18 Apr What’s the deal with FODMAPs?
The low FODMAPs diet seems to be everywhere at the moment, it’s something I get asked about a lot and it’s been touted by some as a cure-all for pretty much everything. Let’s have a look at where it’s come from and who it might help.
Where did it come from?
FODMAPs was developed by a research team at Monash University in Australia to treat irritable bowel syndrome (IBS). It’s based on the theory that cutting back on certain types of poorly absorbed, fermentable carbohydrates will improve gastrointestinal symptoms. It has been extensively trialled and has consistently been shown to improve symptoms of diarrhoea, bloating and abdominal pain.
As such it is now recommended as a second-line treatment for IBS in the UK, after ruling out any other potential nasties and trying out some less restrictive dietary changes.
What’s a FODMAP when it’s at home?
Nope, it’s not a map of your forehead. It stands for: Fermentable Oligo-, Di- and Mono-saccharides And Polyols.
Sounds sexy, I know. The ‘saccharides’ are types of fermentable carbohydrates which are found in foods – for example garlic, onions, peppers.. lots of stuff!
The fancy names simply describe the number of sugars in the carbohydrate. Let’s take lactose (milk sugar) as an example. It’s an example of a disaccharide (‘Di’ meaning ‘two’ in Greek) formed of one glucose bonded to one galactose.
A polyol is a type of sugar alcohol, found naturally in fruit and used as an artificial sweetener (manitol, sorbitol) the kind that you have in your chewing gum.
What does it involve?
Stage 1: The first 2-6 weeks involves excluding high-FODMAPs foods from your diet. This means excludes a ridonkulous amount of food and should be done with a dietitian to ensure you’re getting what you need in terms of nutrition. If you don’t have any improvement in your symptoms at this point, then FODMAPs isn’t likely to work for you.
Stage 2: Re-challenging with certain FODMAPs-containing foods, usually one type at a time. Carefully monitoring and recording any symptoms and discussing these with your dietitian.
Stage 3: Working with your dietitian, developing a personally tailored diet plan including foods that don’t worsen your symptoms and some foods that you can tolerate in certain amounts.
How does it work?
FODMAPs aren’t digested very well and so they can ferment in our gut, causing gas to build up. This happens to everyone and is part of the digestion process. The pain and discomfort that IBS sufferers experience may be due to an increased sensitivity to this bloating which non-sufferers don’t have or tolerate better.
The fibre and sugar alcohols found in FODMAPs can also cause water to be drawn into the gut. In people struggling with diarrhoea symptoms, this can sometimes make them worse.
How it can go wrong
FODMAPs can be a highly effective way to treat IBS. However, as it’s completely tailored to the individual it can be pretty hard to nail without support and guidance from a trained dietitian.
The aim of the whole thing is to reintroduce as many foods as you can; leaving you with a much less restrictive diet that helps you to manage YOUR symptoms. Continuing the restrictive part of the diet long-term can be dangerous – it not only leaves you at high risk of missing out on essential vitamins and minerals but also fibre which helps to keep your microbiota happy.
Some people are just being sent home from their GPs with a low FODMAPs leaflet and left to their own devices. This is not cool. It defies the whole point of the diet not to reintroduce foods, some people are left with that leaflet from their GP – have a quick glance at an app and have a massively restricted diet for a very long time.
Is it a cure-all for EVERYTHING?
Although hailed as a miracle cure for oh-so many things thesedays, a) isn’t for everyone and b) isn’t the only way. Although there is some research going on into the effectiveness of a low FODMAPs diet for inflammatory bowel disease, it’s currently only recommended for treating IBS symptoms.
A recent small study also compared the outcomes for treatment of IBS versus yoga – both had equally positive effects. This study again highlights the need for more research into our gut-brain axis; looking into how the way and manage our anxiety etc we feel affects our guts and vice-versa.
Do you need to be on FODMAPs?
It seems to be the next big ‘thing’ in dieting but I just want to to stress again that it’s only been recommended for use in treating IBS symptoms, under supervision from a trained healthcare professional.
Y’all know I’m against unnecessary diets and whilst FODMAPs might work for some people, it is also VERY restrictive and could easily lead to deficiencies. For people who’re chronic dieters and who might regularly look for new restrictive diets in the hope of improving their health – FODMAPs could seem to be very appealing. If you’re trying out FODMAPs for reasons other than IBS, make sure to check in with GP, Dietitian or other healthcare professional to make sure you’re not needlessly cutting loads of stuff out, that your reasons for doing it are… well, reasonable… and that you’re getting what you need from your diet.
Do you get a bit of bloating? We all do that. It’s your food digesting. Diet changes, stress and life events can cause digestive problems in everyone. Eating more fibre, fruit and veg etc can also cause these symptoms as our microbiota adjusts to these changes.
These symptoms shouldn’t last for very long though, and they shouldn’t affect your quality of life. If they do then the first stop should be to your GP to rule out any medical causes for your symptoms. If you do receive a diagnosis of IBS and are interested in FODMAPs then ask for a referral to a dietitian who’ll discuss the next steps and whether it’s the right fit for you.
If you’re interested in working with a private dietitian then a good place to start could be the Freelance Dietitians site – where you can search for a registered dietitian by speciality.