The FODMAP diet

The number of diagnoses of irritable bowel syndrome (IBS, or IBS) is constantly increasing around the world. In industrialized countries, the prevalence is 10-15% of the population – among which are a large number of people with celiac disease ( gluten sensitivity ). 

The many studies on functional colopathies have led to an observation: FODMAPs – from the English Fermentable Oligo-, Di-, Monosaccharides and Polyols – are incriminated. These are fermentable foods containing short-chain carbohydrates (or simple sugars), abundant in the modern Western diet, which would be likely to create functional gastrointestinal disorders (GIFD) in fragile people. 

Thus, a list of FODMAPs was clearly defined and the FODMAP diet was born.

THE PRINCIPLES OF THE DIET

Principles

The FODMAP diet recommends avoiding foods rich in simple carbohydrates:

• Oligosaccharides, including fructans and galacto-oligosaccharides.
• Disaccharides, including lactose.
• Monosaccharides, including fructose.
• Polyols, including sorbitol, xylitol and mannitol.

These foods include cereal products as well as fruits and vegetables , legumes, dairy products, beverages, oilseeds and sweet products. The FODMAP diet also draws up a precise list of foods low in fermentable carbohydrates, to be favored to avoid the inconveniences associated with IBS (recurrent abdominal pain, transit disorders, abdominal swelling , fatigue, irritability, menstrual cycle disorders in woman, headaches…).

Foods to Avoid

It is possible to draw up a kind of checklist of the main foods with a high FODMAP content:

• Grain products  : breakfast cereals, barley, wheat products, foods made from rye, spelled.
• Oilseeds and seeds  : cashews, pistachios, pumpkin seeds, sunflower seeds, sesame, hazelnuts.
• Legumes  : soybeans , beans, lentils, chickpeas, split peas.
• Vegetables  : garlic, artichoke, asparagus, mushrooms, cauliflower, onion, leek, Jerusalem artichoke, avocado , red cabbage, butternut squash, shallot, green cabbage, fennel.
• Fruits  : apricot, cherry, fig, persimmon, mango, watermelon, blackberry, nectarine, peach, pear, apple , plum, date, prune, dried fruit.
• Dishes prepared with products high in FODMAPs .
• Dairy products  : ice cream, soft cheeses, kefir, milk (sheep, goat, cow), yogurt , products made from milk or soy powder, dairy desserts.
• Sweet products  : jam, honey, compote, fruit in syrup.
• Drinks  : cider, fruit juice, rum, sweet wine, cooked wine, instant drink with coffee and chicory.
• Polyols  : all products containing fructose syrup, sorbitol, mannitol, isomalt, maltitol, xylitol, polydextrose.

Favorite foods

Certain foods, on the contrary, due to their low content of fermentable carbohydrates, are to be preferred:

• Fruits (no more than one serving per meal): citrus fruits, berries (strawberry, raspberry, blackcurrant, currant), pineapple , banana, cantaloupe melon, yellow melon, passion fruit, papaya, kiwi, coconut, grapes, rhubarb, lychee.
• Sweet products (in moderation): brown sugar, dark chocolate , maple syrup, table sugar.
• Seasonings and fats  : spices, ketchup, mayonnaise, mustard, olives, soy sauce, vinegar, butter, oils, margarine.
• Vegetables  : eggplant, Bok Choy, chard, carrot, heart of palm, cucumber, squash, spinach, bean sprouts, butter beans, green beans, green salad (lettuce, romaine, arugula, escarole, watercress, endive, lamb’s lettuce, mesclun), okra, parsnip, pepper, potato , radish, rutabaga, turnip, tomato, herbs, ginger .
• Vegetables to eat in moderation  : broccoli, celery, Chinese cabbage, kale, Brussels sprouts, peas, sweet potato, zucchini.
• Drinks  : coffee , beer and wine in moderation, tea, herbal tea.
• Dairy products  : vegetable milk except soy, firm cheese, lactose-free milk and yogurt, dessert made from vegetable milk.
• Oilseeds and seeds  : almonds, peanuts, chia seeds, flax, walnuts, pine nuts, Brazil nuts.
• Proteins  : meat, fish, shellfish, seafood, eggs , tempeh, tofu, seitan.
• Cereals and cereal products  : any product derived from amaranth, oats, corn, millet, rice, quinoa, buckwheat, sorghum, tapioca.

What about gluten?

Officially, the FODMAP diet is for people with IBS, not celiac disease. Thus, no specific recommendation is made about gluten, apart from recommendations regarding the consumption of certain fermentable cereals. The problem arises when an individual combines IBS and gluten sensitivity. In which case, he must also remove any food containing gluten or traces of gluten.

The FODMAP diet, an evolutionary diet

The FODMAP diet is still in its infancy, and adapts to each individual. It is advisable to: 

• Proceed with an attack phase (the elimination phase), between 2 and 6 weeks, where FODMAP foods are completely eliminated from the diet, until the symptoms associated with IBS have been reduced.
• A second phase involves consumer testing (re-introduction phase), where one eats a single FODMAP food at a time, to determine personal tolerance to the food. It is a question of reintroducing foods that are rather well tolerated, and also determining the tolerated doses.
• Food tests must be repeated regularly, because tolerance to a food can change over time (maintenance phase).   Moreover, the evolution of the intestinal bacterial population (microbiota) can also interfere with tolerance. 

ADVANTAGES

• An individual, tailor-made diet.
• Promising results on IBS symptomatology.
• Flat stomach effect, since bloating , gas and transit disorders associated with intestinal disease disappear.
• Weight loss, since the diet eliminates simple sugars and high GI carbohydrates.
• Positive repercussions on mood, the belly being a “second brain”, and the feeling of well-being being proven.

DISADVANTAGES

The starting assumptions of the paleo diet are scientifically erroneous:

• The FODMAP diet is very restrictive and frustrating, especially in the elimination phase.
• Lack of micronutrients, especially calcium.
• Possible deterioration of the richness of the microbiota, since the consumption of prebiotics and probiotics is considerably reduced.
• Affects social life.
• The FODMAP diet is still in the experimental stage. Furthermore, the adjustments during the maintenance phase are numerous and tedious.

ORIGINS