6 Things You Should Know About the Low-FODMAP Diet (And Why You Should Care)

FODMAPs may sound like a new medical device or GPS system, but they're actually one of the hottest topics in digestive health and wellness. You're likely to hear a lot more about them in the coming years, so let's set the record straight.
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FODMAPs may sound like a new medical device or GPS system, but they're actually one of the hottest topics in digestive health and wellness. You're likely to hear a lot more about them in the coming years, so let's set the record straight with six key things you should know.

FODMAPs are not a single ingredient, allergen or protein; they're a group of carbohydrates.

FODMAPs are found in a wide range of foods, from apples to milk and from honey to kidney beans. These carbohydrates are poorly absorbed in the intestine and, in some people, can cause stomach upset and other gastrointestinal symptoms.

If you have persistent gastrointestinal symptoms, a low-FODMAP diet may help.

First conceived by Dr. Susan Shepherd, the low-FODMAP diet has been found to be one of the more effective ways to relieve symptoms of irritable bowel syndrome (IBS), and now studies are finding that the benefits of a low-FODMAP diet may extend far beyond this population. The diet does not ban all FODMAPs but teaches individuals how to make wise food choices that avoid foods containing high amounts of FODMAPs.

The diet requires close monitoring of food and ingredients, but rest assured, there are plenty of foods to eat.

"The low-FODMAP diet still includes delicious healthy foods including fruits such as banana, strawberries, kiwifruit, vegetables such as potato, zucchini, bell peppers, squash, rice, quinoa, many nuts and seeds, meat, eggs, and more," Dr. Shepherd says.

Dr. Shepherd has authored several books on the low-FODMAP diet, including The Low-FODMAP Diet Cookbook, which is due out this June.

The gluten-containing grains wheat, barley and rye are high in FODMAPs.

Wheat, barley and rye-based products are all on the list of high FODMAP foods, so the low-FODMAP diet can help to eliminate some of the major foods that are recommended for people following a medically necessary gluten-free diet. With that being said, it is important for people with celiac disease to know that gluten-free foods can still contain high levels of FODMAPs. For some of the many patients with celiac disease who continue to suffer from ongoing digestive problems even after going on a gluten-free diet, fructose malabsorption may be the culprit. A low-FODMAP diet combined with their strict gluten-free diet will help to limit excess amounts of fructose.

For those who do not have celiac disease but appear to be sensitive to gluten (known as "non-celiac gluten sensitivity"), research has indicated that some of these individuals may respond better to a low-FODMAP diet than they do to the gluten-free diet. Some researchers have even begun to explore whether a portion of the gluten sensitive population is actually not sensitive to gluten, but to other foods that contain a high level of FODMAPs.

Expert gastroenterologist Sheila Crowe, M.D., FRCPC, FACP, FACG, AGAF, of the UC San Diego School of Medicine and member of the Scientific/Medical Advisory Council for the National Foundation for Celiac Awareness (NFCA), is among those exploring the role of FODMAPs.

"When I see a patient who believes he/she is gluten sensitive without celiac disease but has not improved on a gluten-free diet, I always consider the possibility of bacterial overgrowth of the small intestine and/or fermentable starches (FODMAPs) in the diet," she says. "These same problems can play a role in patients with celiac disease who do not seem to completely respond to even a very strict gluten-free diet."

FODMAPs are not bad; they're just not for everyone.

Just like with gluten, some individuals respond strongly and negatively to a high level of FODMAPs; for others, high levels of FODMAPs result in no ill effects. FODMAPs are not inherently bad, but the amount ingested needs to be monitored in certain people.

The low-FODMAP diet is not a cure-all.

Every body is different. As is the case for all treatments and medical diets, it's not effective for everyone. This is especially important to remember because the diet is so restrictive. Some people will see an incredible health improvement by reducing their FODMAPs intake; for those who don't, continuing to follow the diet can be an unnecessary stress and cost.

If you're considering a low-FODMAP diet, talk to your doctor or dietitian first.

It's best to discuss any change to your diet with a medical specialist, and the low-FODMAP diet is no exception. Expert guidance and support is essential to successfully follow the low-FODMAP diet since identifying which foods to eat and which to avoid is a challenge, especially when you're starting off. The more educated you are, the better, so make an appointment and be sure to read books and articles from credible sources.

"It is important to rule out any other conditions that might be causing your symptoms first," Dr. Shepherd explains. "Then, consulting with a dietitian with experience in the low-FODMAP diet can make sure you are not avoiding foods unnecessarily, and can help you plan a low-FODMAP diet that is varied and nutritionally adequate."

If you'd like to learn more about FODMAPs, and particularly their role in gluten-related disorders, Dr. Shepherd will be participating in a free webinar presented by NFCA on Wednesday, March 26 at 8:30 p.m. ET/5:30 p.m. PT. Register for the webinar at www.celiaccentral.org/webinars.

NFCA will host a follow-up Facebook chat to discuss the webinar and key takeaways on Thursday, March 27 at 10 a.m. ET/7 a.m. PT. Visit NFCA on Facebook at www.facebook.com/nfceliacawareness.

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