FODMAPs = Tummy Troubles

FODMAPs = Tummy Troubles
Written by Melissa Hurley

Have you heard of FODMAP? It stands for Fermentable Oligo-Di-Monosaccharides and Polyols. Who cares, you say? I know, I know, why must everything be an acronym (so I can pronounce it, I assume) and with fancy terms. Well, you may care about FODMAPs if you notice some symptoms of intolerance after you eat, such as bloating, diarrhea, or constipation, as well as flatulence (ooops) and stomach pain as a result of muscle spasms. Not fun stuff!!

Let’s break it down. FODMAPs can be very confusing because the words in the abbreviation refer to very large groups of carbohydrates (sugars), and each of those groups has several subgroups. Not all carbohydrates are considered FODMAPs and to make it all even more complicated, not all members of every group are actually problematic, only the fermentable ones (remember that Fermentable is the “F” in FODMAPs). For example, “monosaccharides” is just a chemical name for simple sugars, but only one type of monosaccharide is actually a FODMAP, because only one kind is fermentable. How can anyone keep it all straight?!

FODMAPs are osmotic (means they pull water into the intestinal tract), may not be digested or absorbed well and could be fermented upon by bacteria in the intestinal tract when eaten in excess. FODMAPs like fructose should be absorbed through the lining of the small intestine, but when an individual has difficulty doing this, the fructose continues on down to the large intestine where it is treated as a foreign substance which causes the bacteria there to go to town and wreck havoc on your system.

On a broad scope, FODMAPs include:

• Fructose (fruits, honey, high fructose corn syrup (HFCS), etc)

• Lactose (dairy)

• Fructans (wheat, garlic, onion, inulin etc)

• Galactans (legumes such as beans, lentils, soybeans, etc)

• Polyols (sweeteners containing isomalt, mannitol, sorbitol, xylitol, stone fruits such as avocado, apricots, cherries, nectarines, peaches, plums, etc)

You might be thinking, I eat paleo, I don’t eat many carbohydrates; however, you maynot realize that fruits & veggies are indeed carbs. The most common Paleo foods high in FODMAPs are:

• Fruits: apples, avocados, cherries, mangos, peaches, pears, watermelons, fruit juice and dried fruit

• Vegetables: onions, garlic, cabbage, broccoli, Brussels sprouts, asparagus, artichoke, eggplant, mushrooms, cauliflower

• Dairy products (depending on how strict): milk, yogurt, soft cheeses

• Other: sugar alcohols (any sweetener that ends in –ol), honey, agave

If that uncomfortable feeling of having a beach ball trapped in your stomach (often accompanied by cramps, diarrhea, constipation, or other gut symptoms) sounds like you, and a Paleo diet alone isn’t helping, restricting FODMAPs is a logical next step to try. This doesn’t have to mean cutting out all FODMAPs completely forever, but a strict elimination period can be a very useful diagnostic tool to work out exactly what you do and don’t tolerate well, and in what quantities.

During the initial elimination period, stick to a low-FODMAPs diet and take whatever steps necessary to restore the health of your gut flora (FODMAPs foods cause gas and bloating by overfeeding the gut flora, so if you react poorly to FODMAPs, chances are you have a gut flora overgrowth to treat). It’s helpful to keep a journal of how you feel every day, so you have an accurate record to examine at the end of your experiment.

References

Muir JG, et al. Fructans and Free Fructose Content of Common Australian Vegetables and Fruit. J. Agric. Food Chem. 2007; 55: 6619-6627.

Shephred SJ, et al. Fructose Malabsorption and Symptoms of Irritable Bowel Syndrome: Guidelines for Effective Dietary Management. J Am Diet Assoc.2006; 106: 1631-1639.

Gibson PR, et al. Evidence-Based Dietary Management of Functional Gastrointestinal Symptoms: The FODMAP Approach. Journal of Gastroenterology and Hepatology. 2010; 25: 252– 258.

Paleo low-FODMAP diet food list: https://radicatamedicine.files.wordpress.com/2014/06/paleo-fodmap-food-list.pdf

Stanford Hospital and Clinic. Digestive Health Center Nutrition Center: https://stanfordhealthcare.org/content/dam/SHC/for-patients-component/programs-services/clinical-nutrition-services/docs/pdf-lowfodmapdiet.pdf