WHAT are FODMAPS?
For many years’ people with IBS have reported symptoms with food and the development of the Low FODMAP diet in Australia verified what patients have always known – eating certain foods can increase symptoms of IBS.
The term FODMAPS is an acronym that stands for:
Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. They are a collection of poorly absorbed simple and complex sugars that are found in a variety of fruits and vegetables and also in milk and wheat.
The process of drawing fluid into the bowel and the fermentation of FODMAPs by bacteria produce the symptoms experienced by people with IBS. Symptom improvement can follow the reduction of high FODMAP foods for around three-quarters of people, including improvement in bowel habits, especially diarrhoea. These sugars are found in a wide variety of foods in the diet, and not everyone with IBS will have symptoms with all of them.
The diet involves reducing high FODMAP food for four to eight weeks and then re-introducing them using a specific protocol, if symptoms improve, to identify which ones are problematic for the person. Participants then follow a FODMAP modified diet, particular to their circumstances. Re-introduction of high FODMAP foods to identify symptom triggers is very important because we do know that a FODMAP diet results in changes in the numbers of good bacteria found in the bowel. Microbiota changes occur because some FODMAPs are also prebiotic, food for gut bacteria. Having diverse good bacteria populations in our large intestine is essential for long-term bowel health. We do not know the long-term effects of a complete FODMAP restricted diet so increasing consumption of prebiotic containing foods that are tolerated well, is a necessary and important part of the process.
The diet should be completed with the help of a FODMAP knowledgeable dietitian, to ensure that the nutritional content of the diet is not compromised; advice is provided that is up to date, and the person is fully informed about proper foods to eat, to facilitate ease of dietary change. With the information in mind, note that most FODMAP food lists available online are out of date or just simply incorrect.
A GP or Gastroenterologist can refer patients with IBS to a dietitian to follow the FODMAP diet when simple lifestyle changes have been attempted, and symptoms persist. Some freelance dietitians do accept self-referral for a reasonable cost if required.
A dietitian has the expertise to carry out a full nutritional and lifestyle assessment and determine if the diet is appropriate and necessary.
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How do FODMAPs affect my sensitive bowel?
Poorly absorbed sugars pass through the small intestine and enter the colon, where they are fermented by bacteria, releasing gas, which stretches the sensitive bowel causing bloating, wind and pain. Fructose, lactose, and polyols tend to retain water in the bowel and may result in loose motions and diarrhoea.
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What foods contain FODMAPs?
- Some Vegetables. Onions and garlic, pulses (peas, beans, and lentils) and brassicas (cabbages, cauliflower, broccoli, and sprouts) can tend to generate a lot of gas. Beetroot can tend to make the bowels loose.
- Wheat may also be a problem in some people.
- Fruits. Stone fruits (such as plums, prunes, peaches, nectarines, apricots.) Apples and pears. Fruit juice concentrate.
- Milk and dairy products containing lactose. This only applies to people who are lactase deficient.
- Some sweets. Sorbitol in chewing gum and sugar-free mints. High fructose corn syrup (used as a sweetener in many drinks, ready meals)