What the FODMAP?!?!

I happily admit that I love talking about aspects involved in the functioning of the lower digestive tract and the bowels. I understand that these are not quite topics of conversation to be had at parties or the dinner table or on a date. Bowel movements, gas, farts (and what extra-smelly farts mean) and the digestive system in general are subjects discussed with reluctance and often a desire for privacy.

Fiber, carbohydrates and their effect on the functioning of your GI tract is a topic of particular nuance. I am speaking specifically of a family of carbohydrates known collectively as FODMAPs and their relationship to IBS (irritable bowel syndrome), SIBO (small intestine bacterial overgrowth), dysbiosis (an imbalance in your gut flora, of which SIBO and IBS are examples)  and other dysbiosis-associated disorders (inflammatory bowel disease, celiac disease).

FODMAPs is an acronym for Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols.

This is nothing more a fancy, scientific sounding way to say that certain carbohydrates are gas causing, especially to a dysbiotic or imbalanced gut flora. Excess gas creates distension, bloating, pain, and of course, farts, sometimes particularly foul smelling ones.

FODMAPs are found in a wide variety of foods in a seemingly random way. They are found in foods that are very healthy and otherwise excellent for supporting the optimal functioning of the digestive system.

nfortunately, for many people, foods high in these FODMAPS create a myriad of unpleasant symptoms which can include increased belching and lower gas, indigestion, bloating after meals, bloating that gets worse throughout the day and an upset stomach.

There is an ever-growing body of research that suggests that eating foods that are lower in FODMAPs and minimizing high FODMAP foods provides a lot of symptomatic relief for IBS, SIBO, ulcerative colitis and Crohn's disease. More simple sounding conditions and other functional bowel disorders like chronic constipation can also be relieved by a low FODMAP approach.

In these circumstances, and for those whose symptoms are persistent and unabating, a four to six week low FODMAP diet is warranted to determine if it helps symptoms.

If it does, you now have a tool to help control your symptoms. This is great to know for your own comfort as well as for if/when you travel or have social obligations that you otherwise may dread.  The very fact that this approach helps your symptoms also gives you a clue into at least one factor that is contributing to them, namely an imbalance in your microbiome.

Elimination-challenge diets will give you an enormous amount of data about yourself. Foods are not restricted simply due to the fact that they are on a list or you read it on the Internet. Foods are eliminated and then challenged in order to acquire knowledge, to learn!

FODMAPs, as you may have noticed, have several categories (monosaccharides, disaccharides, etc). While at first it may be confusing and disorienting, it presents a way for you to be particularly nuanced within the challenge phase. 

After foods are eliminated/greatly reduced for 4-6 weeks, they are strategically introduced one at a time, with time in between, to assess the impact they have on YOUR BODY.

With FODMAPs, there are 2 distinct patterns that generally emerge:

1.       Those people who may not be sensitive to all FODMAPs, just the ones in particular groups. An example of this would be someone who is sensitive to lactose, a common disaccharide. They are likely reactive to other disaccharides as well.

2.       There is often a dose-dependency response. For example, perhaps you could have 2-3 spears of broccoli (which contains high amounts of oligosaccharides), but not a whole serving of it.  You can begin to assess your own level of tolerance of foods, which will give you far more confidence.

Taking the time to strategically incorporate FODMAP containing foods after reducing them lets you tease out the nuances of what types of foods are going to create or worsen your symptoms. This is something that you want to know. This is your golden nugget.

Some examples of the foods contained within the categories of FODMAPs are:

Oligosaccharides

Broccoli, beets, cauliflower, Brussels sprouts, artichoke, asparagus, onion, garlic, many types of beans, cashew, pistachio, wheat, barley, rye.

Oligosaccharides are sugar molecules with multiple strings of sugar. Fructans are an example of this.

Disaccharides

Milk, ice cream, cream, cream cheese, mozzarella, cottage cheese, ricotta.

Disaccharides are two sugar molecules linked together. Lactose is a common example.

Monosaccharides

Apple, mango, pear, watermelon, cherries, figs, and blackberries.

Monosaccharides are single sugar molecules. Fructose is a common example, and thus fruits and other foods that are high in fructose are also high FODMAP.

Polyols

Avocado, apple, cherries, cauliflower, bell pepper, sweet corn, maltitol, xylitol, mannitol, sorbitol.

Polyols are sugar alcohols. If you ever are curious about the power of polyols, you might find it interesting to peruse the reviews for the no-sugar gummy bears on Amazon. They are made with maltitol (sugar alcohols are, in theory, suitable for diabetics as they do not significantly raise blood sugar levels but this is limited to those who can tolerate them, and who don't exceed the serving size). Buyer beware when consuming maltitol.

A glance through these short lists reveals many foods that are often touted as high fiber (and they are!) and excellent for digestive health (and they are for those with healthy gut flora and a balanced microbiome). 

You may, perhaps have a completely different experience of these foods. They may feel like they tear you up inside. Create symptoms. That is when you want to consider a trial of a low FODMAP diet followed by a challenge. And, of course, begin to rebalance your microbiome.