by Diana Arundell
Amidst all the ‘fashionable’ diets that come and go, the low ‘FODMAP’ diet is one which has solid research behind it, showing that it can significantly improve gastro intestinal symptoms in many people with irritable bowel syndrome (IBS) and clinically I have seen patients with inflammatory bowel disease also experience relief.
It is believed that the symptoms of IBS such as gastro intestinal pain and discomfort, bloating, wind and irregular bowel motions can be triggered by a group of foods known as ‘FODMAP’s. These food groups are not broken down effectively by everyone and the undigested carbohydrates then draw water into the small intestine and lead to excess gas production in the large intestine, and it’s the combination of these consequences that leads to the uncomfortable symptoms.
‘FODMAP’ is actually an acronym for Fermentable, Oligosaccharides, Disaccharides, Monosaccharides And Polyols. Polyols are a form of sugar alcohol and the others are molecules of short chain carbohydrates. As the name suggests, the low FODMAP diet is made up of food groups containing low amounts of these molecules.
Some examples of high FODMAP containing foods which may trigger symptoms in some people with IBS include:
- Oligosaccharides (fructans and galacto-oligosaccharides GOS): Garlic, onion, wheat, rye, barley, cashews, pistachios, inulin. GOS: Legumes, chickpeas, lentils.
- Disaccharides (eg. Lactose): Dairy such as milk, cheese, yoghurt.
- Monosaccharides (eg. Excess fructose): Honey, high fructose corn syrup, apples, watermelon, mango, pear, dried fruit.
- Polyols: Sweeteners such as sorbitol (420), mannitol (421), xylitol (967), maltitol (965), isomalt (953), apples, apricots, pears, nectarines, plums, prunes and mushrooms.
NB. This is a very modified short list of some of the higher containing FODMAP foods and an individualised program should be prescribed by a qualified medical professional.
When it comes to treating gastro intestinal health issues and manipulating a regular diet or eating plan, it’s always best to work together with a qualified and experienced nutritionist. Everyone has different requirements based on genetics, medical history and current signs and symptoms so there is never a one-size-fits-all diet EVER. The idea is to work with a professional to manage diet and symptoms with the goal of having the minimal amount of ‘restriction’ placed on an eating program.
Any sort of restrictive diet ideally should only be followed short term as longer term may lead to deficiencies of nutrients required by the body and specifically in the case of FODMAPs, nutrients required for healthy gastrointestinal tract function. FODMAPs contain prebiotics which help feed the gut with nutrients that support the growth of probiotics or favourable bacteria. It is not ideal to follow a completely low FODMAP diet longer term and therefore there is a specific approach to follow.
The low FODMAP diet is usually implemented in a specific way with the ultimate goal being to identify which of the FODMAPs is specifically responsible for gastro intestinal discomfort. A practitioner will guide you through two phases of a low FODMAP diet. The first is the ‘elimination phase’ that involves eliminating all high FODMAP food groups until there has been a significant improvement of symptoms, and that may take 2-4 weeks. A food and symptom diary needs to be diligently kept throughout both phases of the low FODMAP diet. Your health practitioner will provide a list of allowable food options and meal ideas to make the process easier.
The second phase of the low FODMAP diet is the ‘reintroduction phase’ and the goal of this phase is to systematically introduce FODMAPs back into the diet and determine how much of each FODMAP group may be tolerated. People have individual reactions to the individual FODMAPs so it may be a case that only one group of the FODMAPs is responsible for discomfort rather than all of them. The reintroduction phase should take 5 weeks as each week one specific group at a time is trialled with symptoms being closely monitored. This method will identify if there is an instant reaction as well as if there is a certain amount tolerated before a reaction occurs. Once completed, an eating plan can be prescribed ensuring the offending FODMAPs are excluded or minimised and all nutritional requirements of the individual are met.
When treating any gastrointestinal disturbance, a comprehensive gut healing approach should be undertaken to ensure that symptoms as well as specific causes are addressed. For example with all gastro intestinal illnesses, not only do foods that trigger symptoms need to be avoided for a certain period of time to reduce irritation, but also nutrients and herbs to heal the gut lining and reduce inflammation and build gut immunity and integrity is also important. This often means that in future, foods that may have previously triggered a sensitivity reaction may well be able to be tolerated.
The low FODMAP diet was developed by researchers at Monash University and since its development there are several excellent books and Apps to help make the eating program as user friendly as possible. New foods are continually being tested and the App is updated as new research emerges. The App also contains meal plans, recipes and shopping lists.
For more information about the low FODMAP diet including the Apps, please check out www.med.monash.edu/cecs/gastro/fodmap
Diana Arundell is a university-qualified naturopath and consults from her Avoca Naturopath clinic. She has a special interest in fertility and pregnancy health, digestive health, immune function and family wellness programs. She was a nutrition lecturer at Macquarie University for 10 years, and is an accredited Journey Practitioner. For further information please contact Diana Arundell at Avoca Naturopath on 0410 465 900. www.avocanaturopath.com.au