Low FODMAP Diet.
FODMAP refers to fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. They are all short chain carbohydrates (sugars), found naturally in foods, which can be fermented by the gut bacteria to produce all the symptoms of irritable bowel syndrome (IBS) – bloating, constipation, diarrhoea, loose stools, cramps and pain. It can also contribute to reflux and indigestion.
A low FODMAP diet excludes these foods for a period of 4 to 6 weeks. If in this time your symptoms subside then it confirms that FODMAPS are causing you problems. After the exclusion phase, slowly reintroduce, preferably one category at a time, and see which you are most sensitive to. I will next outline the common FODMAP foods, and then return to the topic of reintroduction.
Common FODMAP containing foods:
Vegetables – garlic, onions (except the green part of spring onions), cauliflower, cabbage, kale, asparagus, broad beans, Jerusalem and globe artichokes, mangetout and all the pulses including kidney beans, chickpeas, and lentils,
Fruit – apples, stone in fruit (plums, mango, cherry, apricot, etc), date, fig (famous for making you go!), avocado, pomegranate, raisins, prunes, watermelon, blackberry, nectarine.
Grains – all the gluten containing grains – wheat, rye, barley, spelt, kamut. Gluten free oats and rice are fine. So sadly, you need to avoid conventional bread, pasta, cakes and biscuits. Lots of alternatives are now available though.
Dairy – milk (lactose) of all sorts (so including goats), soft cheese, yoghurt.
Nuts – almonds, cashews, peanuts, and pistachio.
Polyols – found in artificial sugars such as xylitol, erythritol, etc.
In the elimination phase reduce FODMAPS from your diet as far as possible but don’t think you have too completely. This isn’t like a food allergy where you must avoid even a minute trace. FODMAPs reactions are dose related. The more you eat the more you will react. And they cross react. So, if you have toast and peanut butter for breakfast, an apple for a snack, a cream cheese sandwich for lunch and chilli con carne (onions, garlic, kidney beans) for dinner then you are going to be in trouble the next morning – if not before.
Go slowly in the reintroduction phase and see which if any groups affect you the most. One person might react more to the fruit sugar fructose found in apples and another to the milk sugar, lactose, found in milk. Some people react to them all.
Many of the foods listed above are otherwise very healthy and you do want to get back to eating as many of them as possible. A course of digestive enzymes as you reintroduce foods may help. Ultimately, we need to work on the health of our digestive health, including the balance of healthy and unhealthy bacteria, as this is the source of the problem. Relaxation techniques, acupuncture, herbs, certain supplements and so on can be very beneficial.
I offer kinesiology sessions to troubleshoot food issues and take you through the ins and outs of dietary strategies such as the low FODMAPs diet.
I strongly recommend buying a recipe book as there are all sorts of tips which can make the diet both easier and tastier. There are many available now but I particularly like:
The Low FODMAP Recipe Book, by Lucy Whigham
For a broader look at how to heal the gut with diet I really like:
food for a happy gut, by Naomi Devlin
Chris Kresser has a great article on FODMAPs and how it may be linked to issues such as stress, SIBO (small intestine bacterial overgrowth), how a paleo diet may help and more.
Whilst a low FODMAPs diet seems complicated in the beginning most people find it fairly easy to do once they get into it and for some the benefits are life transforming.