Gut Stuff and FODMAPs

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What are FODMAPS?

endoFODMAP is an abbreviation for: Fermentable, Oligosaccharides, disaccharides, Monosaccharides and Polyols. These are groups of poorly absorbed carbohydrates ( typically other external factors contribute to the shift in our bodies inability to break them down such as stress, poor sleep, medications, an illness etc). The poor breakdown and digestion often leads to bloating, diarrhea, gas, cramping, constipation, potential weight gain and a shift in the bacteria that live in our intestines. These changes, specifically the shifts in our gut bacteria typically worsen previous symptoms of IBS, Fibromyalgia, endometriosis, depression and more.

The groups of foods that the FODMAPS are found in:

  • I LOVE this image from Joe Leech (Diet VS Disease), which hels to differentiate the different FODMAP containing foods.
https://www.filepicker.io/api/file/nZWr61RWRE2fcg2rSYpB
Example photo from Diet Vs Disease. I would also recommend using Monash University or Michigan University (My GI Nutrition) for other reliable resources.

What can the “FODMAPs diet” be helpful for management of?

  • Irritable Bowel Syndrome (IBS)
  • Other forms of Functional Gastrointestinal Disorder (FGID)
  • Small intestinal bacterial overgrowth (SIBO)
  • Certain auto-immune conditions such as rheumatoid arthritis, multiple sclerosis or eczema
  • Fibromyalgia
  • Depression
  • Frequent migraines that appear to be triggered by meals

What are the phases of the FODMAP diet?

The FODMAP diet consists of three phases.

Phase 1: Elimination phase (6-8weeks):

During the elimination phase individuals must completely eliminate ALL FODMAP containing foods. It may also be recommended that you supplement with a probiotic during this phase (the strain depends on individual symptoms). The elimination phase aids with changing the bacterial balance in our G.I tract. Research highlights that ALL fodmaps must be eliminated for a minimum of 4 weeks to alter bacteria in our intestines, reducing symptoms associated with poorly absorbed carbohydrates, decreases the potential for falsely identifying one of the FODMAPS as a trigger food and to aids with identifying individual thresholds for the various groups. After the 6-8 week elimination review  for either:

1. No improvement: discontinue the FODMAP elimination diet and consider other food intolerances such as histamine, food chemicals etc.

OR

2. Partial or significant improvement: continue onto phase 2: re-challenge

Phase 2: Re-challenge

The re-challenge phase involves trialing the various groups to identify thresholds of potential trigger foods. The re-challenge phase can make many individuals nervous especially since most see a positive improvement during phase 1. However, elimination of all the FODMAPS for an extended period of time can greatly increase our risk of developing nutrient deficiencies. In addition you have begun to re-establish a healthy balance of bacteria in your gut and in order to maintain this balance the bacteria need the fiber and carbohydrates found in many of these foods to survive. The key is identifying what your different tolerance levels are for the different groups are to maintain this bacterial balance. Please see an example of what a re-challenge schedule may look like below: (*Note: this may look different from person to person and is typically individualized by a dietitian or G.I Specialist)

https://i1.wp.com/i.pinimg.com/originals/ba/5b/81/ba5b81d9a52920729a8250a28b2fa653.jpg?w=960&ssl=1
An Example Reintroduction Schedule made by Joe Leech, RD MSc (Diet Vs Disease)

Phase 3: Maintenance Plan:

Determining the specific amounts you can tolerate for any of the FODMAP groups that are potential triggers for your symptoms and develop a Maintenance plan and thresholds (amounts you can have at a time) of the various groups.

Other information:

Working with a health care practitioner that is familiar with the FODMAPS elimination and reintroduction diet or even better one that specializes in G.I health can be a key to a successful elimination and developing a manageable and realistic maintenance plan.

Although many see the positive impact nutrition can have, I always like to emphasize that diet and what you eat is only one piece of the puzzle. Other important factors to consider include physical activity, managing stress and healthy sleep habits. Be aware of all the areas you may need to tweak in order to maximize the effectiveness of the FODMAP diet and of course never be afraid to seek support in any of these areas!

Please note that this article does not replace the advice or expertise of a registered dietitian, who specialises in the low FODMAP diet. It is strongly recommended if you decide to pursue  a  low FODMAP diet that you do the reintroduction and testing of FODMAPs with the help of a FODMAP trained dietitian or health care practitioner.

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