Diets in Detail – The Low FODMAP Diet

Fri 19th Jan, 2018 - 4:32pm by Emma Cockrell

The Low FODMAP diet is an eating pattern that is recommended by many practitioners to help reduce the discomfort of Irritable Bowel Syndrome.

Irritable Bowel Syndrome

BUPA estimates that as many at 1/5 of the UK adult population suffers with Irritable Bowel Syndrome (IBS). Symptoms listed by BUPA can include

• Pain or discomfort in your tummy (abdomen).  The discomfort may vary from a sudden sharp pain to a constant dull ache. You may also get cramps. This pain may ease if you go to the toilet and may get worse after eating.
• Changes in bowel habits. Your stool  may vary in consistency and can alternate between constipation and diarrhoea. You may also pass small amounts of mucus. Sometimes you may need to go to the toilet urgently, and at other times you may have problems going. After going to the toilet, your bowels may feel like they haven’t been completely emptied.
• Your abdomen may look and feel bloated.

If there is no medical explanation for these symptoms a doctor may diagnose IBS. IBS is not a disease in itself, but the term coined to describe the combination of unpleasant symptoms with no obvious medical underlying cause.

The Nutritionhelp Starting Place for IBS

It is not surprising therefore, that a number of clients coming to Nutritionhelp are complaining of IBS. Since the balance of microbes in the gut is key to healthy digestion, this is usually where my recommendations will start. If beneficial bacteria have become reduced (e.g. after taking antibiotics etc), it is quite possible that intestinal yeasts, such as Candida albicans, have become over-active. Yeast can then impact not only on the digestive process, but also interfere with the health and strength of the gut wall. This means that the gut can become sensitive to certain foods, resulting in symptoms.

• Sugar and refined grains can cause irritation and inflammation within the digestive tract, while also feeding intestinal yeast. These should be avoided. Fruit too, although a healthy source of nutrients, should be avoided while on a diet to support gut ecology. A piece of fruit will happily feed intestinal yeast.
• The extra-fast proving methods employed by supermarket bakeries means that yeasted bread can be a big problem for many. If intestinal yeast is overgrown, it may cause a sensitivity reaction to yeasted products. so these should be avoided.
• Beneficial bacteria are essential not only to keep unhelpful intestinal yeasts and pathogens under control, but also to support basic digestion. A probiotic supplement can often be beneficial in the short-term to cope with IBS. Long-term use of a probiotic helps to recolonise beneficial bacteria in the gut and encourage a robust digestive system.
• Erica White’s Four Point Plan covers the above points in helpful detail, and this forms the back-bone of recommendations.

But I still Get Symptoms…

For many clients, the basic anti-Candida protocol is sufficient to see a dramatic decrease in symptoms, leading to a marked improvement in quality of life.

However, for some clients, the constipation/diarrhoea/bloating/abdominal pain continue. This is where we need to do some detective work, and consider questions such as:

1. Has the client properly followed the diet recommendations? There is no point trying to find what else may leading to symptoms if a client is having a baguette at the weekends, or a piece of fruit with breakfast.
2. Is the client going through extra stress? It is essential to give time to meals, to allow proper digestion. Someone eating ‘on the go’ may well experience digestive discomfort such as bloating.
3. Are there specific foods which the individual is struggling to digest? Grains, dairy, certain veg?

What are FODMAP foods?

It is with this final point that the low FODMAP diet may be considered. Dr Murray writes:

Relatively recently, a great deal of attention has finally started to look at certain foods that play a central role in digestive disturbances such as excessive gas, bloating, and changes in regularity…One of the most common culprits in causing digestive disturbances are FODMAPs – small carbohydrates in certain foods. FODMAP is an acronym for:

Fermentable – foods that are quicken broken down (fermented) by bacteria in the large intestine

Oligosaccharides – “oligo” means “few” and “saccharide” means sugar. These molecules are made up of individual sugars joined together in a chain. Beans are a common source of oligosaccharides.

Disaccharides – “di” means two sugar, so a disaccharide is composed of two sugar molecules bonded together. Sucrose is a disaccharide.

Monosaccharides – “mono” means single, so a monosaccharide is a single sugar molecule. Fructose is a monosaccharide.

And Polyols – these are sugar alcohols often used as sweeteners. Some examples are xylitol, maltitol, and erythritol

That is the science behind low FODMAP recommendations. So what does this diet look like?

The Low FODMAP Diet

It is generally suggested that the following foods should be avoided for a couple of weeks and then slowly introduced, one by one. This should highlight any culprit foods that are impacting onto digestion.

• Vegetables: Artichokes, asparagus, broccoli, beetroot, brussels sprouts, cabbage, cauliflower, garlic, fennel, leaks, mushrooms, okra, onions, peas, shallots.
• Fruit: Apples, applesauce, apricots, blackberries, boysenberries, cherries, canned fruit, dates, figs, pears, peaches, watermelon.
• Dairy products: Milk (from cows, goats and sheep), ice cream, most yogurts, sour cream, soft and fresh cheeses (cottage, ricotta, etc).
• Legumes: Beans, chickpeas, lentils, red kidney beans, baked beans, soybeans.
• Wheat: bread, pasta, most breakfast cereals, tortillas, waffles, pancakes, crackers, biscuits.
• Other grains: Barley and rye.
• Beverages: Beer, fortified wines, soft drinks with high fructose corn syrup, milk, soy milk, fruit juices.
• Sweeteners: Fructose, honey, high fructose corn syrup, xylitol, mannitol, maltitol, sorbitol.

Anyone who knows the Erica White Anti-Candida diet will see that there are a lot of over-laps here in what should be avoided. In particular, fruit, sweetened beverages, sweeteners and most dairy.

From experience, the two food groups which often cause the most problem for IBS symptoms (after avoiding sugars and yeasts) are gluten (wheat, rye, barley and oats) and dairy. It has never been so easy to find gluten-free grains, pasta and flours, and dairy alternatives. With some encouragement and experimentation, it is possible to have a very varied diet without these foods – which can promote inflammation.

Support Digestion

However, the low FODMAP diet includes a number of ‘healthy foods – vegetables and legumes. For some individuals these may be particularly hard to digest.  This is where it may be helpful to look at ways to support digestion, and consider how to keep up a good veggie intake.  Dr Murray makes the following observation:

Many of the foods excluded on the low-FODMAP produce beneficial effects on the intestinal microbiome – the collection of microbial genetic material in the gastrointestinal tract. A more rational approach may be to focus on supporting FODMAP absorption through the use of supplemental enzyme formulations rather than eliminating these foods..The answer is not to go on such a restrictive diet, but to use digestive enzymes. A broad-spectrum enzyme formulation is probably the best way to go.

…Follow a low-FODMAP diet for 10 days supplemented with a broad-spectrum enzyme supplement. This ten day period will help determine if FODMAPs are an issue in your digestive health complaints. If symptoms dramatically improve, then I would recommend to continue to keep FODMAP intake low, but not necessary totally avoided, we need those good foods. Just be sure to continue to use the digestive enzymes. You can then slowly increase the intake of FODMAPs to determine your intake threshold for producing symptoms. With the enzyme support, it should be significantly higher and they may not be an issue at all.

My approach is always to encourage a client to eat as varied a diet as possible (choosing from healthy ‘clean’ foods of course!) And this is where a digestive enzyme supplement may be beneficial as Murray notes. Plant-based enzymes, such as bromelain from pineapple and papain from papaya, help break down foods, reducing the strain on the body’s own digestive enzymes. For many this can be wonderfully helpful. There are a range of digestive enzyme formulas to try. Many clients use digestive enzyme supplements when they are having a bean-based meal, which they may otherwise struggle to digest.

Healing the Digestive Tract

There remains a few clients however, for whom digestive enzymes do not do the trick. In this case we nutritionally work to support the health of the digestive tract and digestive process, while the client continues to avoid culprit foods. I can help with recipe suggestions (e.g. use chives instead of onions, use veg in smoothies),  and cooking ideas (e.g. remove the outer skins from cooked chickpeas or blend vegetables into soups), Reducing inflammation, and building gut integrity with foods and supplements, while balancing the gut microbiome with Erica White’s Four Point Plan, may mean that in time, good digestion is restored, IBS cleared, and healthy foods enjoyed!

Get in touch if you want to know more about Digestive Enzymes, or would like a consultation to support your own digestion.