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FODMAP Diet: A Fad Diet or Helpful for Everyone?
The FODMAP diet is gaining traction on blogs, media and in the research studies. Does that mean that this “newish” idea could help everyone or is it another dreaded Fad diet?
Remember, over 100 years ago researchers thought carbohydrates were the biggest problem for people with digestive conditions. Recent studies are starting to show significant improvement (74%) in digestive symptoms using the FODMAP Diet [1]. Based on that, I think the idea is worth a more in-depth look. So, let’s start with a primer of what you need to know.
What is the FODMAP Diet?
Let’s start with the alphabet soup name: “FODMAP.” It’s a medical acronym for Fermentable, Oligosaccharides, Disaccharides, Monosaccharides and Polyols. Yummy right? The diet portion of the name is in reference to a sequence in which the foods with higher FODMAP content are removed and slowly added back in. First, let’s figure out what those big words mean, then I’ll tell you how they might be hurting you and how to avoid them.
F is for Fermentable – In this context, the fermentation of these carbohydrates occurs either in the small or large intestine. In many cases, this is normal and happens in healthy people. But in people affected by IBS the fermentation causes more pain than normal. The theory here is (in affected people) a reduction in all fermentation will improve the quality of patients’ lives.
O is for Oligosaccharides – “Oligo” is a Greek prefix for having few or little and saccharide is another word for sugar. So, this is a word that means short-chain carbohydrates. In the case of FODMAPS, we’re talking specifically about fucto-oligosaccharides (fructans) and galacto-oligosaccharides (galactans). The fructans group is comprised of FOS and inulin. Glacatans are made up of Raffinose and Stachyose (mostly found in beans).
D is for Disaccharides – “Di” meaning two, and again saccharide meaning sugar. So, this word means two sugar molecules linked together. Interestingly, in the case of FODMAPs, researchers don’t believe all disaccharides are problematic… only lactose (milk sugar).
M is for Monosaccharides – “Mono” meaning one, this word is used to describe one basic sugar molecule. In the context of FODMAPs, researchers don’t implicate all monosaccharaides only fructose.
And
P is for Polyols – This is another name for sugar alcohols such as sorbitol, mannitol, xylitol and isomalt. These sugars are malabsorbed by everyone and are free to be fermented by bacteria wherever the bacteria find them. Even healthy people can experience digestive problems from eating sugar alcohols.
I’m sure you’re thinking, “Great but why do I care?” Well, it turns out researchers have found that these specific foods contribute to digestive problems like diarrhea, constipation, gas, pain and bloating.
How Do FODMAP’s Hurt Us?
Simply put, researchers have isolated these foods as possibly harmful for digestion because they all share one specific characteristic: they are poorly absorbed in the small intestine. [2] If they aren’t absorbed properly then they can hang out too long in the intestines and become a feast for bacteria, which is where the “F” for fermentable comes into play.
As the bacteria ferment the nutrients, their waste products affect us. This can increase intra-abdominal pressure causing both stomach pain and reflux problems. [3] It is thought that some of their by-products activate a feedback loop that regulates gut motility, accelerating small bowel transit times. [4] There is also an increase in osmotic load (or more water delivered to distil small intestine and colon) due to the size of some of molecules. [5]
The thought is that if we increase the speed, pressure and amount of water delivered to the colon it will cause more digestive problems. And with a 74% rate of success in people who stop eating these foods, it sure seems that this is an extremely helpful idea for some people with digestive problems.
Do You Have FODMAP Intolerance?
The researchers acknowledge that the FODMAP diet doesn’t cure anything but it can provide great symptom relief. So, how would you go about determining if you’re someone who is reacting to FODMAPs and could benefit from avoiding foods with higher FODMAP content? Test removing them and then add them back in.
At the core of our message, here at SCDlifestyle, is that every food should be tested. And foods containing higher amounts of FODMAPs are high on the list of foods that should be tested if you’re still experiencing digestive problems even after eliminating grains, starches, and sugars.
Step 1 in testing FODMAP intolerance is to remove foods with high FODMAP content, which includes:
Fruits: apple, apricot, avocado, blackberry, cherry, lychee, nashi, nectarine, peach, pear, persimmon, plum, prune, watermelon and dried fruits
Vegetables: asparagus, artichoke, beetroot, bell pepper, broccoli, Brussels sprouts, cabbage, cauliflower, eggplant, fennel, garlic, leek, mushroom, okra, onion, shallots, sweet corn
Sweeteners: honey, corn syrup, sorbitol, mannitol, isomalt, maltitol, xylitol
Legumes: all beans, chickpeas and lentils
Dairy: milk from cow, goat, sheep, custard, ice cream, yogurt, soft unripe cheese
Grains: wheat, rye, barley
Then, wait 4-6 weeks and see how you feel…
Is The FODMAP Diet a Forever Thing?
No, in fact it wasn’t ever thought of as a long-term solution. This is something that many people aren’t talking about. But Step 2 in this diet is to add the foods back into your diet. Here’s what one of the most recent studies in 2012 had to say:
“A trial of a low FODMAP diet can be conducted. This is usually recommended for 4-6 weeks, following which, a rechallenge of any potentially well-absorbed carbohydrates can be undertaken, that is, fructose, lactose, sorbitol and mannitol. Tolerance to fuctans and GOS [galactans] can then be tested.” [6]
Sounds like these researchers believe the same thing we do, which is that every food has the potential to harm depending on the health of the body or the quantity consumed. It’s worth noting that in my review of the FODMAP literature it was commonly referred to as a diet to provide symptom-relief, not curative.
I think they are learning what we have, which is that everyone has a custom diet and that diet will change depending on the health of the GI tract. In fact, here’s another quote from that study:
“In addition, FODMAPs have prebiotic effects due to the production of short-chain fatty acids after fermentation. Therefore, all patients are encouraged to try and reintroduce FODMAPs to a level that they can comfortably tolerate.”
We know that short-chain fatty acids can be very beneficial to the colon. And there are many proponents of prebiotics to help with digestive disorders. But beyond that most of the FODMAP vegetables and fruits aren’t filled with toxins so they shouldn’t be labeled as bad foods.
Our Personal FODMAP Experiences
Personal experience can always trump theories. So at this point, I’m sure you’re curious to know if we’ve tested FODMAPs.
I noticed minor reactions to some higher FODMAP foods the first time I tried them. Onions, broccoli and cauliflower didn’t sit well at first, but a few weeks later, I used the same gradual introduction techniques we teach now and did just fine with smaller doses. I continue to handle them just fine.
Jordan was as FODMAP sensitive as they come his first year on the diet. In fact, he couldn’t even eat a cup of cooked broccoli. He couldn’t do garlic or onion either – not even a small bit for flavor without noticing some violent reactions. Three years later, he’s able to tolerate those foods just fine. I’ve even seem him mash several high FODMAP foods in one sitting like apples, asparagus and avocados.
So, was it the FODMAP foods? Coincidental? Something else?
The FODMAP Paradox
Paradoxically, many people will see short-term relief by removing high FODMAP foods, but most can add those back only weeks later with no problems. So, what is going on here?
In our experience, we think a few factors are at play. The first is the additive effect. If your diet contains small amounts of all these FODMAP foods eaten daily and then you cut them all out, it’s likely you’ll notice some relief but it’s also likely that you’d be able to eat some of those foods in small quantities each day and not have problems.
Instinctually we should know this (but I often forget it); after all it is universal to all foods, not just FODMAPs. We have an upper tolerance to everything we eat… Eat 10 bananas, 5 cups of broccoli or 10 cups of spinach and you’ll spend equal time on the toilet for each one of those transgressions. It seems that the tolerance for FODMAP foods is just lower in susceptible people.
The second factor seems to be gut health. After a washout period of removing high FODMAPS, high salicylates, and other toxic foods, people’s tolerances to all food improves almost universally. Why? Maybe it’s the SIBO connection, gut flora rebalancing, pathogen killing or decreasing the inflammation levels for a few weeks that allows some healing to take place. I don’t think anyone can say for certain right now, but I believe the relative health of the gut is the most important factor in food tolerance.
In summary, if you think FODMAP foods might be triggering your digestive symptoms here’s how to find out:
Step1. Remove high FODMAP foods for 4-6 weeks and track your symptoms during this time
Step2. Re-introduce the foods using our 3-day rule for gradual re-introduction and track your symptoms.
In the future, we’ll explore how our gut flora changes in response to what we eat. But I think most people can handle FODMAPs if they’re eating a low-toxin diet, their overall diet isn’t extremely FODMAP heavy, and then they slowly re-introduce them.
Have you tested high FODMAP foods? I’d love to hear your experience below in the comments.
-Steve
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[1] http://www.ncbi.nlm.nih.gov/pubmed/17000196
[2] http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1746.2009.06149.x/full
[3] http://www.ncbi.nlm.nih.gov/pubmed/22488077
[4] http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2006.03186.x/full
[5] http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2010.04237.x/full
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