Recently one of my "Facebook Fructose Malabsorption Friends" posed a simple question:
"Is it safe to assume that all low FODMAP foods are safe for FM?"
Let me back up for a second. This question in fact is not a simple question; it is a loaded question.
If you search Fructose Malabsorption on Google 75% of the entries will include the acronym FODMAP. And if you visit a bookstore or search for Fructose Malabsorption books on the internet you will find 100+ FODMAP "diet" cookbooks. You could spend a lifetime looking at all of the suggested websites and recipes.
So, what is a FODMAP?
Is it a diet?
Is it a type of food?
FODMAP is an acronym for fermentable oligosaccharides, disaccharides, monosaccharides and polyols- that is a mouthful! Basically, FODMAPS are foods that aren’t well absorbed in the small intestine, pass into the colon and undergo fermentation by bacteria.
Let's stop and understand this is a natural process. This is something that happens in our gut each and every day and is essential to a happy, healthy gut. Fermentation by bacteria should happen in your colon and is good for you.
Everyone should eat FODMAP foods (maybe not all FODMAP foods....I will get to this later).
FODMAP foods are high in fiber, contain vital nutrients and feed the natural bacteria living in our guts. We know now that bacteria lives in our gut for a reason and is important to having a healthy gut. We need bacteria in our gut to function.
Have you heard all of the hype about "your gut biome" (your gut bacteria)? When you visit the refrigerated dairy section at your local supermarket do you see numerous yogurts, kefirs and cottage cheese products advertising added "BENEFICIAL BACTERIA"? Or, when you visit the vitamin isle do you see plenty of probiotics packaged in pills? How about the rise in advertised fermented foods like sauerkraut? Let me say it again; we need bacteria in our gut to function. In the last few years doctors have discovered, accepted and promoted a healthy gut biome and healthy bacteria. And, consequently so have Madison Avenue marketing companies.
Back to FODMAP. Why is FODMAP associated with Fructose Malabsorption? Who invented FODMAP?
A team at Monash University in Australia led by Dr Peter Gibson and Dr Sue Shepherd developed the low FODMAP diet. Dr Gibson, Dr Shepherd and their partners knew that FODMAP foods caused fermentation in the gut. Their theory was that if a patient reduced FODMAP foods, then consequently they would have less fermentation and less symptoms. Their original patients felt better and had less symptoms. The low FODMAP diet was born! This is where social media, food product marketing and debunked medical claims found on the internet took a great idea and altered it. What was a tool used to help identify which FODMAP containing foods caused you to have an irritable gut was turned into a diet- a diet where all FODMAP foods are severely limited or eliminated all together. The FODMAP program was invented as a program, not a diet. It is a 6 week elimination program that helps you determine what is safe for you and your unique gut. It is not a way of living or a one size fits all diet.
Why not stay on a low FODMAP diet for ever? What are the consequences? If cookbook authors are doing it why shouldn't we?
If you eliminate FODMAPS you are eliminating many real whole foods that are beneficial to our health. FODMAPS are needed to maintain a healthy bacterial population in our colons. They promote healthy bowel movements, decrease the risk of colorectal cancer, and reduce the risk of diabetes and cardiovascular disease.
In addition researchers at Monash University (where the FODMAP concept was born) recommend, “that a low FODMAP diet be followed strictly for just two to six weeks...and not be followed as a permanent diet for life” (www.fodmapguru.com). The originators of the FODMAP concept do NOT suggest a long term low FODMAP diet.
What is the Google connection between Fructose Malabsorption and FODMAP? Why did my Facebook friend pose her simple question?
A symptom of Fructose Malabsorption is gas. Not just occasional gas, but gas that tells you based on smell and frequency that your gut biome is really off. Something you are eating is disrupting your unique gut biome, altering the symbiotic relationship. You can see why the Fructose Malabsorption and FODMAP connection happened. FM causes gas, low FODMAP foods reduce gas; therefore, low FODMAP is good for FM. Wrong!
Monash University developed the FODMAP program as a tool to help IBS patients determine what foods are safe and what foods are not safe for your unique gut. The FODMAP program was NOT developed for Fructose Malabsorption patients specifically. It was developed for Irritable Bowel patients. It was developed for patients who haven't yet been given a Fructose Malabsorption diagnosis. It is a tool to help you and your health care professional determine what is disrupting your gut.
Monash University has also put out a statement regarding your gut biome, natural bacteria and the production of bowel wind (gas). Gas can be good, too-it is a sign of a healthy gut.
Here is a quote from the Monash University website regarding food reintroduction and FODMAPS:
"When you experience symptoms, it is vital that you are tuned in to the severity. Pain and significant discomfort are not OK and you can discuss these outcomes with your treating dietitian who can advise further on future challenges and food trials you may better tolerate. But for many people, the reintroduction of FODMAPs, or FODMAP ingestion when eating, results in gas production and a little bloating. The initial thought is that there has been a reaction and the food should again be removed from the diet, but we ask you to think about it in a different light.
Fermentation and gas production after eating high FODMAP foods is beneficial to the gut. If you experience some gas related symptoms that are tolerable and perhaps just include some mild bloating and flatus, this could be a good sign that you are providing fuel that encourages good bacteria in your gut. Everyone experiences some bloating and flatus and it is important not to immediately consider these as ‘symptoms’ of IBS, rather they should be considered a normal part of healthy digestion (as long as there is no significant discomfort or pain!).
So remember, a little gas is a good thing."
But, wait, are all FODMAP foods bad for people with Fructose Malabsorption? And, are low FODMAP foods safe for Fructose Malabsorption?
The simple answer is NO.
Everyone has a unique gut and unique gut biome. What works for me, may not work for you.
And, NO, not all FODMAP foods are bad for people with Fructose Malabsorption.
For example: I do not have an issue with feta cheese or mushrooms. Both of these foods are listed on the Monash University High and Low FODMAP food list.
In addition, pineapple is listed as a safe, low FODMAP food on this list. And, we know pineapple is not necessarily a safe food for patients with Fructose Malabsorption. Yes, I can occasionally (once a month or so and based on what I ate the rest of the day) eat a few bites of pineapple. But, if I sat down and ate a full serving of pineapple I would cause a Fructose Volcano in my gut.
What's a Fructose Volcano? If you have Fructose Malabsorption your body has a difficult time absorbing digested fructose. The majority of the fructose you eat is not absorbed into your bloodstream; and sits in your gut resulting in all sorts of issues. It’s like a volcano waiting to erupt causing gas that makes you feel bloated, producing bowel wind, changing your bowel output (diarrhea and/or constipation), and causing a major inflammatory response.
Back to the original question:
"Is it safe to assume that all low FODMAP foods are safe for FM?"
No, all low FODMAP foods are not safe for Fructose Malabsorption.
There is not a one size fits all diet for everyone who has Fructose Malabsorption. We each need to determine what works for us and our unique gut.
This is what makes Fructose Malabsorption so hard. Why can't there be a one size fits all diet? Life would be so much easier.
We, Fructose Malabsorption patients, have a few things in common (I explore this topic on my FBF blog):
1. We know that high levels of fructose sugar cause a Fructose Volcano in our gut- a volcano waiting to erupt causing gas that makes you feel bloated, producing bowel wind, and changing your bowel output. A volcano that causes chronic inflammation and can affect all aspects of our health. But, we have an answer! We know what the culprit is-FRUCTOSE!
2. We know that glucose is like a spaceship transporting fructose across the gut barrier into our bloodstream thus preventing the fructose volcano. By paying attention to the fructose and glucose loads in food you can alleviate your symptoms, stop feeling like a volcano is about to erupt from your gut, and start living a healthy lifestyle again.
3. Eating protein sources with essential amino acids also aids in the digestion of fructose. For the last few years I have intuitively known that protein is my gut's friend. I have even figured out that if I want to eat vegetables or fruit that are higher in fructose eating a protein source with it helps. I never knew scientifically why this worked, but I intuitively knew why. Recently one of my new Fructose Malabsorption friends shared an article from the Journal of Pediatric Gastroenterology and Nutrition that proves my theory. Amino acids, found in proteins, have been scientifically proven to aid in fructose absorption.
4. Yes, we all have a unique gut voice and need to find this voice and listen to it. Because of our malabsorption we become intuitive eaters. We learn what works and what doesn't work. We know how to feed our guts, how to make healthy choices and how to find joy in safe eating habits. It's as if each of our guts has it's own one of a kind fingerprint.
5. Fructose Malabsorption is a roller coaster. Sometimes you feel like you are on top of the world feeling 100% healthy, and sometimes you are plummeting to the ground towards a Fructose Volcano. We are not alone. We have Fructose Malabsorption in common. We can be in community together, support each other and teach each other.
As a Fructose Malabsorption Community how can we support each other and share recipes if each of us is unique?
I have learned a lot about this question since starting this website 1 year ago. What works for me, may not work for you. In fact I recently added a disclaimer to all of my recipes:
Everyone with Fructose Malabsorption tolerates different levels of fructose and has their own unique gut and gut voice. It is best to make a list of what feels good and what doesn’t, listen to your gut voice, and remember it is all about the daily balance.
When I originally started the Families Balancing Fructose website I thought it would include a lot of recipes, a spotlight of products, FM resources and a few blog articles. Over the last year I have shifted my focus. Yes, I still have recipes and favorite products listed; but, I have focused more on blog articles in the last six months. As Fructose Malabsorption patients we need to learn how to advocate for ourselves, understand what is happening inside our guts, and determine what makes our unique gut happy. We need to find foods and recipes that work for us individually. Let's share with each other, but also remember everyone is unique.
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