What is Low FODMAP & How Can We Embrace It?

The first thing to know about Low FODMAP is that it is an Australian invention and now recognised around the world. The low FODMAP diet was developed by Dr Peter Gibson and Dr Susan Shepherd at Monash University in the early 2000s and first published in research in 2006. This dietary therapy has revolutionised the treatment for conditions like Irritable Bowel Syndrome (IBS) globally. This is just another example of exciting scientific research and development happening in Australian universities. What is low FODMAP and how can we embrace it? To begin with FODMAPs are short-chain carbohydrates, which are resistant to digestion in the small intestine. These carbs end up in the large intestine with your gut bacteria ferment them for fuel and can cause lots of wind and disruptions to your digestive system. IBS type symptoms are often the result for many individuals (Mansueto, 2015).

What Are Common FODMAPs?

Some of the common FODMAPs are fructose, lactose, fructans, GOS, and polyols. Many people will know that fructose is a simple sugar in fruit and vegetables. Lactose is a carbohydrate present in dairy foods such as milk, yoghurt and cream, and related products. Fructans can be found in grains like wheat, rye, barley, and spelt. GOS are generally present in many legumes such as lentils, chickpeas, lima beans, and many other legumes and pulses. Polyols are sugar alcohols like xylitol, sorbitol, maltitol, and mannitol, which are found in some fruits, vegetables, sugar free gums and low carb or protein bars (Gunnars, 2018).

What does FODMAP stand for?

FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. This is a bit of a mouthful, and I can understand why they shortened it. It would be a challenging mission to sell this dietary therapy to the world without the handy edition utilising the acronym (Catassi, 2017). The fermenting takes place when the FODMAPs reach your colon and your gut bacteria feed on them. Methane and hydrogen are produced via this process, which can lead to farting, bloating, belly cramps, pain, and constipation. Some FODMAPs may also have an osmotic effect, drawing water into the bowel, which can lead to diarrhea.

The modern human being lives inside his or her head. By this I mean within an intellectual conception of themselves. It is pretty difficult to maintain this artifice when one is serial farting and battling to keep control of their bowels. IBS is a confronting and debilitating condition, which makes living a ‘so called’ normal life an impossible task to achieve.

Discovering the low FODMAP Diet

The low FODMAP diet, as we have learned was created by Australians’ Dr Peter Gibson and Dr Susan Shepherd. These two were responsible for the team from Monash University, which researched and developed an understanding of IBS and a dietary therapeutic response to it. The basis being that FODMAPs are poorly absorbed, and they cause a raft of digestive issues in reaction to them. What to do about this problem? The low FODMAP diet, which is a temporary-eating plan that restricts the consumption of foods containing FODMAP sugars. Please note the use of the term ‘temporary’ in this description of the low FODMAP diet. It is not a permanent diet. Instead, it is a process that is used to determine a person’s individual thresholds and tolerances so they can minimise their IBS type symptoms while achieving maximum food variety.

Harking back to the fact that most of us live inside our minds from the neck up, so to speak. We similarly like to think of ourselves as static entities remaining in a perpetual status quo. Ideas and conceptions about things are not real. Therefore, our fixed ideas about what we like to eat, and drink are not agile and responsive to the living reality of our ever-changing lives. Our desperate desire for security and certainty sends us down this cul-de-sac or dead end. Our health is best served by a diet that remains flexible to the needs of our body. I remember my constant reminders to my children with regard to their eating preferences in response to the familiar “but I don’t like such n such.” I would say, “kids your body is constantly growing and changing, give it a try because you may now like it.” Sometimes this worked and sometimes it went down like a lead balloon. The important premise here is that this remains true not just for children but through our entire lives. Eating a varied diet and not the same old things every day is vital to your good health.

Understanding the low FODMAP Dietary Therapy

It is a 3-step plan. This 3 stage dietary intervention removes, reintroduces, and retrains. Thus, this is not a life sentence straight off the bat. Many people have psychological reactions to dietary therapies because they strongly identify with their existing diet. The old ‘I am what I eat’ conception. The low FODMAP diet is a 2-6 week programme. It is, also, a highly personalised plan and not a one size fits all approach to dietary therapy. Studies and meta-analysis reviews have found that 50% to 80% of IBS patients have had a clinically meaningful response to the low FODMAP diet (Hill, 2017). In fact, dietary therapy is the primary treatment for those with Irritable bowel syndrome globally. The first stage of the low FODMAP diet is identifying the high FODMAP foods from your diet and their replacement with low FODMAP alternatives. Immediately, the individual undergoing the therapy is challenged to see this as a glass half-full opportunity rather than a glass half-empty situation. Working with a FODMAP trained dietitian is essential at this time to prevent unnecessary over restriction and keep the focus on what you can eat. Thankfully we now have a range of specialty products available in supermarkets, making it much easier to follow a low FODMAP diet than it was 20 years ago.

The Monash FODMAP App

There is even a Monash FODMAP App to help you navigate your food choices. This utilises a traffic light system, where red identifies high Fodmap foods, amber the moderate ones, and green the low Fodmap alternatives (Monash, 2019). This innovative use of technology on your phone or tablet takes all the legwork out of finding dietary alternatives for between 2-6 weeks. In the past, criticism of the low FODMAP diet was based on the complexity of working out which foods you could and could not eat. Now, this is a thing of the past and it is so easy with the app to check on foods whilst shopping at the supermarket and grocers.

Get the App https://www.monashfodmap.com/ibs-central/i-have-ibs/get-the-app/

If your digestive issues are improving after 2-6 weeks on the low FODMAP diet, then, it is time to move onto the phase 2. If they are not and you have strictly adhered to the diet for the defined period it may be that your IBS symptoms are not related to FODMAPs and may be caused by something else like stress. Check out the article titled “Irritable Bowel Syndrome: A Local Allergy Response to Histamines” for more detailed information directly about IBS and effective treatments. At this time, a specialised dietitian can also help you troubleshoot by assessing your diet for sneaky FODMAPs or identify if a different approach is more suitable.

Stage 2 of the low FODMAP Dietary Therapy

In stage 2, the low FODMAP diet is continued but you begin a series of FODMAP challenges to discover which FODMAPS you can tolerate, and which ones you have a threshold for and are involved in triggering your IBS symptoms. Thus, this is a narrowing down process by eating foods rich in just one FODMAP group in increasing serve sizes for 3 days. By observing your body’s response to this regime and recording your symptoms or their absence valuable data is discovered. A FODMAP dietitian and the Monash FODMAP App are the best resources to assist you in identifying these kinds of foods which are predominantly rich in only one FODMAP group. An example is milk, which is high in lactose, but in no other FODMAP group. You can read more about introducing lactose here. Then, you are encouraged to move onto foods with 2 FODMAP groups like apples, pears, some legumes and wheat products. There is also a diary within the app for recording your responses to the reintroduction challenges.

The Third Stage of the low FODMAP Plan

In this, the third phase of the dietary therapy individuals are working toward relaxing dietary restrictions and developing a personalised FODMAP diet. We are all unique and have a unique microbiome within us. More foods are reintroduced into the diet where that goes well, and poorly tolerated foods are restricted to a level, which offers symptom relief. Repeating FODMAP challenges over time is recommended, as tolerances and thresholds can change over time. There are no hard and fast rules in the low FODMAP diet. It is all about finding your own personalised dietary plan going forward. It is recommended to engage with the low FODMAP diet under the guidance of a dietitian who has trained in managing IBS or the low FODMAP diet for best results.

Outcomes of the low FODMAP Dietary Therapy

The most positive outcomes from undergoing the low FODMAP diet is a lessening of the symptoms suffered by those with IBS. The lessening of bloating, farting, diarrhea, constipation, and stomach pain will be a blessed relief for sufferers of the condition. The reduction of the associated mental stress from the lessening of these symptoms cannot be underestimated as well. Understanding more about your physical wellbeing and how your body functions is another very valuable outcome. You cannot outsource the responsibility for your health to others despite what the current system seems to intimate. Knowing oneself means knowing via experience the ins and out of your body. Our bodies are highly tuned colonies of cells and microorganisms working in concert. Getting to know your microbiome must become a top priority if you wish to operate without the debilitating symptoms of IBS. Eat more fibre is a useful mantra to remember. However, it is important to remember that not all types of fibres will be suitable for those with IBS. Some fibre types can in fact worsen symptoms. So, for those with IBS low FODMAP certified fibres are ideal options and the recommended fibre by Joanna Baker, an experienced FODMAP dietician, is Kfibre (www.kfibre.com).

Optimal living requires a lifestyle and diet suited to the physical reality of who you are and not some concept derived from unreal cultural aspirations. Walk the talk could become cut the crap in the age of the microbiome.

Authored by Sudha Hamilton

Sudha Hamilton is a natural health writer, historian, and chef. His published titles include House Therapy: Discover Who You Really Are At Home; Healing Our Wellbeing; and Sacred Chef.

Contribution by Joanna Baker APD, AN, RN

Joanna is a Dietitian & Registered Nurse who loves food. Her passion for digestive health stems from a lifelong battle with IBS which has taught her both how hard it is to live with an unpredictable gut and how life changing it can be when food sensitivities are well managed. Joanna is trained and experienced in the low FODMAP diet and food chemical sensitivities. She has worked in FODMAP testing with FODMAP Friendly and presented to dietitians around Australia as well as Chicago and Dallas in the USA on the low FODMAP diet and functional gastro-intestinal disorders. She is currently on the Food Allergy and Intolerance Interest Group committee with at Dietitians Australia and the advisory board for the Master of Dietetics at Deakin university. Most of all though, Joanna loves working with her team of dietitians at Everyday Nutrition where she supports people to manage their IBS and learn to enjoy food again.

REFERENCES

Catassi G, Lionetti E, Gatti S, Catassi C. The Low FODMAP Diet: Many Question Marks for a Catchy Acronym. Nutrients. 2017 Mar 16;9(3):292. doi: 10.3390/nu9030292. PMID: 28300773; PMCID: PMC5372955.

Gunnars.K, FODMAP 101: A Detailed Beginner’s Guide, 2018, https://www.healthline.com/nutrition/fodmaps-101. Viewed 22 August 2021.

Hill P, Muir JG, Gibson PR. Controversies and Recent Developments of the Low-FODMAP Diet. Gastroenterol Hepatol (N Y). 2017;13(1):36-45.

Iacovou M, Tan V, Muir JG, Gibson PR. The Low FODMAP Diet and Its Application in East and Southeast Asia. J Neurogastroenterol Motil. 2015 Oct 1;21(4):459-70. doi: 10.5056/jnm15111. PMID: 26350937; PMCID: PMC4622128.

Mansueto P, Seidita A, D’Alcamo A, Carroccio A. Role of FODMAPs in Patients With Irritable Bowel Syndrome. Nutr Clin Pract. 2015 Oct;30(5):665-82. doi: 10.1177/0884533615569886. Epub 2015 Feb 18. PMID: 25694210.

Rossi. M, A Beginner’s Guide to the Low-FODMAP Diet, Healthline, https://www.healthline.com/nutrition/low-fodmap-diet, Viewed 22 August 2021.

Shepherd. S, Low FODMAP Diet, https://shepherdworks.com.au/disease-information/low-fodmap-diet/, Viewed 24 August 2021.

“Starting the FODMAP diet”, Monash University, https://www.monashfodmap.com/ibs-central/i-have-ibs/starting-the-low-fodmap-diet/, 2019, Viewed 24 August 2021.

Veloso. H, FODMAP Diet: What You Need to Know, https://www.hopkinsmedicine.org/health/wellness-and-prevention/fodmap-diet-what-you-need-to-know,Viewed 25 August 2021.