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Maria Berglund Rantén

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FODMAP diet and its role in intestinal health

As a regular Food Pharmacy reader, you know by now that what we eat can have a major impact on our body and health. Digestive problems are extremely common and many suffer from IBS problems. This post will explore the low FODMAP diet – what it means, what the research says and how effective it is in the long run.

The low FODMAP diet is a diet developed by researchers at Monash University. The diet eliminates foods that contain substances called FODMAPs, which are then reintroduced at a later time to detect personal tolerance levels – the diet is thus made in different steps. It is not a weight loss diet, but the purpose is to improve digestive symptoms such as swelling and gas which lower the quality of life of those who react strongly to these foods. But the big question is – does it work and is this the best long-term option to improve gut health?

FODMAPs are foods that contain large amounts of short sugar chains that are not broken down in the gut. Instead, they are fermented by unhealthy intestinal bacteria that have often migrated up from the large intestine to the small intestine. The fermentation leads to the formation of hydrogen gas and methane gas, which in turn can give rise to troublesome bloating and gas in sensitive people. Hydrogen gas generally leads to diarrhea and methane gas to constipation.

What do the letters in FODMAP stand for?

F is for fermentable – bacteria in the intestine that ferment non-degraded carbohydrates that produce gas.
O is for oligosaccharides – galacto-oligosaccharides (GOS) and fructans, found in foods such as wheat, rye, onions, garlic, legumes.
D is for disaccharides – Lactose, which is found in certain dairy products such as milk, soft cheeses and yoghurt.
M is for monosaccharides – fructose, which is found in juices, soft drinks, sweets, apples, pears, dried fruit, honey, and corn syrup.
P is for polyols including sorbitol and mannitol, which are found in certain fruits and vegetables, and are also used as artificial sweeteners.

What can I eat when I follow a FODMAP diet?

The foods that Monash University believes you can eat include;
Animal protein – fish, poultry, meat, shellfish, and eggs.

Herbal protein: tempeh, solid tofu
Vegetables: eggplant, alfalfa, green beans, peppers, bok choy, bamboo shoots, endive salad, lettuce, spinach, kale, carrots, celery, cucumbers, ginger, kale, harcot verts, chives, olives, parsnips, potatoes, turnips, turnips, squash, pumpkin, tomatoes, turnips, yams, water chestnuts, zucchini, and peppers.
Fruits: grape, bananas, cantaloupe, honeydew melon, green kiwi, grapefruit, lemons, lime, tangerines, oranges, passion fruit, rhubarb, star fruit, strawberries, raspberries, blueberries, cranberries, papaya, and pineapple.
Dairy and alternatives: lactose-free dairy products, hard cheeses, brie / Camembert, feta cheese, almond milk, soy milk, and dairy-free ice creams (but of course in smaller quantities).
Cereals: gluten-free alternative oats, rice, quinoa, tapioca, and psyllium.
Nuts and seeds: almonds (10 nuts), Brazil nuts, chestnuts, chia seeds, macadamia nuts, peanuts, pecans, pine nuts, poppy seeds, pumpkin seeds, sunflower seeds, and walnuts.
Sugars/sweetened products: small amounts of dark chocolate with a high cocoa content, maple syrup, rice syrup.
Spices/other: Oils, herbs, and most spices (not garlic, or onion powder).

What should you avoid with a FODMAP diet?

The following are some of the foods that should be temporarily avoided or significantly reduced:

Animal protein: chorizo, sausages and other processed meats.
Herbal protein: legumes such as lentils, beans, chickpeas, and peas
Vegetables: artichoke, asparagus, cabbage, cauliflower, broccoli, all onions & garlic, fennel, okra, beets, mushrooms, green peppers, sugar peas, corn on the cob, avocado and celery (this can be allowed but in small quantities).
Fruits: apples, pears, dried fruit, cherries, lychee, mango, peach, nectarine, peach, apricot, plum, fig, dates, goji berries, pomegranate, watermelon, and canned fruit (in layers).
Dairy and alternatives: regular milk from cows, goats and sheep, milk chocolate, butter, yoghurt, cottage cheese, ice cream, and everything else made from these products.
Barley: wheat, rye and barley and everything made from these cereals (bread, pasta, cous cous, flour, noodles, cereals, etc.)
Nuts and seeds: cashews, pistachios, and almond flour.
Sugar/sweetened products: honey, high fructose corn syrup, fructose, sugar-free sweets, alcohol, sports drinks, coconut water, and fruit juices.

What does the research say about the FODMAP diet?

Many studies on a large number of people have found links between low consumption of FODMAP foods and relief of indigestion such as gas, swelling, stomach pain, diarrhea and constipation. Unfortunately, most of these studies have not been long enough and more research is needed in the FODMAP area. This does not mean that a low-FODMAP diet is not effective, and in our experience, a FODMAP diet is very effective when done in combination with going to the basics of why there are unhealthy intestinal bacteria in the small intestine.

As with all diets, it is important to seek professional help before embarking on a long-term special diet as diets may contain insufficient nutrients. The FODMAP diet is of course not personally adapted to your specific needs, but the researchers have tested the FODMAP substances and seen that an exclusion of these foods can help. Of course, the amount of food also matters. The more you eat, say avocado, celery, chocolate, etc., the greater the risk that you trigger gas and swelling.

From diversity to simplicity – can a FODMAP diet have a negative impact on health?

Yes, unfortunately, but in our opinion this is rarely something you read about. If you search for FODMAP, it is written very positively, but as a “carrier of bad news”, I want to change this…. Although a low FODMAP diet can reduce or eliminate IBS symptoms, especially abdominal pain, bloating and diarrhea (which of course is great), it can also cause disorders in the intestinal flora by affecting the diversity of microbes. Diversity is something I have written about before and this is a must when it comes to health. When the ecosystem loses its diversity (in this case microbial diversity), the whole system weakens.

Research shows that certain beneficial bacteria such asFaecalibacterium, Roseburia, Bifidobacterium, Akkermansia and Lactobacillus need a large variety of fiber and the right carbohydrates to thrive. When you limit your fiber intake for a longer period of time, these species of bacteria decrease, which can have major negative health effects. Now, of course, you should not eat a low FODMAP diet for a long time, but people who have suffered from troublesome IBS symptoms for a long time, sometimes most of their lives, become desperate and may stay on the same restrictive diet for many years because they think they are helped. And this is where the danger lies – when you only stick with the same diet, which can have negative effects later. We get so many clients who paint themselves into a corner, finally tolerate very few foods and then it becomes a challenge to broaden the diet. Most people get better after a while, but there are those people have unfortunately got such huge imbalances in their gut that it can be extremely difficult to help them and it can be very stressful mentally to remain strong for the duration.

Our Clinical Experience

At Nordic Wellth, we rarely recommend a low FODMAP diet per se. We take a personal approach that may include temporarily reducing the intake of specific FODMAP foods, as well as other foods that cause symptoms, to give the digestive system a break. We do this while examining why a person has an unhealthy microbiome and treating the underlying dysbiosis (ie. imbalance of the intestinal flora). If you have suffered from IBS for a long time, we strongly recommend that you take professional help to sort out the root causes of your gastrointestinal problems.

All Nordic Wellth nutritionists work according to the same model. We have developed well-developed guidelines to ensure that all consultations maintain the same high standard, regardless of which therapist you go to. In addition to a solid university education from England, all therapists are coached by me so that our thinking in the consultation process is homogeneous. This way of working has been very successful for our clients. With us, you are in good hands, so if you suffer from chronic symptoms, just book an appointment no matter where in the country you live

Live well, be well!

Maria

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