So if you have Irritable Bowel Syndrome (IBS), you've probably heard people talking about FODMAPs and the low FODMAP diet. But what are they and how can the low FODMAP diet help reduce your IBS symptoms?
FODMAP stands for:
Oligosaccharides (fructans and galacto-oligosaccharides- GOS)
Disaccharides (lactose- milk sugar)
Monosaccharides (excess fructose)
Polyols (sugar alcohols- sorbitol and mannitol)
Essentially, FODMAPs are small, short chained carbohydrates or sugars that your body has difficulty breaking down and aren't absorbed properly. That means they get to the intestines where they draw water into the gut and are fermented by the bacteria in your gut leading to bloating, gas, and diarrhea.
There is evidence that following a low FODMAP diet can reduce symptoms of IBS including abdominal pain, bloating, and diarrhea in participants with IBS. Before starting this diet, I would recommend trying out some more general tips from my previous post on IBS here as the diet is fairly labour intensive and you want to make sure you've tried other options first. As well, make sure to speak to your doctor if you do not have a diagnosis of IBS or have not had other causes of symptoms ruled out such as Celiac Disease.
Sometimes when we talk about FODMAPs, people are under the impression that this includes all sugars since they feel better on low carbohydrate diets. There are lots of carbohydrates and sugars that are more easily digested and absorbed and don't have this effect of drawing in water and being fermented- you don't need to (and shouldn't) cut out all carbohydrates and sugars to help with IBS on the low FODMAP diet!
The list below of foods containing FODMAPs can definitely be daunting but it's important to note that you don't eliminate all these foods forever! It is not recommended to be on the full FODMAP elimination diet long-term as it not only limits your food choices but can reduce some of the beneficial bacteria in your gut. Instead, this diet is more of a learning experience. After you've eliminated FODMAPs until you see an improvement in symptoms, which is typically 2-6 weeks, you'll start slowly reintroducing foods from one sub-group at a time, for example lactose including milk and yogurt to find if you tolerate that group and if so, how much you can tolerate. By the end, you should have a very good idea of what types of food triggers you and how much of those foods you can tolerate!
Some clients choose to eliminate one group at a time instead of all FODMAPs, especially if you notice a pattern of certain foods that aggravate your symptoms using your food and symptom journal. As you can tell, this diet is pretty darn complicated so it's a good idea to work with a Registered Dietitian knowledgable in the diet to ensure you are getting adequate nutrients and to help you work through it. If you're interested in working with me to help you with the diet, you can click here for pricing and services offered.
Now that we've got all of that out of the way, let's talk about what foods contain the different categories of FODMAPs! I've summarized some of the high FODMAP foods in a table but I also have some more detailed information below!
Many people who find relief from their gut symptoms when they go on a gluten-free diet and don't suffer from Celiac Disease are actually finding relief from the lack of fructans (carbohydrate) as opposed to the gluten (protein). Fructans are found in many gluten-containing grains including wheat, rye, and barley but also in garlic and onions and some fruits.
Another major source of fructans is from inulin- this is added to many processed foods with added fibre since it does not change the texture of a food. This may be added to everything from granola bars to protein powder so it's important to check the label!
I love bread but non-sourdough bread is a source of fructans and therefore considered high FODMAP!
Humans can't digest oligosaccharides as we don't have enzyme necessary to break them down- they are also called pre-biotics since they act as food for the bacteria in the gut. This is beneficial for gut health but may cause symptoms in individuals with IBS due to the fermentation process. Due to this beneficial effect, you may also see GOS added to foods when they talk about pre-biotics on the label.
Pulses, including lentils and chickpeas are excellent sources of fibre and protein but are limited on the low FODMAP diet- small portions such as 1/4 cup canned chickpeas or 1/2 cup canned lentils may be included.
Cow's milk, cream cheese, ricotta cheese, sour cream, ice cream made from cow's milk, kefir, and yogurt are some of the foods that contain lactose. Hard cheeses such as cheddar are considered low FODMAP as the lactose is mostly used up and removed in the process of cheese-making.
Cow's milk, yogurt, and ice cream, and kefir contain lactose, which is a FODMAP
Fructose is absorbed through a different transporter than other sugars in the gut and because of this if there is more fructose than other sugars, it may not be absorbed properly and instead draws water into the gut and is fermented.
Honey is a sweetener to avoid on the low-FODMAP diet.
Polyols is another name for sugar alcohols, which are often not absorbed properly. They are found in some vegetables and fruits but also in processed foods as they are used as a low calorie sweetener in no-sugar added products such as gum and candy. The subgroups here are called mannitol and sorbitol but essentially on labels you want to avoid ingredients ending in 'ol.' They will also be listed as sugar alcohols under carbohydrates on the food label.
Apples are one example of a food high in sugar alcohols
I know what you're thinking: that's a lot of foods to take out!!
It certainly isn't an easy diet to follow- it requires planning and research, which is why getting a proper diagnosis, trying other things first and working with a dietitian is so important! You can still have a tasty, well balanced diet during the elimination phase of the diet as there are lots of foods that are low-FODMAP!
If you are looking into the low FODMAP diet, the best resource out there is the Monash University low FODMAP Diet app- this is the university that tests foods for their FODMAP content so it is the most up-to-date and comprehensive list out there. It is around $10, however; all the money from the app goes towards testing FODMAP contents of foods. It tells you which group the foods may be high in at different portion sizes- I can't recommend it enough!
There are lots of foods that can be included on the low-FODMAP diet including meats and eggs, gluten-free grains and pseudo-grains such as quinoa, rice, and sorghum, (gluten-free grains also tend to be low-FODMAP) fruits such as bananas, oranges, and strawberries, and vegetables such as eggplant, peppers, carrots, and and lettuce!
I'm going to talk more about foods you can include on the elimination phase of the low-FODMAP diet next time with a focus on vegetarian and vegan diets since these are the most difficult since many plant-based protein sources are out! Did I mention that I did the elimination phase of the low FODMAP diet for two weeks to be able to better help you with tips? During Halloween parties?! Stay tuned for more information on the low FODMAP diet!