FODMAPs 101

Many times, patients tell me that ever since they started eating healthier (meaning a lot of fruits, vegetables, nuts and seeds) they feel incredibly bloated. This could be due to increased consumption of FODMAPs, short for carbohydrates called :

Fermentable

Oligosaccharides (fructans and galacto-oligosaccharides- GOS)

Disaccharides (lactose, milk from sugar)

Monosaccharaides (excess fructose)

And

Polyols (sugar alcohols like mannitol and sorbitol)

When the small intestine is unable to absorb them, they travel to the large intestine where they are fermented by bacteria resulting in gas, bloating and distention. This malabsorption is also common for individuals with inflammatory bowel disease (IBD), Irritable Bowel Syndrome (IBS), celiac and/or bacterial overgrowth. IBS is relatively common, found in 1 in 7 adults. However, it is important not to “self-diagnose” yourself with IBS given it could be a secondary symptom from another underlying gastrointestinal disease. Therefore, in addition to standard medical/dietary advice from your healthcare professional, you may find this information useful.

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How are FOMDAPs malabsorbed?

These are small-chained carbohydrates (sugars and fibers) that can be poorly absorbed:

FRUCTOSE (in excess of glucose): Most people absorb fructose, but about 30-40% of healthy individuals and those with IBS malabsorb it when eating it in excess of glucose.

LACTOSE: Is composed of two sugar units joined together, which need to be “chopped” into two sugar units by an enzyme (lactase) for absorption of a single unit to occur. Lactase is in the wall of the small intestine and its level depend on various factors such as ethnicity and presence of some gut disorders.

POLYOLS: Are completely absorbed across the small intestine.

FRUCTANS: found in wheat, rye, onions and garlic. Fructans and GOS (found in legumes like beans and chickpeas) are usually restricted for those with IBS. Humans do not have the enzymes to break them down so they pass malaborbed from the small to the large intestine.

What is a low-FODMAP diet?

It is methodical diet where you are carefully guided by a registered dietitian to remove high-FODMAP foods for 2-6 weeks and then gradually re-introduce and re-challenge troublesome foods. The goal is to determine dietary triggers and FODMAP thresholds, therefore it is not meant to be strictly restrictive for life…it is a TEMPORARY diet.

Current research indicates that restriction of FODMAPs is an effective dietary intervention for reducing IBS symptoms in about 75% of patients who follow the diet for 8-12 weeks. There are now well-designed clinical trials to support the efficacy of a low FODMAP diet, however further studies are needed to assess long-term efficacy to determine any adverse outcomes from effects on the gut microbiota.

 

What does a low-FODMAP meal look like?

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Low-FODMAP plate image - lunch and dinner

If you feel this a diet for you, we can gladly guide you by providing personalized guidance, additional strategies and support by a team of experts to help you improve your digestive health.

To get a head start, you can print the image above of “FODMAPS 101” in PDF format.

 

References

Knight-Sepulveda K, Kais S, Santaolalla R, Areu MT. Diet and Inflammatory Bowel Disease. Gastroenterology & Hepatology. 2015; 11(8): 511-520.

Nanayakkara WS, Skidmore PM, O’Brien L, Wilkinson TJ, Gearry RB. Efficacy of the low FODMAP diet for treating irritable bowel syndrome: the evidence to date. Clinical and Experimental Gastroenterology. 2016;9:131-142.

Monash University. About FODMAP and IBS. https://www.monashfodmap.com/about-fodmap-and-ibs/ Accessed November 9, 2017.

 

 

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