In my naturopathic medical practice in Jerusalem, I have seen that food intolerance plays a significant role in the exacerbation of IBS symtoms. IBS sufferers often tell me that they have seen much resolution on gluten free or dairy free diets or by avoiding foods that they felt triggered their stomach problems. The testing I do in my clinic in Jerusalem (IgG food intolerances testing) helps the majority of patients find out exactly which foods are causing their IBS, however not all patients get full resolution. The reason seems to be that although certain proteins in foods do cause stomach upset, like gluten, certain sugars may also play a major role in IBS, particulary the FODMAPs. Symptoms of gas, bloating, cramping and/or diarrhea may occur in those who could be sensitive to the effects of FODMAPs.
Why are FODMAPs a problem? FODMAPS are for the most part highly osmotic (meaning they pull water into the intestinal tract), which can increase bowel motions and promote diarrhea. But even more problematic is that FODMAPs are often not well digested or absorbed (especially in patients who have enzyme deficienies ie. lactase deficiency) leaving these foods to be fermented upon by bacteria in the intestinal tract producing gas, bloating and wind.
Occasionally a person will develop an abnormal amount of “bad” bacteria in their stomachs and often FODMAPs are seen as excellent food for these “bad” gut bacteria. This is thought to be the reason why some people suffer more than others from FODMAPs. This bad bacterial overgrowth is usually in the small intestine and usually exists due to overuse of antibiotics which may have let certain classes of “bad” bacteria proliferate while killing off the good bacteria. Upon eating the FODMAPs these bacteria tend to produce gas and toxins which lead to diahrrea. A low FODMAP diet may help reduce these symptoms by removing the bad bacterias’ foodsource.
What Foods contain FODMAPs? (note this list is not exhaustive or complete)
The FODMAPs in the diet are broken into 5 different classes:
· Fructose (fruits, honey, high fructose corn syrup (HFCS), etc)
· Lactose (dairy)
· Fructans (wheat, onion, garlic, etc)(fructans are also known as inulin)
· Galactans (beans, lentils, legumes such as soy, etc)
· Polyols (sweeteners containing sorbitol, mannitol, xylitol, maltitol, stone fruits such as avocado, apricots, cherries, nectarines, peaches, plums, etc)
Should a person be on FODMAPs forever?
It is not generally recommended to follow a low FODMAP diet for life; restricting dietary intake of a wide array of foods should generally be avoided if possible to reduce the risk of nutrient deficiencies. FODMAPs are a normal part of the diet and have benefits for health, such as providing fibre and prebiotics for gastrointestinal health.
How does one figure out which FODMAP food classes are the problem?
In my naturopathic practice in Jerusalem I use my own FODMAPs elimination and reintroduction protocol for helping patients clearly and easily identify which FODMAP foods are causing their symptoms. More often than not, a person is not sensitive to all the FODMAP classes.
To determine if FODMAPs might be contributing to your symptoms, the most effective strategy is to eliminate all FODMAP-containing foods and observe ones symptoms. Following the elimination of all FODMAPs, the next step is to systematically rechallenge one-by-one of each FODMAP to help determine if they can be tolerated. This trial can take a long period of time and it is best to work with a certified nutritionist or naturopath doctor so that you can most safely and easily determine which foods to both avoid and then how to properly reintroduce the foods.
Can you suggest some good resources to get more information on FODMAPs?
There are many resources available on FODMAPs but I like the book called IBS Free at Last: Change your Carbs, Change Your Life. By Patsy Catsos M.S., R.D., L.D. For more research based literature on this topic you can read Evidence Based Dietary Management of Functional Gastrointestinal Symptoms: The FODMAP Approach, Journal of Gastroenterology and Hepatology (February 2010) and the Clinical Ramifications of Malabsorption of Fructose and Other Short Chain Carbohydrates" Nutrition Issues in Gastroenterology in Journal of Practical Gastroenterology. (August 2007)
FODMAPs is a reliatively new concept and many of your western medical doctors may not have heard of this---so inform them! From experience I can tell you that the results of a Low FODMAP diet can be startling. I encourage anyone who suffers from IBS to look more into FODMAPs and if appropriate see if avoiding them helps to resolve the problem.
Dr. Anders Nerman, ND
Dr. Anders Nerman, N.D. is a Naturopathic Doctor with an Integrative Family Medical practice in Wolfson Medical Center in Jerusalem, Israel. For more visit www.drnerman.com or call 972-54-427-8667.
Information is provided for informational purposes only and is not intended as a substitute for the advice provided by your physician or other healthcare professional. Always speak with your physician or other healthcare professional before taking any medication or nutritional, herbal or homeopathic supplement, or adopting any treatment for a health problem.