Low-FODMAP Diet: A New Fad?

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Back in 2009 (can it really be that long ago?), I wrote a short series on irritable bowel syndrome (IBS). IBS is a condition (not a disease) characterized by a number of symptoms including bloating, cramping, gas, diarrhea, and constipation. About one in five Americans has IBS, and having it can range from being mildly annoying to downright debilitating. There are different kinds of treatments available, including changing one’s diet, exercising, stress reduction, and medication.

A treatment from down under
People who have IBS will tell you that sometimes the above approaches work for them, and sometimes they don’t. Like dealing with diabetes, managing IBS is part art and part science. But thanks to researchers from Australia, a newer approach is available that may help the millions of IBS sufferers get a little more relief. This treatment, or approach, is called the “low-FODMAP diet.”

What are FODMAPs?
Most of you are probably already quite familiar with carbohydrate; at least, how carbohydrate affects blood glucose. There are different kinds of carbohydrates, including a group called fermentable short-chain carbohydrates. FODMAPs is an acronym for “fermentable, oligo-, di- and mono-saccharides and polyols.” This group of carbs is fermented, or used as food, by bacteria in the gut. Fermentation can cause those pesky symptoms of IBS, such as bloating, gas, and cramping or pain. FODMAPs pull water into the gut, which in turn, can cause diarrhea. Some people are more affected by these symptoms than others.

What foods contain FODMAPs?
FODMAP-containing foods are found just about everywhere. Here’s a short list:

• Milk and other dairy foods (lactose)
• Apples, pears, honey, molasses (fructose)
• Wheat, onions, garlic (fructans)
• Kidney beans, chickpeas, lentils (galacto-oligosaccharides)
• Prunes, apricots, cherries, sugar-free gum and candy (polyols)

In addition, combining a high-fructose food with a food that contains polyols, for example, can make IBS symptoms even worse.

What is a low-FODMAP diet?
If you have IBS and haven’t found much relief with other treatment approaches, consider a low-FODMAP diet. Like other diets out there, this type of a diet is somewhat restrictive. For this reason, it’s important to make sure you get a balance of nutrients for overall health. Cutting out milk and other dairy foods means that you need to get calcium and vitamin D elsewhere. This may include drinking lactose-free milk, eating certain types of cheeses, and/or taking supplements. Also, fiber intake may be low on a low-FODMAP diet, so it’s important to get fiber from “acceptable” foods such as oatmeal, rice bran, blueberries, and strawberries, for example. You’ll note that wheat isn’t allowed on this plan, so you’ll find many gluten-free foods to be helpful.

What do you eat on a low-FODMAP diet?
This diet can seem very restrictive, but there are a lot of foods that you can eat. Here are some examples:

• Vegetables: green beans, lettuce, cucumber, tomato, zucchini, carrots
• Fruits: banana, oranges, canteloupe, grapes
• Dairy foods: lactose-free milk and yogurt, rice milk, hard cheeses
• Protein: meat, poultry, fish, tofu
• Grains: rice, oats, and quinoa, plus gluten-free breads, pasta, and crackers
• Nuts and seeds: almonds, pumpkin seeds, walnuts, pine nuts, sesame seeds

Cooking with onion and garlic is a no-no but there are alternatives, such as chives and scallions. You can also cook garlic in oil and remove the garlic before eating.

Does a low-FODMAP diet work?
Unlike other types of diets out there, research shows that, first, people with IBS who eat high-FODMAP foods are more likely to have an exacerbation of symptoms than people who don’t. Second, in a 2011 study, a low-FODMAP diet improved symptoms in 86% of people compared to 49% in those eating a standard IBS diet. Studies in Australia and the UK have shown that the low-FODMAP diet improves symptoms in 75% of people with IBS. This dietary approach is now catching on in the US (previously, this approach had been met with some skepticism).

The low-FODMAP diet is somewhat similar to a gluten-free diet in that there truly is a list of “eat this, not that” foods. It’s best to work with a dietitian (and ideally, a gastroenterologist) who is familiar with this approach. You may need to ask several dietitians to find one who is versed in the low-FODMAP diet.

Other resources that can be helpful are The Complete Idiot’s Guide to Eating Well with IBS by Kate Scarlata, a dietitian who specializes in this area, as well as her blog. You can find a food list here.

Finally, if you have IBS and are still plagued by symptoms, talk to your doctor about the low-FODMAP approach.

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