Welcome to April, also known as IBS Awareness Month. Irritable Bowel Syndrome (IBS) is a common functional gut disorder with 1 in 5 having IBS in Australia! 15% of the population worldwide have IBS, that is over 1 BILLION people! IBS is so common, if you do not have IBS yourself, you may certainly know someone who does.
IBS and FODMAPs – where to begin with patients?
Many are undiagnosed or unaware they have IBS and the causes are still unknown. Risk factors may pre-dispose someone to IBS, such as diet, smoking, alcohol consumption, genetic factors, small intestinal bacterial overgrowth (SIBO), stress, anxiety, other psychological states, intolerances or severe infections. Symptoms can affect quality of life and may include reoccurring abdominal pain, excessive bloating, changes in bowel frequency and form and/or wind, with the absence of abnormal pathology. While there is no cure, a Low FODMAP Diet is evidenced to help up to 85% of those with IBS minimise or prevent IBS-type symptoms and improve overall quality of life.
How does the low FODMAP diet work?
FODMAPs are a collection of short chain carbohydrates and sugar alcohols found in foods that are broken down by bacteria in the large intestine. FODMAP is an acronym:
Fermentable
Oligosaccharides
Disaccharides
Monosaccharides
And
Polyols
Oligosaccharides include fructans and galacto-oligosaccharides (GOS). Fructans are found in wheat, onion, garlic and some fruits and vegetables. GOS can be found in some legumes, beans and nuts.
Disaccharides includes lactose which is found in milk products such as cow’s milk, custard and ice-cream.
Monosaccharides represent fructose when in excess of glucose. This is seen in some dried fruit, mango, apples, asparagus, pears, cherries and honey.
Polyols include sorbitol and mannitol, found in stone fruit, mushrooms, cauliflower and some ‘sugar-free’ chewing gum and mints.
There are 3 phases to the low FODMAP diet which is most successful under the guidance of a FODMAP-trained Dietitian.
The 3 phases of the low FODMAP diet
Phase 1 of the low FODMAP diet
The initial phase of the low FODMAP diet swaps high FODMAP foods for low FODMAP foods. Some examples of high FODMAP to low FODMAP swaps include:
High FODMAP | > | Low FODMAP Alternative |
Cow’s Milk | > | Almond Milk |
Garlic | > | Green Chives |
Apple | > | Orange |
Cashews | > | Macadamia Nuts |
Silken Tofu | > | Firm Tofu |
Leek Bulb (white part) | > | Leek Leaves (green part) |
This phase can last 2-6 weeks and the aim is symptom improvement.
Phase 2 of the low FODMAP diet
The reintroduction phase is important to identify which specific FODMAP groups trigger an individual’s symptoms. This phase involves 3-day challenges where different FODMAP groups are introduced separately. This is followed by 2-3 days back on the low FODMAP diet to minimise any symptoms before the next challenge. Once specific FODMAP groups are identified to trigger symptoms versus well-tolerated FODMAPs, phase 3 may occur.
Phase 3 of the low FODMAP diet
The personalisation phase of the low FODMAP diet may be life-long and is important to reintroduce well-tolerated FODMAP groups back into the diet. FODMAPs include prebiotics which can be so important for gut health. As FODMAP tolerance may change over time, individuals are encouraged to re-challenge FODMAPs to try re-introducing them back into the diet where possible.
High FODMAP vs. low FODMAP foods:
Many foods contain FODMAPs and the serve size is very important in determining the FODMAP content of food. Some high FODMAP foods include wheat-based breads, cereals and pasta; sugar free mints and gum; legumes such as silken tofu and beans; garlic, onion, honey, apples, pears, mango, stone fruits, inulin, chicory root, cow’s milk, many dairy-based yoghurts, many soft cheeses, custards and ice-creams … just to name a few.
There are many low FODMAP foods including oranges, lemons, raspberries, blueberries, kiwi fruit, pineapple, spinach, red capsicum, carrots, radish, silver beet, potatoes, lain meats, fish, chicken, turkey, firm tofu, rice milk, almond milk, lactose-free milks, Greek yoghurt, eggs, hard cheeses and ½ cup canned lentils that are rinsed and strained.
Low FODMAP, not No FODMAP
Evidence suggests FODMAP sugars are best kept to a minimum in the low FODMAP diet to minimise digestive disturbance, but do not need to be completely avoided. Therefore, foods need to be low FODMAP, and not necessarily No FODMAP or FODMAP free.
Is the low FODMAP diet for everyone?
This approach is not suitable for all individuals, particularly if other aspects of health or nutritional status are contradictory to implementing a restrictive diet. Vulnerable individuals with nutritional deficiencies or disordered eating, or history of should be excluded. A gentle or simplified approach to the low FODMAP diet may be suitable for those with poor compliance, older adults or children, known food intolerances or comorbidity with existing dietary restrictions, such as individuals with Inflammatory Bowel Disease, Heart disease, Coeliac Disease or Cardiovascular Disease.
Reach out to a FODMAP-trained Dietitian for personalised support through your gut-health journey.
By Kiarra Martindale, APD, BBiomedSc, MDiet
Kiarra Martindale is a Gut Health, IBS and FODMAP-trained Dietitian. She is a nationally recognised Accredited Practising Dietitian, Sports Dietitian, Anthropometrist, Nutritionist and Presenter.