FODMAPs, Food and You

What are FODMAPs?

Truth: Everyone eats FODMAPs and just about everyone experiences the digestive repercussions of FODMAP intolerance to some degree. FODMAPs are indigestible sugars that linger in the intestinal tract and become food for gut bacteria. In this environment, water is retained, gas is produced and GI discomfort manifests ranging from barely noticeable to severe symptoms of irritable bowel syndrome (IBS). Common IBS symptoms include bloating, painful abdominal distention, flatulence, constipation, diarrhea or both.

If you’ve never heard of FODMAPs, you’re not alone. This awkward acronym is relatively new to medical terminology and refers to a collection of poorly absorbed, rapidly

Fermented short-chain carbohydrates and sugar alcohols that include
Oligosaccharides, specifically fructans and galactans, the
Disaccharide lactose, the
Monosaccharide fructose,
And
Polyols, or sugar alcohols.

Fructans and galactans are chains of sugar molecules found in grains, legumes, fruits and vegetables that are poorly digested and poorly absorbed by everyone yet symptoms vary greatly ranging from none to severe. Lactose intolerance, the inability to digest milk sugar, affects those with a deficiency of the lactase enzyme and fructose, the principal sugar in fruit, is poorly absorbed by about one in three people. Although polyols, or sugar alcohols occur naturally in some fruits and vegetables, they are usually consumed in excess as manufactured sugar substitutes.

How Do FODMAPs Create Symptoms of IBS?

Fermentation in the large intestine, under healthy conditions, is a beneficial process where carbohydrates that have been poorly digested and absorbed end up in the colon and become food for the trillions of bacteria living there. Everything that eats creates waste including gut bacteria that produce hydrogen, carbon dioxide and methane gases. In people with FODMAP intolerance, or slow transit time of food through the digestive tract or an overgrowth of bacteria (SIBO), the fermentation process can become lengthy and exaggerated. Excessive gas is produced and fluid retention occurs as the body attempts to dilute the carbohydrate load resulting in the onerous and often very painful symptoms of IBS.
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FODMAP Food List

Fructans are highly concentrated in nectarines, watermelon, tamarillo, white peaches, artichoke, garlic, onions, leeks, wheat, rye, barley, chickpeas, lentils, beans, soybeans, pistachios, cashews, chicory root, coconut cream and flour and the soluble fiber inulin. In more moderate amounts, fructans are found in pomegranate seeds, asparagus, beets, broccoli, brussels sprouts, savoy cabbage, butternut squash, fennel, green peas, snow peas and sweet corn, well-rinsed canned chickpeas, well-rinsed red and brown lentils, almonds, hazelnuts and all other nuts and seeds.

Galactans are found in beans, soy and lentils.

Lactose is found in dairy products and most people can tolerate some lactose per serving of food. Lactose is particularly high in cow’s, goat’s and sheep’s milk however, full-fat sour cream, cream, butter and cheese have hardly any lactose content at all.

Fructose in its free form can create symptoms of IBS when it exceeds glucose concentrations in foods. Foods high in free fructose compared to glucose include apples, Asian pears, boysenberries, cherries, figs, mangoes, pears, tamarillo, watermelon, asparagus, artichokes, sugar snap peas, agave nectar, high-fructose corn syrup, fructose, fruit juice concentrate, and honey.

Polyols are sugar alcohols that at more than 0.5 gram per serving, can cause GI distress. Polyols occur naturally in apples, apricots, Asian pears, blackberries, nectarines, peaches, pears, plums, prunes, watermelon, cauliflower, mushrooms, snow peas, cherries, longans, lychee, and to a lesser extent, avocado and sweet potato. Manufactured products high in polyols include sorbitol, manitol, maltitol, xylitol, polydextrose, and isomalt.

Still Having IBS Symptoms on Paleo?

If you’re Paleo, you avoid grains as well as diary, legumes, soy and processed food that contain manufactured sugar alcohols. Therefore, by nature of the diet, you greatly minimize your FODMAP intake. However, if you’re still having symptoms of IBS, you may want to restrict all additional FODMAPs until your symptoms disappear. Then proceed to reintroduce one food per week, and see how you feel. Eating portions that are too large or too small can confuse results and different FODMAPs eaten together have a cumulative effect so take care to reintroduce foods in portions of average size, and when possible, choose foods that contain only one type of FODMAP. This process takes patience but it’s worth it. After eliminating all high-FODMAP foods and then carefully reintroducing them, I was able to determine that although I experience sensitivity to foods in all FODMAP categories, I am particularly sensitive to fructans. It was a real eye-opener for me to learn what caused so many years of debilitating IBS and it’s completely liberating to be able to control my symptoms!

For more information on FODMAPs, I recommend The Compete Low-FODMAP Diet by Sue Shepard and Peter Gibson as well as Aglaee Jacob’s comprehensive color-coded Paleo low-FODMAP diet chart that you can download as a free pdf from her website.

Wishing you good health!

Sally.