First, what are FODMAPs?
The low FODMAP diet, an elimination diet often recommended for irritable bowel disease (IBD) and irritable bowel syndrome (IBS) patients, can be frustrating and complicated to follow without the support of a dietitian. They may desperately want relief from IBD and IBS symptoms, but it can be hard to know where to start. What do I need to avoid in a low FODMAP diet? Which foods have a high FODMAP content? Which foods are low FODMAP? Finding out what each letter in this long, strange word stands for is a good jumping-off point.
FODMAPs are natural sugars found in foods that can be difficult for many people to digest. If you have Irritable Bowel Syndrome (IBS), Crohn’s, or Ulcerative Colitis (IBD), FODMAPs may be contributing to digestive symptoms like abdominal pain, bloating, and diarrhea.
Here's a FODMAP breakdown:
Fructose is a natural fruit sugar found in many fruits. Honey, high-fructose corn syrup, and agave can be a problem, either due to the lack of an enzyme in the body or the ratio of glucose to fructose in fruit. Fruits with high glucose: fructose ratio are low FODMAP and generally well tolerated, such as blueberries, strawberries, cantaloupe, honeydew, and ripe bananas, but those with a high fructose: glucose ratio such as apples, watermelon, and mangoes are high FODMAP and may not be.
Lactose is a carbohydrate found in dairy products, which can be a problem for IBD and IBS patients due to a partial or complete lack of the enzyme lactase which digests lactose. Dairy foods such as cow’s milk, yogurt, and ice cream are lactose-containing foods. Those on the low FODMAP diet should substitute with lactose-free or non-dairy milk, such as almond milk, rice milk, or soy milk made from soybean protein extract. (Soy milk made from soybeans is high FODMAP. According to Monash University, the creators of this diet, soy milk made from soy protein is safe, because the FODMAP component is removed in processing.)
Fructans are carbohydrates that are completely malabsorbed because the intestine lacks an enzyme to break their fructose bond. Wheat accounts for most of people’s fructan intake, which can be found in breads, cereals, and pasta, but they can also be present in onions, garlic, and some other vegetables. This is not to be confused with Celiac Disease, or gluten sensitivity which is related to the wheat protein, gluten.
Galactans are carbohydrates that are also malabsorbed because the intestine does not have the enzyme to break them down. Beans, peas, and lentils contain FODMAPs and are primary examples.
Polyols are also known as sugar alcohols, and are found naturally in some fruits and vegetables. They are also added to sugar-free gum, mints, and cough drops. The names of some of these artificial sweeteners end in ol- like sorbitol, xylitol, mannitol, and maltitol. Apples, pears, stone fruits, mushrooms, and cauliflower are also high sources of polyols and contain FODMAPs.
How do FODMAPs trigger symptoms?
1. When FODMAPs pass into the colon, they ferment and create gas.
2. While in the colon, FODMAPs pull water into the intestinal tract.
3. This water and gas builds up in your gut, causing bloating, cramping, pain and diarrhea/ constipation.
A low FODMAP diet can help.
These painful symptoms are preventable in up to 70% of people with IBS.*
For patients with IBD (Crohn’s disease and ulcerative colitis), the Low FODMAP diet can be a beneficial addition to your medical treatment and has been shown to help improve quality of life.**
* Source: P. Gibson, “The evidence base for efficacy of the low FODMAP diet in irritable bowel syndrome”
** Source: World Journal of Gastroenterology May, 2017.
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