What are FODMAPs? Are they the key to HEAL

• What are FODMAPs? Are they the key to HEAL IBS?

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What are FODMAPs?

FODMAPs are an acronym for the sugars from foods that are short-chained carbohydrates that are fermentable, and poorly absorbed in the gut. If you haven’t heard the term “FODMAPs” thrown around at work or at the gym lately, you probably will soon enough.

Essentially, FODMAPs are specific sugars found in food; such as fructose, lactose, fructans, galactans, and polyols. Because they are not absorbed completely by the human body, they are easily fermented by gut bacteria, and can cause significant gastrointestinal (GI) problems.

Dr. Sue Shepherd, the founder of the low FODMAPs diet, describes it this way,

“These are complex names for a collection of molecules found in food, that can be poorly absorbed by some people. When the molecules are poorly absorbed in the small intestine of the digestive tract, these molecules then continue along their journey along the digestive tract, arriving at the large intestine, where they act as a food source to the bacteria that live there normally. The bacteria then digest/ferment these FODMAPs and can cause symptoms of Irritable Bowel Syndrome (IBS).”

Understanding IBS & FODMAPs

IBS affects more than 10% of the world’s population. FODMAPs has been shown to not only take the burden off the digestive system but also greatly reduce the symptoms of IBS. This low FODMAPs diet has brought much needed hope to millions of people because IBS is such a common, complicated disease. Here are some important facts that I have learned about IBS from an article that published in the journal Clinical Epidemiology last year: (1)

• Younger women are most at risk, and people over 50 are 25% less likely to be affected.
• Only 30% of people with IBS will consult a physician for treatment, which tells us that there is a huge group of people out there that are suffering with IBS and have no idea how to treat it because they don’t even know what they’re up against!
• It’s important to realize that these people aren’t steering clear from the doctor because they don’t want help, but because they are confused. According to the study, undiagnosed IBS patients “do not have significantly different abdominal symptoms to those who do consult, but they do have greater levels of anxiety and lower quality of life.” The symptoms of IBS are hard to diagnose because they are so similar to common digestive symptoms.
• Also, even though people are not likely to die sooner because of it, “Patients diagnosed with IBS are highly likely to have other functional diseases and have more surgery than the general population,” which could indirectly lead to higher mortality rates and other sickness and/or disease.

Typically developing symptoms like abdominal pain, bloating, gas, and altered bowel habits (ranging from constipation to diarrhea) indicate IBS; however, the primary cause of IBS has been unknown, which has added to its mysterious nature. (3)

For the past several years gluten has become a common scapegoat for IBS as it has been a growing treatment or approach for all bowels and digestive issues, but this approach is not always necessary or appropriate for every IBS sufferer. (4)

One of the first articles to question the gluten theory was published in the journal Current Allergy and Asthma Reports by Australian researchers who made some serious waves with their 2013 study, “Is Gluten a Cause of Gastrointestinal Symptoms in People Without Celiac Disease?”

After repeating a randomized control trial that appeared to suggest gluten made GI symptoms worse, the Monash University scientists were unable to confirm that, “Patients with self-perceived NCGS [non-celiac Gluten Sensitivity] have specific gluten sensitivity.” (5)

Which means that many people that believe they are gluten-intolerant may actually be suffering from other GI issues related to FODMAPs and not specifically gluten.

Next thing you know, this study went viral and FODMAPs were put on the map!

The foundation of this study not only invalidates the very existence of non-celiac gluten sensitivity(NCGS), but also suggests that another agent is responsible for the symptoms that people experience after eating gluten-containing foods.

For years, we have filled our pantries with ancient grains like quinoa and gluten-free products, and have painstakingly transformed the way that we approach food to avoid the wheat protein that now has (supposedly) virtually no effect on our health! For some this has been devastating life change, and for others just a minor annoyance.

More research is still needed, and the jury is still out, so don’t go throwing away your gluten-free lifestyle just yet! As research continues to shed light on this topic, there is still good reason to avoid wheat and most grains. Instead of just focusing on going gluten-free, however, you may want to look at adopting a low-FODMAP diet.

Low FODMAPs Diet to Treat IBS & SIBO

The same Australian researchers that were unable to prove that specific gluten sensitivities existed set out to discover the real cause of GI complaints, and feel confident that the culprits are Fermentable, Oligo-, Di-, Monosaccharides, and polyols; more commonly known as “FODMAPs.” (6)

The team took 37 patients with NCGS and irritable bowel syndrome (IBS) and conducted a double-blind cross-over trial where they all were given a reduced FODMAPs diet, and then randomly assigned each person to one of three groups: high-gluten, low-gluten and a control diet where no gluten was provided for 2 weeks. The results were quite astounding: (6)

• GI symptoms consistently and significantly improved during reduced FODMAPs intake for all participants.
• Every person experienced significantly worse symptoms when gluten or whey proteins were reintroduced into their diet.
• Only 8% of participants suffered from gluten-specific effects.
• GI issues linked to gluten were not reproduced.

A 2014 study published in the journal Gastroenterology discovered similar results. Testing to see how the typical Western diet fared against one low in FODMAPs, the researchers took 30 patients with IBS and 8 healthy people who acted as the “control group” and randomly separated them into two groups for 21 days: one that ate less than 0.5 g of FODMAPs per meal and one that ate “regular” food. (7)

The participants rated their daily symptoms on a 0 – 100 scale and at the end of the 3 weeks reported an average 22.8 score compared to the 44.9 that came with the typical Australian diet. Literally cutting their usual bloating, gas and abdominal pain by 50%, just think what this can mean for people suffering from IBS all over the world!

Allison Siebecker, ND, MSOM, L.Ac has seen similar results in her practice regarding small intestinal bacterial overgrowth (referred to as SIBO); a condition defined as “the abnormal growth in the small intestine of bacteria that are normally found only in the colon.” (8)

Intimately connected, SIBO oftentimes cause symptoms very similar to IBS and is involved in the disease processes that cause IBS. In turn, IBS has actually been shown to cause SIBO. (8)

Essentially designed to restrict food sources for harmful bacteria, which are primarily carbohydrates, Dr. Siebecker advises that the “established SIBO treatment diets are the Specific Carbohydrate Diet (SCD), the Gut and Psychology Syndrome Diet (Gaps Diet), the Low Fodmap Diet (LFD) or a combination of these diets such as SCD + LFD.” (9)

To get control of their symptoms without the use of drugs or undergoing surgery, Patsy Catsos, MS, RD recommends that a FODMAP elimination diet be done for 2 weeks. (10)

Then she recommends re-challenging your body with one FODMAP item at a time, until you get to the final diet that includes all the foods that are well tolerated. Anyone with IBS and SIBO will be able to nail down the triggers and get their situation in control within a relatively short period of time.

The hope that this provides patients with IBS and SIBO cannot be overemphasized. I cannot begin to tell you how many times people have asked me why their GI problems didn’t go away after cutting out gluten.

Now that I am recommending a low FODMAP approach in these cases, we’re starting to see some amazing results!

LOW FODMAPs Diet: Food Lists

FOODS TO AVOID:

According to Stanford University Medical Center, foods rich in FODMAPs are:

• Fructose – fruits, honey, high fructose corn syrup, etc.
• Lactose – dairy, or products with added lactose.
• Fructans – wheat, garlic, onion, inulin etc.
• Galactans – legumes such as beans, lentils, soybeans, etc.
• Polyols – sweeteners containing isomalt, mannitol, sorbitol, xylitol, stone fruits such as avocado, apricots, cherries, nectarines, peaches, plums, etc.

It’ll take some getting use to, but don’t worry; in no time flat you’ll be a veritable expert at avoiding poorly absorbed short-chain carbohydrates! Keep in mind that the point of this diet is to limit products that ferment in your stomach, NOT to avoid probiotic-rich fermented foods. This would be a major mistake because fermented veggies and raw dairy are mainstays of the GAPS protocol.

FOODS TO INCLUDE:

Foods low in FODMAPs include: (11, 12)

VEGETABLES

• Alfalfa/bean sprouts
• Bamboo shoots
• Bell peppers
• Bok choy
• Cabbage
• Carrots
• Chives
• Choy sum
• Cucumbers
• Green beans
• Fresh herbs
• Kale
• Lettuce and salad greens
• Parsnips
• Potatoes
• Pumpkin
• Radishes
• Spinach
• Squash
• Tomato
• Turnips
• Water chestnuts
• Zucchini

FRUITS

• Banana
• Blueberries
• Cranberries
• Grapes
• Mandarin
• Melon (cantaloupe, honeydew)
• Lemon
• Lime
• Orange
• Passion fruit
• Pineapple
• Rhubarb
• Strawberries
• Tangerine

DAIRY & MILK/ALTERNATIVES

• Raw hard cheese (cheddar, Colby, parmesan, Swiss, etc.)
• Almond, coconut or rice milk

MEAT & PROTEIN SOURCES

• Eggs
• Grass-fed beef
• Grass-fed lamb
• Wild-caught fish
• Free-range chicken
• Free-range turkey
• Tempeh

BREADS, GRAINS, & SNACKS

• Gluten-free breads
• Gluten-free oats
• Gluten-free pasta
• GMO-free corn
• GMO-free rice
• Quinoa
• Sourdough spelt

NUTS & SEEDS (Sprouted or Nut Butters Preferred)

• Macadamia
• Organic peanut
• Pecans
• Pine nuts
• Pumpkin seeds
• Walnuts

SEASONS & CONDIMENTS

• Cooking oils (avocado, coconut, grape seed)
• Grass-fed butter
• Jams/jellies
• Maple syrup
• Mayonnaise
• Most herbs and spices
• Mustard
• Olives
• Pesto
• Pickles
• Relish
• Salsa
• Salad dressings (homemade)
• Soy sauce
• Vinegar

FOODS TO LIMIT:

Additionally, some foods are considered to contain a moderate amount of FODMAPs, so it is recommended to limit serving sizes:

FRUITS

• 1⁄4 avocado
• < 3 cherries
• 1/2 grapefruit (medium)
• 1/2 pomegranate (small)
• 1/4 cup shredded coconut
• < 10 dried banana chips

VEGETABLES

• 1⁄4 cup artichoke hearts (canned)
• < 3 asparagus spears
• < 4 beet slices
• < 1⁄2 cup broccoli
• < 1⁄2 cup Brussel sprouts < 1⁄4 cup butternut pumpkin
• < 1 cup cabbage (savoy)
• < 1 celery stick
• < 1⁄2 cup green peas 3 okra pods
• < 10 pods snow peas 1⁄2 corn cob
• < 1⁄2 cup sweet potatoes

NUTS

• Almonds (< 10)
• Hazelnuts (<10 b="">

As you can see, this diet is similar to conventional gluten-free diets, but with an added twist Going FODMAP-free doesn’t have to be a headache, though. Just like the transition it took to go gluten or dairy or sugar free, it just takes some planning, you can even purchase a low FODMAP diet app for your smartphone!

Have you tried the low-FODMAPs diet? Did it help your IBS symptoms?