Irritable Bowel Syndrome & FODMAPs

Irritable bowel syndrome (IBS) is the most common functional gut disorders affecting between 9-23% of people in Canada and the US. It is characterized by abdominal pain, bloating, flatulence and altered bowel habits. While many people suffer only mild, intermittent symptoms, others have more severe reaction that affects their quality of life.

An Australian research team has developed a dietary therapy to help ease the symptoms of IBS and other functional gut disorders (constipation, abdominal bloating, diarrhea, and other unspecified bowel disorders) by identifying and limiting a group of specific foods called FODMAPs.

The acronym FODMAP stands for Fermentable, Oligo-, Di-, Mono-saccharides and Polyols which is used to describe a group of fermentable short-chain carbohydrates. These carbohydrates are most likely to be fermented by our gut bacteria causing gas, bloating and diarrhea. Limiting the global amount of FODMAPs in one’s diet has been shown to reduce symptoms of IBS and other functional gut disorders in many (but not all) people.

The list of FODMAP foods to limit or avoid can, at first, appear overwhelming (list below). It spans the gamut of regular go-to foods like apples, bread and yogurt. If you suffer from IBS or other gut disorders and wish to try a low-FODMAP diet you may wish to enlist the help of an experienced nutritionist or dietician. It is possible that nutritional deficiencies could develop over time if a variety of low-FODMAP foods are not consumed.

The FODMAP diet is not intended to be followed for life. It is a plan to help identify and minimize the most troublesome foods for each individual. As you can see, the vast majority of FODMAP foods are extremely healthy and provide important nutrients and fibre to feed our friendly bacteria in our gut. We don’t want to ban all these nutritious nuggets forever, but simply limit one’s overall consumption of the most troublesome FODMAPs that trigger symptoms of IBS.

If you do want to give it a go by yourself, try eliminating the high FODMAP foods from the list below for a period of two weeks. If your symptoms improve, try adding small portions of foods from one category of the FODMAP list, for example, a few cashews from the fructan group. Continue to slowly add foods one at a time back into your meal plan noting any symptoms that occur in a food diary so you are able to identify those that are the most problematic.

While on this plan ensure you eat a wide variety of low FODMAP foods from the list below. Aim to consume at least 7 servings from the vegetables list each day. Great choices include dark green leafy vegetables such as kale, Swiss chard and spinach, as well as, tomatoes, carrots and green beans. (See recipe for Kale Chips below).

Don’t simply opt for gluten-free bread; eat whole, non-gluten grains like oatmeal, quinoa, wild rice and millet. Berries are nutritional powerhouses, so snacking on berries is a great way to help meet your nutritional needs. See the full list of low-FODMAP foods below.

A note of caution, the long-term safety of the FODMAP diet is still to be determined. There are concerns for those following the diet for prolonged periods of time, in particular –

  • whether there is a potential increase in risk for developing colon cancer
  • what are the potential consequences of reducing prebiotics for healthy gut bacteria
  • potential development of nutritional deficiencies if followed for prolonged period of time

Be aware that there are many out-dated FODMAP lists on the internet. The best resources come from Monash University where much of the primary research has been undertaken. http://www.med.monash.edu/cecs/gastro/fodmap/

HIGH FODMAP FOODS

FructansGalactansLactoseExcess FructosePolyols 
OligosaccharideOligosaccharideDisaccharidesMonosaccharidesSugar Alcohols
Vegetables: artichokes, aspargus, beets, garlic, leek, onions, raddichioLegumes: chickpeas, lentils, kidney beans, baked beans, soybeans, soy milk, soy flourMilk Products: cow, sheep and goat's milk, ice cream, yogurtFruits: apples, pears, mangoes, figs, watermelonFruits: apples, apricots, cherries, peaches, nectarines, pears, plums, prunes
Grains: gluten grains- wheat, barley, rye and inulinCheese: ricotta, cottage cheese, mascarponeSweeteners: agave, high fructose corn syrup, honeyVegetables: avocados, cauliflower, green pepper, mushrooms, pumpkin, snow peas
Nuts: cashews, pistachiosSweeteners: sorbitol, mannitol, isomalt, maltitol, xylitol

LOW FODMAP FOODS

OK FructansOK Galactans OK LactoseOK FructoseOK Polyols
Vegetables: carrots, green beans, tomatoes, potatoes, sweet potatoes, spinach, chard, kale, lettuce, corn, eggplant, bell peppers, summer squash, zucchini, turnipsLegumes: firm tofuLactose-free milk and milk productsFruits: ripe bananas, blueberries, raspberries, strawberries, grapefruit, oranges, limes, lemons, kiwi, grapes, honeydew, rhubarb, pineapple, cantaloupe, honeydewFruits: ripe bananas, blueberries, raspberries, grapes, grapefruit, honeydew, kiwi, lemons, limes, oranges.
Gluten free grains: rice, corn, quinoa, buckwheat, oats, millet, amaranthCheese: hard cheese: cheddar, parmesan, swiss, mozzarella. Ripened cheese: feta, brie, camembert Sweeteners: table sugar, maple syrupSweeteners: table sugar, glucose

Kale Chips

  • 1 bunch curly kale
  • Drizzle olive oil (about 1-2 teaspoons)
  • Pinch of good quality sea salt

Preheat an oven to 300 degrees F.

With a knife or kitchen shears remove the leaves from the thick stems and tear into bite size pieces. Wash and thoroughly dry kale with a salad spinner or tea towel. Drizzle kale with olive oil and sprinkle with salt.
Bake for about 10 minutes and then rotate the pan. Bake for another 5-10 minutes or until the edges are brown and crisp but not burnt.

Resources:

De Giorgio R1, Volta U1, Gibson PR2. Sensitivity to wheat, gluten and FODMAPs in IBS: facts or fiction? Gut. 2015 Jun 15. pii: gutjnl-2015-309757. doi: 10.1136/gutjnl-2015-309757.

Mansueto P1, Seidita A2, D’Alcamo A2, Carroccio A3. Role of FODMAPs in Patients With Irritable Bowel Syndrome: A Review. Nutr Clin Pract. 2015 Feb 18. pii: 0884533615569886. 

Marsh A1, Eslick EM, Eslick GD. Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis. Eur J Nutr. 2015 May 17.

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