What You Need to Know About FODMAPs

FODMAPs are types of carbohydrates, or sugars, that either are not completely digested or do not absorb fully in the gut, which can trigger gastrointestinal (GI) symptoms in people who have Irritable Bowel Syndrome (IBS) or other GI disorders. GI symptoms such as abdominal pain and discomfort, bloating, passing gas, distension, diarrhea, and constipation are common complaints from those with IBS.

Technically, FODMAP stands for fermentable oligo-, di-, mono-saccharides and polyols, which are the scientific terms that are used to classify this group of carbohydrates. FODMAPs can be found in a range of foods in varying amounts. While some foods contain just one type, other foods contain several types of FODMAPs.

FODMAPs are found in many foods, including fruits, vegetables, breads, cereals, nuts, legumes, candy, and food additives. Most people can eat high FODMAP foods every day without any problems, but some people may have difficulty tolerating one or more of the FODMAP groups.  You may also find that while a large amount of a specific FODMAP may not be tolerated, a smaller amount may be tolerated just fine. While it is impossible to estimate the FODMAP content of a specific food, there are many resources to help guide you in determining which foods have high, moderate, and low amounts of FODMAPs.

The main food sources of the four groups includes:

• Oligosaccharides: Wheat, rye, legumes and various vegetables.
• Disaccharides: Milk, yogurt, ice cream and soft cheese.
• Monosaccharides: Various fruit including figs and mangos, and sweeteners such as high fructose corn syrup, honey and agave nectar.
• Polyols: Certain fruits and vegetables including blackberries and cauliflower, as well as some alternative sweeteners.

When FODMAPs are in the small intestine they move slowly and attract water, and when they pass into the large intestine, they are fermented very quickly by bacteria in the gut, which produces gas. This extra gas and water causes the intestinal wall to stretch and expand producing uncomfortable GI symptoms.

Because children with IBS have a highly sensitive gut, this stretching of the intestinal wall can cause pain and discomfort, bloating, diarrhea and/or constipation, among other issues.

Low FODMAP Diets

A low FODMAP diet may be necessary for children with medically-diagnosed IBS and while it can be beneficial in other GI conditions, it is best to speak with your child’s doctor before starting elimination diets as they do not come without risks. The purpose of a low FODMAP diet is not to permanently eliminate all FODMAPs but rather to identify and minimize the types of carbs that contribute to digestive symptoms. Tolerance can be dependent on the amount of FODMAP you consume during a given time.

Many foods can be eaten on a low FODMAP diet, including:

• Meats, fish and eggs, unless they have added high-FODMAP ingredients like wheat or high-fructose corn syrup
• All fats and oils
• Most herbs and spices
• Nuts and seeds:  Almonds, peanuts, macadamia nuts, pine nuts, sesame seeds (but not pistachios or cashews, which are high in FODMAPs)
• Fruits: Unripe bananas, blueberries, cantaloupe, grapefruit, grapes, kiwi, lemons, lime, mandarins, melons (except watermelon), oranges, passionfruit, raspberries, strawberries (ask your doctor or dietitian for recommended servings)
• Sweeteners: Maple syrup, molasses, and stevia
• Dairy products: Lactose-free dairy products, hard cheeses and aged softer varieties like brie and camembert
• Vegetables: Bell peppers, bok choy, carrots, celery, cucumbers, eggplant, ginger, green beans, kale, lettuce, chives, olives, parsnips, potatoes, radishes, spinach, green onions, squash, sweet potatoes, tomatoes, turnips, yams, water chestnuts, zucchini (ask your doctor or dietitian for recommended servings)
• Grains:  Oats, rice, quinoa, sorghum, tapioca (ask your doctor or dietitian for recommended servings)
• Beverages: Water and tea

This list is neither definitive nor exhaustive, and keep in mind that every child is different and may not tolerate some foods either because of FODMAPs or for other reasons.

When starting your child on a low FODMAP diet, it is generally recommended to completely eliminate all high-FODMAP foods for a few weeks with the guidance of your doctor or dietitian. Note, this diet may not be effective if you only eliminate some high-FODMAP foods but not others. If FODMAPs are the cause of GI distress, then your child may experience relief within a few days. Symptom relief is usually seen within 2 to 6 weeks of following the restricted diet.

Over the next 8 to 12 weeks, you can begin to reintroduce some foods, one FODMAP at a time. It is recommended to introduce 1 food at a time over a 3-day period to help more clearly identify possible trigger foods. As you are introducing a food, you will also want to increase the serving size every day to help identify the amount that is tolerated. This can be helpful in determining which foods are causing the troublesome symptoms.

Since starting a low FODMAP diet can be difficult, it is recommended that you talk to a physician first, as they may be able to help you avoid unnecessary dietary restrictions.

Studies have shown that people with common digestive disorders who are on low FODMAP diets can experience reduced pain and bloating. These benefits are generally apparent within 2-6 weeks after starting a low FODMAP diet.

While the diet does not cure IBS, it may help children live more comfortably with their condition. In addition, there is evidence that a low FODMAP diet can have a positive impact on IBS symptoms, especially abdominal pain and bloating, reduced distension, and/or diarrhea or constipation.

High FODMAP Foods

It can also be helpful to become familiar with foods that are high in FODMAPs so that you can minimize exposure. Common foods and ingredients that are high in FODMAPs include:

• Fruits such as apples, apricots, blackberries, canned fruit, pears, peaches, watermelon
• Sweeteners such as fructose, high fructose corn syrup, honey, xylitol, sorbitol
• Dairy products such as milk, ice cream, most yogurts, sour cream, soft and fresh cheeses and whey protein supplements
• Vegetables such as asparagus, broccoli, Brussels sprouts, cabbage, cauliflower, garlic, mushrooms, okra, onions and peas
• Legumes such as beans, chickpeas and lentils
• Wheat such as bread, pasta, some breakfast cereals, tortillas, waffles and crackers
• Other grains such as barley and rye
• Beverages such as soft drinks with high-fructose corn syrup, milk, soy milk and fruit juices

A low FODMAP diet does not improve symptoms for ALL children with IBS. Other diet therapies may be needed in addition to, or as a replacement of a low FODMAP diet. Diet therapies should always be guided by a physician or dietitian. Look for our upcoming blog about other diet therapies used in IBS.

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Sources:

https://www.monashfodmap.com/about-fodmap-and-ibs

https://www.healthline.com/nutrition/fodmaps-101#low-fodmap-diet

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5622700/