What are FODMAPs?
FODMAP, which stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols, are groups of small-chain carbohydrates that, very often, are not wholly absorbed in the small intestine.
The FODMAP carbohydrates, more specifically sugars and fibers, can be found in everyday foods such as:
- Fructose — fruits, honey, high-fructose corn syrup, agave
- Lactose sugar — dairy
- Fructans — wheat, onions, garlic
- Galactans — beans, lentils, soybeans
- Polyols — sugar alcohols and fruits with pits or seeds such as apples, avocados, cherries, figs, peaches, and plums
Symptoms Caused by FODMAPs & What to Look for When Diagnosing Your Patients
FODMAP intolerance is a condition where a patient’s body has difficulty digesting certain carbohydrates, such as those listed above.
Patients experiencing a FODMAP intolerance may experience symptoms like gas, bloating, constipation, vomiting, or diarrhea. These symptoms occur because the digestive system poorly absorbs sugars found in FODMAPs, causing those sugars to remain in the gut, causing an increase in water flow through the intestinal tract, and rapid fermentation by gut bacteria.
All the extra water and gas that ends up in the intestines causes them to distend or bloat. As a result, the patient’s body has an urgent need to complete a bowel movement, which often relieves symptoms temporarily.
What is the Low-FODMAP Diet and When Should You Recommend to Your Patients?
The low-FODMAP diet is a type of elimination diet that aims to prevent these symptoms from occurring in FODMAP intolerant patients. It does this by restricting all FODMAPs for a short amount of time to determine dietary triggers. Healthcare providers should consider a low-FODMAP diet to manage patient symptoms with Irritable Bowel Syndrome (IBS) and other functional GI disorders.
During CDI’s recent Post-DDW 2021 Functional GI Trends Webinar, Rajiv Sharma, MD, an integrative gastroenterologist, described that the first symptom of IBS he notices an improvement in when implementing a low-FODMAP diet is bloating and said, “That is one [symptom] I feel responds pretty quickly [to a low-FODMAP diet].”
“I always like to try diet first for anybody with IBS symptoms. I’m a big diet guy and with my practice, I have had very good success with a low-FODMAP diet. I have seen measurable improvement for my patients. The data is very strong.”
– Rajiv Sharma, MD
Some gastroenterologists may recommend a low-FODMAP diet, then work with a dietician for assistance in implementing it.
“I often will recommend [a low-FODMAP diet], and when I do, I typically refer people to a dietician whenever I can,” said Brennan Spiegel, MD, MSHS at Cedars-Sinai during the webinar.
Although a low-FODMAP diet has shown success in some patients, it’s not for everyone, and luckily there are other options and therapies available. As Dr. Shanti Eswaran, MD at Michigan Medicine, explained at CDI’s recent webinar: “I think that diet for IBS is incredibly powerful. It’s a GI-related disease, so of course, it’s going to be affected by the process of eating, but it’s not for everyone.”
She then went on to explain that this can be because “the low-FODMAP diet, at least at first glance, is extremely restricting and daunting. It’s a time commitment, and some patients aren’t interested.”
Ongoing FODMAP Research
Current research regarding the low-FODMAP diet involves finding a way to refine it further. “The low-FODMAP diet is effective in many patients with IBS, but it’s such a blunt instrument, and it is not very elegant in terms of how it improves symptoms,” said Dr. Eswaran.
Dr. Eswaran and the team at Michigan Medicine are currently researching low FODMAP diets and various combinations of restrictions that can maintain the diet’s benefits while making it more feasible for patients suffering from IBS symptoms to manage.