Fermentable Oligo-, Di- and Mono-saccharides, And Polyols
These types of carbohydrates got their own team name based on the length of their carbohydrate chains and have been known to worsen the symptoms of some digestive disorders, such as irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). These short-chain carbohydrates are poorly absorbed in the small intestine, attract excess water to the intestine and as they sit around waiting to be processed, they rapidly ferment in the gut, which can lead to increased gas, distention, bloating, cramping, and diarrhoea.
Oligosaccharides are unable to be digested as humans lack the digestive enzymes required to break them down. Foods that fit this category are artichokes, asparagus, beets, brussels sprouts, broccoli, cabbage, fennel, garlic, leeks, okra, onions, peas, shallots, wheat, rye, barley, legumes, lentils, chickpeas, apples, peaches, persimmon, watermelon, and pistachios
A disaccharide, Lactose is a made up of two sugar units. Lactose is only a FODMAP when there is an insufficient level of lactase, the enzyme required to break lactose down. Several factors can influence lactase production such as genetics, ethnicity (Asian, African American, Hispanic, Native American, Alaska Native, and Pacific Islander), and other gut disorders. Common foods are milk, yogurt, ice cream, custard, and soft cheeses.
Fructose is a monosaccharide, a simple sugar and requires no digestion, however when fructose levels are greater than glucose, an alternative absorption method is used. This alternative method of absorption is impaired in some individuals, leading to fructose malabsorption. Common foods are apples, cherries, mangoes, pears, watermelon, asparagus, artichokes, sugar snap peas, honey, and high fructose corn syrup.
Fructans: Globe and Jerusalem artichokes, garlic (in large amounts), leek, onion (brown, white, Spanish, spring and onion powder), shallots, wheat (in large amounts), rye (in large amounts), barley (in large amounts), inulin, Fructo-oligosaccharides.
Polyols are a type of sugar alcohol that absorbs one third of what is consumed, and absorption is slow, fermenting in the intestinal tract. Common foods in this group are apples, apricots, cherries, pears, nectarines, peaches, plums, prunes, watermelon, avocado, cauliflower, mushrooms, snow peas, and the artificial sweeteners sorbitol, mannitol, maltitol, and xylitol.
The first phase of the Low FODMAP Diet generally involves the strict restriction of all high FODMAP foods for 4-6 weeks. Identify these foods and seek alternatives to ensure your diet is still nutritionally adequate, preferably with the supervision of a naturopath or nutritionist. The symptom response over this period should be noted, and a review appointment will then provide guidance on the second phase.
The second phase is where foods that were restricted in the first phase are reintroduced gradually and the diet is liberalised to suit the individual’s threshold. This is where the type and amount of FODMAPs that can be tolerated by the individual are identified so that their long-term diet can be established. It is very important to determine the level of FODMAPs that can be comfortably tolerated, so that the prebiotic effects of FODMAPs can be enjoyed and the diet is not overly restricted. The professional guidance during the reintroduction process can help to minimise symptoms and to ensure maximum variety is achieved in the diet.
The result should be a long-term diet that is lower in the problematic FODMAPs for the individual than were originally consumed, but is not as FODMAP-restricted as the first phase of the diet. This easier to manage dietary plan is tailored to the individual’s tolerance and continually increasing research has shown this approach decreases the occurrence and severity of gas, abdominal discomfort, bloating, craping and diarrhoea in IBS patients
Note: This is a LOW FODMAP Diet, not a NO FODMAP Diet. Eliminating all FODMAP foods from the diet over the long term is not desirable or recommended. I strongly recommend you consult a healthcare professional when making such changes to your diet
**Not a complete list of FODMAP containing foods