Digestion, Diets | August 3, 2016 | Author: Naturopath
Every 1 in 7 Australian adults today are said to suffer from Irritable Bowel Syndrome (IBS) or other gut-related disorders. These rather worrying figures are estimated to be even worse in America, Europe and some Asian countries. Any sufferer will attest to the uncomfortable symptom of abdominal pain, consistent problems with bowel movements and even crippling psychological symptoms such as anxiety and depression.
Although there is no definitive understanding of what exactly causes IBS and other such gut-related disorders, it is no secret that modern food production methods such genetic modification, preservation, sweetening and coloring, to name a few, have greatly compromised the quality of the foods that we eat and their ultimate nutritional value. It is however quite unfair to finger these as a sole cause for the gut-related diseases that people seem to suffer from as certain lifestyle habits such as smoking, excessive drinking and emotional or physical stress may also be considered contributing factors. There are also suggestions genetics and prior adverse life experiences such as infections and trauma to and of the gut may predispose people to IBS. Finally, there seems to be a link between disruptions in the brain-gut axis that allows sensations to be transmitted from the brain to the gut that are fundamental in maintaining healthy bowel functions.
Regardless of the cause, sufferers usually find themselves having to deal with the direct effects of these diseases. Many have been rather frustrated to find that sometimes even certain foods such as fruits, vegetable and some dairy products that are otherwise considered healthy by conventional standards seem to actually worsen symptoms of IBS and other gut-related disorders. This common phenomenon among IBS patients spurred the research carried out by a team of Monash University researchers which provided evidence for a diet low in FODMAPs to treat IBS symptoms.
‘Saccharides’ is basically a technical term for sugars and thus the acronym FODMAPs simply describes the types of sugars by use of prefixes (Oligo-, Di-, Mono- etc.) that are able to undergo a process of chemical changes that end up producing alcohol, known as ‘Fermentation’.
The main problem with these sugars is that they are not properly absorbed into the gastrointestinal tract and are easily fermented by the bacteria in the gut. The sugars also allow for fluids to move into the large bowel through means of a process called osmosis. This results in a concoction of undigested sugars in the gut that ultimately cause symptoms such as diarrhea or constipation (or a combination of both), gas, bloating, flatulence and pain. The FODMAP diet does not seek to suggest that FODMAP containing foods are a direct cause of gut-related ailments such as IBS and Crohn's disease but rather point to them as a source for an exacerbation of the effects. The diet aims to restrict the intake of foods that are high in FODMAPs.
In one study of patients with Crohn's disease and others with Ulcerative colitis were given dietary advice that restricted the intake of FODMAPs at a gastrointestinal dietary service in Victoria, Australia. It was found that the low FODMAP diet was effective in the treatment of symptoms of at least 1 in 2 patients with Crohn’s disease or ulcerative colitis. In another study involving patients with IBS and fructose malabsorption it was found that patients who were put on a strict low fructose and fructans diet showed great symptomatic improvement.
The foods that are high in FODMAPs are actually quite common foods that most people consume on a regular basis without being aware of their potential effect on their guts. It is the sugar types in the foods, such as fructose from common fruits or lactose from dairy products that cause the reactions that result in manifestation of gut-related symptoms.
Milk, soft cheeses (ricotta, cottage, mascarpone etc.), yogurt, condensed and evaporated milk, powdered milk and deserts like ice-cream and custards.
Fruits that have high fructose content such as apples, watermelon, pears, peaches, and sweeteners such as honey and high fructose corn syrup.
Herbs and root plants such as artichokes (Globe and Jerusalem), leek, Onions (all kinds), Spring Onions and large amounts of Rye, Barley and Wheat.
Legumes, beans (baked, kidney etc.), Chickpeas and Lentils
Fibrous fruits and veg such as Apples, Pears, Nectarines, Plums and Mushrooms.
The FODMAPs diet is essentially aimed as a temporary dietary intervention that is divided up into phases. The first phase of the low FODMAP diet involves a complete restriction of all foods that contain high FODMAPs. This phase generally lasts between 6 to 8 weeks and should be done under or following consultation with a professional, firstly to establish a legitimate diagnosis of a functional gut disorder and to have proper recommendation or advise on the low FODMAPs diet. After the initial complete-restriction phase, a systematic reintroduction of FODMAPs foods will be carried out by a professional who will monitor the effects of each food source on the individual patient’s gut health.
Every person is different and therefore, degrees of intolerance, adjustment and readjustment will differ from one person to the next. This is the reason that the FODMAPs diet is very often individualized.
The diet itself is generally considered safe and can even be recommended by professionals for children that have been officially diagnosed with a functional gut disorder such as IBS. It is not recommended however, that children who generally benefit from treatment with the FODMAPs diet continue on it indefinitely. The diet is also safe for patients who have previously undergone gastrointestinal surgical procedures.
Shepherd SJ, Parker FJ, Muir JG and Gibson, PR Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome- randomised placebo-controlled evidence Clin. Gastroenterol. Hepatol. 2008; 6(7):765-771
Gearry, P. Irving, J. Barrett, D. Nathan, S. Shepherd, P. Gibson Journal of Crohn’s and Colitis, Volume 3, Issue 1, Pages 8-14 Halmos, EP, Power VA, Shepherd SJ, et al. A Diet Low in FODMAPs Reduces Symptoms of Irritable Bowel Syndrome Gastroenterology 2014; 146(1)67-75
Ong DK, Mitchell SB, Barrett JS, Shepherd SJ, Irving PI, Biesiekierski JR, Smith S, Gibson PR, Muir JG. Manipulation of dietary short chain carbohydrates alters the pattern of hydrogen and methane gas production and genesis of symptoms in patients with irritable bowel syndrome. J. Gastroenterol. Hepatol. 2010 Aug; 25(8):1366-73