This therapeutic diet is very restrictive, but to be beneficial we must be strict. Check which foods you should eliminate in a first phase and how to reintroduce it.

The number of people with gastrointestinal problems does not stop growing worldwide and their treatment represents a challenge for health professionals, because they have symptoms that significantly affect the quality of life. In fact, they are one of the main causes of absence from work and school.

These alterations require a comprehensive treatment beyond mere medication. In that sense, the diet known as FODMAP (acronym for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) has become a key strategy.

FODMAP DIET: WHAT IS IT

FODMAP is a fermentable low-short-chain carbohydrate (HCCC) diet created more than ten years ago in Australia. The acronym stands for each of these carbohydrates: fermentable oligosaccharides, disaccharides, monosaccharides and polyols.

This type of carbohydrates are found in smaller or greater quantities in dairy products (lactose is one of them) and in plant foods as common as wheat and other cereals, legumes and some vegetables and fruits.

The low-FODMAP diet has proven effective and has been accepted internationally as a dietary strategy for adults with irritable bowel syndrome.

The low FODMAP diet stands for:

• F for FERMENTABLES. Carbohydrates quickly fermented by intestinal bacteria. They produce short-chain fatty acids.
• Or ORLIGOSACHARIDES. Molecules composed of various sugars, such as those found in wheat, rye, legumes, garlic …
• D of DISACCHARIDES. Group of carbohydrates to which lactose, milk sugar, belongs, poorly ingested by some people.
• M for MONOSACCHARISES. Carbohydrates with a single sugar molecule (glucose, fructose, galactose,)
• A of AND…
• P for POLIOLES. Alcohols that are absorbed slowly. They are used as sweeteners and are found in fruits, mushrooms, etc.

LOW FODMAPS DIET: WHO SHOULD BE BETTER OFF

The FODMAP diet is recommended for people with irritable bowel syndrome (IBS) or non-celiac gluten sensitivity. And it can also be helpful in inflammatory bowel diseases (ulcerative colitis and Crohn’s disease) and others with similar gastrointestinal symptoms.

The underlying problem of all these alterations is usually a malabsorption of nutrients that can generate:

• Vitamin deficits.
• Conditions such as intestinal hypersensitivity due to increased gas production.
• Small intestinal bacterial overgrowth (SIBO).
• Increased gas production in the large intestine.

Therefore, foods that make a great contribution of FODMAP are harmful in these cases.

THE 3 PHASES OF THE LOW FODMAP DIET

A diet low in FODMAP consists of three steps that must be strictly adhered to for it to be beneficial; First you have to eliminate foods rich in FODMAP and then reintroduce them one by one.

Phase 1: Eliminate FODMAP-rich foods

Foods with high FODMAP content are replaced for 2-6 weeks with others with low content.

Phase 2: Reintroduce them little by little

For 8-12 weeks the eliminated foods are reintroduced:

• Try only one food group and avoid the remaining ones.
• From the chosen group, try a food for three days with a day of rest between them and increase the size of the ration.
• Record your symptoms in a journal.

Phase 3: Customize the diet

Tolerance varies from one person to another, so everyone has to find their balance.

LOW FODMAP FOODS

You can include them in your diet:

• FRUIT: blueberries, green banana, strawberry, kiwi, lemon, tangerine, melon, blackberry, orange, papaya, pineapple and grapefruit.
• VEGETABLES: celery, eggplant, broccoli, zucchini, pumpkin, parsnip, cabbage and cauliflower, spinach, green beans, lettuce, fresh corn, potato, cucumber, pepper, tomato and carrot.
• DRY FRUITS: peanuts, macadamia, walnuts, Brazil nuts, pecans and pine nuts
• GRAINS: rice, oatmeal (up to half a cup), spelt (sourdough bread), corn, gluten-free bread, gluten-free pasta, polenta and quinoa.
• OTHERS: sugar, stevia, nuts, glucose, maple syrup and agave syrup.

FOODS HIGH IN FODMAP

You should avoid them in the first weeks and reintroduce them little by little, in the second phase:

Fructis

• Vegetables: garlic, artichoke, dried onion, shallots, cabbage, asparagus, leek and beetroot.
• Cereals: rye, wheat pasta, bran and wheat.
• Fruits: custard apple, dried fruit, pomegranate and watermelon.
• Nuts: cashew and pistachio.

Galectins

• Legumes: chickpea, dried beans and lentils
• Nuts: cashew and pistachio

Fructose

• Fruits: fruit in syrup, fig, mango, apple, pear, watermelon and fruit juice
• Sweeteners: fruit concentrate, fructose, high fructose corn syrup and honey large servings of fruit.

Polyols

• Vegetables: avocado, cauliflower, sweet corn and mushrooms
• Fruits: apricot, cherry, plum (fresh and raisin), apple, peach, blackberry, nectarine, pear and watermelon.

Lactose

• All dairy products contain lactose, which should be avoided.

LOW MENU IN FODMAP: EXAMPLE

At first, the low-FODMAP diet may seem very restrictive. This menu will help you get through the first phase in which more food is temporarily removed:

Breakfast

• Option 1: Buckwheat bread toast with vegetable pâté. Rice or sesame drink.
• Option 2: chia with vegetable drink and cinnamon or vegetable drink of hazelnuts or sesame.

Food

• Option 1: a pumpkin and cinnamon cream accompanied by a quinoa salad.
• Option 2: Zucchini spaghetti with cheese-free pesto. Buckwheat with spinach and carrot.

Dinner

• Option 1: Grilled zucchini or zucchini cream with vegan butter. Tempeh with spinach.
• Option 2: turnip and carrot cream accompanied by oat flakes and hemp seeds.

LOW FODMAP DIET FOR PEOPLE WITH IRRITABLE BOWEL

The low-FODMAP diet has proven effective and has been accepted internationally as a dietary strategy for adults with irritable bowel syndrome.

WHY HCCCS AFFECT YOU

HCCCs have three functional properties that can aggravate gastrointestinal discomfort:

• They absorb liquid.
• They increase intestinal motility.
• They are rapidly fermented by digestive bacteria with the consequent production of short-chain fatty acids (SCFAs) and gases such as carbon dioxide, methane and hydrogen.

These characteristics do not prevent the effects of HCCCs from being beneficial for most people:

• Modulate the immune system
• Reduce cholesterol and triglyceride levels
• Facilitate calcium absorption
• They stimulate the growth of beneficial digestive bacteria.

However, when the response to HCCC is exaggerated, as happens to people with certain diseases and sensitivities, discomfort such as bloating, gas, pain, nausea, constipation or diarrhea, etc. is exacerbated.

Therefore, in these people a diet low in FODMAPS may be indicated, which should be done for a limited time. To do it well and ensure that you do not stop getting any nutrients, the advice of a nutrition professional can be very useful.

FODMAP DIET FOR PEOPLE WITH CELIAC DISEASE

A special case is celiac disease, a multisystem autoimmune disorder of genetic origin, triggered by gluten intake.

It has gastrointestinal manifestations similar to IBS and the usual treatment is a gluten-free diet, a protein present in some cereals such as wheat, rye, barley. Gluten produces small intestinal inflammations and its exclusion improves symptoms and clinic.

However, there are people who even on a gluten-free diet still have gastrointestinal symptoms. In those cases, it has been proven that recurrent symptoms are due to the presence of other sources of FODMAP, such as some fruits and vegetables, so a diet without FODMAP can help.

NOT A DIET FOR LIFE

As we’ve seen, a diet low in FODMAP can help improve the gut symptoms of IBS and other diseases. But it is not, in any case, a diet to follow for life. The nutritionist is the one who must assess your need.

The phases of the low FODMAP diet:

• First phase. At first, a low-FODMAP diet of two to six weeks is proposed, giving the patient low-FODMAP food alternatives.
• Playoff. After this time, it is recommended to introduce foods from a group of carbohydrates (for example, fructus), one at a time and for a period of three days in a row. After three days, another food from the same group is introduced, and so on, observing the tolerance and associated symptoms that the person is having.
• Third and final phase. The person who follows the FODMAP diet has learned in this time to know what he tolerates better and worse, and in the end, he is established a more open diet than the beginning, taking into account foods high in FODMAP that the person tolerates and accepts correctly.

Thus, it is a diet that varies depending on the individual tolerance of each person and at the end many verify that it is not necessary that their diet is as strict as the one initially proposed. It is more open when it comes to its variety, easier to carry and more practical in managing the symptoms associated with intestinal problems.

In the case of a diet low in strict FODMAP, it should not exceed six weeks. If maintained in the long term, it can have a negative impact on the gut microbiota and detrimental health consequences, because FODMAPs, as we said before, also play a beneficial role.

WHERE YOU CAN FIND OUT MORE

Nowadays interested people have at their disposal a large number of digital resources that can help them to take a diet low in FODMAP more easily and, above all, safely. One of the most recommended apps where you can find additional information about these foods, and about starting and monitoring a low FODMAP diet, is the FODMAP APP. It is a proposal of the University of Monash, in Australia, which unveiled this diet and carried out the first investigations on its effects.