GI ISSUES: FODMAPs Update 2017

Background
In the late spring of 2014 we launched headlong into a low FODMAP diet hoping to settle our chronically unruly guts. FODMAP is an acronym for short-chain fermentable carbohydrates: Fermentable Oligosaccharide, Disaccharide, Monosaccharide And Polyol, which doesn’t tell most of us much. You may be familiar with lactose, to which some people are intolerant and their intolerance manifests as GI distress, especially as indigestion and excess gas production. Lactose is a FODMAP, a disaccharide, and it is the only one that can be neutralized with a pill, as in one containing the enzyme lactase. A few other FODMAPs are familiar names, like sorbitol and fructose. The rest are obscure, such as fructans.

Eliminating fructans from our diet all but eliminated our GI problems. Unfortunately, fructans is the most ubiquitous of the potential irritants, being found in our favorite foods like wheat, rye, garlic, onions, broccoli, asparagus, peaches, and many nuts as well as a long list of other foods. However, the low FODMAP diet been so effective for us, we’ve had little trouble sticking with it.

(This is not to be confused with our ketogenic diet, which is an ultra-low carb diet. The keto diet was attractive to us because we had to eliminate so many carbs with the low FODMAP diet that it was hard to know what to eat. The high fat, moderate protein keto diet had the answer.)

When we self-imposed this low FODMAP dietary restriction on ourselves, it was kind of a fringe theory but that has changed. There was a new report noted below indicating that the benefits of going low FODMAP for those of us with “visceral (gut) hypersensitivity” are now well founded. We were personally convinced, but it’s always nice to have the medical literature on your side:

There are currently at least 10 randomised controlled trials or randomised comparative trials showing the low FODMAP diet leads to clinical response in 50%–80% of patients with IBS, in particular with improvements in bloating, flatulence, diarrhoea and global symptoms. *

New Information
Most of what was reported was already familiar to us, but there are new details backed-up by MRIs. The most significant to us was that symptoms of folks with IBS (Irritable Bowel Syndrome) suggest which of the FODMAPs to which an individual is intolerant. That’s quite helpful because it can speed the process of sorting out which FODMAP or FODMAPs one needs to eliminate.

The researchers identified 2 general categories, individuals whose discomfort is largely due to excess water being drawn into the gut, which often contributes to diarrhea and those who are generally distressed by excess gas in the colon. This difference is what was identified on MRI:

Unabsorbed fructose, polyols and lactose lead to increased small intestinal water. Unabsorbed carbohydrates, including fructans and GOS, are fermented in the colon leading to gas production. The resulting luminal distension leads to functional GI symptoms in those with visceral hypersensitivity and IBS.**

If you are like us and spend too much time with GI discomfort, you might want to consider a low FODMAP diet, especially since the concept is now more widely accepted by the medical community. It’s easiest to work with a dietitian or nutritionist to guide you up the steep learning curve or you can do it yourself like we did. You can check out my piece “Beyond Gluten” from July 2014 to learn how we proceeded. LINK: http://detail.travelfit.us/page15/index.html

Reference *, **
The Low FODMAP Diet: Recent Advances in Understanding Its Mechanisms and Efficacy in IBS
Heidi M Staudacher; Kevin Whelan
DISCLOSURES Gut. 2017;66(8):1517-1527.
This article was electronically received by us on Oct 19, 2017 from MedScape Ob/Gyn.