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What is the Low FODMAP Diet?

Those who experience digestive distress after eating may consider a low FODMAP diet. FODMAP stands for fermentable, olio-, di-, mono-saccharides and polyols. In essence, these foods are short-chain carbohydrates that act like fast food in the body.

Patricia Hunter, Clinical Diabetes Educator, discusses the low FODMAP diet.
What is the Low FODMAP Diet?
Featured Speaker:
Patricia Hunter
Patricia Hunter works for SNHH as a Clinical Diabetes Educator in the Outpatient Diabetes Education department.
Transcription:

Bill Klaproth (Host): Do you often experience digestive stress after eating certain foods? Well the low FODMAP diet may provide answers and start your journey back to good gut health. That’s what we want. Here to tell us more about the low FODMAP diet is Patricia Hunter, a clinical diabetes educator at Southern New Hampshire Health. Patricia, thank you so much for your time today. So, what is a FODMAP?

Patricia Hunter (Guest): FODMAP is an acronym that was coined in 2005 by two Australian researchers, two brilliant people, Sue Shepard and Peter Gibson and it defines a group of commonly malabsorbed carbohydrates, sugars and fibers. They’re different from other carbohydrates because intestinal bacteria quickly ferments them and FODMAPs are essentially fast food for our gut bacteria. When bacteria eats the poorly digested FODMAPs they create gas, which can make a person feel bloated. FODMAPs are very small carbohydrates and they are osmotically active. They draw water into the intestine and that can lead to diarrhea and other intestinal symptoms of bloating and distention.

Bill: This is really interesting. So FODMAP is spelled F-O-D-M-A-P so what does the acronym stand for? What is the FODMAP acronym?

Patricia: So my next statement is going to sound a little bit like Greek, but the acronym stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. So I’m going to go through and tell you what each of the actual letters stand for. So the F stands for fermentable, meaning that it creates gas. Oligosaccharides are a type of water soluble fiber found in wheat, onion, garlic, and beans. The D stands for disaccharides. Many of us recognize that lactose is a commonly malabsorbed sugar found in dairy foods, so that’s a common one people can identify with. Monosaccharides refer to fructose also known to all of us as fruit sugars found in apples, pears, honey, and agave syrup. The concentration is different in various fruits, and last polyols refer to sugar alcohols that are often found in sugar free gums and mints and also found in pears and different stone fruits, so it’s complicated.

Bill: Yeah, very interesting. So how does this translate into a diet? What’s the FODMAP diet then?

Patricia: So the diet is a two to six week elimination diet that involves removing high FODMAP foods to see if it alleviates the triggers that people are having, what’s causing their GI symptoms. In this particular phase, you can often see an individual have a reduction of 50% to 75% of their symptoms so it can be highly effective. It is a learning diet rather than a plan you would follow forever. The goal is to help a person determine what are their personal triggers. After you finish this elimination phase, if the person sees great benefit with it, a dietician will guide you on how to reintroduce or challenge these food groups in a very methodical manner. This allows you to actually understand better your tolerance to various FODMAPs and I guess the most positive thing I can say is many people find they can liberalize their FODMAP diet restrictions and there’s only a need to restrict some of those food groups. So I just stress that you need to work with someone who’s knowledgeable on the nuances of this plan because we’re really looking for every individual – as a dietician I want every individual to have the most varied diet that they can, not restrictive.

Bill: So this is how we find if we have problem malabsorbed carbohydrates. This makes total sense. So is this a gluten free diet?

Patricia: No the low FODMAP is not a gluten free diet. The low FODMAP modifies small chain carbohydrates and gluten is a protein. Wheat, barley, rye, they contain the proteins and gluten also contains fructan, a source of FODMAP carbohydrates. The low FODMAP minimizes wheat, barley and rye so gluten will be minimized as well but it’s actually the fructan that you’re trying to avoid.

Bill: Patricia we hear a lot about sugar and stay away from sugar. So is table sugar a low FODMAP?

Patricia: Table sugar is low in FODMAPs and so when you have sucrose, or table sugar, it is 50% glucose and 50% fructose and glucose helps fructose be absorbed so it’s rare that people have a problem with table sugar. I recommend that you watch the amount of added sugar per sitting because we all know it contains very little nutrients and may lead to inflammation and poor health.

Bill: Is the FODMAP diet a dairy free diet?

Patricia: No it is not. The part of dairy that is modified on this plan is lactose. Lactose is found in cows, sheep, and goat’s milk. Dairy foods are allowed on a low FODMAP plan including butter which contains only traces of lactose or small amounts of whipped cream, hard and aged cheeses such as cheddar and swiss contain negligible, actually zero amounts of lactose, the two I mentioned. Even American and mozzarella cheese are relatively low in lactose. It’s the soft cheeses or wet cheeses, sometimes people refer to it that way, the cottage cheese and the ricotta that would actually have much more lactose and need to be monitored.

Bill: Hmmm I didn’t know that. See? You’re teaching us already. So what about pork or beef or chicken? Do those foods contain FODMAPs?

Patricia: So the very good news is that these are protein rich foods so they contain no carbohydrates unless they’ve been breaded. Therefore, it would not be a source of FODMAPs. Fish, eggs are suitable protein sources and it’s important for an individual to become a very good label reader to see if by chance there was any wheat or onion or garlic or hidden sources on a food but typically your plain meats are fine.

Bill: So speaking of hidden sources, what are some common sources of hidden FODMAPs?

Patricia: FODMAPs can lurk in many manufactured foods such as marinara sauce, chicken stalk, beef stalk, salad dressings, and those sources often have onion and garlic in them to flavor the foods. Another example would be granola bars. It’s very common for manufacturers to add honey as a natural form of sugar but honey is very high in fructan or fructose and chicory root extract, often manufacturers will add that to increase the fiber content. Even a gluten free product is not necessarily low in FODMAPs if the manufacturer has added chicory root extract.

Bill: So when it comes to cooking, does cooking lower FODMAPs contents so they are better tolerated?

Patricia: This area needs a little bit more research. Fructans and glycosides are water soluble. So when I keep talking about onion and garlic, adding onion to water, the fructans leach into the water and can make people feel poorly and so cooking water can be a problem but certainly when you’re looking at a product like canned beans, there is less FODMAPs in a canned bean that’s been sitting in water than a dried bean that’s minimally soaked. So we’re not quite sure exactly how much FODMAPs would be altered during cooking at this time, and so for now we basically ask that people select lower FODMAP foods when they’re preparing meals.

Bill: So in closing, Patricia, this has been very interesting, do you have any closing thoughts for those having GI symptoms?

Patricia: I think obviously this plan is complicated but can yield great rewards and the understanding of a person’s tolerances to certain foods. There are many health conditions that can effect your GI tract and cause uncomfortable, embarrassing and inconvenient symptoms so it’s really important to consult with your doctor and not to self-diagnose. Your healthcare professional can rule out serious conditions such as celiac disease and colon cancer, and before a person starts on a low FODMAP plan, it’s really important for celiac disease. The second is to make sure that you’re getting credible information about FODMAPs. There’s many sources online, but in New England, we’re very fortunate to have two dieticians that have a lot of – that have actually been leaders in the field for the rest of us. One is Patsy Catsos. She has a website called – and a book, IBS Free At Last. You can go there and get great information and even search a topic specifically. Kate Scarlata has a blog and she has many written materials that you can print off, and if you’re interested, I have a FODMAP presentation at Southern New Hampshire Health, October 16th at 6:00, so we’d love to see people sign up for that.

Bill: Fascinating information. Please sign up for that October 16th event. You will learn a lot and it may change your life that’s for sure. Patricia thank you so much for your time today and for more information on all the things that Patricia talked about, please visit snhhealth.org, that’s snhhealth.org. This is Simply Healthy, a podcast by Southern New Hampshire Health. I’m Bill thanks for listening.