Never heard of FODMAPs? They’re a big problem with a bad acronym. Fermentable oligosaccharides, disaccharides, monosaccharides and polyols are in fruits, vegetables, bread products and alcohol. For some people, they’re the mack daddy of food troublemakers.
FODMAPs can create a buffet of gastrointestinal nastiness, from extreme bloating to excess flatulence and diarrhea. This isn’t like overeating on Thanksgiving or having a bad bout with an unfamiliar ethnic food. “This is chronic and can cause real pain,” says Dr. Joyann Kroser of Crozer-Keystone Gastroenterology Associates. “Some people get visibly distended stomachs and look pregnant, or have chronic diarrhea. If these symptoms continue for more than three months and interfere with your quality of life, it’s time to get help.”
That help is sought by millions who suffer from GI sensitivities. April was named National IBS Awareness Month to bring attention to both the problem and the remedies. Kroser notes that medications are available, but many of her patients are reluctant to use them as first-line treatments—and so they opt for diet modifications.
Because of its degree of difficulty, a low-FODMAP diet may not be the first recommendation for IBS sufferers. “We generally start by eliminating or reducing lactose or gluten, and possibly highly acidic foods,” says Dr. Brenda McBride of Main Line Integrative Nutrition in Bryn Mawr.
Most of us are familiar with lactose and gluten—two things that can cause tummy trouble. Those issues are so common that grocery stores usually have special sections for products without lactose and gluten. “If people are still experiencing symptoms, then we look at a low-FODMAP diet,” McBride says.
But FODMAPs are hard to explain and tough to identify. Pressed for a simplified explanation, McBride says they’re essentially fibers and sugars that some people can’t digest. “When you eat foods that aren’t easily digestible, they sit in the gut and the bacteria there ferments it,” McBride says. “That draws water into the bowel and, in the fermentation process, creates gas. That causes a stretching of the intestines. The body wants to get that gas out, and that manifests in IBS symptoms.”
Lactose is a FODMAP, as are the carbohydrate parts of wheat, rye and barley. Fructose is another big FODMAP culprit—and one of the most difficult to reduce. It exists in things we think are healthy food choices, like most fruits and vegetables. High-fructose FODMAP no-nos include apples, grapefruit, peaches, pears, plums, many kinds of berries, watermelon, asparagus, cauliflower, celery, leeks, shallots, mushrooms, peas, cabbage and most beans. Onions and garlic are two of the most ubiquitous FODMAPs,
and they’re the basis of many dishes from many cultures.
Sound difficult to manage? There’s an app for that. Kroser points patients to Australia’s Monash University, which has an app and other educational materials about low-FODMAP diets on its website. She also emphasizes that the stringency of the diet doesn’t have to last forever. “Be super-strict for a minimum of two weeks, and do it for a month if you can,” she says. “You should start to see a difference in the symptoms by then. It takes that long to see results because it takes awhile for the microbiome in our gut to change.”
For many people, the low-FODMAP diet works so well that they stay on it, even though finding foods to eat can be tough. To help, Dr. Onyx Adegbola created Casa de Sante, a West Chester-based company that produces low-FODMAP foods and beverages. Trained at Johns Hopkins and Columbia universities, Adegbola had a career in oncology and pharmaceuticals before she tackled a problem close to home: her brother’s IBS. “He was on medication and trying the FODMAP diet, but it was hard for him to find foods that didn’t have, for example, onions and garlic,” Adegbola says. “I looked into it and realized just how many people suffer from this, but how few food choices are available. That was my inspiration.”
Launched in 2017, Casa de Sante sells spices, salad dressings, soy sauces, teas and lemonades through its website, plus Amazon and Walmart. “We started with seven items,” Adegbola says.
High demand has generated six-figure sales, and Adegbola plans to expand the line. But she’s not branching out into alcohol—even though wine is made from grapes and, therefore, high in FODMAPs.
McBride advises her patients to limit red and white wine, rum, gin, and most other spirits. Beer has a lot of carbohydrates but, relatively speaking, is lower in sugars, so she says it’s the best option.
Cheers!
Visit www.monashfodmap.com.
