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What’s the scoop with the FODMAP Diet?

What’s the scoop with the FODMAP Diet?
By Barbara Hopkins, MMSc, RD, LD

Food intolerance is not life-threatening but intolerance to one or more foods can be life-altering.  Food intolerance (FI) is different than food allergy since FI does not involve IgE.  FI affects the gastrointestinal tract leading to symptoms of bloating, flatulence, and diarrhea; some intolerance may provoke the immune system and promote inflammation.

The clinical condition and disease most often associated with food intolerance are Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD), respectfully.   There are tests that claim to be effective in identifying FI, however none have strong evidence-based data to support their claims.1 An elimination diet is currently considered the most accurate way to test food intolerance, and the FODMAP diet has data to support its effectiveness.2

What is FODMAP?  FODMAP is an acronym that stands for fermentable (F), oligosaccharides (O), disaccharides (D), monosaccharides (M), and (A), polyhydric alcohols (P).3 The oligosaccharides include fructoligosaccharides (FOS), galactooligosaccharides (GOS), fructans, raffinose, and inulin. The disaccharides include lactose and sucrose; monosaccharides refer to fructose.  The polyhydric alcohols include sorbitol, mannitol, sylitol, and maltitol.  The FODMAP diet is relatively new with most of the literature on its efficacy occurring over the past five years.  Although earlier studies brought some skepticism, current publications shed a better light on FODMAP benefits.  Most of the data indicate that   the FODMAP diet reduces functional symptoms of IBS.2   These data are based on dietitian guided diet education.4

The FODMAP diet involves two phases: elimination and reintroduction.  The elimination diet, avoidance of high FODMAP foods, should be followed for 2-6 weeks.  Once the person is symptom free, high FODMAP foods are added back into the diet, and tolerance is assessed. For more information about the diet and a list of low FODMAP and high FODMAP foods, visit the website of renowned RDN FODMAP expert Kate Scarlata: http://www.katescarlata.com/fodmaps/5. Examples of high FODMAP foods can be found in Table 1.

There are still questions about the FODMAP diet.  Does the diet lead to nutrient deficiencies? Does the FODMAP diet negatively alter gut microbiota?  Dietitian led intervention/counseling sessions to prevent nutrient deficiencies and the ingestion of probiotics address these concerns. 

 

Table 1. Example of Foods with high FODMAP Content

Monosaccharide

Disaccharides

Oligosaccharides

Polyols

Apples, pears, mango, watermelon, cherries, honey, asparagus, artichokes, sugar snap peas,fructose, high-fructose corn syrup, dried fruit

Milk (cow, goat, and sheep), ice cream, custard, yogurt, soft and fresh cheeses

Watermelon, persimmon, artichokes, chickpeas, lentils, red kidney beans, baked beans

Apples, apricots , nectarines, pears, peaches, plums, cauliflower, mushroom


Adapted from Mansueto4

  1. Vojdani A. The evolution of food immune reactivity testing: why immunoglobulin G or immunoglobulin A antibody for food may not be reproducible from one lab to another.  Altern Ther Health Med. 2015;21(suppl 1): 8-22.
  2. Marsh A, Enid ME, Eslick GD.  Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis. Eur J Nutr. 2016: 55:897-906.
  3. Spiller R. Irritable bowel syndrome: new insights into symptom mechanisms and advances in treatment.  F1000Research. 2016; 5: 1-11. doi:10.12688/f1000research.7992.1.
  4. Mansueto P, Seidita A, Aleamo A, Carroccio A. Role of FODMAP in patients with irritable bowel syndrome. Nutr Clin Pract. 2015; 30: 665-682.
  5. Kate Scarlata Website. www.katescarlata.com. Accessed May 15, 2016.




 

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