What is the low FODMAP diet? And what, for goodness sake are FODMAPs? You will be surprised to find out that the low FODMAP diet is to the irritable bowel syndrome sufferer, what the gluten free diet is to a person with coeliac disease or non-coeliac gluten sensitivity. The best news is, there is a new food label available to make the live's of those who need FODMAP friendly foods easier.
What is the low FODMAP diet?
The low FODMAP diet has proven that limiting FODMAPs is an effective and successful way to manage the symptoms of irritable bowel syndrome (IBS) and other gastrointestinal disorders.
FODMAPs are short-chain carbohydrates that for some, are poorly absorbed in the gut and quickly fermented by gut bacteria, producing gas which causes the symptoms of IBS and other gastrointestinal problems. The low FODMAP diet allows sufferers to manage their symptoms through diet, heavily reducing intake of foods high in FODMAPs, and removing dependence on medications which were not always effective anyway.
How the low FODMAP diet relates to the gluten free diet?
In the past we have talked about the fact that the road to recovery from gluten intolerance isn’t always easy or instantaneous. Some people have other dietary requirements they discover as a result of still not feeling better on a gluten free diet, which is the last thing you want when removing all gluten containing foods from your diet! Those with a gluten intolerance may also have reactions to lactose but there are a number of other foods that could be preventing your body from healing and functioning efficiently, namely the short-chain carbohydrates known as FODMAPs. We are sure to have a few people's attention now, perhaps this could be the relief you have been waiting for?!
Interesting research in Australia has also found that those who were self-diagnosed non-coeliac gluten sensitive also responded well to a low FODMAP diet. So well in fact, that they could eat gluten without experiencing any ill-effects as long as they were following the diet. Eureka!
What exactly are FODMAPs?
FODMAPs are short-chain carbohydrates, which probably means little the average person (or is that just us?) but many of these carbohydrates are harder to breakdown for some people. The acronym however, can be broken down and it goes like this;
Fermentable - because when they aren’t absorbed they are broken down through fermentation
Oligosaccharides - fructans and galactans (galacto-oligosaccharides, shortened to GOS)
Disaccharides - lactose
Monosaccharides - fructose
Polyol - sugar replacers such as sorbitol and xylitol
High FODMAP foods
These are some of the more common foods to avoid on a low FODMAP diet;
Fructans - nectarines, watermelon, white peaches, artichokes, asparagus, beetroot, brussels sprouts, cabbage, fennel, garlic, leeks, onions, peas, wheat, barley, rye (gluten containing grains), chickpeas, lentils, pistachios and finally legumes, which are known as GOS and aren't absorbed by anyone (you know what too many baked beans can do to you!).
Lactose - milk (cow’s, sheep’s or goat’s milk/skim, low or full fat), custard, ice cream, milk powder, evaporated or condensed milk and yoghurts.
Fructose - apples, cherries, mangoes, nashi pears, watermelon, sugar snap peas, honey, sweeteners (corn syrup, fructose, fruit juice concentrate).
Polyols - apples, apricots, blackberries, cherries, lychees, nectarines, pears, peaches, plums, prunes, watermelon, avocados, cauliflower, mushrooms, snow peas, diet foods that claim to be sugar free or low-carb, sweeteners such as sorbitol, mannitol, maltitol and xylitol.
Perhaps is seems like a lot of foods to miss out on but be strong, it might be worth it for the relief, plus when you see the list of 'allowed' foods further on you won't be so depressed.
How to start a low FODMAP diet…
If you believe you may benefit from a low FODMAP diet, the first step is to contact your dietitian, these things are always best done in the company of a professional. A dietitian will be able to determine if a low FODMAP diet is the correct approach for you. They may recommend you purchase or loan from a library, Dr. Sue Shepherd’s book, Food Intolerance Management Plan. It is very informative, with a step by step approach to the low FODMAP diet and contains many great recipes.
The low FODMAP diet recommends you strictly avoid all high FODMAP foods, such as those listed above, for two months. If your symptoms have improved you can then begin to re-introduce certain FODMAP groups to see if you can tolerate them. This food challenge is best undertaken with the guidance of a registered dietitian because they will be well placed to interpret reactions and make suggestions.
Before you start a low FODMAP diet you can have a breath hydrogen test to ascertain whether or not you have fructose or lactose malabsorption. If you do you will know to exclude these from the re-challenge when you begin to add high FODMAP foods back into your diet. Perhaps a blessing or a curse if you are already on a gluten free diet...
Low FODMAP foods
It does seem you need to avoid a lot of foods on the low FODMAP diet but the ‘allowed’ list is actually substantial, really...trust us. We recommend you focus on what you can have rather than the alternative, it will only make you rescind into the depths of food envy! Here are some of the alternative and allowed foods;
Fructans - most fruit (except those listed above as high in fructans), alfalfa, avocado, bamboo shoots, bean shoots, bok choy, broccoli, capsicums, cauliflower, celery, chives, cucumber, eggplant, lettuce, mushrooms, olives, potatoes, pumpkin, snow peas, sweet potato, tomatoes, zucchini, gluten free grains, seeds and nuts.
Lactose - Butter and hard, formed or ripened cheeses, lactose free dairy products, coconut or soy yoghurt and alternative milks such as almond, soy or rice milk.
Fructose - apricots, avocados, bananas, blackberries, blueberries, cranberries, grapefruit, grapes, honeydew melon, kiwifruit, citrus fruits, lychees, nectarines, passionfruit, peaches, pineapple, plums, raspberries, rhubarb, rockmelon, strawberries, tomatoes, golden syrup, maple syrup, jam, nut butter and sucrose (table sugar, brown sugar, icing sugar etc.)
Polyols - bananas, blueberries, cranberries, grapefruit, grapes, honeydew melon, kiwifruit, citrus fruits, mangoes, passionfruit, paw paw, pineapple, raspberries, rhubarb, rockmelon, strawberries, most vegetables (except those listed above as high in polyols), regular confectionary (no diet products), stevia.
How can some foods be in both lists?
The concept of some foods being high in one type of FODMAP and low in another can be hard to grasp. It only comes into play when you are doing a food challenge and trying to work out which FODMAPs you are sensitive to. For the first 2 months you would avoid all foods on the high FODMAP list, even if they also appear on the low FODMAP list.
To demonstrate a food that is on both lists lets use avocado. Avocado is high in polyols but low in fructose (it is also low in fructans but lets not complicate this even more!).
Scenario 1: You re-challenge polyols and find your symptoms worsen.
Result: Take avocado and any other high polyol food off the menu for the foreseeable future. This means when you re-challenge fructose you will not be able to include avocado at all. Damn.
Scenario 2: You re-challenge polyols and find your symptoms remain reduced.
Result: Put avocado and any other high polyol food back on the menu. Even if you re-challenge but cannot tolerate fructose you can still eat avocado, because it is low in fructose. Win!
In summary, if you challenge a FODMAP group and find you can tolerate something on the high list that also appears on the low list, it is okay to add it back into your diet at this point. Yay!
Confused still? Challenging the FODMAP groups to add foods back into your diet is complex, for this reason it is always recommended to work with a dietitian.
The future of the low FODMAP diet
Thanks to all the hard work of Dr. Sue Shepherd and her team, there is now a logo that will be printed on any accredited ‘FODMAP friendly’ foods by the manufacturer, much like the crossed grain symbol. This will make it easy for those following a low FODMAP diet to quickly identify products that are suitable for them to eat.
For more information and an interview with Dr. Shepherd please take a look at Friendly Little Kitchen, which by the way, has plenty of low FODMAP recipes for you to peruse!
If you are gluten intolerant but do not have coeliac disease, the low FODMAP diet been proven to be a great treatment. However it is important for the non-coeliac gluten sensitive to explore all potential health ailments with their doctor; firstly to ensure there is nothing more sinister at play and secondly to ensure you are not restricting your diet unnecessarily.