Seven things you should know about the FODMAP Diet

19 April 2017

There is good research to link FODMAP foods and digestive symptoms like abdominal pain, bloating, wind, diarrhoea and constipation commonly experienced by those with Irritable Bowel Syndrome (IBS).1

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IBS is not a disease in itself, but a syndrome with a collection of symptoms. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. Fruits, vegetables, legumes, gluten grains and dairy that contain fermentable sugars or tiny short-chain carbohydrates. These are poorly absorbed by some people in the small intestine and left to be consumed by bacteria that reside further down the gastrointestinal tract.

Individual food intolerances are often hard to pinpoint especially where reactions are delayed. As a first step to eliminating such debilitating symptoms in IBS sufferers, many are seeing good results with a low-FODMAP diet.2

Some may find the diet quite complex and restrictive to follow but it is important to remove all FODMAP foods for the first few weeks at least.

Many of the FODMAP foods are highly nutritious so once symptoms resolve it may be possible to reintroduce one food item at a time and only eliminate them long term if symptoms return.

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Less desirable strains of bacteria and yeast tend to produce more gas than beneficial bacteria such as bifidobacteria, therefore causing more bloating and gas. Those with IBS tend to have an imbalance in gut flora.1

Small intestinal bacterial overgrowth (SIBO) is one theory for excessive bloating shortly after consuming FODMAPs. As the name suggests, there is an overgrowth of undesirable types of bacteria in the small intestine, an area which is usually low in bacteria and where bacterial gas production would not normally occur.1

Those with IBS tend to have an increased hypersensitivity to normal levels of distension in the narrow walls of the small intestine.1

Malabsorbed FODMAPs are reported to have an osmotic effect in the large intestine, drawing in liquid and resulting looser stools.1

It is thought that those less able to absorb foods adequately in the small intestine may have a damaged gut lining known as intestinal permeability. It could be said, therefore, that it is not so much the fault of the specific food, but more the effect of a sensitive gut with an imbalanced gut flora.

As FODMAPs include prebiotics, the food source preferred by our good bacteria such as bifidobacteria to help them grow and flourish, any restriction could lead to further imbalance in gut flora count and diversity, and a reduction in bifidobacteria in particular.4 Prebiotics are high in Jerusalem artichokes, onion, garlic, asparagus, leeks and bananas, or purchased in a supplement form (e.g. GOS, FOS and inulin).

Probiotic foods or supplements are live bacteria known to help restore a healthy gut flora5 and lining, support digestive function, regular healthy bowel movements and have been reported to improve IBS symptoms in some people. NICE now approves the use of a month’s trial of probiotic supplements to reduce IBS symptoms. A multi-strain probiotic such as Bio-Kult Advanced 14-strain could be taken successfully alongside a low-FODMAP diet, which retails at £8.99 for 30 capsules from www.bio-kult.com.

References

Barrett JS, Gibson PR. Fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) and nonallergic food intolerance: FODMAPs or food chemicals? Therap Adv Gastroenterol 2012;5(4):261-8.
Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology 2014;146(1):67-75.e5. ;Staudacher HM, Whelan K, Irving PM, Lomer MC. Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome. J Hum Nutr Diet 2011;24(5):487-95.
Staudacher HM, Lomer MC, Anderson JL, et al. Fermentable carbohydrate restriction reduces luminal bifidobacteria and gastrointestinal symptoms in patients with irritable bowel syndrome. J Nutr 2012;142(8):1510-8.
Dahlqvist G, Piessevaux H. Irritable bowel syndrome: the role of the intestinal microbiota, pathogenesis and therapeutic targets. Acta Gastroenterol Belg 2011;74(3):375-80.