FODMAPS: What are they, and why they upset digestion?
Many people are confused when they get symptoms of gas, fluctuating bowel activity, and cramps. I remember in my 20s often crouching over with abdominal pain, which seemed to come on after eating. You may recall I have previously mentioned I thought I was lactose intolerant and stopped drinking milk and started drinking a lot of soybeans (e.g. soymilk) in my 20s. I did have one gallbladder attack, with the pain being even worse, but also I had intermittent gas and felt bloated most of the time.
I had gastroscopy/endoscopy and the Gastroenterologist could not rule out irritable bowel syndrome (IBS), because unfortunately unlike other gastroenterological conditions it is not diagnosed in the usual medical way, it is ‘diagnosed’ by ruling out other causes. Finally, in my 30s my doctor (GP) put me on a low FODMAP diet and my symptoms left.
What are FODMAPS you ask? They are Fermentable Oligosaccharides Disaccharides Monosaccharides And Polyols that are found in many foods and can wreak havoc with the gut bacteria’s function. Up to 1 in 3 adults have fructose malabsorption (1,2,3).
- Monosaccharides are the simplest of sugars or the smallest sugar units. Some monosaccharides are fermentable in the gut, which can cause IBS and gut discomfort.
- Disaccharides have two sugar molecules and common forms are sucrose, maltose, and fructose, depending on the severity of FODMAP sensitivity they can be tolerated in small amounts.
- Oligosaccharides are simple sugars in long chains (polymers), which if undigested serves as food for bad gut bacteria. Fructans are fructose polymers and are the naturally occurring storage of carbohydrates of a variety of vegetables, including onions and garlic, fruits and cereals. Additional sources of fructans are inulin or Fructo-oligosaccharides (FOS). Like fructans, galactooligosaccharides (GOS) or chains of galactose molecules are also malabsorbed in the small intestine. Some individuals do not produce enzymes that hydrolyse galactose-galactose bonds are too readily fermented but the bacteria in the large bowel.
- Polyols are added to food to make them sweeter. Some can form negative effects on the gut, as they can’t be completely digested.
The easiest way to find out if you have FODMAP sensitivity is to go on a low FODMAP diet for a month or so and see if your symptoms improve (4,5). Now that I know I am sensitive to FODMAPS I limit their intake, and I certainly feel it if I eat too much as my symptoms return. That is not to say I never ever eat FODMAPS, but I make them occasional foods rather than staples of my diet.
As mentioned above due to incomplete digestion the sugars can feed ‘bad’ bacteria in the gut. Dysbiosis (the technical term) or ‘bacteria out of balance’ is the cause of so many ailments and research is only just starting to see the link with chronic health conditions such as cancer, cardiovascular disease, diabetes, and gut health. If avoiding the foods that cause the ‘bad bugs’ to feed is a way to keep healthy, I certainly think that it’s a far simpler solution than waiting to be prescribed antibiotics, or other treatments, which can often cause more problems than the ‘solutions’ they are aimed at creating. Now that my gut bacteria have become more balanced; by refusing antibiotics for over 5 years, avoiding soy and taking regular pro- and probiotics, I am much less sensitive to FODMAPS than I used to be.
I have created a table of LOW and HIGH FODMAP foods so that you can investigate further if you think you might also be sensitive to FODMAPS (5).
HealthEqualsFreedom.com FODMAP List
KEY of high FODMAP ingredients: F=FRUCTOSE, L=LACTOSE, P= POLYOLS F/G=Fructans/Galacto-oligosaccharides
I hope I have simplified a topic that you were not aware of or find confusing. If you think that this might help someone else a friend or family member feel free to share.
Yours in good health,
#DrRachel, #HEF, #certifiedorganic, #FODMAPS #healthequalsfreedom
- Nelis GF, Vermeeren MA, Jansen W. Role of Fructose-sorbitol malabsorption in the irritable bowel syndrome. Gastroenterology. 1990;99:1016-1020
- Rumessen JJ, Gudmand-Hoyer E. Fructans of chicory: Intestinal transport and fermentation of different chain length and relation to fructose and sorbitol malabsorption. Am J Clin Nutr. 1998: 68:357-364.
- Skoog SM, Bharucha AE. Dietary fructose and gastrointestinal symptoms. A review. Am J Gastroentrol. 2004;99:2046-2050.
- Shepherd SJ, Parker FJ, Muir JG and Gibson PR. Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome-randomised placebo-controlled evidence. Clin. Gastroentrol. Hepatol. 2008;6(7):765-771. http://www.sciencedirect.com/science/article/pii/S1542356508001511
- Halmos EP, Power VA, Shepherd SJ, et al. A Diet Low in FODMAPS Reduces Symptoms of Irritable Bowel Syndrome. Gastroenterology 2014;146(1):67-75e5.