Putting together the best diet that will fit your metabolic needs, goals, and health limitations can be a difficult task. It is very tricky to navigate through the world of modern diet tips and advice from fitness and lifestyle experts - partly because we naturally gravitate towards the easy way out and instant solutions. We want results and we want them now. But peak health, well-being, and longevity are not achieved overnight, or in a matter of weeks, months, maybe even years. It all depends on our current state of health, age, sex, level of activity, many lifestyle factors, and also your medical history. There is no easy way to obtain health and there is no deadline with health. Health is a lifelong journey and in order to become and stay healthy, we have to maintain our habits for the rest of our lives. If you build a beautiful house and stop taking care of it once it is finished, it will break down sooner or later, and our bodies work in a similar manner. Once you achieve your desired health, weight, or fitness goal, you have to keep doing all the things that got your there in a first place (though sometimes you can loosen up a little bit), but going back to the old habits will inevitably bring you back to where you don’t want to be.
Sometimes you dial in your diet and lifestyle perfectly, but you still don’t feel perfectly healthy. If you cut out all of the potentially harmful foods from your diet like sugar, gluten, grains in general, processed dairy and soy, add gut healing foods to your plate like green vegetables, healthy fats, quality complete protein, fermented foods, and bone broth, but still feel like something is off, chances are you need a different diet intervention. There is a certain food group that might further sabotage your efforts, even though these foods are considered healthy, nutrient dense, and naturally whole. These foods can be difficult to digest for a few reasons and can cause digestive issues like gas, bloating, constipation, or diarrhea and are linked to problems like IBS (irritable bowel syndrome) and SIBO (small intestinal bacterial overgrowth). This group of foods is called FODMAPs, and we are going to take a closer look at them today, because no matter whether you have or have not heard about them before, they are very important to discuss, especially if you feel like you have reached a dead end with your diet and you don’t know how to get past it.
FODMAPS - FRIENDS OR FOES?
The word FODMAP is actually an acronym that stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols. FODMAPs are different types of carbohydrates found in fruits, vegetables, grains, and dairy and what makes them special is the fact that they are fermentable. They are difficult to digest and absorb, so instead of these carbohydrates being broken down in our small intestines like the rest of the macronutrients we consume, FODMAPs are transported into the large intestine along with fiber, where they either are broken down by a specific enzyme, or stay inside our large intestine where our gut bacteria ferments them, which causes a few problems we will talk about later in this post.
FODMAPs include many foods you are probably eating on a daily basis, so it might be difficult for you to say goodbye to them. The thing is, most FODMAP foods are okay for the average human body, most people don’t react to them at all because the daily dose is very low in their diet. But some people might be very sensitive to these carbohydrates and they might need to cut them out of their diets completely (at least for a while to allow the body to heal enough to be able to handle them again). Let’s take a closer look at FODMAPs. We mentioned four types of carbohydrates that fall into the FODMAP category, but it doesn’t mean that all oligo-, di- and mono- saccharides and polyols are FODMAPs. There are specific members of these saccharide groups that are fermentable. These are specifically raffinose, fructans, and galactans (from the oligosaccharide family), lactose (disaccharide), fructose (monosaccharide), and polyol sweeteners like sorbitol, mannitol, xylitol, and maltitol (basically every sugar alcohol that ends with -ol). Here is a full list of foods high and low in FODMAPs that includes information about which fermentable carbohydrate is present in specific foods. You may notice that some foods contain more than one FODMAP carbohydrate.
This is a very important thing to notice, because the effects of FODMAPs in the body are cumulative, meaning that eating two types of fermentable carbohydrates can cause a worse reaction than just eating one (eating a lot of grapes rich in fructose along with using plenty of garlic loaded with fructans will make your digestive issues even worse than having just one of them). Oligosaccharide and polyol sensitivity is very common, but the amount of these carbohydrates in our diet is not high enough to actually cause any reaction in most people, but for those who already suffer from non-FODMAP related digestive issues, they might notice their symptoms become even worse. Why is that?
BREAKING IT DOWN
Everything we eat is broken down into individual simple sugars in our digestive tract, and this process starts in our mouth. One of the enzymes responsible for carbohydrate digestion is called amylase and it is present in our saliva, produced by chewing (this is why chewing is so important for digestion and why smoothies and liquid food are not the best everyday option, especially if you suffer from digestive issues). Amylase, however, is not able to break down strong bonds between the molecules of FODMAPs in the small intestine (where sugars are absorbed into the bloodstream via our gut lining), so they travel further into our large intestine. Amylase is not the only enzyme responsible for the digestion of carbohydrates. For example, lactase is another digestive enzyme, this one (as the name might suggest) breaks down lactose. The human body produces plenty of lactase at the beginning of our lives when mother’s milk is the main source of nutrients, but once we stop being breastfed, our lactase production slows down. People who are very sensitive to lactose actually lack this enzyme and are no longer able to digest lactose in the small intestine.
The same thing applies to raffinose (found in beans), the human body doesn’t produce an enzyme that would break it down completely. And as these undigested carbohydrates travel into the large intestine, they become food for our gut flora. This is where the fermentable characteristic kicks in - our gut bacteria ferments those carbohydrate molecules and creates metabolic byproducts that cause those dreaded digestive issues like gas, bloating, or constipation. FODMAPs also cause osmosis in the gut, which means they draw water into the large intestine, causing bloating and diarrhea. These metabolic byproducts can also serve as food for other microbes in the body and also can be absorbed by the gut lining into the bloodstream, where they can cause more health issues. Here you can see how our gut flora affects the overall health of our body and how important it is to really find the proper diet for your metabolic individuality. Our gut flora is as individual as our fingerprints and the composition of our microbiome plays a major role in our overall health.
FODMAPS AND DIGESTIVE DISORDERS
There is a strong correlation between IBS and high FODMAPs intake, so it should be no surprise that using a low FODMAP diet has been shown to be very helpful for IBS patients. Even though FODMAPs don’t cause IBS, limiting the intake of fermentable carbohydrates helps to eliminate digestive symptoms, in fact, 75% of IBS patients noticed improvements in their digestive issues while eating a low FODMAP diet. One of the causes of IBS is gut flora imbalance, so gut healing and maintaining healthy gut flora is crucial. FODMAPs can sabotage your gut healing efforts, and cause the same problems as IBS itself. Cutting off all FODMAP foods might seem very drastic at first, but for many people, it is just a temporary dietary modification and FODMAPs can be reintroduced and consumed in a limited amount (based on your personal reintroduction results). A healthy digestive system is able to deal with much more than an unhealthy gut, including digesting a limited amount of FODMAPs without severe reactions.
Another condition that is often linked to FODMAP consumption is SIBO, short for Small Intestinal Bacterial Overgrowth. With SIBO, our gut flora basically becomes overgrown and gets into places it doesn’t belong. We primarily need these bacteria in the large intestine and if they set up camp in the small intestine, things can get gassy. We know bacteria feed on carbohydrates, so it is easy to understand that overconsumption of carbohydrates can contribute to overgrowth in our bacteria population. Gas, bloating, constipation, or diarrhea are the most common symptoms of bacterial overgrowth. Rapid weight loss, inability to gain weight, and nutrient deficiencies are also possible signs of SIBO. There is a great podcast episode on the connection between SIBO and FODMAP consumption, check it out if you want to learn more details!
There is a connection between SIBO and IBS, and studies say that up to 80% of IBS patients also suffer from SIBO. One more thing that should be mentioned is the connection between chronic stress and digestive issues. Stress actually inhibits the absorption of carbohydrates in the large intestine and if you consume a lot of fermentable carbohydrates on top of your stressful lifestyle, you can experience some of the digestive problems mentioned above. Isn’t it fascinating how interconnected all of the systems in our bodies are? How food we put on our plate affects every single process in the body? If you are interested in more details about gut flora and the effect of our food choices on the body, I strongly recommend reading The Good Gut and It Starts With Food, as well as our older posts about enzymes, gut healing fermented foods, and collagen, as well as our series about sugar.
ELIMINATING AND REINTRODUCING
Very often we experience discomfort in the gut area (gas, bloating, cramps) and for many people these symptoms become so common that they have learned to accept them as normal. The simple truth is that we need to eliminate what is harming us first to actually experience what it feels like to live without these problems. For some of us, it might be a whole new experience. I know people in my life that don’t even remember what it feels like not to be constipated. Every elimination diet is difficult at first (The Loving Diet book talks about this beautifully), but you have to realize two things. One - it is most likely temporary, and two - it is going to heal you. We have to want this change for ourselves, we need to put our health first and we need to love ourselves more than we love garlic bread or bowl of grapes. If you suffer from any kind of digestive distress, looking into a low FODMAP diet is a great step. It is always best to eliminate all FODMAPs for a certain period of time (I would suggest at least 4 weeks, depending on the severity of your problems, but you might even need to stick to it for two or three months) and then slowly reintroduce them a little bit at a time (introducing one new food every 4 days to allow space for delayed reactions).
Be sure to keep a food journal for your reintroduction phase so you can easily track which foods are friends or foes, and also what is the reasonable amount of certain foods you can tolerate. Maybe an apple here and there doesn’t cause you any troubles, but an apple a day might actually not keep a doctor away in your book. Download and print out this food list, check out more resources like this, look into low FODMAP recipes (maybe you will discover new favorites you never tried before), and start your gut healing journey equipped with the most important thing: knowledge. You just learned about a potential culprit of your health problems and it is much easier to fight an enemy if you know who are you dealing with!