The low FODMAP diet is not a weight loss diet. It is a nutritional treatment that can be used to reduce the symptoms of irritable bowel syndrome (IBS). An Australian nutritionist developed this diet as early as 2005, which significantly reduces the digestive discomfort experienced by people dealing with IBS. The word FODMAP is an acronym representing the four groups of fermentable carbohydrates.
So, as promised in the article: Celiac Disease, Gluten Intolerance, or Irritable Bowel Syndrome? , here is the description of this acronym:
F for Fermentable
Fermentable carbohydrates are small-sized carbohydrates that are poorly absorbed by the small intestine and rapidly fermented by bacteria in the large intestine. These carbohydrates can play a role in triggering IBS symptoms. Indeed, in individuals with IBS, consuming these carbohydrates leads to a significant influx of water into the intestine and increased gas production during fermentation, causing intestinal distension (expansion of the intestines, often experienced as a feeling of bloating or "looking a few months pregnant"). Then, combined with factors such as visceral hypersensitivity (a condition where pain is felt during the stretching of the digestive tract), stress, and anxiety, IBS symptoms can be triggered (e.g., abdominal pain, bloating, flatulence, diarrhea, and/or constipation).
These carbohydrates include fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.
O for Oligosaccharides
The oligosaccharides include the fructose - mainly the fructans, theinuline and the levanes - and the galacto-oligosaccharides (GOS)Fructans are carbohydrates found notably in wheat (e.g., bread, pasta), barley, rye, onions, and garlic, etc. They are also present in asparagus, cabbage, beetroot, leeks, and more.
GOS are carbohydrates found, among other things, in legumes (e.g., lentils, chickpeas, red beans, etc.) and artichokes, etc.
D for disaccharides
Disaccharides refer to a sugar composed of two small sugars. They mainly include the following sugars: sucrose (combination of glucose and fructose), maltose (association of two glucoses) and lactose (association of glucose and galactose).
The disaccharide that causes the most problems is lactose, a carbohydrate found in dairy products such as milk, cream, ice cream, yogurt, and cheese.
M for monosaccharides
Monosaccharides include fructose, a carbohydrate found in certain foods such as honey, vegetables, and fruits. For example, apples, dates, and raisins contain a lot of fructose.
A pour and/and
P for polyols
Polyols are carbohydrates that contain "alcohol" groups. There are several types of polyols. They include sorbitol and mannitol, carbohydrates naturally found in certain fruits and vegetables such as apples, apricots, dates, prunes, pears, peaches, cauliflower, mushrooms, and more.
They are also found in their synthetic form, as additives or artificial sweeteners in certain sweets (e.g., sugar-free candies, chocolates not naturally sweetened, sugar-free chewing gum, sugar-free ice cream, etc.).
Nutritional Approach to FODMAP
Now that we have demystified the acronym, let's take a look at what the low FODMAP diet involves. This diet is divided into three phases: the low FODMAP diet, the reintroduction phase, and the personalization of the low FODMAP diet.
Phase 1 – Low FODMAP Diet
This first phase lasts from 2 to 6 weeks. During this phase, all high FODMAP foods are replaced with low FODMAP foods for each of the four groups.
Phase 2 – Reintroduction of FODMAPs
The second phase lasts from 6 to 8 weeks. During this phase, foods from each group are reintroduced into the diet according to a reintroduction protocol or plan. The reintroduction is done gradually, one group at a time, and with only a few foods per group, usually one or two. The protocol provides a list of foods to reintroduce for each carbohydrate group, along with the quantity and frequency of consumption. The quantity and frequency are important because there can be a cumulative effect, and sensitivity to a carbohydrate group may vary over time. The protocol also specifies the order in which groups are reintroduced, which can vary between individuals. This phase helps identify which groups and/or foods trigger symptoms.
Phase 3 – Personalization of the low FODMAP diet
During the third phase, the results of the second phase are interpreted and the diet is customized according to each individual's tolerance and sensitivity. Foods are reintroduced based on symptoms, and only the foods and groups that trigger them are restricted. Generally, it is unlikely that an entire carbohydrate group will need to be completely eliminated.
Conclusion
The low diet in FODMAP is a nutritional approach that can be used for individuals with IBS. However, as we have seen, it is not a diet that should be followed for life. The low FODMAP diet is only the first phase of the nutritional approach; afterwards, it is important to reintroduce foods and personalize the diet according to the specific needs of each individual. To do this, do not hesitate to consult a dietitian, who can support you throughout this process.
References
Bouthillier, Lise. January 2019. "Digestive Tract Diseases." NUT 2047 – Clinical Nutrition 2. Montreal: University of Montreal.
Nahikian, M. (2016). Nutrition Therapy for Irritable Bowel Syndrome. Nutrition Therapy and Pathophysiology, Cengage Learning, pp. 415–418.