Irritable bowel syndrome or IBS is one of the most common digestive system problems, affecting millions of people worldwide.
Many patients' symptoms might be caused by certain foods, and so the therapeutic strategy of nutritional manipulation has recently become quite popular.
FODMAP is just one of the diet plans that many people with IBS are using. But what is this plan, how's it formulated and who is it suitable for?
What is irritable bowel syndrome?
IBS is the most common digestive system problem worldwide, affecting about 15% of the world's population. People with IBS experience abdominal pain and intestinal dysfunction which can significantly damage their quality of life and ability to function normally day-to-day.
Common symptoms include constipation, diarrhea and alternating between both along with abdominal pain and bloating.
Many doctors and scientists have conducted research on IBS in order to find the most effective treatment, but all the causes of IBS are still unclear. It's possible that a combination of internal physiological and environmental factors affect times when people will be really ill and symptoms will be worse.
The improvement of symptoms depending on the type of diet led researchers to look for nutritional strategies to provide relief for IBS sufferers.
FODMAP is an acronym that stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols and is a nutrition plan that focuses on reducing types of sugars from one's diet that studies have shown correlate with symptoms.
The intention is to reduce sugars in food such as oligosaccharides, disaccharides, monosaccharides and fermentable polyols. An article published in 2020 in the magazine Annual Reviews found that between 52-to-86% of those suffering from irritable bowel syndrome reported a significant improvement in symptoms when they followed FODMAP which includes a considerable reduction to the point of complete avoidance of these types of sugars.
How avoidance lowers and reduces symptoms
The types of sugars in FODMAP aren't fully digested or well absorbed in the small intestine so therefore they may create unpleasant effects and affect bowel movements, causing constipation and/or diarrhea. When these sugars are present in different areas of the large intestine it causes their fermentation by certain bacteria that creates unpleasant side effects. So, complete avoidance of foods that contain these types of sugars should greatly alleviate symptoms.
It's important to state that with all the evidence of improving symptoms with the help of this diet, it's not suitable for everyone and one must understand what it requires before deciding to try it.
How can you follow the diet effectively?
The diet is broken up into three stages. It's very important to carry them out with guidance from a clinical dietitian who can help and assist at every stage in order to create individualized adjustment and correct progress between the stages.
First step: completely remove from your menu all the foods that contain the types of sugars that are suspected to be problematic.
The goal is to reduce those types of sugars to see if one has less constipation or diarrhea. It's recommended to stick to this stage of complete abstinence from all foods for six weeks, but after two weeks, one will see if there's improvement and if this direction really suits you.
If there's no improvement after two weeks, choose another nutritional treatment or recognize that there may be other factors causing digestive problems. Types of foods that can be left on the menu at this stage include rice, quinoa, eggs, hard cheeses, most types of meat and fish, many kinds of vegetables and fruits such as citrus fruits, strawberries, carrots and broccoli.
Second stage: If after six weeks one sees a clear improvement in symptoms, gradually bring back foods rich in the same sugars that were avoided in the first stage. The correct way to do this is to gradually add one food at a time for a few days. During these days, start with exposure to a small amount and gradually increase each day. The goal is to identify which food causes symptoms and in what amount.
Third stage: At this stage one should already know the foods good for you, in which doses and which ones are not. Now the goal is to build a personal menu that will become a lifestyle for each person, which includes all the foods that don't create symptoms.
Yes, this means that there are foods that need to be eliminated but then one will know which types of foods are suitable so it will be possible to create a healthy eating routine that's good for the digestive system.
It's possible to get an even more detailed table from a clinical dietitian that's suitable for Israeli cuisine.
Benefits of FODMAP
The FODMAP stages allow an accurate personal examination of a variety of foods in order to locate those that aggravate IBS symptoms. Individual foods are examined until a full and varied daily menu is put together, including an emphasis on understanding the amounts uniquely appropriate for each person.
There are books and various apps available that help those who want to succeed in working according to a diet, with a lot of information and tools for the success of the process. Yet it's important to say that a lot of patience is required because it's a long process that requires great care until a personal nutrition plan is formulated.
What are the disadvantages of FODMAP?
Some people may remain stuck in the first phase of avoiding many foods for fear of exposing themselves to unpleasant symptoms again. In these cases, they may remain on a very limited menu in terms of variety, which may in the long run cause nutritional deficiencies. Also, the numerous restrictions on the types of foods may create a feeling of frustration and take the pleasure out of eating when many foods are eliminated.
Some people suggest that such strict preoccupation with limiting foods may trigger different types of eating disorders, so it's advisable to do the whole process of nutritional change under the close supervision of a clinical dietitian who's an expert in this area.
In conclusion, FODMAP is an important tool in helping to reduce IBS symptoms. The stages aren't always simple to follow, but can certainly help many people find the foods that are good for them and identify and watch out for those that aggravate symptoms. It's important to say that this diet is one nutritional therapeutic approach among many available for IBS. If FODMAP doesn't alleviate symptoms look for other methods.
Yael Dror M.Sc is a clinical and physiological dietitian and part of the nutrition team at "Medics" medical center.