In recent times we can hear and read a lot of talk being centered around FODMAP diets. Often times I get calls from people asking me to guide them on FODMAP diets. Are these diets also one of those ‘fad diets’ which come with a wave just to wane of after making some noise? Well, one thing is for sure; these diets are not any kind of a fad, but yes, many people may be just unaware of who and why and how these diets are to be followed. Yes, these diets are generally recommended by experts in Gastroenterology and Nutritionists or Registered Dieticians for their patients with gut issues having discomfort in their digestive tract. There could be signs of bloating, constipation or and diarrhoea or both at various times and all of these might be effecting their quality of life in the end.
However, one thing needs to be kept in mind is that, not all issues relating to the gut may require diets low in FODMAPs. No one size fits all, and hence it is essential that anyone having similar problems should first consult their health care providers, preferably gastroenterologists followed by the dietician dealing with managing them with low FODMAP diets. It could well be possible that, those similar looking symptoms may be related to some other over lapping problem with different root causes and hence may require a different approach. So the red flags of the problem should be excluded first.
What are FODMAPs ?
Most of the plant foods that we consume in the form of grains, legumes, fruits, vegetables and some animal sources like dairy have a group of starches or carbohydrates. These could be of various types generally having some fibre which could be soluble or insoluble. Now, this group of starches are of different types and are termed as – ‘Fermentable, Oligosaccharides, Disaccharides, Monosaccharides, and Polyols’. These are actually supposed to be quite beneficial for the human gut as they promote the growth of the friendly or the good bacteria. However, the problem lies when all or some of these starches are not digested by some people and produce symptoms like bloating, distension, constipation or and diarrhoea causing the gut or the bowel to be irritable and mal functional. This condition is what is termed as Irritable Bowel Syndrome (IBS). These starches tend to pull more water in the intestine causing stretching of the abdomen (bloating and distension), pain and further as they pass into the large intestine, cause fermentation and gas. This may eventually cause constipation or diarrhoea or both alternatively. Some may be constipated dominant (IBS- C), while others may have loose stools pre dominantly (IBS – D), while still others may have a mixed pattern (IBS –M).
In fact this phenomenon of water being absorbed in the intestine happens in all individuals, but those with IBS symptoms tend to have a sensitive gut and the motility of the intestinal contents (the partially digested food) is impacted – either it can slow down too much (constipation) or may rush out too fast (diarrhoea).
In healthy normal individuals the food content will pass through the small intestine slowly attracting water and on reaching the large intestine, the gut bacteria use these FODMAPs as a fuel to survive. The bacteria rapidly ferment the FODMAPs producing gas without causing much discomfort. But in others this may cause extreme discomfort and also impact their quality of life.
Which Foods Comprise FODMAPs
Some of the foods under the various categories of High FODMAPs are as follows:
Fruits – Apples, apricots, peaches, pears, plums, prunes, water melon, pomegranates.
Grains – Wheat and all wheat products, barley, cous cous, rye (not the spice rai)
Dairy – Milk and all milk products.
Vegetables – Beets, cauliflower, onion, garlic, leeks, mushroom, okra, peas, Brussels sprouts,
Legumes – Chickpeas, kidney beans, toor dal, balck eyed beans, soyabeans, lentils, lima beans, split peas, Black gram
Sweeteners – Honey, fructose, high fructose corn syrup, mannitol, sormito, molasses, xylitol, isomalt.
Some of the Low FODMAPs foods would be
Fruits – Banana, avocado, blackberry, red grapes, kiwi, lemon, lime, tomatoes, olives, oranges ,pineapple, strawberry, papaya, cantaloupe.
Vegetables – Carrots, bell peppers, common cabbage, egg plant, green beans, lettuce, potatoes, radish, cucumber, sweet potato, zucchini, spinach, kale, fennel
Grains – Rice, corn, amaranth, quinoa, oats, spelt products gluten free products, millets like sorghum, pearl millet, foxtail millet, finger millet, little millet, barnyard millet
Dairy and Alternatives – All non dairy milk – almond milk, soya milk, hemp milk, lactose free milk and its products, cottage cheese, butter, ghee, coconut milk, cheese
Legumes – Small amounts of moong dal, green gram whole, tofu, canned beans, canned peas, small amounts of black gram dal as a ingredient in a recipe (dosa, idli)
Sweeteners – Sugar (sucrose), maple syrup, brown sugar.
Apart from the above, all nuts and seeds including most spices are low in FODMAPs. Care may be taken to include the Indian asafoetida as it contains some added gluten.
Approach to Follow a Low FODMAP Diet
Having known the list of various high and low FODMAP foods, it might seem quite easy for anyone to just avoid and include these foods in their diet and comfort themselves that they are following this regimen. Well, it is not as simple as it may sound. Having excluded the so called offending foods, one may still not experience complete relief from symptoms, or maybe they might manifest some other issues over a period of time. Or simply, they might just get tired of following their restrictive diet and just give up some day, only to see a return of symptoms. It may be borne in mind that a low FODMAP diet is not a one to be done lifelong. As explained earlier, FODMAPs are actually beneficial for our gut, but since some individuals may have a ‘sensitive gut’, the aim should be to fine tune one’s diet with at least some of these foods, over a period of time and zero down to the ones that they may be able to tolerate. In short these diets need to be customised to every individual. This is generally achieved over a period of 8 -10 weeks.
These diets are generally recommended for patients with not only IBS, but may be beneficial for those with issues of inflammatory bowel disease or even endometriosis. Secondly, it may not be possible for each such individual to follow or adhere to the diet, may be due to the nature of their work, home environment or anyone travelling a lot, or even anyone with a lot of underlying stress. It is here that the help and guidance of a registered dietician certified in FODMAP diet management would be of great help to successfully manoeuvre through the journey of this regimen. She or he would walk you down the 3 phases of this regimen – Elimination, Re introduction and Personalisation. This would enable the individual to gradually and carefully include at least some of the foods from each category and in a suitable proportion, over a period of time and finally customise to a diet with some FODMAPs rather than a zero FODMAP diet. Moreover, following this diet blindly over long duration could also lead to malnutrition with many nutrient deficiencies or obesity and other disorders.
After all, FODMAP foods are an important component of our diet for a healthy gut with the friendly bacteria which contribute to our overall well being. The only thing is it should be a customised approach to ensure good, balanced nutrition and health.