Low-FODMAP Diet
What is the Low-FODMAP diet?
Most patients with irritable bowel syndrome (IBS) associate their symptoms with eating and many patients ease their symptoms by avoiding certain foods or using elimination diets. An elimination diet involves taking multiple foods out of your diet, followed by a period of reintroduction of these foods, in order to determine your personal food sensitivities. The most extensively studied elimination diet for IBS is the low FODMAP diet. FODMAP stands for Fermentable, Oligo-, Di-, Mono-saccharides And Polyols, and consists of groups of certain types of carbohydrates that are thought to trigger GI symptoms. The Low-FODMAP diet was conceived about 10 years ago about by Australian researchers and is the elimination diet thought to be most effective for treating IBS related symptoms.
What effects do FODMAPS have on the digestive system?
FODMAPs are short-chain carbohydrates (sugars) that are highly fermentable, which means that they go through chemical changes in the GI system, and are poorly absorbed during digestion. When FODMAPs reach the colon (large intestine), bacteria ferment these sugars, turning them into gas and chemicals. This stretches the walls of the colon, causing abdominal bloating, distension, cramping, pain, and/or changes in bowel habits in many patients with IBS. FODMAPs are not unhealthy or harmful, but may exacerbate GI symptoms in those with sensitive GI tracts.
When is a Low-FODMAP diet recommended?
Eliminating or restricting FODMAPs from the diet may greatly improve symptoms of IBS. Bloating and abdominal pain are the most likely symptoms to improve but you may see improvements in fatigue, bowel movements, and general quality of life as well. Working with your GI provider and a dietitian familiar with GI conditions can improve the chances of getting better with this type of elimination diet strategy, but the low FODMAP diet doesn’t help everyone. Patients with a history of eating disorders, at risk for malnutrition, or who have complex medical histories may not be good candidates for this dietary strategy.
How does the low FODMAP diet work?
There are three phases of the low FODMAP diet: 1) Elimination, 2) Reintroduction, and 3) Personalization. During the elimination phase, which lasts 2-4 weeks, all FODMAPs are taken out of the diet. If symptoms are significantly improved with the elimination phase, patients will start the reintroduction phase, where groups of FODMAPs are added back in one at a time, monitoring for a recurrence of symptoms. Once it is determined which FODMAPs cause symptoms, many patients avoid these foods, but still ingest other FODMAPs on a regular basis. This allows for as much nutritional diversity as possible. Following this personally developed Low-FODMAP plan does not cure IBS, but it may lead to management of symptoms and better quality of life.
Many patients are overwhelmed by the list of “Do’s and Don’ts.” Because of this, many patients find great value in working with an experienced dietitian during the elimination and reintroduction phases.
What foods are suitable, and what should be avoided while on a Low-FODMAP diet?
Visit gi.org for examples of Low and High FODMAP foods.
*Read labels of packaged foods to ensure they do not have added high FODMAP ingredients (ex: high fructose corn syrup, wheat, onion, garlic, etc.)