Low FODMAP Diet – A basic Guide
I have recently embarked upon a low FODMAP diet to help manage the symptoms of two digestive disorders that I suffer known as Irritable Bowel Syndrome (IBS) and Small Intestine Bacterial Overgrowth (SIBO). Below I will be discussing the reasons for following a FODMAP diet and how it works, but if you want to know more about IBS and SIBO then I recommend you take a look at my previous posts SIBO – a basic guide and Autoimmune Protocol – The basics (which discusses IBS).
What is it?
A low FODMAP diet is a type of elimination diet used by people with Irritable Bowel Syndrome (IBS) to help identity foods which may be causing their digestive issues. The term FODMAPs refers to Fermentable, Oligo-saccharides, Di-saccharides, mono-saccharides and polys.
F – Fermentable; these types of foods are fermented in the large bowel, broken down by bacteria.
O – Oligo-saccharides; oligo stands for ‘few’ and saccharides means sugar. These molecules are individual sugars joined together in a chain
D – Di-saccharides; the ‘di’ means two, making this a double sugar molecule.
M – Mono-saccharides; Mono means single, this is a single molecule sugar.
P – Ployols are sugar alcohols; they get their name from their molecule make up, because they are between a sugar and an alcohol molecule, they aren’t actually alcohol!
These are all types of short-chain carbohydrates which have been identified as being problematic to those with digestive issues. Research has shown that if these short chain carbohydrates aren’t properly digested they can ferment in the lower part of the large intestines, drawing in water hydrogen and methane causing issues such as bloating, gas and pain. There have been many studies carried out using a low FODMAP diet to help manage the symptoms of IBS and the results found that as many as 3 out of 4 patients reduced their symptoms by up to 50%. Although the diet is aimed at those with IBS, it can and has been used to help manage the symptoms of a number of health conditions such as those who no longer have a colon, those with other forms of functional gastrointestinal disorders, those with a small intestine bacterial overgrowth, those with auto immune conditions* (such as rheumatoid arthritis, multiple sclerosis) and those with fibromyalgia.
How a FODMAP diet works
When starting a low FODMAP diet a patient has to cut out all foods high in FODMAPs for about 6 – 8 weeks**. It takes a minimum of three weeks for the gut to ‘reset’ so ideally a patient shouldn’t look to reintroduce foods before this. This gives the gut time to repair and heal, calming inflammation that will have occurred. After the 6-8 weeks a patient can then very slowly start to reintroduce foods, starting with just one food type at a time. Ideally a patient should start with a smaller potion and if tolerated work up to a bigger portion size. It can take about 2-3 days for symptoms to show so some websites suggest reintroducing one item of food every 5 days.
Patients are recommended to keep a diary of how they feel after introducing foods so that they can identify any that cause them issues, also noting down if they feel ok on smaller amounts of a food and unwell on higher amounts. If this occurs then it means a person can enjoy that food in smaller doses but they should avoid eating too much of it.
* For more details on Autoimmune (AI) conditions take a look at my posts Autoimmune Protocol a basic guide.
** There are websites that suggest that it’s ok to reintroduce items after 3 weeks, but that’s usually if a person has had a breath test to determine if certain foods are triggers for them. If you don’t allow your gut time to heal and inflammation to reduce, you won’t be able to tell if a food is causing you issues when reintroducing them.
FODMAPS are generally split into sub groups, they include; fructose, fructans, galacto-oligosaccharides (GOS), lactose and polys.
Fructose; Fructose (in excess of glucose) is found in fruits such as apples, melons and mango, it’s also found in high fructose corn syrup and honey.
Fructans are found in wheat, garlic, onion, and inulin
Galacto-Oligosaccharides (GOS) are found in legumes and beans, such as lentils and soybeans.
Polyols are found in sweeteners such as xylitol, erythritol, sorbitol, mannitol and stone fruits such as avocado, apricots, cherries, plums, nectarines and peaches.
Lactose is found in dairy items such as buttermilk, chocolate, creamy cheeses and cheese sauces, custard, ice cream and milk (including goat’s milk).
There are some foods that are considered ‘Moderate’ FODMAPs. Some websites suggest that they can be eaten during the elimination phase but you have to be aware of the portion size. If too much of a moderate item is consumed, it then becomes high FODMAP. Some websites suggest avoiding these-++- moderate items completely during the initial elimination stage then look to reintroduce them first in the reintroduction period. If you are unsure what foods are triggers for you then it’s worth avoiding them for the 6-8 week period, so that when you do decide to reintroduce them (again, you will still need to monitor the portion size), you will be able to detect if there they cause any flare in your symptoms.
FODMAP – Food Lists
To find out more about foods that are low, moderate or high in FODMAPs check out the Monash University website. Dr Sue Shepherd was the first person to examine a low FODMAP diet in connection to digestive distress. She now works closely with professor Peter Gibson at Monash University where they continue to carry out research on FODMAPs and IBS. As they are the leading researchers in this area the always have the most up to date details on foods that are low FODMAP. They also have an app that you can download via iOS or Android where you can look up the foods, make notes on items, record your responses during reintroduction as well as tons of recipes. The app is about £5.99.
There are tons of websites and books around gut health and FODMAPs and its worth investing in a book or two so that you can keep a copy in the kitchen for FODMAP reference. You can also go online and print of lists too; I personally have a number of websites saved in my bookmarks on my computer and in my iPhone so that I can always refer to them if needed. I have listed two books below that I bought myself. I have to note that neither of these books are autoimmune protocol or paleo.
Low-FODMAP: Low-FODMAP Recipes: Healthy Low-FODMAP Diet Plan & Recipes Cookbook to Get IBS Relief and Improve Digestions, The Foods for Healthy Gut Paperback – by Warawaran Roongruangsri
The Quiet Gut Cookbook; 135 easy low FODMAP recipes to soothe symptoms of IBS, OBE ad Celoac Disease – by Sonoma Press
For some useful tips on how to follow an elimination diet you can have a look at my AIP – the basics article, where it gives a step by step guide to following the autoimmune protocol (AIP) diet. Although it’s a different form of elimination diet, it still has the same principles – you need to prepare, plan and be organised so that once you start on your elimination journey you aren’t likely to ‘fall off the waggon’ .
In 2013 I began a paleo diet to help manage my symptoms of Myalgic Encepalopathy (ME)***. In 2014 tweaked my diet further to incorporate a ketogenic diet (very low carb – high fat) as I was diagnosed with Small Intestine Bacterial Overgrowth (SIBO) as well as auto brewery syndrome (or fermenting gut as my specialist prefers to refer to it). As my symptoms have not improved much and my SIBO is still active, I recently began a protocol to target the bacterial overgrowth known as The Gut Health Protocol TGHP (See SIBO article for more details). TGHP targets the bacterial infection using natural supplements and combines the low FODMAP diet with a ketogenic diet. If a person is known to suffer an autoimmune (AI) condition or similar, then an autoimmune protocol is also advised, as ME has many of the symptoms of an AI condition I am also following this protocol. As a result, the recipes I will be making from now on will be low carb (ketogenic), low FODMAP and AIP! I hope that by sharing them, it will help others who might also be following this combination of elimination diets.
If you want to know more about any of these diets then take a look at my ‘health’ section where you will find information on the paleo diet, the ketogenic diet, SIBO and AIP.