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Low FODMAP Diet for Irritable Bowel Syndrome
What are FODMAPS?
“FODMAP” is the acronym for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols, a group of short-chain carbohydrates and sugar alcohols (polyols).
These nutrients are ubiquitous in the diet. The key FODMAPs are:
• Oligosaccharides, such as fructans/fructo-oligosaccharides (found in grains and vegetables) and galactans/galacto-oligosaccharides (found in legumes)
• Disaccharides, such as lactose (found in milk)
• Monosaccharides, such as fructose (found in fruit)
• Polyols, such as sorbitol (found in sweetened products)
WHAT EFFECT DO FODMAPS HAVE IN THE DIGESTIVE SYSTEM?
Susceptible people can experience intestinal symptoms from ingestion of FODMAPs for a number of reasons.
• The carbohydrates are not well absorbed into the body and remain in the digestive tract for longer periods.
• FODMAPs draw water into the intestines, which can increase bowel motions and promote diarrhoea
• These carbohydrates can be metabolised by the bacteria that normally reside in the bowel, producing gas, bloating and wind.
To determine if FODMAPs might be contributing to your symptoms, the most effective strategy is to eliminate all FODMAP-containing foods and observe your symptoms. Following the elimination of all FODMAPs, the next step is to complete systematic rechallenge one-by-one of each FODMAP to help determine the tolerable doses and types of FODMAPs for you.
It is not generally recommended that you follow a low FODMAP diet for life; restricting dietary intake of a wide array of foods should generally be avoided if possible to reduce the risk of nutrient deficiencies.
FODMAPs are a normal part of the diet and have benefits for health, such as providing fibre and prebiotics for gastrointestinal health.
HOW TO EAT A LOW FODMAP DIET – ELIMINATION PHASE
To trial the low FODMAP diet, all high-FODMAP foods need to be eliminated from the diet for at least two weeks, until there has been a significant reduction in symptoms. Relevant symptoms should be monitored and recorded (using the diary in Appendix A) on a daily basis, to track any benefits from the dietary program.
Table 1 gives a detailed list of foods in each FODMAP category that should be avoided. Where quantities are given, these foods should be avoided only above the given dose. Many alternative foods can be consumed whilst following a low FODMAP diet. Table 2 provides a list of suitable foods which can be enjoyed.
THE LOW FODMAP DIET - REINTRODUCTION PHASE
The reintroduction phase may be commenced after two weeks in the elimination phase, when some significant resolution of symptoms has been achieved. The goal is to systematically reintroduce each FODMAP to determine the level of individual FODMAP consumption that can be comfortably tolerated.
A five week program for the reintroduction phase is outlined in Table 3. Each week, one specific carbohydrate type is trialled, with a serving consumed on three separate days. Symptoms are monitored (using the diary in Appendix A) for 48 hours after each dose to determine if there is a possible reaction to that carbohydrate. If you believe there is no reaction over the following 48 hours you can continue with the next dose of that carbohydrate.
If you experience a worsening of symptoms following the reintroduction of a specific FODMAP, then it is recommend to discontinue trialling that FODMAP and wait until symptoms resolve. Once the symptoms have resolved you can move onto the next type of FODMAP to trial.
All other FODMAP sources should continue to be avoided for the duration of the five week reintroduction phase, even if a particular FODMAP appears to be well tolerated from the rechallenge. Small doses of individual FODMAPs may have an additive effect which makes it difficult to determine the individual cause.
CREATING YOUR INDIVIDUALISED LOW FODMAP DIET
For the FODMAP types which aggravated symptoms, it is recommended you continue to avoid, or significantly restrict, foods containing these FODMAPs in your diet. Table 1 provides a list of the foods grouped by FODMAP type to be used as a reference for continued avoidance. Your practitioner may be able to assist to improve your tolerance of FODMAP containing foods over time.
For more information contact us on 07 83 83 83 2