The GI tract is a scorching-hot topic in medicine right now. Not only does the gut’s microbiome likely hold key information about curing epidemics like obesity and cancer, but we’re also coming to realize just how impactful subtle changes can be in how we feel each day.
Enter the low-FODMAP diet. This eating approach has been gaining steam in the past couple years, as people focus in on the gut microbiome and become increasingly aware of how the abundance of processed foods these days (with tons of ingredients) may impact our GI tract.
According to Eric Esrailian, M.D., co-chief of the division of digestive diseases at the David Geffen School of Medicine at UCLA, “FODMAP” is actually an acronym, which stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (yes, it’s a mouthful), and these foods are not “ideally digested” in the GI tract.
You are probably wondering WTF a FODMAP actually is. Let’s clear that up.
FODMAP expert Laura Manning, R.D., clinical nutrition coordinator in the department of gastroenterology at The Mount Sinai Hospital, explains:
“FODMAPs are small-chain carbohydrates commonly found in our everyday foods. But when you consume too many at once, they can cause unpleasant symptoms.”
There are loads of FODMAP foods, including the lactose found in dairy products like milk, yogurts and cheese; the fructose found in honey, agave, mango, apples, cherries, pears, watermelon and high-fructose corn syrup; fructans found in onions, garlic, wheat, artichokes, asparagus, beans, inulin; and polyols in your mushrooms, cauliflower, blackberries, and sugar-free sweeteners like xylitol and mannitol. In case you haven’t guessed already by that list, high-FODMAP foods are tough to completely avoid.
And we don’t want to avoid all FODMAP foods, since, as you probably noticed, they’re mostly what you’d consider totally good-for-for-you foods.
Here’s why FODMAP foods can be such a pain to digest.
“We have a wide variety of healthy bacteria that help with digestion, vitamin metabolism and immune functions, and they get energy from fermenting FODMAPs,” Manning says. “But in some people, the fermentation process can just create a large amount of gas, which stretches the intestines causing bloating and pain; a water shift into the intestines, creating unpleasant diarrhea; and when water and gas both occur, it alters gut motility and you end up with constipation.” I know, right? Yuck.
Everyone’s gut is different, so FODMAP foods affect everyone differently-and to various degrees of discomfort, if any at all. But people usually adopt a low-FODMAP diet when they have frequent uncomfortable symptoms, such as gas, bloating, abdominal pain, cramping, diarrhea or constipation. “These symptoms may be part of a condition called irritable bowel syndrome (IBS),” Esrailian says. “However, even patients without a formal diagnosis of IBS can also experience these symptoms from time to time.”
Full disclosure: I am one of the 25 to 45 million U.S. adults with IBS. You can basically just think of IBS as a finicky stomach-or finicky “large intestine,” to be exact. Researchers aren’t even sure why some of us have trouble digesting FODMAP foods and develop IBS symptoms, buuuut we do. I also have something called fructose malabsorption, which means my gut has extra trouble with foods high in fructose, a type of monosaccharide (the “M” in FODMAP).
Basically, I’ve felt the pain of FODMAP foods-some of which have caused me some pretty debilitating stomachaches over the course of my lifetime. (Bleh.) I’ve also tried the low-FODMAP diet as part of my IBS treatment plan, so I have firsthand knowledge of this very particular way of eating.
Trying a low-FODMAP diet is no small feat.
Lots of scientific studies (led most notably by researchers at Monash University in Australia), have found that the low-FODMAP diet can significantly reduce the annoying symptoms of an IBS sufferer-or even someone who simply seems to have a sensitive stomach.
But one important thing to know going in is that it is temporary. The diet is basically a crash-course in learning your trigger foods, so you know exactly what menu items to avoid and how to appropriately manage your condition in the future.
And I’ll be honest with you: The low-FODMAP diet can be kind of a b*tch to pull off.
Manning says there are three basic phases. To summarize:
Phase 1: Elimination You will significantly decrease all foods that contain FODMAPs for 2-6 weeks, so your gut can stabilize. You should see a serious drop in symptoms.
Phase 2: Re-challenge You will carefully reintroduce foods from each FODMAP category to determine your triggers or sensitivities, one by one. If you’re symptom-free with lactose like dairy? Cool. You can probably eat those with no problem-and move onto another FODMAP group like fructans to see if those are a primary source of your symptoms.
Phase 3: Maintenance Once you retry all the FODMAP food groups, one by one, to see which are causing symptoms, you should be left with a well-balanced eating plan that delivers maximum nutrients and minimal triggers.
You should carry out this diet out under the guidance of a registered dietician, says Manning-and I totally agree. Not only is it a complicated, nuanced, and slow process, but cutting large quantities of food from your diet means you will likely be missing key nutrients and sometimes key sources of calories if you don’t have a little expert help.
Let me warn you: Going low-FODMAP is not fun, or easy. Eating out at restaurants is painful, as you must know every ingredient in the dish to order. Phase 1 is very bland (you will miss sugar, spice and everything nice). It can last several months, depending on how quickly you’re able to identify your triggers-and you introduce foods very gradually to determine symptom sources, whether that’s the onion powder found in everything from canned soup to ketchup, to plain ol’ mangoes.
But the payoff is worth it. (Assuming you are someone who legitimately has a problem digesting FODMAPs.)
After my deep-dive into low-FODMAP eating, I determined that I struggle with the most with lactose, fructose, and fructans-but I also know that there are some foods within those groups that are A-OK for me to eat without symptoms. And today, post-FODMAP eating, my bouts of IBS symptoms have dramatically decreased.
Manning sums up my feelings perfectly. “The most important thing to know about the low-FODMAP diet is that it can be a powerful tool in managing digestive issues through diet,” she says. “It helps you to gain a better understanding of your body and what causes it to act up from time to time.”
The diet might feel long while you’re in the trenches with it, fighting off cravings, but you’re actually just a few short months away from expert management of your personal gut health. After years of suffering digestive problems, I’d take that trade-off any day.
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