates made up of two sugar molecules fused together. Not all disaccharides may be fermented by people with sensitive guts, however.

The one you should know is lactose. Lactose is made up of the two simple sugars glucose and galactose.

Many people are lactose intolerant, which means the inability to break down lactose due to having low levels of the enzyme lactase.

Lactose is found only in dairy foods like

  • milk
  • cheese
  • ice cream
  • yoghurt

However, there are plenty of lactose-free variants available to choose from.


M- The M in FODMAP stands for monosaccharides. The single sugar molecule that may be fermented in the gut is fructose, often referred to as “fruit sugar.”

Fructose is found in fruits and vegetables as well as honey and high-fructose corn syrup (a man-made sweetener used in packaged foods). Some examples of foods with excess fructose are

  • wheat
  • rye
  • gram flour
  • onions
  • artichoke
  • Brussels sprouts
  • broccoli
  • cabbage
  • fennel
  • garlic
  • leeks
  • okra
  • red cabbage
  • shallots
  • watermelon
  • apples
  • mango
  • honey
  • high-fructose corn syrup
  • agave nectar

P– The P in FODMAP stands for polyols. Polyols are also known as sugar alcohols, though they’re neither sugar nor alcoholic and can often be identified by the -ol at the end of them: mannitol, sorbitol, xylitol, and maltitol as well as polydextrose and isomalt.

They include-

  • glycerol
  • isomalt
  • maltitol
  • mannitol
  • sorbitol
  • xylitol
  • apples
  • apricots
  • cherries
  • peaches
  • nectarines
  • pears
  • plums
  • prunes
  • avocados
  • blackberries
  • lychees
  • cauliflower
  • and mushrooms

Limit the intake of them to prevent excess fermentation and extra water from being pulled into your gut and to eliminate your unpleasant gut symptoms.

Foods to Eat on a Low FODMAP Diet

VEGETABLES- Alfalfa sprouts, arugula, bell pepper, bok choy, broccoli, cabbage, carrot, celery root, chard, chives, cucumber, eggplant, fennel, ginger root, green beans, kale, iceberg lettuce, okra, potato.10,11

FRUITS- Banana, blueberries, cantaloupe, clementine, grapes, guava, honeydew melon, kiwifruit, lemon, lime, orange, passionfruit, pineapple, raspberry.12

DAIRY/DAIRY ALTERNATIVE- Cabbage, Cheddar Cheese, parmesan cheese, almond milk, coconut milk, hemp milk, rice milk, lactose-free milk, lactose-free yoghurt.

How to Follow a Low FODMAP Diet

Low FODMAP Diet is not intended forever. There are basically three phases of the program: phase one, where you will eliminate foods high in FODMAP for two to four/six weeks, phase two, when you will begin to reintroduce some of the foods you have removed to find out what you can tolerate and finally, customising the meal plan according to what suits you.13

Elimination

Over the first four weeks, you will eliminate or minimize foods containing FODMAPs. During that time, you will track your IBS symptoms so you can note improvements and determine how the plan is working for you.

Commit to the plan by eating nothing but low fodmap diet plan for two to four/six weeks. Lists of the foods you can eat and the amounts that are ok during this phase have been mentioned above.

When you begin the elimination phase, it’s super important that you keep a detailed journal of what you’re eating and how you feel—just as it was important to keep a journal of your symptoms when you were preparing to see your doctor.

Taking notes not only will help you stay honest about what you’re eating but will also help you pinpoint what’s affecting you and how.

Reintroduction

Once you have tried elimination for two to four/six weeks, and have found relief from your symptoms, it’s time to test the higher-FODMAP foods so you can expand your eating options.

Remember, it’s not that you can never eat FODMAP-containing foods again—you just need to make sure you’re not eating too much of the ones that put you over the edge.

All it takes is a little experimentation and patience to figure out how to enjoy some of the foods you’re missing without retriggering those nasty symptoms.

HOW TO REINTRODUCE:
  • Select food that contains only one type of FODMAP from one of the eliminated groups (fructans, polyols, fructose, lactose, or GOS). Avoid choosing foods like apples, which contain multiple FODMAPs. Otherwise, you won’t know which FODMAP is triggering your symptoms.
  • Start with a small amount. For example, if you’ve really missed wheat, try a half cup of pasta at lunch or dinner and note any symptoms that occur within the next 24 hours.
  • If you experience symptoms, chances are that food group is a trigger. For example, if you had a half cup of pasta and you noticed symptoms, then fructans are likely to be a trigger. You have to restrict them.
  • After your symptoms disappear, try a smaller amount of the same food or move on to another food group.
  • If you don’t experience symptoms, try the same food or a similar food from the same group in a slightly larger quantity. For example, you may wish to have one cup of pasta or two slices of bread.
  • Again, track your symptoms for 24 hours. If you remain symptom-free, you may continue to try the same FOD-MAP group, adding slightly larger quantities each day.
  • If, after a week, you still haven’t had symptoms, then you can assume this group is not a trigger and move on to the next.

Customisation

By identifying food triggers, you can begin to customize your low fodmap diet plan to meet your own unique needs.

To ensure success you should also incorporate the following guidelines along with the low- FODMAP diet:

  • Avoid caffeine, fats, and alcohol. These are not FODMAPs but can create serious issues in your digestive tract.
  • Do not overeat. Keep your portions moderate.
  • Savour your food. When eating quickly, you can gulp air, creating gas and bloating.
  • Don’t let your stomach get too empty. When you’re excessively hungry, you might overindulge, especially if your blood sugar drops too fast.
  • Eat in peace with no adrenaline-fueled discussions about work or stressful personal issues.

Benefits of Low FODMAP Diet

The low-FODMAP diet is recognized as a potential management option for people suffering from IBS and other gastrointestinal disorders.

FODMAPs are not unhealthy or reactive for many people; some can consume huge amounts of these foods with no issues, but when you are sensitive to FODMAPs you will receive some benefit when following the low-FODMAP diet.

Some benefits associated with the low-FODMAP diet are:

Reduction or elimination of IBS symptoms

This benefit is probably the most important for people with IBS. In clinical trials, over 75 percent of the IBS patients who participated reported a reduction of symptoms.

Bloating, gas, constipation, diarrhea, and painful cramps diminished during the course of the research project.

This diet is not a cure-all, and there is a range of improvement from complete disappearance of unpleasant digestion issues to no effect at all.

Improvement of mood

Obviously if you have a happy stomach, you will probably feel more positive emotionally. This better mood might also have deeper roots in your body.

There is a connection between lactose and fructose malabsorption and mild depression.

People who have absorption issues have lower tryptophan concentrations in the body, and the tryptophan present is not absorbed well when there are high concentrations of fructose in the intestines.

Tryptophan is an essential amino acid that is required to synthesize serotonin, a neurotransmitter associated with feeling good emotionally.

Too little tryptophan can cause an imbalance in serotonin levels, creating mood imbalance that can lead to depression.

A low-FODMAP diet (in particular, low-fructose intake) has been linked to an improvement in the symptoms of depression for some patients.

Understanding which food cause issues

The elimination diet associated with FODMAPs will help identify exactly which foods cause your IBS symptoms to worsen as well as foods which can be added back to your meals with no ill effects.

This information is crucial when planning your meals so that you have no digestive issues.

Reset your food tolerance levels

It might seem strange that after eliminating FODMAP foods that trigger your IBS symptoms, you can then add them back in with no ill effects or at least tolerate small amounts.14

Your body has a tolerance cutoff point for almost everything you eat. Have you ever eaten several pints of strawberries because they are in season and felt awful afterward? If you eat FODMAP foods every day and have a low tolerance for them, even a little can send you into intestinal distress eventually.

By completely eliminating these foods and allowing your system to reset, you can start fresh and keep your consumption under your personal tolerance level.

A cleaner healthier gut

Gut health is crucial to general health and can be a contributing factor to autoimmune diseases and conditions such as IBS.

Removing FODMAP foods can help rebalance your gut flora and calm inflammation caused by this food sensitivity.

When your gut becomes healthier you will be able to eat FODMAP foods in small amounts again in some cases, and your digestion will improve universally.

Low FODMAP Diet FAQs

You’ve been given a lot of information, and you probably have questions. The following are the most commonly asked questions about low-FODMAP diets.

Q. HOW WILL I KNOW IF THE LOW-FODMAP DIET WILL WORK FOR ME?

If you have IBS, studies have shown the diet is effective in about 75 percent of cases when people strictly adhered to the dietary guidelines.

Research is less clear about the diet’s efficacy in cases of other bowel disorders, including IBD and celiac disease.

After discussing it with your doctor, the best way to know for certain whether the diet will work for you is to try it.

When you do, track your symptoms, and follow the guidelines exactly. If, after six weeks, you continue to have symptoms, the diet may not be right for you.

Q. WILL I EVER BE ABLE TO GO BACK TO EATING BREAD (OR SOME OTHER FOOD I LOVE)?

Maybe. While there’s a good chance you’ll have to follow some type of FODMAP restriction for the rest of your life, different people have varying FODMAP triggers.

During the reintroduction phase, you’ll discover your triggers. Foods that trigger symptoms will need to be avoided for a few months at least.

But since tolerances to FODMAPs can change over time, you can reintroduce your favorite foods in small amounts again later to see if your tolerances have improved.

Q. CAN I ENJOY A GLASS OF WINE, A BEER, OR A MIXED DRINK ON THE LOW-FODMAP DIET?

WebMD notes that alcoholic beverages can trigger IBS symptoms. While most alcoholic beverages aren’t high in FODMAPs, they can irritate your condition.

You should be able to determine whether alcohol is one of your personal triggers by tracking symptoms.

You may want to do this outside of your initial low-FODMAP diet and reintroduction of food so you don’t confuse your results or misidentify a trigger.

Q. WHAT ABOUT COFFEE, TEA, AND SODA?

Black coffee doesn’t contain FODMAPs, and black, green, and peppermint teas are low in FODMAPs.

However, other teas like chamomile and oolong do contain FODMAPs, and sodas often have HFCS.

Caffeine can stimulate bowel movements, which may be a problem for some people. When it comes to beverages, proceed with caution.

Q. IS A LOW-FODMAP DIET GLUTEN-FREE?

Wheat, barley, and rye are primary sources of gluten, and the diet restricts these. Some gluten-containing ingredients are allowed on the low-FODMAP diet, however.

In a gluten-free diet for celiac disease, it is essential to avoid any wheat, barley, and rye and to avoid cross-contamination of these ingredients.

Unless you also have celiac disease or some other form of gluten intolerance, it isn’t necessary to be as strict about cross-contamination in a low-FODMAP diet.

Q. CAN I CHEAT?

It is important to follow the plan strictly until you begin to reintroduce foods after the initial four weeks.

Q. HOW CAN I GET FLAVOUR INTO MY FOOD WITHOUT USING GARLIC AND ONIONS?

There are several strategies you can use to flavour your foods. To replace onion and garlic flavour you can: use the green part of scallions or leeks (but not the white part); use a pinch of asafetida powder.

If you have celiac disease, then you’ll need to choose asafetida powder that is gluten-free; make garlic oil by simmering garlic in oil, then removing all traces of the solid garlic (see here); make onion oil by simmering onions in oil, then removing all traces of the solid onion.

Q. CAN I ADAPT TO A LOW-FODMAP DIET?

Yes, the low-FODMAP diet can be adapted to any eating plan. However, it is essential you talk with your doctor and/or work with a dietitian to ensure you are receiving proper nutrition.

Q. I HAVE DIABETES. CAN I BE ON A LOW-FODMAP DIET?

You can, although you will need to do a lot of adapting the diet to meet your own dietary needs.

One of the groups of foods restricted on the low-FODMAP diet is sugar alcohols, which are commonly used in sweet treats for diabetics.

Before trying the low-FODMAP diet, talk with the health care provider and the dietitian managing your diabetes care.

Q. WILL I GET ALL THE NUTRIENTS I NEED ON A LOW-FODMAP DIET?

The low-FODMAP diet can be a balanced diet depending on the foods you choose. For example, if you choose to eat only potato chips and candy bars to avoid FODMAPs, then the diet won’t be balanced.

However, if you choose foods from all food groups, then chances are you will get the nutrients you need. You can also work with a dietitian or physician to ensure you are eating a fully balanced and healthy diet.

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

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