Being dietitians, many of our friends and family members confide in us with their gastrointestinal (GI) problems. The more we hear about these GI problems, the more we have researched a FODMAP diet. FODMAP is an acronym that stands for fermentable oligosaccharides, disaccharides, monosaccharaides and polyols. If you’re following a FODMAP diet, you try to avoid foods that contain these short-chain carbohydrates and sugar alcohols that can cause some not-so-fun GI symptoms.
Foods that are high in FODMAPs are poorly absorbed in the small intestine and pass into the large intestine. In the large intestine, they are fermented by bacteria found in the gut, causing gas productions and water attraction, leading to bloating, gas, diarrhea, stomach distention, and overall discomfort. Probably not the look you’re going for to accompany your favorite outfits.
If you feel like these FODMAPs are causing you discomfort, it is time to take action. Think of the FODMAP diet as an elimination diet. To assess your tolerance for these different compounds, you must eliminate all foods high in FODMAPs for 6-8 weeks. We like to think of it as cleansing your GI palate.
Below are all of the compounds that you want to avoid for the first 6-8 weeks.
- Lactose: Lactose is the carbohydrate found in cow’s, sheep’s, and goat’s milk. Lactose intolerance is caused by partial or complete lack of the enzyme lactase, which digests lactose. When lactose is not completely digested, it contributes to abdominal bloating, pain, gas, and diarrhea, often occurring 30 minutes to two hours following the consumption of milk and milk products. Limit foods high in lactose (yogurt, ice cream, milk, ricotta, and cottage cheese).
- Fructose: Fructose is a carbohydrate found in fruit, honey, high-fructose corn syrup (HFCS), and agave syrup, but not all fructose-containing foods need to be limited on a low FODMAPs diet.
- Fructans: Fructans are carbohydrates that are completely malabsorbed (can’t be absorbed by the intestine) because the intestine lacks an enzyme to break their fructose-fructose bond. For this reason, fructans can contribute to bloating, gas, and pain. Wheat accounts for the majority of people’s fructan intake. Limit wheat, onions and garlic along with other vegetables high in fructans.
- Galactans: Galactans are carbohydrates that are malabsorbed for the same reason as fructans; the intestine doesn’t have the enzyme needed to break down galactans. Consequently, galactans can contribute to gas and GI distress. Limit beans and lentils.
- Polyols: Polyols are also known as sugar alcohols. They are found naturally in some fruits and vegetables and added as sweeteners to sugar-free gums, mints, cough drops, and medications. Sugar alcohols have varying effects on the bowel. Limit sugar alcohols, sorbitol, xylitol, mannitol and maltitol. Talk to your doctor about alternative options if you’re concerned that some medicines have these ingredients.
After your 6-8 week FODMAP-free cleanse you gradually will reintroduce foods to identify which compounds are bothersome. Reintroduce one food every four days with a 2-week break between bothersome foods. The goal is to identify the threshold at which you are able to consume FODMAP-containing foods without causing bothersome GI symptoms.
The following foods are used to test each category:
- Lactose: ½-1 cup milk
- Fructose: ½ mango or 1-2 teaspoons honey
- Fructans: 2 slices wheat bread, 1 garlic clove or 1 cup pasta
- Galactans: ½ cup lentils or chickpeas
- Sugar alcohols (polyols): Sorbitol, 2-4 dried apricots; Mannitol, ½ cup mushrooms
High FODMAP food may irritate your GI tract, but the food does not cause an allergic reaction or an autoimmune reaction in your body. Food high in FODMAPs that elicit GI symptoms are causing functional discomfort in your gut that result in gas, bloating, distention, and discomfort. Simply eliminating these foods will get rid of these negative symptoms that leave you feeling ill. The FODMAP diet is a very tricky and tedious elimination diet. Although the diet may be difficult to follow, it can be highly effective. Make sure to consult a registered dietitian to help you successfully execute a FODMAP diet.
Check out this link for a guide for foods high and low in FODMAPs during your 6-8 week FODMAP-free diet. Hang the chart on your refrigerator, take the chart with you, and become familiar with FODMAPs!
– By Sammy Pappas, RD, LDN, CPT, and Mindy Black, Nutrition & Lifestyle Management