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FODMAP: The Diet That May Eliminate Your IBS Symptoms

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FODMAP

Are you looking for relief from your IBS symptoms?

Symptoms of Irritable Bowel Syndrome include abdominal bloating and distension, excess wind (flatulence), abdominal pain, nausea, changes in bowel habits (diarrhea, constipation, or a combination of both), and other gastrointestinal symptoms.

fodmap


What are the FODMAPs?

FODMAPs are found in the foods we eat. FODMAPs is an acronym for:

  • Fermentable
  • Oligosaccharides (eg. Fructans and Galactans)
  • Disaccharides (eg. Lactose)Monosaccharides (eg. excess Fructose)
  • Polyols (eg. Sorbitol, Mannitol, Maltitol, Xylitol and Isomalt)

This is a collection of molecules found in food, that can be poorly absorbed by some people. When the molecules are poorly absorbed in the small intestine of the digestive tract, these molecules then continue along their journey along the digestive tract, arriving at the large intestine, where they act as a food source to the bacteria that live there normally. The bacteria then digest/ferment these foods and can cause symptoms of Irritable Bowel Syndrome.


Where are FODMAPs found?

  • Excess Fructose: Honey, Apples, Mango, Pear, Watermelon, High Fructose Corn Syrup, Corn Syrup Solids
  • Fructans: Artichokes (Globe), Artichokes(Jerusalem), Asparagus, Beetroot, Chicory, Dandelion leaves, Garlic (in large amounts), Leek, Onion (brown, white, Spanish, onion powder), Raddicio lettuce, Spring Onion (white part), Wheat (in large amounts), Rye (in large amounts), Inulin, Fructo-oligosaccharides.
  • Lactose: Milk, icecream, custard, dairy desserts, condensed and evaporated milk, milk powder, yoghurt, margarine, soft unripened cheeses (eg. ricotta, cottage, cream, marscarpone).
  • Galacto-Oligosaccharides (GOS): Legume beans (eg. baked beans, kidney beans, bortolotti beans), Lentils, Chickpeas
  • Polyols: Apples, Apricots, Avocado, Cherries, Longon, Lychee, Nectarines, Pears , Plums, Prunes, Mushrooms, Sorbitol (420), mannitol (421), xylitol (967), maltitol (965) and Isomalt (953).
The most common FODMAP is fructose!

What is fructose?

Fructose is a monosaccharide, or single sugar. It is found in three main forms in the diet as:

  • fructose in fruits, honey and some root vegetables
  • part of the disaccharide, or double sugar, sucrose. Sucrose is made up of glucose and fructose.
  • Sucrose is also known as table sugar.
  • fructans in some vegetables and wheat. Fructans are short chains of fructose. They are also called inulins and fructo-oligosaccharides.

Fructose is the sweetest of all naturally occurring carbohydrates. For this reason it is often added as a sweetening ingredient in prepared foods. Since it is sweeter than table sugar, smaller amounts of fructose are needed to get the same sweetness.


How do I go on the FODMAP diet?

During your elimination trial, it is recommended that you eliminate all FODMAPs either significantly or entirely. Most patients will begin to feel significantly better within a few hours and a few days, but will take up to two weeks to feel fully healthy. A minority of patients have reported that it took up to three months to fully recover. After recovery, you can begin to gradually reintroduce foods using the steps outlined at the end of this article.

Many IBS sufferers with generally mild symptoms will find that a general reduction of fructose intake alone significantly relieves them of their symptoms. Other individuals will find that they must significantly reduce their intake of all FODMAPs to experience relief. You may find over time that eating certain FODMAPs does not bother you.

Finally, it should be noted that fructose – the ubiquitous simple sugar – is often allowed in “safe foods” if the food also contains a glucose-to-fructose ratio greater than one. This is because research shows that ingesting glucose at the same time as fructose (and in the same quantities as fructose) eases fructose absorption.

Is it dangerous to limit fructose intake?

In short: no. While carbohydrates are an essential source of energy, refined sugars are anything but and current research shows that fructose may be best ingested in strict moderation.

Further, some sources report that a modern diet contains upwards of ten times the amount of sugar humans ingested for much of evolution. This may help to explain why fructose malabsorption is found in up to 40% of inhabitants of western countries. You will still be ingesting a significant level of glucose and other carbohydrates. Overall, limiting your fructose intake will likely be beneficial to your health. But when in doubt, listen to your body (and, of course, doctor). It is also not inherently dangerous to limit other FODMAPs, but missing out on whole food groups could easily lead to a diet missing in nutrients and lacking in vitamins.

Which foods contain FODMAPs?

The best way to determine the fructose content of a given food is to use publicly available USDA data.

To save you some time, and to bring your attention to foods which contain non-fructose FODMAPs, the list below names some foods that you will definitely want to avoid at least initially. .

Fruits

Most fruits which are excluded are excluded due to excessive fructose content, or greater than a 1:1 Fructose:Glucose ratio. Also, some contain Polyols.

  • Apples
  • Apricots
  • Cherries
  • Mango
  • Pears
  • Nectarines
  • Peaches
  • Pears
  • Plums and prunes
  • Watermelon
  • High concentration of fructose from canned fruit, dried fruit or fruit juice

Grains

  • Rye
  • Wheat

Lactose-Containing Foods

  • Custard
  • Ice cream
  • Margarine
  • Milk (cow, goat, sheep)
  • Evaporated milk
  • Condensed milk
  • Milk powder
  • Soft cheese, including cottage cheese and ricotta
  • Yogurt
  • Greek yogurt

Legumes

  • Many legumes contain Galacto-Oligosaccharides (GOS).
  • Baked beans
  • Chickpeas
  • Lentils
  • Kidney beans

Sweeteners

  • Sweeteners which end in -ol are excluded because they are fermentable polyols.
  • Fructose
  • High fructose corn syrup
  • It should be noted that HFCS actually only contains marginally more fructose than glucose as compared to refined sucrose. It is included in this list only because it was found on another list (better safe than sorry), and because it still has a F:G ratio greater than 1. The accuracy of this entry will be checked soon for validity.
  • Corn syrup solids
  • See above
  • Palm sugar
  • Honey
  • Agave nectar
  • Isomalt
  • Maltitol
  • Mannitol
  • Sorbitol
  • Xylitol

Vegetables

  • Vegetables may be on this list for containing fructans.
  • Artichokes
  • Asparagus
  • Avocado
  • Beets
  • Broccoli
  • Brussel sprouts
  • Cabbage
  • Cauliflower
  • Garlic
  • Garlic is possibly okay to consume, but should not be ingested in large quantities.
  • Fennel
  • Leeks
  • Mushrooms
  • Okra
  • Onions
  • Onions have recently been reported to be especially troublesome. It is best to completely avoid them.
  • Peas
  • Radiccio lettuce
  • Scallions (white parts)
  • Shallots
  • Sugar snap peas
  • Snow peas


So, what’s safe to eat?

It’s best to obtain your calories principally from a source that is indisputably fodmap-friendly (such as rice or meat). In moderation, however, the following foods are safe to eat on a low-FODMAP diet.

Fruits

  • Banana
  • Blueberry
  • Grapefruit
  • Grapes
  • Honeydew melon
  • Kiwi
  • Lemon
  • Lime
  • Mandarine oranges
  • Orange
  • Raspberry
  • Strawberry

Sweeteners

  • Artificial sweeteners that do not end in -ol
  • Glucose
  • Maple syrup
  • Sugar (sucrose)

Lactose Alternatives

  • Butter
  • Hard cheeses
  • Brie (exceptional cheese)
  • Camembert (exceptional cheese)
  • Lactose-free products, such as lactose-free ice cream and yogurt
  • Gelato
  • Rice milk
  • Sorbet

Vegetables

  • Bok choy
  • Carrots
  • Celery
  • Corn
  • Eggplant
  • Green beans
  • Lettuce
  • Parsnip
  • Scallions (green parts only)
  • Tomato
  • Reintroducing foods/Moving beyond the elimination phase

Once you are symptom-free, you may attempt to reintroduce foods in order to determine exactly what was causing your symptoms. There are really no established guidelines on how to best do this – it varies from individual to individual. Key concepts, however, follow:

  1. Write it down! Be scientific. Keep a food diary. Your future self will thank you.
  2. Only reintroduce one food at a time.
  3. Wait ~72 hours for symptoms to reappear before moving on to the next food

* These statements have not been evaluated by the Food and Drug Administration. The product mentioned in this article are not intended to diagnose, treat, cure, or prevent any disease.   The information in this article is not intended to replace any recommendations or relationship with your physician.  Please review references sited at end of article for scientific support of any claims made.

Categories: Allergies, Gut HealthBy Dr. Jill C. Carnahan, MD, ABIHM, IFMCPSeptember 18, 201110 Comments
Tags: abdominal paindiarrheaeliminate IBSFODMAPFODMAP dietfructoseIBSirritable bowelTreat IBS naturally
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Author: Dr. Jill C. Carnahan, MD, ABIHM, IFMCP

https://www.jillcarnahan.com/

Dr. Jill is Your Functional Medicine Expert! She uses functional medicine to help you find answers to the cause of your illness and addresses the biochemical imbalances that may be making you feel ill. She'll help you search for underlying triggers contributing to your illness through cutting edge lab testing and tailor the intervention to your specific needs as an individual. She may use diet, supplements, lifestyle changes or medication to treat your illness but will seek the most gentle way to help your body restore balance along with the least invasive treatment possible. Dr. Jill is a functional medicine expert consultant and treats environmental and mold-related illness as well

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10 Comments

  1. Diane Macciocchi says:
    February 17, 2015 at 8:24 am

    My 14 yr old son suffers from chronic diarrhea. Has been diagnosed with systemic candida, mthfr heterozygous for 677/1298, weakened immune system along with allergies and Asthma, low subclass blood work, high mycoplasma and very low CD57, possible lyme. Tested at least twice.
    We have only tried the candida diet and Paleo. He is currently taking Nystantin lozenges for 2 months but has had this treatment prior to now as well
    Looking for a great Dr near me in Geneva IL for help. He is dehydrated and looks pale despite tons of water.
    Any help is greatly appreciated.
    Diane

    Reply
    • Jill Carnahan, MD says:
      February 17, 2015 at 8:55 am

      Hi Diane,
      I suggest searching by zip code for a functional medicine trained doc near Geneva, IL. You can search at http://www.functionalmedicine.org. Best of luck on healing for your son!
      warmly
      Dr Jill

      Reply
  2. Lyka says:
    August 8, 2016 at 6:59 am

    Hi Dr Jill

    Im Lyka from Philippines. Two months ago, i was diagnosed gastritis Grade A positive h pylori. i had my triple treatment that time., and only experince epigastic pain.. i have normal abdominal ultrasound, and Ct Scan. Then suddenly after about two months, i experience bloating, gas, heartburn, abdominal pain, loss weight. loss of appetite, back pain, insomia.. I also checked my poop, that there are undigested fibers. Im so stress out about my symptoms. i would like to ask if this is SIBO, leaky gut? Thank You Dr.

    Reply
  3. Alina says:
    November 16, 2016 at 12:34 pm

    I have tried everything for my Rosacea and nothing seems to help. I had antibiotics, creams and if anything the symptoms get worse. would a Fodmaps diet help.

    Reply
    • Jill Carnahan, MD says:
      November 16, 2016 at 2:57 pm

      Treating the SIBO might help – have your physician test you for small intestinal bacterial overgrowth and treat if positive. There is a high association with Rosacea and SIBO.

      Reply
  4. Jamie says:
    January 12, 2017 at 3:31 pm

    Im a 20 year old female who had yeast infection then got BV. Took metronidazole and now am on Diflucan to kill off any other yeast. I have been suffering from excessive flatulence and diarrhea. I am now a vegetarian due to everything I eat causing me to be gassy, which has helped some. However, this has completely left me embarrassed, ashamed and isolated. I cannot go out anywhere because my gas is uncontrollable, I don’t even feel it coming out. I have tried the elimination diet and it helped some but I need help! I am now taking a Probiotic, omega 3 fish oil, multivitamin, and digestive enzymes. But I don’t even know what I have. Is it SIBO, IBS, or leaky gut? All the functional doctors in illinois charge $500 or more for just the FIRST visit. I am just a college student how do I get the help I need if I am not able to afford this care.:[

    Reply
    • Jill Carnahan, MD says:
      January 12, 2017 at 8:44 pm

      Hi Jamie
      You could try the SCD diet but if that doesn’t help you will need to find a doctor to test you to find root cause… I always say “test don’t guess”.
      warmly
      Dr Jill

      Reply
  5. Lima says:
    January 17, 2017 at 5:17 pm

    Which doctor do i need to see to get these symptoms evaluated?

    Reply
    • Jill Carnahan, MD says:
      January 17, 2017 at 8:05 pm

      Hi Lima
      search for a functional medicine doctor in your area – http://www.functionalmedicine.org

      Reply
  6. Pingback: 6 Signs That SIBO Might be the Root Cause of Your IBS | The Health Coach

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Dr. Jill will help you search for underlying triggers contributing to your illness through cutting edge lab testing and tailor the intervention to your specific needs as an individual.
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