The FODMAP diet is gaining traction on blogs, media and in the research studies. Does that mean that this newish idea could help everyone or is it another dreaded Fad diet?
Remember, over 100 years ago researchers thought carbohydrates were the biggest problem for people with digestive conditions. Recent studies are starting to show significant improvement (74%) in digestive symptoms using the FODMAP’s diet [1]. Based on that, I think the idea is worth a more in-depth look. So let’s start with a primer of what you need to know.
What is the FODMAP Diet?
Let’s start with the alphabet soup name: “FODMAP.” It’s a medical acronym for Fermentable, Oligosaccharides, Disaccharides, Monosaccharides and Polyols. Yummy right? The diet portion of the name is in reference to a sequence in which the foods with higher FODMAP content are removed and slowly added back in. First let’s figure out what those big words mean. Then I’ll tell you how they might be hurting you and how to avoid them.
F is for Fermentable – In this context the fermentation of these carbohydrates occurs either in the small or large intestine. In many cases, this is normal and happens in healthy people. But in people affected by IBS the fermentation causes more pain than normal. The theory here is in affected people a reduction in all fermentation will improve patient’s quality of life.
O is for Oligosaccharides –“Oligo” is a Greek prefix for having few or little and saccharide is another word for sugar. So this is a word that means short chain carbohydrates and in the case of FODMAPS, we’re talking specifically about fucto-oligosaccharides (fructans) and galacto-oligosaccharides (galactans). The fructans group is comprised of FOS and inulin. Glacatans are made up of Raffinose and Stachyose (mostly found in beans).
D is for Disaccharides –“Di” meaning two, saccharide = sugar. So it means two sugar molecules linked together. Interestingly, in the case of FODMAPs, researchers don’t believe all disaccharides are problematic, only lactose (milk sugar).
M is for Monosaccharides –“Mono” meaning one, this word is used to describe one basic sugar molecule. In the context of FODMAPs, researchers don’t implicate all monosaccharaides, only fructose.
And
P is for Polyols – Which is another name for sugar alcohols such as sorbiotiol, mannitol, xylitol and isomalt. These sugars are malabsorbed by everyone and are free to be fermented by bacteria where ever the bacteria find them. Even healthy people eating sugar alcohols can experience digestive problems.
I’m sure you’re thinking, “great but why do I care?” Well, it turns out researchers have found that these specific foods contribute to digestive problems like diarrhea, constipation, gas, pain and bloating.
How do FODMAP’s hurt us?
Simply put, researchers have isolated these foods as possibly hurting digestion because they all share one specific characteristic: they are poorly absorbed in the small intestine [2]. If they aren’t absorbed properly, then they can hang out too long in the intestines and become a feast for bacteria, which is where the “F” for fermentable comes into play.
As the bacteria ferment the nutrients, their waste products affect us. This can increase intra-abdominal pressure causing both stomach pain and reflux problems [3]. It is thought that some of their by-products activate a feedback loop that regulates gut motility, accelerating small bowel transit times [4]. There is also an increase in osmotic load (or more water delivered to distil small intestine and colon) due to the size of some of molecules [5].
The thought is that if we increase the speed, pressure and amount of water delivered to the colon it will cause more digestive problems. And with a 74% rate of success in people who stop eating these foods, it sure seems that for some people who have digestive problems this is extremely helpful idea.
Do you have FODMAP intolerance?
The researchers acknowledge that the FODMAP diet doesn’t cure anything but it can provide great symptom relief. So how would you go about determining if you’re someone who is reacting to FODMAPs? And could benefit from avoiding foods with higher FODMAP content? Test removing them and then add them back in.
At the core of our message here at SCDlifestyle is that every food should be tested. And foods containing higher amounts of FODMAPs are high on the list of foods that should be tested if you’re still experiencing digestive problems even after eliminating grains, starches, and sugars.
Step 1 in testing FODMAP intolerance is to removing foods with high FODMAP content, which includes:
Fruits: apple, apricot, avocado, blackberry, cherry, lychee, nashi, nectarine, peach, pear, persimmon, plum, prune, watermelon and dried fruits
Vegetables: asparagus, artichoke, beetroot, bell pepper, broccoli, Brussels sprouts, cabbage, cauliflower, eggplant, fennel, garlic, leek, mushroom, okra, onion, shallots, sweet corn
Sweeteners: honey, corn syrup, sorbitol, mannitol, isomalt, maltitol, xylitol
Legumes: all beans, chickpeas and lentils
Dairy: milk from cow, goat, sheep, custard, ice cream, yogurt, soft unripe cheese
Grains: wheat, rye, barley
Then wait 4-6 weeks and see how you feel…
Is the FODMAP diet a forever thing?
No. In fact, it wasn’t ever thought of as a long term solution. This is something that many people aren’t talking about. But Step 2 in this diet is to add the foods back into your diet. Here’s what one of the most recent studies in 2012 had to say:
“A trial of low FODMAP diet can be conducted. This is usually recommended for 4-6 weeks, following which, rechallenge of any of potentially well absorbed carbohydrates can be undertaken, that is, fructose, lactose, sorbitol and mannitol. Tolerance to fuctans and GOS [galactans] can then be tested.” [6]
Sounds like these researchers believe the same thing we do. That every food has the potential to harm depending on the health of the body or the quantity consumed. It’s worth noting that in my review of the FODMAP literature it was commonly referred to as a diet to provide symptom-relief, not curative.
I think they are learning what we have. That everyone has a custom diet and that diet will change depending on the health of the GI tract. In fact here’s another quote from that study:
“In addition, FODMAPs have prebiotic effects due to the production of short-chain fatty acids after fermentation. Therefore, all patients are encouraged to try and reintroduce FODMAPs to a level that they can comfortably tolerate.”
We know that short-chain fatty acids can be very beneficial to the colon. And there are many proponents of prebiotics to help with digestive disorders. But beyond that most of the FODMAP vegetables and fruits aren’t filled with toxins so they shouldn’t be labeled as bad foods.
Our Personal FODMAP Experiences
Personal experience can always trump theories. So at this point, I’m sure you’re curious to know if we’ve tested FODMAPs.
I noticed minor reactions to some higher FODMAP foods the first time I tried them. Onions, broccoli and cauliflower didn’t sit well at first. But a few weeks later, in smaller doses I used the same gradual introduction techniques we teach now and did just fine. I continue to handle them just fine.
Jordan was as FODMAP sensitive as they come his first year on the diet. In fact, he couldn’t even eat a cup of cooked broccoli. He couldn’t do garlic or onion either. Not even a small bit for flavor without noticing some violent reactions. Three years later he tolerates those foods just fine. I’ve even seem him mash several high FODMAP foods in one sitting like apples, asparagus and avocados.
So was it the FODMAP foods? Coincidental ? Something else?
The FODMAP Paradox
Paradoxically, many people will see short-term relief by removing high FODMAP foods. But, most can add those back only weeks later with no problems. So what is going on here?
In our experience, we think a few factors are at play. The first is the additive effect. If your diet contains small amounts of all these FODMAP foods eaten daily and then you cut them all out. It’s likely you’ll notice some relief but it’s also likely that you’d be able to eat some of those foods in small quantities each day and not have problems.
Instinctually we should know this (but I often forget it); after all it is universal to all foods, not just FODMAPs. We have an upper tolerance to everything we eat… Eat 10 bananas, 5 cups of broccoli or 10 cups of spinach and you’ll spend equal time on the toilet for each one of those transgressions. It seems in susceptible people that the tolerance is just lower for FODMAP foods.
The second factor seems to be gut health. After a wash out period removing high FODMAPS, high salicylates, and other toxic foods almost universally people’s tolerances to all food improves. Why? Maybe it’s the SIBO connection, gut flora rebalancing, pathogen killing or lowering the inflammation levels for a few weeks allows some healing to take place. I don’t think anyone can say for sure right now. But I believe the relative health of the gut is the most important factor in food tolerance.
In summary, if you think FODMAP foods might be triggering your digestive symptoms here’s how to find out.
Step1. Remove high FODMAP foods for 4-6 weeks and track your symptoms during this time
Step2. Re-introduce the foods using our 4-day rule for gradual re-introduction and track your symptoms.
In the future, we’ll explore how our gut flora changes in response to what we eat. But suffice to say, I think most people can handle FODMAPs if they are eating a low-toxin diet, their overall diet isn’t extremely FODMAP heavy and slowly introduce them.
Have you tested high FODMAP foods? I’d love to hear your experience below in the comments.
Steve
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[1] http://www.ncbi.nlm.nih.gov/pubmed/17000196
[2] http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1746.2009.06149.x/full
[3] http://www.ncbi.nlm.nih.gov/pubmed/22488077
[4] http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2006.03186.x/full
[5] http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2010.04237.x/full
[6] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3388522/
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{ 14 comments… read them below or add one }
When my GI told me I had severe gastritis and to come back to him every year for an endoscopy to check for stomach cancer, but because PPIs made my reflux worse and my colon was beautiful, he sent me to a nutritionist and suggested I also check in with a psychologist because he actually told me I was imagining and then causing my symptoms of reflux, bloating, gas, and diarrhea that occurred after every meal. First the nutritionist tried a slight reductions in my FODMAPs but that didn’t change my symptoms. Then, after seeing her a few times, we went on a major FODMAP elimination diet. The only foods I ate were fish, eggs, gluten-free low-fiber (i.e. no brown rice) grains, citrus, small amounts of blueberries, spinach, kale, carrots, bok choy, string beans, tomatoes, bell peppers, maple syrup, table sugar, and oil. That was it. For three weeks, I felt so much better. My near constant reflux was still there, but gas and bloating was minimal and I was down to one, occasionally two, formed BMs a day. The handout my nutritionist gave me listed these foods and at the bottom said that the complete elimination diet was not sufficient nutrient-wise and should only be followed for 1-2 months, at which point I could start adding back in slowly the nutrients I was missing. But she soon proved to be incompetent as a professional and I never heard from her again. And at the end of three weeks, the diarrhea came back in full force over the course of a few days. I chalked it up to PMS and waited it out but my symptoms stayed to the point where I was back to occasionally having BM accidents when the pressure of gas and bloating got to be too much. Even though my symptoms were still there, I stayed on the minimum FODMAP diet for a year until I went to a new GI and nutritionist. In fact, my symptoms had gotten so much worse. Early on in the FODMAP journey and before, if I had a bad day, I could fix it with either medication or eating nothing but white rice for a day, depending on which was easier. But now I noticed that white rice was having zero effect on how I was feeling and I felt like I was starting to feel even worse with corn flours and white potatoes. While they figured out my history and waited for bloodwork, the nutritionist suggested I return to a full diet since I thought I couldn’t feel any worse to see what would happen. Well, excited about summer fruits, I started eating half a stone fruit with breakfast or on a different day, having a small amount of eggplant with dinner, and various other things in small amounts, spread out. Like clockwork, these FODMAPs food that were hiding in my diet before with no clear connection to my symptoms, caused the most horrible gas I’d ever had (like, my dogs find it offensive, have to change my pants from the smell kind of gas). While I’d had episodes that bad before, they didn’t occur daily or within hours after a FODMAP meal and I used to eat a lot of bananas and onions at least once a day, among many other FODMAPs. So basically somehow after this year of FODMAP elimination, I’d made my body more sensitive, either by eliminating them or by having a diet that caused whatever damage the previous GI couldn’t find worse. So I went back to the no FODMAP diet and was diagnosed with SIBO. 2 months of metronidazole and probiotic/caprylic acid/oregano oil and supposedly I was cured of SIBO even though my symptoms hadn’t changed throughout. Reintroduce the FODMAPs and right back to bad gas. So the nutritionist handed me BTVC and said to keep this in the back of my mind because she still had a few things she wanted to try and she tried to keep SCD as a last resort kind of thing due to its restrictiveness. However, I’d first heard of SCD in my own research at least two years prior and it had been in the back of my mind since then. I always considered it restrictive but having spent the previous year following my no FODMAP diet with anaphylactic vigilance at home but also with friends and in restaurants, suddenly it looked gluttonous with choices. I started SCD right away. Fast forward to six weeks into the diet, and I’ve rearranged the phases to have all the high FODMAPs at the end. All my symptoms are decreasing, albeit erratically. The only FODMAPs I’ve introduced so far are bananas, avocados, and squashes (I never ate them before because I wasn’t supposed to be eating sweet potatoes on my no FODMAP diet and I always equated them as similar). I really and truly hope that I can reintroduce them because I told my nutritionist that the only way I considered SCD restrictive would be if I had to follow SCD with no FODMAPs. I can mentally handle doing small amounts of FODMAPs, but to not be able to go near them would be too tough. Also, I was so excited when my symptoms decreased that I started to hope that I was fixing (not just relieving the symptoms) whatever is my problem and started canning peaches, nectarines, and plums like there was no tomorrow and am about to start doing the same with applesauce because if I decide I want to try a FODMAP food in February, I want those beautiful fruits that I longingly passed by this summer. Sorry for such a long-winded response but long story short, no, my body is telling me that the idea of FODMAPs are not a fad at all, but a FODMAP diet is kind of useless on its own, especially when you’re told that rice and potatoes are safe. But FODMAP principles combined with SCD/GAPS principles seems to be the way to go (hopefully).
@Liz – wow I’m so impressed with you’re relentless drive and desire to get healthy. You need to be commended for that! Sounds like you got the food thing down very well. Make sure you rule out other things like parasties and low stomach acid. And keep us updated on your progress!
I follow SCD without FODMAPS and it is very restrictive, but I do see some improvements towards tollerance levels slowly. I do believe as you, Steve and Jordan, that the intestines needs peace and quiet for a while, and then that it is possible with recovery. I am eating some FODMAPS everyday, but try to keep the level as low as possible. i sure think there is a connection with IBS and intollerances.
@Vibeke – You’re doing great! Make sure you get tested to rule out parasites, SIBO or Yeast overgrowth because while you’re doing amazing on the food front many of these underlying causes won’t be impacted.
I thought the SCD/GAPS diets took care of yeast overgrowth? I have yeast and am planning to go on SCD/GAPS. Am I mistaken?
I’ve also been trying a combination of SCD/GAPS and FODMAPS for SIBO, talk about elimination! Trying to work out the kinks and slowly bring back in foods. I’m curious about your mentioning being tested for yeast overgrowth. Do you have advice onthe best way to do this?
Hi Steph, I totally understand. In the beginning I never thought I’d eat more than 4 foods again ha-ha.
The best gut test out there is a DNA/PCR stool test from Metametrix: http://www.metametrix.com/test-menu/profiles/gastrointestinal-function/gi-effects-microbial-ecology
Ask your Doctor to get it and if they won’t, you can order it from http://directlabs.com/ for $268.
In good health,
Jordan
Does this Metametrix test test for SIBO as well or is that a seperate test?
The Metametrix DNA/PCR stool test does not test for SIBO, but another test they have does. Get the basic Organic Acids profile done and that’s where you’ll get a good idea of SIBO.
In good health,
Jordan
I want to rule out parasites and SIBO, but it seems that tests don’t always diagnose properly. Especially parasites. I’m thinking I should just do a parasite cleanse with ParaGone and diatomaceous earth without a diagnosis. And perhaps a liver cleanse?
I have been on the GAPS diet for two years and seen great improvement, but I have some lingering symptoms: bloating after eating dairy, fruits, or vegetables; eczema on my leg and head; extreme fatigue after eating dairy or sweets. (Gluten, too, but I don’t ever eat that).
My bristol chart is #4 and my blood, urine, and hormone tests came back spectacularly good, so I must be absorbing my food. Yet I can’t shake these last few symptoms.
Hi Churyl, I’d highly recommend you get a DNA/PCR stool test, which will find most all bacteria and parasites and it’s very accurate. Here’s the company link:
http://www.metametrix.com/test-menu/profiles/gastrointestinal-function/gi-effects-microbial-ecology
In good health,
Jordan
i’m curious why? why not just do the parasite cleanse?
Ok, sorry for the questions but still in research mode. I keep coming back to this website. I eat a paleo plan and am totally gluten and dairy free. I still have chronic “runs” and have started on FODMAP plan. So my question is that you are about creating an eating plan on scd that fits you. Does that include holding off on adding FODMAPS back in till the very last phase? I am purchasing your books and cd next week after I return from business trip…. Thanks for your help!
basic question – there are many contradictions between FODMAP and SCD -for example – sugar vs honey, rice, potatos etc…. – as one looking for the most suitable diet for fighting crohn – which guidance to use…?