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Low FODMAP Diet: Relief of Abdominal Pain, Bloating, and Gas

Posted by Deborah Graefer, L.Ac., MTOM on

Living with inflammatory bowel diseases like Chron’s disease and ulcerative colitis or other digestive disorders like irritable bowel syndrome (IBS) and Celiac disease is not an easy feat. It is painful, inconvenient, uncomfortable, even embarrassing for some. That is why a wide range of therapies have been suggested to help in symptom management – medications, bulking agents and laxatives, lifestyle changes, and diet. When you look up IBS Diet or Chron’s Diet, you will see lots of dos and don’ts and a long list of foods to avoid. One of the many diet options gaining popularity and expert support is the Low FODMAP Diet.

You don’t have to have IBS to experience relief when following a low FODMAT diet, even though Chron’s and IBS sufferers tend to do well with it. If you have been supporting your gallbladder for some time and still have the above complaints, you may benefit from trying FODMAPs for a while.

What is FODMAP and what does it stand for?

FODMAPs are found in a wide variety of foods we eat on a daily basis. They are either natural components or food additives to enhance the food’s flavor, appearance, or feel.

FODMAP stands for Fermentable, Oligosaccharides, Disaccharides, Monosaccharides and Polyols. This was a term coined by a group of Australian researchers from Monash University and eventually supported by experts all over the world. The publication of this new concept called the FODMAP Diet in Alimentary Pharmacology and Therapeutics in 2005 led to its international popularity. Although it is not synonymous to IBS diet or Chron’s diet, the low FODMAP diet has become a front-line therapy for patients with these conditions.

The researchers who put together this diet believed that the forms of carbohydrates belonging to the FODMAP group may worsen digestive symptoms and increase digestive permeability or leaky gut. Regular intake of low FODMAP Foods is believed to help in the management of abdominal pain, bloating, gas, and altered bowel habit.

FODMAP Foods Explained

1. Oligosaccharides

This category combines two common oligosaccharides that are implicated in numerous IBS symptoms, fructans and galacto-oligosaccharides (GOS). These oligosaccharides have the same activity upon ingestion; they always pass through the gut and escape digestion. It may be beneficial in the sense that they can act as prebiotics, encouraging the growth of good bacteria. However, since they are also both poorly absorbed by the body, they trigger digestive symptoms especially among those with pre-existing conditions.

Fructans are chains of fructose sugars that are bound together with glucose at the end. To be absorbed by the body, this chain needs to be broken down into monosaccharides, or simple sugar. However, we don’t produce the enzymes needed to break down the bonds in fructans. If taken excessively or in patients with pre-existing GI conditions, it may trigger abdominal pain, gas and bloating, as well as altered motility.

GOS, on the other hand, is a galactose sugar chain joined together with glucose at the end. Similar to the bonds of fructose, the human body does not produce the enzyme needed to break the bonds between galactose sugars.

2. Disaccharides

Disaccharides are one of the four chemical groupings of carbohydrates. As for FODMAP, lactose is the main type of disaccharide and it only becomes a problem if the body dies not have sufficient amounts of lipase to break it down. The chances of this happening is influenced by genetics, ethnicity, and other gut disorders.

3. Monosaccharides

Monosaccharides are the simplest form of sugar and the simplest units of carbohydrates. Fructose is the most common FODMAP belonging to this group. Since fructose is said to be associated with obesity, type 2 diabetes, hypertension, and insulin resistance, many manufacturers have tried to substitute fructose with other sweeteners. Unfortunately, these alternatives also fall under another FODMAP category.

4. Polyols

The carbohydrates that belong to this group are called sugar alcohols. Examples are sorbitol, mannitol, maltitol, and xylitol. They are present in fruits and vegetables but are also used in artificial sweeteners. What makes it troublesome for individuals with GI conditions is that the absorption of polyols across the intestinal barrier is so low and they are readily fermented in the gut. So they are not digested but instead remain to become fodder for bad bacteria, which worsens gut symptoms.

Common Misconceptions about Low FODMAP Diet

1. It is Low FODMAP, not “No FODMAP”.

The goal of this diet guide is to keep the intake of high FODMAP foods at a minimum. If you have a GI or gallbladder condition and you are worried about having attacks, please consult your doctor. You may have to follow a stricter diet and regimen.

2. Low FODMAP diet is not meant to be a long-term food guide.

By self-diagnosing and prohibiting yourself from taking certain healthy and organic foods just because they are high FODMAP, you are running the risk of nutrient deficiency. That is why the low FODMAP diet is not meant to be followed for a very long time. Rather, it serves as an elimination diet guide for those with digestive conditions. Moreover, some of the high FODMAP foods can be considered superfoods and well-tolerated by others.

3. It is not necessarily gluten-free and dairy-free.

If you are suffering from Celiac disease or any other condition that requires you to abstain from foods with gluten or dairy, follow your doctor’s orders.

High FODMAP Foods are often blamed for digestive symptoms like distention, gas and bloating, nausea, cramping, and diarrhea. But why is this so? Here are some reasons why high FODMAP foods are bad for us:Why are High FODMAP Foods Bad for Us?

Increased Intestinal Water Volume

Some high FODMAP foods draw too much water into the intestine since they are made up of chains of sugars that are considered osmotically active. Since they have a small molecular size, they are also able to deliver increased amounts of fluid to the colon. For individuals with visceral hypersensitivity, too much water coupled with colonic gas production worsens gastrointestinal symptoms.

Bacterial Fermentation

FODMAPS delivered to the colon from the small intestine, are rapidly fermented. This releases gas and other chemicals that may affect intestinal permeability, trigger digestive symptoms or alter bowel habits for some people.

Affects Intestinal Motility and Permeability

Rapid fermentation and the passage of undigested FODMAPS and other byproducts affect the integrity of the stomach lining, especially within a susceptible host. In the small intestine, FODMAPS may contribute to the overgrowth of bacteria, leading to SIBO. In the colon, swelling or distention can affect hormones, aside from injuring the intestinal wall and impairing its barrier function. The increased death of epithelial cells may increase the likelihood for carcinogenesis or the development of cancer cells in the colon.

Systemic Effects of high FODMAP foods

Aside from the reasons stated above, there are other systemic effects that are attributed to high intake of FODMAPs. One is the increased risk of developing gastro‐esophageal reflux and increased heartburn. There have also been studies associating hormonal changes to motility patterns. Depression is also linked to fructose malabsorption.

FODMAP Food Chart 

1. Fructose

  • Fruit - apple, cherries, figs, pears, mango, nashi, pear, watermelon, dried fruit
  • Sweeteners - fructose, high fructose corn syrup, honey, agave
  • Drinks – Fruit juice

2. Lactose

  • milk, cream, different types of cheese, yoghurt, ice cream, sour cream, whey, mascarpone, custard

3. Fructans

  • Vegetables – artichoke, asparagus, beetroot, broccoli, Brussels sprouts, cabbage, eggplant, fennel, garlic, leek, okra, onion, shallots,
  • Gluten – spelt, cereals, wheat and rye, bread, crackers, cookies, couscous, pasta, buckwheat, millet
  • Fruit – custard apple, persimmon, watermelon
  • Others – chicory, dandelion, inulin, pistachio

4. Galactans

  • Legumes – baked beans, chickpeas, kidney beans, lentils, soy beans

5. Polyols

  • Fruit – apple, apricot, avocado, blackberry, cherry, longon, lychee, nashi, nectarine, peach, pear, plum, prune, watermelon
  • Vegetables – cauliflower, pumpkin, snow peas, bell pepper, mushroom, sweet corn
  • Sweeteners – sorbitol, mannitol, isomalt, maltitol, xylitol

Advantage and Disadvantage of Low FODMAP Diet

Just like any other diet guide, the Low FODMAP diet is not without its critics. Many of these criticisms come from the fact that there are not enough studies to prove the efficacy of this diet to patients with gastrointestinal conditions. Some of the existing studies supporting this idea have also been questioned about their methodology, quality of evidence, and sample size.

Another disadvantage of the low FODMAP diet is that, when followed to the letter and done long-term, may be a risk for nutritional inadequacies.

On the other hand, there are also multiple reasons why the low FODMAP diet has gained a following over the past 12 years. First, it is easily understood and biologically feasible. Second, the dietary principles are clearly defined and well-structured. Thirdly, it has been enhanced and updated regularly over the past decade, providing the latest and most accurate information of food composition and dietary principles.

Conclusion

In conclusion, the low FODMAP diet is not a foolproof solution and a promise of relief for those with gastrointestinal or gallbladder problems. It is more of a scientific food guide that may be used to eliminate possible dietary culprits that trigger various symptoms. Scientifically-based or not, the proof is in the pudding. If it seems applicable to you and your symptoms, try it for a few weeks and see for yourself.



References:

Gibson, P. R. (2017). History of the low FODMAP diet. Journal of gastroenterology and hepatology, 32, 5-7.

Gibson, P. R., & Shepherd, S. J. (2005). Personal view: food for thought–western lifestyle and susceptibility to Crohn's disease. The FODMAP hypothesis. Alimentary pharmacology & therapeutics, 21(12), 1399-1409.

Staudacher, H. M., & Whelan, K. (2017). The low FODMAP diet: recent advances in understanding its mechanisms and efficacy in IBS. Gut, 66(8), 1517-1527.

Khan, M. A., Nusrat, S., Khan, M. I., Nawras, A., & Bielefeldt, K. (2015). Low-FODMAP diet for irritable bowel syndrome: is it ready for prime time?. Digestive diseases and sciences, 60(5), 1169-1177.

Catassi, G., Lionetti, E., Gatti, S., & Catassi, C. (2017). The low FODMAP diet: many question marks for a catchy acronym. Nutrients, 9(3), 292.

Barrett, J. S., & Gibson, P. R. (2012). Fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) and nonallergic food intolerance: FODMAPs or food chemicals?. Therapeutic advances in gastroenterology, 5(4), 261-268.

Marcason, W. (2012). What is the FODMAP diet?. Journal of the Academy of Nutrition and Dietetics, 112(10), 1696.

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