FODMAP – it’s a funny-sounding acronym that very few people have heard of in the U.S. When I say this word (pronounced “fahd-map”), people often give me a quizzical look, and I find it requires quite a bit of explanation. In order for my patients to be successful and find relief with a low FODMAP diet, I know they need to understand what it means and why FODMAPs matter.
FODMAP is an acronym for a group of sugars – Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. The low FODMAP diet was created by a team of physicians, nutrition scientists and dieticians at Monash University in Australia. Over the past decade, we have learned that a diet which limits these specific kinds of sugars alleviates the discomfort so many of my patients face. So much so, that they often come back to my office to tell me that they are no longer taking the medications they’ve been prescribed to help with abdominal cramping, nausea, diarrhea or constipation (or reaching for them WAY less often).
To explain this diet to my patients, I give the example of lactose intolerance. Because everyone knows someone who is lactose intolerant – it’s that common! Lactose is an example of a disaccharide- two sugar rings fused together by an oxygen in the middle. We can’t absorb that double ring directly into our bloodstream, so it must be first broken into its two simpler sugars by the lactase enzyme. As babies, milk/lactose is our predominant source of energy. But as we age, we don’t need it as much, and our bodies naturally stop producing as much of the enzyme that breaks it down. If you lack the enzyme – or if you overwhelm what you’ve got with more milk/lactose than it can handle, LOOK OUT! Those unused lactose molecules? Down the pipeline they go – on and on to the part of the gut where the bacteria live. Those bugs are happy to eat the lactose your body has rejected. And they’ll ferment it into lots of gasses, which equals bloating, abdominal distension, cramping pain and (if it’s really bad) diarrhea. Of course, lactose in any form will do this, it’s not just milk, but also yogurt, ice cream and soft/wet cheeses.
It’s not just lactose that can be difficult for our intestines to handle – it’s other naturally occurring sugars that are found in our food: fructose, and longer more complicated carbohydrates called fructo-oligosaccharides (FOS), galacto-oligosaccharides (GOS) and sugar alcohols such as sorbitol and mannitol. These sugar alcohols (or polyols) occur naturally (think cherries, avocado, apples) but also appear as artificial sweeteners. GOS and FOS are found in some fruits and vegetables, grains or as fiber additives such as inulin.
Once a patient understands the science, I show them an app for their phone to help guide their food choices. When they see the items high in FODMAPs they hesitate. But as they look closer, their eyes light up with delight – they see several foods or ingredients that they already avoid because they know they cause symptoms. Over time, they have developed an intuitive sense that what they eat affects how they feel, and they’ve unknowingly taken the first steps to a low FODMAP diet. More importantly, they identify foods they ingest regularly that may be triggering their symptoms. Most patients leave my office excited to begin this process, with anticipation that their symptoms are now within their power to control.
A strict low FODMAP diet isn’t a life sentence; I call it a ‘learning diet’. After 2-3 weeks patients begin feeling like their true self. Next, they gradually reintroduce foods to determine which (and how much) high FODMAP foods their bodies can tolerate. Not every high FODMAP food will cause problems – every body is different. Registered dietitians are very helpful as they can customize a strategy and suggest meal plans to facilitate this process.
When I decided to create TrueSelf Foods, I took the time to have each product receive a FODMAP Friendly certification so that everyone, no matter what high FODMAP foods they can or cannot eat, could grab one one of our snack bars and know it is a safe choice. Knowledge is power – I want you to eat with confidence.