Taylor Wallace is principal and CEO of Think Healthy Group and a nutrition and food studies professor at Tufts University.
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If you’re looking for a way to find out the cause of certain gastrointestinal issues you’ve been living with, a low FODMAP diet could provide a few clues.
A low FODMAP diet is not a weight loss diet. FODMAPs—which stands for fermentable oligo-, disaccharides-, monosaccharides and polyols—are a group of small chain carbohydrates (sugars and fiber) that aren’t well absorbed in the small intestine. For some people, these small chain carbohydrates can cause symptoms like cramping, bloating and diarrhea.
Commonly used to help treat irritable bowel disease (IBS), a low FODMAP diet isn’t designed to be followed for a long period of time. Rather, it’s a tool to help uncover possible trigger foods. Read on for an introduction to the low FODMAP diet, along with a three-day sample menu created by a registered dietitian who specializes in gastrointestinal (GI) issues.
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FODMAPS are a group of small, nondigestible carbohydrates that contain between one to 10 sugars and are poorly absorbed in the bowel.
FODMAPs are found in a wide variety of common foods such as fruits, vegetables, legumes, cereals, honey, milk and dairy products and sweeteners. The diet addresses four types of fermentable carbohydrates:
When it comes to individuals with IBS, eating a diet high in FODMAPS leads to immune system activation via mast cells and microbiome changes that negatively impact the protective colonic intestinal barrier and contribute to IBS pain, explains Kate Scarlata, a Boston-based dietician who specializes in digestive health. To simplify the science, “a high FODMAP diet in [individuals with] IBS can make the gut more ‘leaky’. While mast cells—a type of immune cell that often resides next to nerves in the colon—activate and further contribute to IBS pain,” she continues.
A low FODMAP diet is often utilized to help treat IBS, a condition that impacts 10% to 15% of Americans, she adds.
The diet is a short-term elimination diet: High FODMAP foods are taken out for a decided amount of time (approximately two to six weeks) to assess whether they’re triggering GI symptoms. The foods are then systematically reintroduced, with an eye toward how well the individual tolerates specific amounts of each food. The end goal is to have as many foods reintroduced as possible, so the individual does not have to constantly avoid every single FODMAP.
It’s important to note that most experts agree that a low FODMAP diet should only be done under the supervision of a health professional, like a doctor or a registered dietician.
“Different people will tolerate different amounts of total FODMAPs or different sources of them,” explains Lauren Harris-Pincus, a registered dietician and author of The Everything Easy Pre-Diabetes Cookbook. For example, one person may be able to tolerate apples (a high FODMAP food), while another deals with immediate gastrointestinal symptoms after a few bites.
Personal triggers aside, foods that can be commonly eaten on a low FODMAP diet include:
While the exact type and amount of FODMAPs your personalized elimination diet avoids may be different from others, there are some common high FODMAP foods many people with IBS can be triggered by. These include:
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It’s estimated that 50% of people with IBS may benefit from following a low FODMAPs diet [1] Phases of the FODMAP Diet Explained. Canadian Digestive Health Foundation. Accessed 9/7/2022. . These benefits include lessened gastrointestinal symptoms such as abdominal pain, cramping, bloating, excess gas, constipation and /or diarrhea.
The three phases of a low FODMAP diet include elimination, reintroduction and integration.
The Elimination Phase: The objective of this phase is to identify the high FODMAP foods in your diet that are aggravating your IBS symptoms. As such, Harris-Pincus says that “the goal is to reduce IBS symptoms by only eating foods considered to be low in FODMAPs.
“Serving size matters as well,” continues Harris-Pincus. “it’s important to pay attention to the portion of any FODMAP-containing food. For example, five strawberries are categorized as low FODMAP while eight strawberries are high in FODMAPs.”
This phase typically lasts between two to six weeks. Some individuals can start to feel better within two days of the elimination diet, but for others it can take weeks.
The Reintroduction Phase: During this phase, FODMAP foods are reintroduced. This phase usually lasts between six to eight weeks. The objective of this phase is to determine which high FODMAP foods trigger symptoms and which do not.
During this phase, high FODMAP foods are gradually introduced back into the diet. If a certain food causes no symptoms, then that food can be included in your regular diet moving forward. It’s important to reintroduce each subgroup of FODMAP separately while your daily diet remains low in FODMAPs, so you can better understand what specifically may be causing your symptoms.
Because the reintroduction phase can be tricky, it’s recommended to lean on the advice of a registered dietitian, who can help you figure out when to reintroduce a certain food. Taking a few days in between the reintroduction of foods is also recommended to avoid any crossover effects.
The Integration Phase: During the third phase of a low FODMAP diet, the objective is to establish a longer-term, personalized diet that provides you with a range of vitamins and nutrients. This likely means adding medium to high FODMAP foods that do not seem to trigger your gastrointestinal symptoms back into your daily meal plan
“The low FODMAP diet was created to alleviate troublesome digestive symptoms for people with IBS and potentially other GI issues,” explains Scarlata. This means that individuals who aren’t living with IBS or similar gastrointestinal issues will probably not find a lot of benefits in following a temporary low FODMAP eating plan, as many high FODMAP foods are rich in important nutrients, like fiber.
A low FODMAP diet is also not typically recommended for individuals living with eating disorders, or those who follow more restrictive diets like veganism, as they may not be able to meet advised nutritional needs while following the diet.
However, for adults living with IBS, going through the phases of a low FODMAP diet can improve quality of life, psychosocial symptoms including anxiety and work performance, according to a 2017 study in Clinical Gastroenterology and Hepatology [2] Eswaran S, Chey WD, Jackson K, et al. A Diet Low in Fermentable Oligo-, Di-, and Monosaccharides and Polyols Improves Quality of Life and Reduces Activity Impairment in Patients With Irritable Bowel Syndrome and Diarrhea. Clin Gastroenterol Hepatol. 2017 Dec;15(12):1890-1899.e3. .
A typical day following a low FODMAP diet might look a little something like this, explains Scarlata:
