Low FODMAP Diet

The gastrointestinal tract or gut (including the small and large intestine) has a significant role in maintaining health. The primary function of the gastrointestinal tract is the digestion and absorption of nutrients from food. However, diseases such as inflammatory bowel disease (Crohn's, Ulcerative Colitis), coeliac disease, bowel cancer, and Irritable Bowel Syndrome (IBS) affect the function of the intestine.
IBS or irritable bowel syndrome is a group of symptoms occurring together, including repetitive pain in your abdomen and changes in your bowel movements, which may be constipation, diarrhea, or both. With irritable bowel syndrome, you have these symptoms without any observable signs of disease or damage to your digestive tract. Doctors are not sure what the exact causes of IBS are.

Anyway, the process for IBS treatment includes:
• Education and counseling about IBS disease
• Taking medicine
• Proper IBS diet (such as a low FODMAPs diet) with a healthy lifestyle
• Stress reduction and maintaining calm

FODMAPs stands for Fermentable, Oligosaccharides, Disaccharides, Monosaccharides, And Polyols.
FODMAPs are a type of carbohydrate found in different foods. Carbohydrates give us energy, along with protein and fat. Since FODMAPs are not absorbed comfortably by the bowel, they start and worsen IBS symptoms. Foods that do not contain carbohydrates are not a concern, such as meat, poultry, fish, eggs, butter, oils, and hard cheeses.
People with irritable bowel syndrome (IBS) may not tolerate foods with FODMAPS, so restricting these foods from the IBS diet improves the symptoms of the disease. Symptoms of FODMAPs intolerance include abdominal discomfort, gas, distention, fullness, bloating, nausea, and or pain after eating foods containing FODMAPs.

The process of digestion FODMAPs has a lot of effects on the gut. To understand the role of these sugars as triggers for IBS, we should know the process of food digestion and absorption in the body. The small intestine breaks down and absorbs nutrients from foods. The large intestine's role is to absorb water and prepare undigested food to remove from the body (feces). During passage through the large intestine, the large population of bacteria ferments undigested food. It results in the production of gases, including hydrogen and methane.
Because these FODMAPs are small in size and are not absorbed well, they can have an osmotic effect on the gut. The osmotic effect increases the delivery of water through the bowel. It can contribute to diarrhea in some people.
As FODMAPs reach the large intestine, bacteria ferment them and produce gases. This gas production can occur in the small or large intestine and cause wind (flatulence), bloating discomfort, and abdominal discomfort/pain. In addition, the gas production in some individuals may slowly move through the bowel, causing constipation.

A low FODMAPs diet is a diet that has a low amount of degradable carbohydrates. A low FODMAPs diet is suitable for people suffering from irritable bowel syndrome or IBS.
To follow a low FODMAPs diet, seek the advice of an expert nutritionist. The dietitian will ensure that your IBS diet remains balanced and is nutritionally adequate while following the low FODMAP diet. We generally recommend trying the low FODMAP diet for 2-6 weeks. Then a dietitian will review your codification and add foods (and control the amount of them) that can be reintroduced into the diet.

The low FODMAP diet is not a traditional diet like those you may have heard of or tried. Instead, it is a learning process that will help you determine which foods worsen your symptoms.
There are three main steps to follow for a low FODMAPs diet:

• Step 1:
Look at the list of high FODMAP foods. If you overeat any of them, try cutting them out from your IBS diet.
• Step 2:
If reducing high FODMPAs from your diet helps you, that may be all you need to do. If not, try to delete all high FODMAP foods in your diet as much as you can for 6-8 weeks.
•Step 3:
After this period, bring foods back one at a time. If your IBS symptoms get worse, you can find out which food caused it.

• Limit products with ingredients like fructose, crystalline fructose (not HFCS *), honey, and sorbitol on the label.
• Eliminate sugar alcohols from your low FODMAPs diet. These include isomalt, sorbitol, maltitol, lactitol, mannitol, erythritol, xylitol, and lactitol. Unfortunately, we can find these sugar alcohols in some foods such as diet drinks, candy, ice cream, processed goods, etc.
• It is better to limit drinks with HFCS to less than the recommended serving size – less than 12 oz of soda.
• Check your drugs for sorbitol and fructose. They do not always write them on the label, so check with your pharmacist or doctor.
• Remember, the amount of fructose found in 2 apples is the same as the amount of fructose in 1 can of soda, but apples have other nutritional value and are beneficial for you.

* What Is HFCS?

HFCS stands for High Fructose Corn Syrup.
There is HFCS in many processed foods. It consists of almost half fructose and half glucose, like regular table sugar (i.e., sucrose). Foods and drinks with HFCS, such as soft drinks, can be ok in your low FODMAPs diet because HFCS may not be a problem for people with FODMAP intolerance if you limit them to 12oz per day and take them with your main meal.
But for some people, even a small amount of processed fruit juice or HFCS causes malabsorption and intestinal discomfort.

When you reduce the intake of FODMAPs in your IBS diet, achieving adequate nutrient intake is still important. This guide recommends the number of serves from the five major food groups. It also lists alternatives to help you in choosing suitable foods.

1. Yogurt, Milk, Cheese

Eat at least 2.5 - 4 servings of yogurt, milk, and cheese per day in your low FODMAPs diet. Each serving of these foods includes:
• 1tub (200g) of regular yogurt or, if you can't absorb lactose, you can use lactose-free yogurt
• 1 cup (250mL) regular milk, or if you can't absorb lactose, you can use lactose-free milk
• 40g cheddar cheese
• 1tbsp cream cheese
• 2tbsp ricotta/cottage cheese - suitable as lactose content is minimal

2. Vegetables

You should eat 5 - 6 servings of vegetables per day in your diet. Each serving of vegetables includes:
• 1 cup salad (lettuce, cucumber, capsicum)
• 1/2 cup cooked vegetables (carrots, zucchini, green beans, squash, pumpkin, parsnip, corn, eggplant)
• 1/2 cup sweet potato

3. Fruit

Eat at least two servings of fruits per day; 1 serving of fruits includes:
• Two small (150g) mandarins, kiwi fruits
• One medium (150g) orange or banana
• 100mL orange juice
• 1 cup (150g) of grapes, strawberries, raspberries, pawpaw, cantaloupe, pineapple, or rhubarb

4. Bread, Cereals, Rice, Pasta, and Noodles Group

At least 4-6 servings of cereal are needed per day in the IBS diet. Each serving includes:
• 1/2 medium (40g) roll or flatbread (gluten-free)
• 1-2 slices (60g) of gluten-free bread or spelt bread
• 1 cup (180g) rice noodles
• 1 cup (180g) of cooked rice (white or brown)
• 1 cup (180g) cooked pasta (gluten-free)
• 1 cup (230g) cooked porridge
• 1 cup (185g) cooked quinoa
• 1/4 cup (30g) muesli (fruit free, wheat-free)
• 1/2 cup (15g) rice puffs, 1 cup (50g) flakes of corn (gluten-free)
• 1-2 (12g) crispbreads (corn, rice, or oat-based)

5. Meat, Fish, Poultry

You should eat at least 2-3 servings of these foods in your diet; each serving includes:
• 80g cooked lean poultry such as chicken or turkey (100g uncooked)
• 65g cooked meat (about 90-100g raw)
• 100g fish (about 115g raw)
• Two slices of roast meat
• Two large eggs
• 1/2 cup (46g) cooked or canned legumes
• 30g nuts, seeds, or peanut butter
• 120g tempeh
• 120g tofu

6. Oils, Fats, and Extra Foods

You should limit your intake of these foods in your diet.
Oils, margarine, biscuits, cakes, pies, chocolate, hot chips, ice cream, alcohol, etc.

✔ Note: Consumption of fat, caffeine, and alcohol in excess in your IBS diet can be additional symptom triggers.

If you follow a low FODMAP diet, you should monitor the amount and type of fiber you consume with a nutritionist. Despite the many benefits of fiber, highly fermented short-chain, soluble dietary fibers, such as oligosaccharides, produce gas. This gas can cause pain, abdominal discomfort, bloating, and abdominal distension in patients with IBS. For better fiber function in the gastrointestinal tract, you must drink a lot of water (at least 4-6 cups per day).

Can you believe that you can still have foods full of flavor without adding high FODMAP ingredients such as onions? Here is a list of flavors that are all low in FODMAPs and add great flavor to food.

• Spring onions (green party only)
• Chives
• Garlic infused oil - either (a) purchase commercially prepared garlic-infused oil or (b) peel and cut garlic into large pieces. Saute in oil for 1-2 minutes to develop flavor in the oil. Discard pieces of garlic and retain the garlic-flavored oil to cook your meal.
• Ginger
• Golden syrup
• Asafoetida powder - pinch only for onion flavor (from Indian spice market)
• Fresh herbs (parsley, coriander, thyme, basil, rosemary)
• Lemon juice
• Maple syrup
• Salt and pepper
• Spices
• Chili

The answer is YES. You may think only foods contain FODMAPs, but some personal care items and many liquid medications may have sugar alcohols (mannitol, sorbitol, xylitol, isomalt, maltitol). For example, cough medicines, cough drops, and liquid pain relievers (fluid gel caps) contain sugar alcohols. If possible, choose a tablet or caplet form rather than liquid medication. Talk to your pharmacist to see if any of your medications have sugar alcohols or lactose since they can worsen your symptoms even when eliminating FODMAPs in your diet.

Researchers are not sure about the best way to bring food back to the diet, but here are three ways.

1- Add low FODMAP foods to your diet, and slowly add foods containing high FODMAPs.
2- Add high FODMAP foods to your diet first.
3- Add your favorite FODMAPs to your diet first.

Choose one of the above options which suits you.

If you have IBS, control your disease symptoms by Oxfordiet's online diet.