FODMAPS

There's a whole slew of buzz words and nutritional protocols relating to our digestive troubles, or #guthealth as we prefer to delicately phrase it, being thrown around these days. I'm sure you have heard of, or perhaps you struggle with some of these – Coeliac disease, gluten intolerant, dairy intolerant, wheat free – and these are very real medical conditions for many.  

One you may not have heard so much about, is FODMAP-Free, or a Low-FODMAP diet, which is gaining popularity as a way to alleviate the shitty side effects of poor digestion. 

The protocol, developed by researchers at Monash University recognises that the most effective way to alleviate IBS symptoms is to avoid foods that contain high levels of a family of carbohydrates known as FODMAPs, due to their poor absorption in the digestive tract. 

Irritable Bowel Syndrome

Currently, one is seven adults suffer from Irritable Bowel Syndrome (IBS), the condition which is characterised by a collection of symptoms including gastrointestinal wind, abdominal pain, bloating, constipation and diarrhoea. Whilst IBS in itself is not dangerous, the symptoms can be bothersome and frustrating, especially for those who suffer from more severe cases in which symptoms begin to significantly negatively affect their everyday life and cause distress. 

So What Is A FODMAP?

FODMAPs are a large group of dietary sugars which recent dietary research concludes trigger IBS and diet sensitivity triggers. The acronym stands for - Fermentable, Oligo-saccharide, Di-saccharide, Mono-saccharide and Polyols which are all carbohydrate molecules which can be poorly absorbed by the small intestine and fermented by bacteria to produce excess gas and the resulting symptoms of IBS. 

The Process Of Digestion

For you to understand how this really works, you need to consider how food is digested & absorbed by the body; so a little revision on the digestive process of the body.

The small intestine is responsible for the breakdown and absorption of nutrients from foods, while the large intestine's role is to absorb water and prepare undigested food for removal (as faeces) from the body. During passage through the large intestine, undigested food is fermented by the bacteria residing in the area, which results in the production of gases.

When we look at the digestion of FODMAPs, once digested, high FODMAP level foods are broken down chemically into short-chain carbohydrates, which are then malabsorbed – either poorly or not at all. This malabsorption can have an osmotic effect in the gut – that being they drag water into the intestine – which can contribute to diarrhoea in some people. Then the undigested molecules pass into the large intestine, where they are readily fermented by colonic bacteria which generate gases, leading to excess wind, bloating, discomfort and/or abdominal pain. These dual actions cause an expansion in the volume of intestinal contents, stretching the intestinal wall and stimulating an array of nerve endings in the gut. Additionally, for some individuals, the excess gas production may slowly move through the bowels – leading to constipation.

The FODMAPs

So we know what these FODMAPs can do, but where do we find them in our general diets? Here are the individual carbohydrate groups and some of their common trigger high FODMAP sources. 

Fermentable 

The process through which gut bacteria degrade undigested carbohydrate to produce gas.

Oligo-Saccharides

Galacto-oligosaccharides

Found in legumes & pulses.

Fructo-oligosaccharides

Found in wheat, rye, onions, garlic, artichoke, asparagus, beetroot, leek, brocoli, brussel sprouts, cabbage, fennel.

Disaccharides

Lactose

Found in milk & milk products.

Mono-Saccharide

Fructose (in excess of glucose)

Found in certain types of fruits; such as figs, guava, mango, watermelon, pears, dried apple, dried apricots, sultanas, raisins, honey & high fructose corn syrup

Polyols

Sugar Polyols - Such as Sorbitol & Mannitol

Found in some fruit and vegetables; particularly stone fruits, apples, apricots, avocados, blackberries, cherries, lychees, peaches, pears, prunes, watermelon, cauliflower, mushrooms, mange-tout.  Often additionally added as artificial sweeteners such as xylitol, mannitol, sorbitol, isomalt.

The FODMAP Protocol

From the research gained measuring the FODMAP content in food, the Monash University team developed a simple system which indicates the level, from the low to high, of FODMAPs in the extensive database, which can be used to alert individuals if a certain food may trigger symptoms when digested.

This research resulted in an application which utilises a traffic light system, according to serving sizes, which clearly depicts the level of FODMAPs in certain foods, and in what dosages may this food be tolerated. Foods in red are high, and should be avoided, orange are moderate and may be tolerated by some people and green are low in FODMAPs and should be fine for consumption by most. The addition of serving sizes, demonstrates that a small dosage may be okay for the individuals, but the increase of size may elicit a response, which takes the guess work out of how much consumption may be fine. 

From this application and research, comes a system by where individuals can test which high FODMAP foods triggered their symptoms or which low FODMAPs they could tolerate, so that they know which sources to avoid and in what doses, in order to reduce the severity of their symptoms. 

Generally, this involves following an elimination diet, whereby under the guidance of a trained dietician, the individual will remove all sources of high FODMAP foods from the diet and note any side effects. From this state of elimination, slowly one group of the FODMAPs will be re-introduced to see if they trigger any response in the body. If symptoms reappear, then this is a sign that this group may be neccessary to be avoided in the future. Once you have worked your way through all of the FODMAP groups, individuals will often find a list of foods that spark symptoms and are known as "trigger" foods (generally high FODMAPs), or they find certain foods are fine and do not elicit any response (generally low FODMAPs). 

It is important to note, the aim is not to stay on the elimination diet for an extended period of time,in fact, recent research has shown that following a strict low FODMAP diet for an extended period of time can reduce levels of certain beneficial bacteria in the gut, rather it is a way to find what high FODMAP trigger foods may need to be reduced in the diet. 

Top Tips For Trialling A Low FODMAP Diet

See A Dietician

This is a medical condition, not a guise for "clean-eating" and as such it is not something to undertake on your own. It is super important to have a professional assess, guide and support you, not only to make sure you are taking the correct action for your short and long term health, but to ensure you have professional advice along the journey. 

Download The Monash University Low FODMAP Diet App

This is absolute key for understanding and following a FODMAP protocol. Not only is it packed out with research and resources (including meal inspiration ideas), it is an efficient tool for when you are on the go and need a reminder of what foods may trigger symptoms. Simply type in the food and it will flash up in the traffic light system so you can understand the level of FODMAPs present. 

Be Prepared

Eliminating and then reintroducing trigger foods into your diet may cause some uncomfortable side effects. It is probably best to not try and undertake this process at a highly stressful time of your life and try to incorporate space into your schedule for some extra rest and recovery. 

Become A Home Chef

Eating out becomes a skilled art when following a FODMAPs diet and can become exceptionally tiresome, particularly if you face the common exclusion of onion and garlic! A beneficial process around this is learning to cook nutritious, FODMAP friendly meals at home (check out #fodmapfriendly  for loads of inspiration) where possible and being organised to prep your meals, so as to follow your plan efficiently. 

Be Gentle With Yourself

When addressing any aspect of your nutrition it is important to place your health at the fore and be gentle on yourself. You may not feel great at certain points and it is important to maintain, or implement, a strong self-care ritual, which may include relaxation, rest and/or exercise to ensure you stay connected and checked-in to your body and mind.