DIGESTION PROBLEMS? TRY THE LOW-FODMAP DIET

Medically Reviewed and Updated by Dr. Sony Sherpa (MBBS) - 05 September 2024

Abdominal discomfort? Fluctuating bowel symptoms?

We all have experienced one or the other digestive problem at some point in our lives, blame of which we always tend to put on our unhealthy lifestyle.

But if the symptoms persist, there is a possibility that you might have to consult a gastroenterologist to determine the underlying problem, who could rule it out as Irritable Bowel Syndrome (IBS).

Affecting the physical health and quality of life of more than 10% of the global population, IBS is a gastrointestinal disorder identified by a series of common symptoms such as diarrhea, constipation, pain, which cannot be explained by any other disease. Although there is no clear cause of the disorder, dietary management has been observed by the patient to have significantly help with IBS. One such widely acclaimed approach to alleviating the signs and symptoms of IBS is Low FODMAP Diet.

What Is FODMAP?

FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. These are types of carbohydrates that can be challenging for some people to digest. When consumed, high FODMAP foods can draw water into the digestive tract, leading to diarrhea. They also ferment in the gut, producing gases like methane and hydrogen, which can cause bloating, abdominal pain, and constipation.

What Is The Low FODMAP Diet?

The low FODMAP diet is a temporary approach designed to alleviate digestive symptoms by identifying food triggers. It involves eliminating all high-FODMAP foods from your diet for a period of time. Once symptoms improve, high FODMAP foods are gradually reintroduced to identify which specific foods trigger discomfort. This diet is not intended to be followed long-term but helps establish a personalized eating plan.

Low FODMAP diets are often prescribed for irritable bowel syndrome (IBS), small intestinal bacterial overgrowth (SIBO), and functional dyspepsia. Symptoms experienced by people with these conditions can range from abdominal pain, bloating, gas, and diarrhea, to constipation. By reducing high FODMAP foods, these symptoms may improve significantly.

Emerging research also explores the role of FODMAPs and the low FODMAP diet in other conditions such as mast cell activation syndrome, Crohn’s disease, celiac disease, and diverticulitis. For instance, studies suggest that a low FODMAP diet can help manage gut symptoms in Crohn’s disease and mast cell activation syndrome by reducing inflammation and easing digestive distress.

Here are some foods from the four FODMAP groups.

• Oligosaccharides:
  • Garlic, onions, wheat, legumes;
• Disaccharides:
  • Milk, cheese, yogurt;
• Monosaccharides:
  • Mango, figs, honey
• Polyols:
  • Blackberry, lychees

Instead of these, people are advised to eat low FODMAP diet foods, which includes:

• Low fructose vegetables:
  • Lettuce, potatoes, green beans, eggplant, bell peppers;
• Low fructose fruits:
  • Banana, clementine, grape, lemon, lime, strawberries;
• Low polyols vegetables:
  • Sweet potato, celery stalk;
• Low polyols fruits:
  • Dragon fruit, papaya, kiwi, oranges, cantaloupe;
• Low lactose products:
  • Almond milk, goat cheese, coconut milk

Incorporating a variety of low FODMAP foods can help manage digestive symptoms. Other options include:

• Proteins
  • Chicken, beef, pork, and fish
• Eggs
  • Eggs are generally low FODMAP, but combining them with high FODMAP ingredients may cause issues.

But since there are several essential food nutrients you would be avoiding; it is strictly advised against to follow this diet on self-guidance. Consult a dietician or nutritionist, who will help chalk out a proper Low- FODMAP plan including the adequate nutrients, vitamins, and mineral supplements to substitute for what you can't eat.

High FODMAP Foods to Avoid or Limit

Foods that are high in FODMAPs include:

• Fruits: Apples, pears, watermelon, and stone fruits.
• Vegetables: Onions, garlic, cauliflower, and mushrooms.
• Dairy Products: Milk, yogurt, soft cheeses, and ice cream.
• Grains: Wheat, rye, and barley.
• Legumes: Beans, lentils, and chickpeas.
• Sweeteners: High fructose corn syrup, honey, and sugar alcohols.
• Breaded Meat and Fish: Breaded or battered meat and fish or meat and fish cooked in garlic and onion based gravy.

How Does the Low FODMAP Diet Work?

The low FODMAP diet works through a structured, three-phase process: the elimination phase, reintroduction phase, and maintenance phase. This methodical approach is designed to identify specific food triggers that contribute to digestive symptoms.

• Elimination Phase (Duration: 2-6 weeks)
  During the elimination phase, all high FODMAP foods are removed from your diet. A low FODMAP elimination diet helps to reduce symptoms like bloating, gas, diarrhea, and abdominal pain. While this phase can provide significant symptom relief, it is meant to be temporary and not a long-term solution.
• Reintroduction Phase (Duration: 6-8 weeks)
  After your symptoms improve, high FODMAP foods are slowly reintroduced one at a time. This step allows you to identify which specific FODMAPs trigger your symptoms. Foods are added back systematically, usually in small amounts, so you can monitor your body's response.
• Maintenance Phase (Ongoing)
  Once you've identified your personal triggers, you can create a balanced diet that includes as many FODMAP foods as you can tolerate without causing symptoms. The goal is to maintain a varied diet while managing your digestive health effectively.

Some people may initially feel worse during the elimination phase of the low FODMAP diet. The FODMAP diet may be challenging due to changes in gut bacteria, adjusting to new foods, or difficulty finding suitable replacements. If your symptoms continue or get worse, it is important to see a doctor to make sure you are following the diet correctly and to address any underlying health problems.

Effectiveness Of Low FODMAP

Research in this theory is limited but substantial. Around 75% of IBS patients who participated in the studies saw positive results after weeks of adhering to the program. Healthy control group participants did not show any difference between an unrestricted diet and the FODMAP diet. Per a study conducted by NCBI, following a low FODMAP diet helped improve stomach pain and bloating by 81% and 75% respectively. The same survey also revealed reduced flatulence, and constipation frequency.

When to Consult a Doctor

The low FODMAP diet can be helpful for many people, however, it is important to consult a healthcare professional in the following situations:

• Severe Symptoms: In case of severe symptoms like persistent abdominal pain, significant weight loss, or bloody stools, consult a doctor to rule out more serious conditions.
• Difficulty Following the Diet: If you find it challenging to adhere to the diet or are unsure about food choices, a dietitian can provide guidance to ensure nutritional balance.
• Persistent Symptoms: If symptoms do not get better or get worse during the elimination phase, it’s important to seek medical advice to adjust the diet or explore other treatments.

Drawbacks of the Low FODMAP Diet

Although the low FODMAP diet can be helpful, it has some downsides to consider:

• Not Universally Effective: Not all people with IBS will experience relief from the low FODMAP diet. Some may not see significant improvements, and the diet may not address all digestive issues.
• Nutritional Deficiencies: The restrictive nature of the diet can lead to deficiencies in essential nutrients if not carefully managed.
• Complexity: The diet can be complex to follow, requiring careful planning and monitoring.

Does the Low FODMAP Diet Cause Weight Loss?

The low FODMAP diet is not primarily intended for weight loss, but some people may experience weight loss as a secondary effect. This can occur because the diet eliminates many high-calorie and high-fat foods that are often culprits in digestive distress. However, there is no assurance of weight loss, which may vary depending on individual adherence to the diet and overall calorie intake. It is important to focus on balanced nutrition and consult with a healthcare provider to ensure that any weight loss is healthy and sustainable.

How to Get Fiber on a Low FODMAP Diet

Getting adequate fiber while on a low FODMAP diet is essential for maintaining digestive health. Here are some low FODMAP sources of fiber:

• Fruits: Bananas, strawberries, blueberries, and kiwi are low FODMAP and good sources of fiber.
• Vegetables: Carrots, spinach, zucchini, and bell peppers can add fiber to your diet.
• Grains: Oats, quinoa, and brown rice are low FODMAP grains that provide fiber.
• Nuts and Seeds: Chia seeds, flaxseeds, and pumpkin seeds are also good sources of fiber.

It is important to introduce these fiber sources gradually and monitor your symptoms to ensure they do not trigger discomfort. Consulting with a dietitian can help you balance fiber intake while adhering to a low FODMAP diet.

Tips To Properly Incorporate Low FODMAP Diet In Your Routine

Incorporating a food plan like this can be tricky. Here are some tips on how to start on the FODMAP diet successfully.

1. Speak With A Professional
   It is important to consult a dietitian/nutritionist. Each person is unique in their dietary requirements. Someone who is properly trained in nutrition can assist with designing a FODMAP program that works for you.
    
2. Slowly Introduce Yourself Into The Diet
   Ease into the program by changing a few food habits a day. Developing new food routine can be difficult due to your body craving other foods you are trying to avoid.
    
3. Keep A Food Diary
   Keep a diary of what you eat is an easy way of making sure you are on the right track. It does not have to be complex, but you want to track the following:
   • The foods in each meal
   • High FODMAP foods you have consumed
   • Symptoms that you experienced after each meal
   • Things that are affecting you (Stress, menstrual cycle, etc.)

Low FODMAP Diet Mistakes To Avoid

Following the FODMAP diet can be effective to relieve your digestive disorder symptoms. To stick to the right program, avoid the following mistakes.

• Have An Accurate Diagnosis And Plan
  IBS and other digestive disorders share many symptoms. See your doctor to properly diagnose your condition. There are some digestive disorders this diet does not work for. See a dietitian/nutritionist to create a diet plan that will work for your needs. You will want an accurate food list from a trained professional.
   
• Keep Up Your Other Health Needs
  IBS patients know that the disease is multifaceted. Eating the right foods is not enough. Exercise, stress reduction and other factors also affect your syndrome.
   
• Be Diligent About Your Adherence
  Part of the food plan is keeping to the other restrictions that make it effective. Some habits that lead to ineffectiveness of the program include:
  • Irregular eating/missing meals
  • Not reading labels
  • Ignoring portion sizes
  • Low fiber intake

One Last Reminder

The FODMAP diet has its nutritional limits. After a few weeks, you will want to start trying other foods to fill in those nutritional requirements you are lacking. Your dietitian /nutritionist can assist you with how to incorporate these foods back into your diet.

To search for the best hosptials and doctors for Irritable Bowel Syndrome (IBS) in India, Thailand and Malaysia please use the Mya Care search engine.

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