FODMAP: a closer look
When I was diagnosed with Fructose Malabsorption 10+ years ago a low FODMAP diet didn’t have the notoriety of today. Low FODMAP recipe books did not exist. Apps dedicated to tracking a low FODMAP diet were not readily available. A low FODMAP diet was not the standard protocol, and patients didn’t have access to the technology we do today with misleading information.
In 2008 after my diagnosis my doctor and dietitian advised me to limit my daily fructose load to less than 15 grams per day, avoid all man-made highly processed products, steer clear of all man-made sweeteners that are high in fructose, keep a food journal, and most importantly eat a diverse diet of real whole foods. A low FODMAP diet was never suggested to me.
Now in 2018, ten years later, I am thriving. My gut is not yelling at me. I do not go to bed so bloated that I look 3 months pregnant. I have a ton of energy and am happy.
Yes, there still are limitations in my life. We rarely go out to eat, and when we do we search out a local, chef driven restaurant committed to using real whole food ingredients. Most of the items in our grocery cart are not convenience items. My cart is filled with whole foods found in the perimeter of the store. In addition to weekly runs to the grocery store we visit our local bakery, Breadsmith, at least twice a week to purchase fresh baguettes and sandwich bread. A fair amount of my time is spent meal planning and cooking. I still get very nervous when eating at a friend’s house; worried that I might eat something that doesn’t agree with me. But, I can live with these limitations because I feel so much better than I did when I was first diagnosed. I know what doesn’t work for me. I have an answer and I know how to treat my intolerance by eating real whole food.
When I started my website adventure in the fall of 2017, I didn’t realize how different my journey to gut health would be compared to people who are diagnosed with Fructose Malabsorption today. When I was diagnosed only two books were available at my local bookstore about Fructose Malabsorption and neither mentioned the low FODMAP diet. When I originally googled Fructose Malabsorption, hardly any websites were dedicated to Fructose Malabsorption and suggested diets. The only websites I could find were rare medical journals. I didn’t even own a phone and had no idea what an app was.
Honestly, I feel lucky. My only sources of information were my dietitian and my doctor. I knew my body couldn’t process high amounts of fructose and I knew how to simply eliminate that from my diet. I didn’t have incessant food product marketing, fad diets and debunked health claims clouding my understanding of how to treat myself.
So here I am trying to help people with Fructose Malabsorption, trying to connect with others who have children like I do who live with Fructose Malabsorption. And, I am faced with this new reality: access to information on our phones and computers trumps visiting a medical professional.
Given this new reality, I want to understand what it is like to get diagnosed with Fructose Malabsorption today. What are the hot topics? Where do people look for help? What diet is most suggested?
A low FODMAP diet appears to be the most suggested diet when diagnosed with Fructose Malabsorption. There are 100+ books on store shelves about FODMAP diets. Google FODMAP and you could spend a lifetime looking at all of the websites. And, let’s be honest-we all look to the internet for health advice.
So, what is FODMAP? FODMAP is an acronym for fermentable oligosaccharides, disaccharides, monosaccharides and polyols-a mouthful! Basically, FODMAPS are foods that aren’t well absorbed in the small intestine, pass into the colon and undergo fermentation by bacteria. Please understand this is a natural process. Fermentation by bacteria should happen in your colon and is good for you. Everyone should eat FODMAP foods. They are high in fiber and contain vital nutrients. We know now that bacteria lives in our gut for a reason and is important to having a healthy gut.
Why then is a low FODMAP diet suggested? Who invented the FODMAP diet and why?
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.
I am definitely NOT advocating against the FODMAP diet. What I am advocating for is to use this diet the way it was meant to be used. In actuality, it wasn’t a diet when Monash University introduced the low FODMAP concept. It was a diagnostic tool used to help patients with IBS regain a healthy gut. There are 3 phases of the low FODMAP diet, not one.
- A low FODMAP phase where you limit your FODMAP foods for 2-6 weeks under the care of a medical professional.
- A re-challenge phase where you slowly re-introduce foods and journal your symptoms. This phase takes 6-8 weeks and assistance from a medical professional is suggested.
- The third phase is an adapted FODMAP diet program. Your medical professional will create a lifestyle diet for you that is diverse and includes tolerable FODMAP foods.
The FODMAP concept is not a diet. It is a tool to help you settle your gut and determine what works for YOU and doesn’t work for YOU!. It is not a 100% lifestyle change. Each of has a unique gut biome, and the goal of this concept is to listen to your gut and figure out what makes you unique.
So why are people living a low FODMAP diet lifestyle?
I think there are multiple reasons for this.
- When we have known what it is like to have IBS and not to have IBS it is scary to think about eating something that might not agree with you and make you feel sick again. The concept of reintroducing food can be daunting.
- I also think the wealth of information, albeit fake information on the internet, is pushing people to try the FODMAP diet without understanding the original concept.
- And, since all of us our guilty of using the internet to diagnose and treat ourselves we are not searching out relationships with medical professionals who can help us.
Why not stay on a low FODMAP diet for ever? What are the consequences?
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.
Truly, I can see a lot of benefits from the 3 phase FODMAP approach. What took me years to determine regarding my unique gut could have been discovered in a matter of a few months if I had known of and adopted the FODMAP concept. For example, I learned after a lot of trial and error and food journaling that sugar alcohols, like sorbitol don’t work for me.
If you choose to follow the low FODMAP concept, then consult a trained doctor and/or dietitian who can guide you along your food journey. Thriving with Fructose Malabsorption is possible. It takes time to understand your gut’s voice, but it is worth it.