5 EASY STEPS TO THE FODMAPs MENU
If you more than often feel bloated, have gas, pain and one of the first things you look for when at a new spot is where the nearest washroom is located, you are not alone. You may be one of the at least 20% of North American adults who suffer from irritable bowel syndrome (IBS), functional diarrhea and functional abdominal bloating which are all classified as functional gut disorders (FGDs).1 FGDs are a result of functional changes of the intestine and /or nervous system versus the presence of physical abnormalities in the gut. To date, foods are not considered a cause but rather symptom-triggering factors. Although food changes can make a big difference to feeling your best, people have shared with me how challenging it is to commit to implementing FODMAPs so I’ve broken it down to just 5 easy steps to the FODMAPs Menu for you!
CUSTOM CARE & LAB TESTING
As a part of a plan to assist those with digestive concerns, I have found that it is best to individualize each person’s care and identify those foods that are least tolerated by testing for allergies and or intolerances. In addition other digestive testing can help differentiate what your digestive symptoms are actually related to. One common pattern that has been found with people who have FGDs is that the foods that are often the most complicated to break down and are often not tolerated well. It only makes sense that if your digestive system is irritated that you would have difficulties digesting these foods.
WHAT ARE FODMAPs?
One group of these hard to digest foods (which are mainly sugars) include FODMAPs or Fermentable, Oligo-, Di- and Mono-saccharides and Polyols (the science lingo), used to describe a group of carbs that easily ferment and are known as fermentable short-chain carbohydrates. Some research suggests that a low FODMAPs diet can improve symptoms for those with FGDs by up to 75%.2 The low FODMAPs diet was originally developed by dietitian Dr. Sue Shepherd and gastroenterologist, Dr. Peter Gibson.
Your friendly bacteria that help to keep your digestion happy, literally (as a healthy gut also contains serotonin receptors which promote a positive mood and good sleep) are greatly influenced by the food that you eat. Digestive symptoms that seem all too common such as cramping, diarrhea, gas and bloating can be caused by the fermentation of food by the gut bacteria. Foods that are easily fermented by the gut bacteria include FODMAPs. So long story short FODMAPs can cause cramping, diarrhea, gas and bloating.
That dreaded “belly bloat” is present in 82% of those with IBS and can interfere with a person’s quality of life including one’s self confidence, work productivity and overall well-being. It is also one of the most common reasons why people seek support including the use of anti-gas medications which may often not work.3
WHO CAN BENEFIT FROM THE FODMAPs MENU?
Anyone who is experiencing digestive symptoms may benefit from the FODMAPs menu. In particular those with irritable bowel disease (IBS), small intestinal bacterial overgrowth (SIBO)(overgrowth of bacteria in the small intestine that are normally in the colon, which some studies suggest maybe the underlying cause of IBS and that IBS causes SIBO)4, non-celiac Gluten sensitivity (NCGS)5, and colitis.6
IBS seems to be more at risk for younger women and only 30% of those affected with IBS will consult a doctor for support.7 Thus there are many people suffering needlessly from a very treatable condition that limits a considerable amount of people from living their best lives! The philosophy of the FODMAPs is to reduce those foods that not only are difficult for those with digestive disorders to digest but also limit the gut bacteria of the foods that are at high risk of fermentation in the GI system which promote uncomfortable digestive symptoms.
WHAT ARE FOODS THAT CONTAIN FODMAPs?
You may already know about some FODMAPs but not necessarily make the connection. For example, if you like dairy but dairy doesn’t like you, you may be lactose intolerant, which is one of the most common FODMAPs. Other common FODMAP reactions include fructose intolerance or malabsorption and sugar alcohol intolerances. Sugar alcohols end in “ol” such as xylitol which is often found in sugar-free products.
FODMAPs are common in the Standard North American Diet (SNAD) and a complete list includes: oligosaccharides (fructans, galactans), disaccharides (lactose), monosaccharides (fructose), and polyols (sugar alcohols and stone fruit). Foods that fall into these categories are outlined in tables 1-3. As with any food reactions the degree that you will experience symptoms depends on frequency, quantity and genetic predisposition. FODMAP reactions are thus cumulative i.e. if you have digestive difficulties the more FODMAPs you eat the worse your symptoms will more than likely be.
• Fructans: Wheat, garlic, onion, inulin etc.
• Galactans: Beans & lentils
• Lactose: Dairy
• Fructose: Fruits, honey, high fructose corn syrup (HFCS)
• Sweeteners: Containing isomalt or ending in”ol” (mannitol, sorbitol, xylitol)
• Stone fruits: Avocado, apricots, cherries, nectarines, peaches, plums, etc.
Table 1-Get To Know the FODMAPs
Carbs that are broken down into sugars and digested by bacteria in the intestines, producing gas and other by-products.
• Fructans: Wheat, garlic, onion, inulin (fibre), FOS sources of fibre, etc. Fructans are made of a chain of fructose molecules that can be malabsorbed in those who lack the ability to break them down. Wheat most often is the largest culprit in this food category.9 Inulin and FOS sources of fructans are often added to foods to increase their fibre content and FOS can be found in probiotic formulas to enhance the fermentable fibres which enhance the growth of friendly gut bacteria. This can benefit many individuals however for those with the inability to breakdown fructans it can lead to poor tolerance especially those with IBS.
• Galactans: Beans & lentils: Galactans are made of chains of the sugar galactose. The human body lacks the enzymes to break down galactans and thus they are malabsorbed which can lead to gas and GI distress.
• Lactose: (glucose & galactose) Sugar in dairy. Those with lactose intolerance have a reduced level of the enzyme lactase and thus don’t break down into glucose and galactose that are digestible. The undigested lactose travels to the colon where fermentation takes place leading to gas and other digestive symptoms, usually within a half hour to two hours after the consumption of lactose containing dairy products.5 A lactose intolerance can be confirmed with a hydrogen breath test.
• Fructose: Sugar in fruits, honey, agave, high fructose corn syrup (HFCS). Fructose malabsorption occurs when there is incomplete absorption of fructose in the small intestine. The incompletely digested fructose then travels to the distal small bowel and the colon, where it is fermented by the gut bacteria and leads to gas and bloating. Fructose does not require any digestion before it is absorbed. This process is increased when fructose and glucose are present in a greater than 1:1 ratio in a food (i.e. apples, pears and mangos). Glucose partners with fructose and helps it get completely absorbed in the small intestine. If more fructose than glucose is present there is more fructose that is not absorbed allowing it to travel to the colon where it is fermented. Like lactose a hydrogen breath test can confirm fructose intolerance. Research shows that ingesting more than 50g of fructose can produce fructose malabsorption in 80% of people.7 It is best for those with digestive symptoms to avoid greater than 3g of fructose per serving i.e. one serving of FODMAP-friendly fruit per snack. Ripe fruits contain less fructose.8
|P||Polyols:Sugar alcohols that end primarily in “ol”. Sorbitol, mannitol, xylitol, maltitol and isomalt AND stone fruit
• Sugar alcohols: Humans can only partially digest and absorb in the small intestine potentially leading to gas, pain and other GI symptoms including diarrhea due to their laxative effect. Polys can often be found in low calorie sweeteners, sugar-free and diet products. Research has found that xylitol creates less GI distress compared to mannitol and sorbitol.10
• Stone Fruit: Avocado, apricots, cherries, nectarines, peaches, plums, etc.
HOW DO FODMAPs AFFECT PEOPLE WITH DIGESTIVE DISORDERS?
Starches the most common carb in the diet consists of very long chains of glucose molecules. FODMAPs conversely are primarily “short-chain carbs” with only 1, 2 or a few sugars linked together. For people with digestive concerns, these carbs may not get broken down properly and pass through the intestine unchanged. When FODMAPs move into the colon, they get used as fuel or fermented by the gut bacteria that live there. This is normally a healthy process that allows dietary fibres to feed the friendly gut bacteria leading to a healthy digestive system and many other health benefits. Friendly bacteria tend to produce methane however the bacteria that feed on FODMAPs that are not completely digested producing another type of gas hydrogen.8 When they produce hydrogen it may lead to the common symptoms of gas, bloating, cramps, pain and constipation. In addition FODMAPs tend to draw water into the intestine as they are “osmotically active” which can contribute to diarrhea. All of this liquid and excess gas expand the intestine signaling the nerves surrounding the digestive organs. For those with IBS these nerve networks are hyper-sensitive. Even a small change in fluid volume can cause an overreaction leading to IBS symptoms.
FODMAPs are not the cause of digestive disorders such as IBS instead the difficulty digesting them is the end result of the gastrointestinal imbalance which leads triggers digestive symptoms. Growing evidence reveals the beneficial role of minimizing FODMAPs for those with functional gastrointestinal disorders (FGDs) such as IBS. 2,9 Each person’s degree of sensitivity to FODMAPs is unique to them.
SHOULD I TRY A FODMAPs DIET?
It is always best to consult your health care team before beginning any new health regime and ensure that proper testing is completed to make sure it is the right direction for you. A low FODMAPs diet may be helpful for those with IBS or other functional digestive symptoms such as bloating, diarrhea, gas, cramping, diarrhea and or constipation. Keep in mind that it is not just elimination or reduction that is important but replacement as well with other nutritious whole foods. Your health care team may recommend a period of time of removal of FODMAPs followed by a “challenge” with various FODMAPs to assess your overall long term tolerance and what symptoms specifically each food leads to.
WHAT FOODS DO I AVOID ON A FODMAPs MENU?
Table 2: High FODMAPs Foods To Avoid
Gluten Grains & Fibre:
|Beans & Legumes:|
Butter & Margarine
Most soft cheeses i.e. cottage
High-fructose corn syrup (HFCS)
WHAT FOODS CAN I HAVE ON A FODMAPs MENU? THE 5 STEP METHOD TO FODMAPs
Simply focus on introducing one column at a time in table 3 and before you know it , the menu will become easy!
- STEP 1: VEGGIES: FOCUS ON ADDING LOW FODMAPs VEGGIES
- STEP 2: FRUITS: FOCUS ON ADDING LOW FODMAPs OPTIONS
- STEP 3: PROTEIN: FOCUS ON ADDING LOW FODSMAPs OPTIONS
- STEP 4: FATS: FOCUS ON ADDING LOW FODMAPs OPTIONS
- STEP 5: GLUTEN-FREE GRAINS, SWEETENERS & CONDIMENTS: FOCUS ON ADDING LOW FODMAPs OPTIONS
|STEP 1 |
|STEP 2 |
|STEP 4 |
GLUTEN-FREE GRAINS & OTHER
Artichoke hearts (¼ cup)
Asparagus (<3 spears)
Beets (<4 slices)
Broccoli (< ½ cup)
Brussels sprouts (< ½ cup)
Cabbage (< ½ cup)
Celery (<1 stick)
Corn (< ½ cup)
(Peas < ½ cup)
(Snow peas <10)
Spring onion (only green)
(Sweet potatoes < ¼ cup)
Grapefruit (<½ medium)
Melons (except watermelon)
Pomegrante (<½ small)
|PROTEIN, MEATS & EGGS:|
Non-dairy milks (i.e. almond, cashew, coconut, flax)
Lactose-free dairy products
Hard Cheeses (i.e.
Brie & Camembert
|FATS & OILS:|
Extra virgin olive oil (EVOO)
Extra virgin coconut oil (EVCO)
NUTS & SEEDS:
Coconut (<¼ cup)
All seeds i.e. pumpkin, sesame, poppy, chia, flax
Apple cider vinegar (ACV)
Ketchup (sugar & gluten-free)
Note: Those foods with quantities noted in brackets are considered low-FODMAPs in the quantity given.
FAST TRACK SUMMARY FOODS TO INCLUDE ON A LOW FODMAPs MENU
FAST TRACK FOODS TO AVOID ON A LOW FODMAPs MENU
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- National Digestive Diseases Information Clearinghouse. Irritable bowel syndrome. NIH Publication No. 07-693. September 2007. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/ibs Gibson PR, Shepherd SJ. Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. J Gastroenterol Hepatol. 2010;25(2):252-258.
- Ringel Y, Williams RE, Kalilani L, Cook SF. Prevalence, characteristics, and impact of bloating symptoms in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol. 2009;7(1) 68-72.
- Magge, Suma, MD & Lembo, Anthony, MD, Low-FODMAP Diet Treatment of Irritable Bowel Syndrome, Gastroenterol Hepatol (N Y). 2012 Nov; 8(11): 739–745.
- PMCID: PMC3966170
- Biesiekierski JR1, Peters SL, Newnham ED, Rosella O, Muir JG, Gibson PR., No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates., 2013 Aug;145(2):320-8.e1-3. doi: 10.1053/j.gastro.2013.04.051. Epub 2013 May 4., PMID:
- Jane G. Muir, PhD* and Peter R. Gibson, MD, The Low FODMAP Diet for Treatment of Irritable Bowel Syndrome and Other Gastrointestinal Disorders, Gastroenterol Hepatol (N Y). 2013 Jul; 9(7): 450–452. , PMCID: PMC3736783
- Caroline Canavan, Joe West, and Timothy Card, The epidemiology of irritable bowel syndrome, lin Epidemiol. 2014; 6: 71–80. , Published online 2014 Feb 4. doi: 2147/CLEP.S40245, PMCID: PMC3921083
- Ong DK1, Mitchell SB, Barrett JS, Shepherd SJ, Irving PM, Biesiekierski JR, Smith S, Gibson PR, Muir JG., Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome., J Gastroenterol Hepatol. 2010 Aug;25(8):1366-73. doi: 10.1111/j.1440-1746.2010.06370.x.
- Shepherd SJ, Parker FC, Muir JG, Gibson PR. Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: Randomized placebo-controlled evidence. Clin Gastroenterol Hepatol. 2008;6(7):765-771.