A Low FODMAP Diet

Did you know that there's a specific diet for the treatment of irritable bowel syndrome? We'll tell you more about foods with a low FODMAP in this article.

A diet low in FODMAPs is a diet in which some components are reduced or even eliminated. The acronym FODMAP refers to Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols. We’ll tell you more about these foods in the following article.

In fact, all of these compounds are a type of carbohydrate. When these compounds don’t absorb well in the intestine, they ferment in the colon. According to their functional properties, FODMAPs include fructose, lactose, fructooligosaccharides —FOS—, galactooligosaccharides —GOS— and polyalcohols.

Classification of FODMAPs

Each of them includes specific characteristics in their hydrolysis and absorption:

1. Oligosaccharides

Fructans and galactans belong to this group. They both have 3-10 monosaccharides. These compounds are present in vegetables, fruits, and cereals and have prebiotic effects. Therefore, the food industry uses them to fortify products.

2. Disaccharides: low FODMAP diet

Lactose is a disaccharide that’s digested thanks to an enzyme called lactase. The prevalence of lactose malabsorption has a wide interindividual variation. For this reason, there are lactose intolerant people who tolerate small amounts of milk.

3. Monosaccharides

If eaten by itself, fructose usually ferments. The digestive tract typically tolerates it better if the individual eats it with another monosaccharide. Apples, pears, and peaches are fruits that have a higher fructose content than glucose. Therefore, you should limit your consumption of these foods.

4. Low FODMAP diet: polyols

Sorbitol, xylitol, mannitol and maltitol polyols are considered polyols. They’re often used in different foods. In addition, they’re widely used in products for diabetics because of their sweetening properties.

Implementing a diet low in FODMAP’s

The follow-up of this diet consists of two phases. At first, the individual eliminates all foods that are rich in FODMAPs, while in a second phase they gradually reintroduce them based on tolerance.

As a result, the individual can perform the elimination-introduction process several times. This is because if gastrointestinal discomfort occurs when introducing a food, it’s necessary to return to the start to continue incorporating others.

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1. Restriction phase

It usually lasts 6 to 8 weeks and includes eating only foods that are low FODMAP foods for relief from digestive symptoms. Therefore, some aspects to take into account when implementing are:

• Identification of individuals eating habits and lifestyles. This allows the individual to know which FODMAPS they eat daily.
• Explaining the science behind the diet increases adherence to it. 
• Specific dietary instruction that educates about low FODMAP foods.
• A professional should discuss techniques for handling situations when the individual is unable to control how they prepare their food such as meals they eat outside the home.

The foods that should be avoided in this phase are:

• Fruits: avocado, apricot, apple, pear, melon, mango, grapes, plums, canned fruit, dates, blackberries, nectarine, watermelon and fruit juices.
• Dairy products: milk, yogurt, fresh cheese – Burgos, ricotta, cottage cheese, mascarpone – ice cream, cream, butter, and other milk products.
• Vegetables: artichokes, onions, garlic, asparagus, brussels sprouts, mushrooms, broccoli, cabbage, leeks, beets, corn, endive, mushrooms, and tomato sauces.
• Legumes: chickpeas, lentils, white beans, peas, red beans, beans, soybeans, and soy products.
• Cereals: brown rice, cereals, and whole-grain products, amaranth, wheat, and rye. The latter are tolerated in small quantities.
• Nuts: almonds, pistachios, hazelnuts, peanuts and cashews.
• Sweeteners: honey, high fructose corn syrup, sorbitol, mannitol, xylitol, and isomalt.

In addition, people following this diet should avoid pastries, sauces, dressings, marinades, sausages, and processed meats. Similarly, they should avoid alcoholic and soft drinks.

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2. Low FODMAP diet: exposure phase

In this stage, you have to introduce the restricted foods from the previous stage gradually. The individual chooses foods containing one type of FODMAP, in order to determine the amount of FODMAP of each group that they can tolerate. For example, they could introduce small amounts of apple and pear at the same time to know fructose tolerance.

This allows the individualization of food  and helps to discover food triggers. As a result, this also allows for food variety and avoids unnecessary restrictions, while maintaining control of the symptoms reached in the first stage.

Reasons to follow a low FODMAP diet

This change in a diet could become a first-line therapeutic approach in people with irritable bowel syndrome. This is because of the symptomatic relief it produces, especially in those with bloating, abdominal pain and diarrhea.

However, more studies are needed to evaluate the effect of this diet on subjects with certain illnesses. These illnesses may include functional dyspepsia, gastroesophageal reflux disease, gastroparesis, non-celiac gluten sensitivity, and inflammatory bowel disease.

A professional needs to carefully consider who this diet is suited for. It is a strict regime and is implemented for a long time.

Also, the implementation of this diet requires supervision from a gastroenterologist and a dietitian. Finally, we mustn’t forget that nutritional education is paramount, due to its complexity and the risk of inadequate nutrient intake.