What is the FODMAP diet or low-FODMAP diet
The FODMAP diet consists of eliminating certain foods that are probably poorly tolerated by people suffering from Irritable Bowel Syndrome and may also alleviate some symptoms of patients with Crohn's disease or ulcerative colitis. These foods can also be related to food intolerances. This diet helps to overcome abdominal pain, gas, the feeling of bloating …, which characterize these ailments.
As explained by Dr. Javier Alcedo González, Head of the Motility and Functional Pathology Section of the Digestive System Service of the Miguel Servet University Hospital in Zaragoza and Member of the Board of Directors of the Spanish Association of Gastroenterology, “FODMAP is the acronym for a group of fermentable carbohydrates (fructans, oligosaccharides, disaccharides, monosaccharides and polyols) that in their digestion increase the amount of gas and liquid in the intestine ”.
What does FODMAP mean?
- F for fermentable
- Or from oligo
- D for disaccharides
- M for monosaccharides
- A de and (and in English)
- P for polyols
Fermentable Carbs: Where Are They?
- Fructans, like inulin, are fermentable carbohydrates that are present in common foods such as wheat or onion or leeks.
- Monosaccharides are simple sugars, like glucose, galactose, and fructose.
- Disaccharides are formed by the union of two monosaccharides. The most common are sucrose or common sugar –formed by the union of glucose and fructose–, lactose –glucose and galactose–, which is milk sugar, and maltose –two glucose molecules.
- Galacto-oligosaccharides are a type of indigestible and soluble prebiotic fibers, already present in breast milk, which end up fermenting in the colon. They usually come from dairy, legumes, some nuts and seeds.
- Polyols are sweet alcohols that are naturally part of certain foods or that can be obtained from other sugars.
To clarify these concepts a little more, let's say that if monosaccharides and disaccharides are sugars and are characterized by being crystalline, white and have a sweet taste, when they are present in larger molecules, that is, when they become oligosaccharides and polysaccharides, they become starches and fibers and their characteristics change.
The first and most obvious change is its flavor, which is no longer so sweet. The oligosaccharides are composed of three to ten monosaccharides and, when the body itself which produces, may have an important role in cell communication.
There are two important classes of oligosaccharides and polysaccharides, the fructooligosaccharides (FOS), which come exclusively from plant foods and consist of a chain of fructose molecules, and the galactooligosaccharides (GOS), which are chains of galacts and are abundant in soybeans. .
Both FOS and GOS, due to their characteristics, are not fully digested, and these fibers are what feed the intestinal microbiota, especially the “good” (or less pro-inflammatory) bacteria in the intestine, reducing the colony of “bad” bacteria. ”(Or more pro-inflammatory).
Therefore, all these components are beneficial for healthy people , but, in people with the problems we have described, they can cause problems and therefore the low-FODMAP diet limits their consumption.
Who can go on a low-FODMAP diet
As Dr. Javier Alcedo explains, “most of the scientific evidence that supports the prescription of the low-FODMAP diet comes from studies with patients who meet criteria for Irritable Bowel Syndrome. There are also some data that suggest benefit in selected cases of inflammatory bowel disease, and even in extradigestive pathologies such as fibromyalgia , although the lack of results makes it necessary to be very cautious in the decision to use diet in these scenarios. Finally, it should be noted that the breath tests to evaluate lactose and fructose malabsorption are of little use in predicting the success of a low FODMAP diet ”.
Alcedo emphasizes that both abdominal bloating and diarrhea are "very frequent clinical manifestations in the general population and may be due to numerous factors or pathologies, so it is not acceptable in all cases to propose a nutritional change as a solution."
As they are common symptoms to other ailments, “it is necessary to rule out chronic pathologies such as celiac disease, inflammatory bowel disease or bile salt malabsorption beforehand.
Without a prescription, the FODMAP diet should not be followed
If there is no medical indication, it is not advisable to do the FODMAP diet since it excludes or greatly limits the consumption of valuable foods, rich in prebiotic fibers that have a beneficial effect on the intestinal microbiota.
What's more, not even with a diagnosis of Irritable Colon Syndrome does it begin by indicating a low FODMAP diet. Dr. Alcedo points out that first “it is recommended to try to start healthy hygienic-dietary habits such as eating at regular times, avoiding large meals and ultra-processed or high-fat foods, and reducing alcohol consumption. Selective avoidance of foods that the patient himself has identified as poorly tolerated is also feasible, as long as the resulting restriction is not too extensive. Lastly, pharmacological measures such as the use of spasmolytics, antidiarrheals or laxatives, or depending on the symptomatic profile certain antibiotics and low-dose antidepressants, should be prescribed before opting for a low-FODMAP diet. "
It should also be taken into account that the low FODMAP diet, by restricting the consumption of a large number of foods, must be supervised by an endocrinologist or a dietician-nutritionist.
FODMAP: list of foods to avoid
These are foods that are probably not well tolerated by people suffering from Irritable Bowel Syndrome and conditions with similar symptoms:
CEREALS, VEGETABLES AND TUBERS
- Integral rice
- Sweet potato
- Barley and derivatives (flour, flakes …)
- Rye and derivatives (flour, flakes …)
- Kamut and derivatives (flour, flakes …)
- Legumes (chickpeas, lentils, beans …)
- Wheat and derivatives (bran, couscous, flour …)
DAIRY PRODUCTS
- Cow, goat and sheep milk and all its derivatives (yogurts, cheeses, creams, ice creams …)
VEGETABLES AND VEGETABLES
- Garlic
- Artichoke
- Broccoli
- Onion and the like (shallots …)
- Cabbage
- Brussels sprouts
- Cauliflower
- Mushrooms
- Asparagus
- Green peas
- Leek
- Beet
- Cabbage
- Mushrooms
FRUIT
- Avocado
- Apricots
- Khaki
- Cherries
- Plums
- Custard apple
- Pomegranate
- Figs
- Mango
- Apple
- Peach (and similar: nectarine, Paraguayans …)
- Quince
- Blackberry
- Pear
- Grapefruit
- Watermelon
- And all the dried fruit
NUTS
- Cashew nuts
- Pistachios
PROTEIN FOODS
- Processed meats that contain lactose, gluten …
- Sausages that contain lactose, gluten …
- Crab sticks
- Seitan
SWEETS
- Normal sugar-free gum and candies
- Milk chocolate
- Sweeteners: isomalt, mannitol, xylitol, maltitol and in general the finishes in "ol"
- Fructose
- Molasses
- Jams and preserves
- Honey
- Agave Syrup
FODMAP: list of recommended foods
These are the foods that are probably well tolerated by people who suffer from Irritable Bowel Syndrome and ailments with similar symptoms:
CEREALS, VEGETABLES AND TUBERS
- White rice and derivatives (flour, semolina, pancakes …)
- Oats and derivatives (bran, bread, pasta, breakfast cereals …)
- Gluten-free, lactose, and fructose-free cereals
- Spelled and derivatives (bread, pasta, breakfast cereals …)
- Corn and derivatives (flour, polenta, pancakes …)
- Son
- Potato
- Quinoa
- Flax seeds
- Sorghum
- Tapioca
- Buckwheat
- Cassava and derivatives (tapioca …)
DAIRY PRODUCTS
- Vegetable drinks of almonds, rice, oats, coconut, spelled
- Lactose free milk
- Butter
- Margarine
- Lactose-free cheeses
- Dry cured cheeses (Manchego or Parmesan type)
- Lactose-free yogurts
VEGETABLES AND VEGETABLES
(Some of these foods have a restricted daily allowance)
- Chard
- Celery
- Eggplant
- Green shoots
- Zucchini
- pumpkin
- Canons
- Chive
- Chinese cabbage
- Parsnip
- Endives
- Endive
- Spinach
- Green beans
- Lettuce
- Cucumber
- Peppers
- Arugula
- Tomato
- Carrot
FRUIT
(You can take 1 piece or equivalent of these fruits allowed in each meal without exceeding 3 pieces a day or its equivalent in juice)
- Blueberries
- Coconut
- Raspberry
- Strawberries
- Kiwi
- Lime
- Lemon
- Tangerine
- Cantaloupe
- Orange
- Papaya
- Pineapple
- Banana
- Grapefruit
- grapes
NUTS
- Almonds (maximum 10)
- Hazelnuts (maximum 10)
- Walnuts 4-5
- Pumpkin seeds (maximum one tablespoon)
PROTEIN FOODS
- Meat
- Sausages (gluten and lactose free)
- Eggs
- Shellfish
- Fish
- Tofu
- Tempeh
SWEETS
- Aspartame
- Sugar
- Cocoa powder
- Negotiated chocolate without milk or lactose
- Saccharin
- Maple syrup
Low FODMAP Diet Standard Menu
- Breakfast. Tea, coffee or infusion if desired with lactose-free milk or vegetable drinks of rice, oats, almonds or spelled (not soy) + 2 slices of spelled bread with serrano ham or rolled oats with lactose-free yogurt or cooked in milk Lactose-free or vegetable drinks of rice, oats, almonds or spelled (not soy) + 1 piece of fruit of those allowed (which can also be reserved for mid-morning)
- Food. Rice with vegetables (carrot, zucchini, green beans, spinach) + salmon with salad + 1 fruit allowed
- Snack . 1 lactose-free yogurt or 1 fruit allowed + 4 walnuts or 10 almonds or hazelnuts
- Dinner. Vegetable cream allowed (without cream and without onion, leek or garlic in the sauce) + Spanish omelette (without onion) + 1 allowed fruit or 1 lactose-free yogurt
Low FODMAP Diet Phases
The low-FODMAP diet has three phases:
- Elimination phase. The elimination of the habitual feeding the foods that can probably trigger problems is directed. This phase usually lasts between 2 and 3 weeks. As Dr. Alcedo explains, "this period is sufficient to assess whether or not it has been able to cause improvement in symptoms."
- Reintroduction phase. After having eliminated the foods that normally cause problems, they are introduced again little by little, to see how the organism of the affected person reacts to their consumption.
- Final phase or personalized feeding. Knowing what the person tolerates and what not after having gone through the reintroduction phase, some guidelines are given for their habitual diet that will depend on what they tolerate or do not tolerate. “The ultimate goal is for the reintroduction of food to be as complete as the symptoms of the subject who has followed the diet allow, dispensing with as few foods as possible. Nowadays it is known that the variety of nutrition, especially with regard to common sources of fermentable carbohydrates, such as fruits and vegetables, is directly related to the increase in the diversity of the microorganisms that make up our microbiota. This last factor is clearly associated with better health states ”, says the specialist.
What deficiencies can a low-FODMAP diet cause
If a low-FODMAP diet is followed for a long time, it can “cause notable nutritional deficiencies - lower caloric intake, antioxidants, vitamins, iron, calcium, etc. - as a permanent modification of the microbiota with uncertain and probably harmful effects ”, says Dr. Alcedo.
In addition, it must also be taken into account that they are diets that involve a greater economic expense and that make day-to-day life difficult, since you cannot easily share meals, go to restaurants, etc.
What long-term effects the FODMAP diet can have on the gut microbiota
In principle, as the indicated restriction period is very short, 2 or 3 weeks, the impact on the intestinal microbiota appears to be slight or even none at all. But, as the specialist warns, “if the FODMAP restriction is carried out for a prolonged period, a reduction in the variety of substrates that feed the microbiota is expected, which could lead to a reduction in their diversity, or at least to changes in the proportion of each microbial species "
This would have consequences not only in the "gastrointestinal balance, but it is also speculated that it could intervene in the appearance of extraintestinal disorders of a very different nature (autoimmune, neurological, dermatological, etc)".
Does The Low FODMAP Diet Really Work?
There are quality scientific studies that support the efficacy of this diet in reducing symptoms in the short term in patients with irritable bowel syndrome . As explained by the specialist, "an improvement in bloating and abdominal pain, flatulence, diarrhea and constipation has been observed in 50% to 75% of the subjects", adding that "other researchers have concluded that the benefit could maintained for up to 6 months if the restriction period is prolonged beyond the recommended 2 weeks, but there are no reliable longer-term data. "
Why not confuse the low-FODMAP diet with the gluten-free diet
As the specialist clarifies, “both the gluten-free diet and the low-FODMAP diet or some that propose dietary recommendations considered healthy (edited by internationally renowned scientific associations) have been shown to provide clinical benefits. However, each is based on different food group restrictions and is applicable to different subgroups of patients. Gluten is a protein found in wheat, barley, and rye. The gluten-free diet is a permanent measure, applicable mainly to celiac patients, allergic to gluten or wheat, or who have been diagnosed with a non-celiac sensitivity to wheat.The low-FODMAP diet is a remedy applicable only temporarily to patients with irritable bowel syndrome, which includes the withdrawal of gluten in addition to the restriction of many other carbohydrate-containing foods, such as fructose and lactose. "
