Understanding FODMAPs and the associated diet

You may have already heard about the FODMAPs diet if you have some digestive troubles. Let’s see what it’s hidden behind this acronyme.

 

First of all, what are FODMAPs?

FODMAPs are sugars poorly digested by our body. They will be fermented by the bacteria hosted in our colon. Indeed, they use these FODMAPs as energy. This process is natural.

However, these fermentations can be excessive and may cause bloating and pain in sensitive people. FODMAPs can also, by the osmosis effect, accelerate transit (they cause a call for water in the intestines).

 

 

Let’s see in more detail the meaning of the acronym FODMAPs

 

Fermentescible

Our colon is naturally populated by billions of microbes. As human, we are not able to absorb many sugars because we do not have the right enzymes. When these sugars reach the colon, bacteria will use them as energy : this is the fermentation process. This fermentation induces the production of gas.

 

Oligosaccharides

“Oligo” means “a little” and saccharides refers to a chain of different sugar molecules. We cannot digest these sugars, only our bacteria can. There are two types of oligosaccharides: fructans including fructo-oligosaccharides (FOS) and inulin, and galacooligosaccharide (GOS).

 

 

Disaccharide

“Di” means two, which means that a disaccharide is a sugar chain made up of two molecules. In FODMAPs, this disaccharide refers to lactose, the milk sugar composed of a molecule of galactose and glucose. We have an enzyme that makes it possible to “cut” these two sugar molecules: the lactase. However, in adulthood, many of us no longer sufficiently synthesize this enzyme. This phenomenon is normal: milk is normally dedicated to the infant.

 

Monosaccharide

Mono” means one, so monosaccharides are simple sugars.

In FODMAPs, monosaccharide refers to fructose. It is present in some fruits and sweeteners, but also in some vegetables and cereals.

Fructose requires a carrier to be able to cross the epithelial barrier, and thus be absorbed. Its absorption depends on the concentration of glucose. When a food have in similar amounts of glucose and fructose, it is relatively well absorbed. On the other hand, if fructose is found is higher concentration than glucose (a phenomenon called “excess fructose”), the absorption is slow and incomplete.

Fructose malabsorption is not an illness or a condition. It is just a part of personn’s physiology. Some people are not well equipped to absorb excess of fructose while others are.

 

And,

 

Polyols

These are alcoholic sugars. They are fairly easy to spot because their names end with – ol : mannitol, xylitol, erythriol, sorbitol.

Polyols are absorbed through pores in the epithelium of the small intestine by passive diffusion. The absorption of polyols depends on their size, the dose ingested, the size of the pores and the transit time (varies according to people), as well as the presence or not of intestinal diseases (such as celiac disease).

Because polyols are poorly absorbed, they remain in the small intestine attraccting water. The luminal water content increases, causing a distension perceived as painful in people with visceral hypersensitivity. In addition, they will be fermented in the colon by the bacteria. This results by the release of gas and bloating.

Polyols occur naturally in some fruits and vegetables. They are often used in food manufacturing as humectants(water-building agents) and artificiak sweeteners (particularly in “sugar free” chewings gum and confectionery. They can be identified by their food additive numbers: sorbitol (420), mannitol (421), maltitol (965), xylitol (967), isomalt (953).

 

Carbohydrate families Common food (not exhaustive)
Oligosaccharide Fructololigosaccharin including fructans, short chain of fructose (only 1% absorbed within or small intestine)

Galactooligosaccharide (GOS) including raffinose and stachyose

 

Wheat, barley, onions, leeks, garlic, Jerusalem artichoke, cabbage, artichoke, peach, watermelon, rye

Legumes, unfermented soybeans, cruciferous vegetables, beets

 

Disaccharide Lactose (galactose + glucose) Dairy products – except hard cheese: milk, condensed milk, powdered milk, milk drink, yogurt, drinking yogurt, milk dessert, fromage blanc, ice cream, melted cheese
Monosaccharide Fructose Some fruits,  fruit juices, honey, agave syrup, ultra-processed products
Polyols All those ending in –ol: sorbitol, mannitol, erythriol… Sorbitol: certain fruits, such as apricot, plums, avocado, apple, watermelon, cherry, mushrooms, sweets without sugars…

Mannitol  : mushrooms, cauliflower, sweet peas, seaweed, corn, peas, E421…

Xylitol  : potato, berries, mushrooms, corn, salad

 

Why are we talking about it ?

FODMAPs are responsible for many inconveniences, including irritable bowel syndrome. A diet low in FODMAPs is highly recommended for people suffering from IBS.

 

 

Indeed, according to the Monash University, 75 to 80% of people with IBS who eliminate foods rich in FODMAPs see their symptoms improve!

 

I invite you to watch this video of Monash Univeristy explaining very well the effect of FODMAPs in our body.

 

The FODMAPs diet

It was created by the Dr Sue Shepherd from the Monash Univeristy (Australia). It is little known in France unlike the Anglo-Saxon countries.

 

Who is the FODMAPs diet for  ?

This diet has proven its effectiveness for all people suffering from intestinal disorders.

 

Warning: do not go on the FODMAPs diet without first consulting a health professional. If you are over 50, have blood in your stool, and have a history of colorectal cancer in your family, I strongly recommend that you consult.

 

 

Diet phases

The FODMAPs diet is divided into three phases:

  • The elimintation phase (4 to 12 weeks maximum). During these few weeks you will have to remove all foods containing FODMAPs (and there are many!). You will continue this step until a clear improvement in your symptoms, without exceeding 12 weeks.

 

  • The reintroduction phase. This phase is complex and requires monitoring by a health professional. The goal is to reintroduce one by one foods containing FODMAPs to determine your tolerance. The rules to follow are:
    • Introduce one food group at a time in small quantities (2 to 3 tablespoons)
    • Indroduce 1 food per week , 2 to 3 times a week
    • The food tested culd be taken at an interval of 2 hours of meals to clearly identify the symptoms but always within a low FODMAP meal.
    • The portions consumed of the food may be increased depending on the tolerance

If you do experience symptoms, go back to a low FODMAP diet until symptoms disappear. The food should be tested again, reducing the portion in half. If symptoms persist, go back to phase 1 and test an other food.

If the symptoms remain silent, another food from the same group can be tested.

 

  • The so-called “cruising ” phase is the sustainable phase. It is important to widen the diet as much as possible in order to maintain a varied diet. You will have to test again foods that you didn’t tolerate previously, as your tolerance may increase as your intestines are no longer as badly attacked. In addition, although nutrition is important, a holistic approach is essential in the management of IBS. Stress management and the regular physical activity practice will help you manage IBS.

 

A “simplified” FODMAPs diet may be offered to you following the dietary consultation. As each person has different eating habits and sensitivities, the diet should be individualized .

 

 

What are the pros and cons of the FODMAPs diet?

One of the advantages of this diet is that it categorizes foods according to the type of sugar which is predominant in the food. This helps you target the family (or families) that cause you the most troubles. Thanks to this diet you will be able to determine which foods and above all, how much you can eat without symptoms.

 

The low FODMAPs diet is an exclusion diet and therefore difficult to maintain (phase 1 and 2). The slightest deviation can ruin your efforts.

 

 

The low FODMAP diet is not a quick fix and won’t be enough on its own to solve your digestive problems. It is possible that after 3 months under a low FODMAP diet your symptoms are still present, even accentuated. Why? Because you will not have traited the roots of your problems, but only eliminated a list of healthy foods. 

This diet must be accompanied by  a regeneration cure of your intestinal mucosa. If you suffer from hyper-fermentation, your intestinal mucosa is irritated. Repairing it is therefore essentialWe also have to understand the cause of this hyper-fermentation.

 

 

What’s next ?

Foods containing FODMAPs should be consumed according to your tolerance. The quantities may be small, but you should try to have a diet asdiverse as possible. This point is very important, because in the long term, the total eviction of foods containing FODMAPs has an impact which seems to be negative on the microbiota. Indeed studies have shown that this diet leads to reduction of Bifidobacteria and production of short chain fatty acids, essential elements for good intestinal health.

 

 

How to do this diet?

Before starting a low FODMAP diet it is important to make sure that your symptoms are not related to an organic disease.

In addition, this diet is not the priority to “cure” your disorders. Good dietary habits have to be taken at first. The elimination or reduction of certain foods can help you, without necessarily going through the low FODMAPs protocle.

The digestive capacity, the enzymatic secretions and the quality of your chewing will be the main factors which will determine your level of tolerance.

 

 

Note: the diet low in FODMAPs is not the only one recommended in the management of SIBO, SIFO or dysbiosis. Only a health professional can advise you on one therapeutic regimen more than another. You will find dozens of different “forbidden” and “to eat” food lists on the web. Get help. Also, remember: probiotics are like antibiotics: it is not automatic!

 

 

Resources

 

 Recipes low in FODMAPs (in English)

 

I can only recommend the application created by Monash University in Melbourne, downloadable to your smartphone (€ 9, in English only).

 

You can also use the MySymptome application to monitor the progress of your symptoms.

 

 

A little song quite funny to listen to 🙂

 

 

 

 

 

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