What types of “FOOD” are good for a sensitive digestive system?
The FODMAP Food Concept has been researched since 2005 and has proven to be effective in several scientific studies on patients with Irritable Bowel Syndrome (IBS).
Application of this type of diet and the FODMAP level of food is subject to ongoing research. Therefore it is important to use the latest findings and up-to-date lists.
What is FODMAP and how does it work?
FODMAP stands for "Fermentable Oligo, Di, Monosaccharides and Polyols". These are short-chained carbohydrate compounds including fructose, lactose, fructans, galactans as well as sugar alcohols such as sorbitol. These substances are present by nature in certain foods or are added during the food production process.
FODMAPs act in the digestive tract in two main mechanisms: They remove water from the small intestine (osmotic effect) and they are also quickly fermented in the large intestine (strong fermentation).
In sensitive people, this may result in symptoms such as bloating, tummy ache, diarrhoea and/or obstipation.
Limiting the intake of food rich in FODMAPs as a test can make sense because several scientific studies have shown that a low FODMAP diet (LFD) can significantly reduce the symptoms and improve quality of life.
Why doesn’t everybody tolerate high FODMAP food?
The individual tolerance to FODMAP can be different from person to person. It is dependent, amongst others, on the following factors:
- digestive capacity (breakdown and absorption of nutrient)
- susceptibility of the intestinal tract in terms of perception of stimuli and control of intestinal movement
- composition of microbiota in the intestine (“gut flora”)
In the case of intolerance and/or hypersensitivity of the intestinal tract (e.g. because of a functional bowel condition such as irritable bowel syndrome), FODMAPs are not easily tolerated.
How can I find out whether I can tolerate FODMAP or not?
Today, there is still not an easy method to find out whether a person is sensitive to FODMAP or not. The best approach is therefore to start with Phase 1 of the FODMAP concept. This is the so called “diagnostic elimination diet”. It involves reducing the intake of FODMAPs for a limited period of time. If doing so, everything else in terms of food, intake of drugs and lifestyle should remain as normal as possible. This makes it possible to assess at the end whether FODMAPs have played a role in the symptoms or not.
Phase 2 is then about trying to find out precisely which FODMAP and to what extent it is causing the symptoms. This allows the individual FODMAP tolerance (or “FODMAP sensitivity”) to be determined.
The three phases of the FODMAP concept
The FODMAP concept consists of three phases with different objectives and nutritional recommendations:
Phase 1- Diagnostic elimination: For a period of two to six weeks, any food rich in FODMAPs will be avoided while adhering to a low FODMAP diet (LFD).
This phase has seen the most research, discussions and publications so far. However, this is the first stage and is not intended for a long-term diet!
Phase 1 serves the purpose of finding out whether the symptoms can be relieved and wellbeing improved.
After Phase 1, you will know:
Does it help me to limit FODMAPs?
Phase 2 - FODMAP Re-Exposition/“FODMAP Challenge“: This aims at finding out which FODMAP foods will be tolerated and in what amounts. In this phase many insights can be gained on personal triggers and individual FODMAP tolerance. This allows the diet to be personalized.
After Phase 2, you will know:
How many FODMAPs can I tolerate?
Which food is not good for me?
Phase 3 - Individual long-term diet: The objective is to control the symptoms as effectively as possible by restricting as little food as possible in the diet. The diet should also be healthy and balanced because this is extremely important for human health and the intestine.
After Phase 3, you will know:
Can I eliminate what causes my symptoms?
Do I eat everything I can tolerate?
Is my diet balanced and varied?
Prior to starting with a low FODMAP diet, celiac disease should be excluded by means of a blood test. All other insights (e.g. on lactose/fructose tolerance) will be gained during the three phases of the FODMAP concept.
Understanding and implementing the FODMAP concept correctly is complex and elaborate.
For long-term success, it is decisive that the FODMAP concept is used individually and in a targeted fashion. Therefore, (starting with Phase 2 at the latest) it should be applied under the supervision of an experienced nutritionist. They will support proper application, help with choosing individual key aspects and recommend additional measures, if needed.
The FODMAP level in food
The FODMAP level in food can be analyzed in a laboratory. Since 2007, data has been published and since 2012, the Monash University has made it available via an app. The FODMAP database is growing, slowly but surely.
The analysis of different FODMAPs in food is sophisticated and expensive. With the purchase of the Monash Low FODMAP App, you will be contributing to the analysis of more food.
However, pure FODMAP figures are not very helpful in daily life. For daily use, the measuring results have to be recalculated to normal serving sizes and recommendations on food choices have to be implemented (lists, tables).
FODMAP food table for download
My FODMAP food table is based on published data on FODMAP levels, realistic serving sizes and my long-term experience with implementing the concept in practice.
Here, you can find two versions of my most current list:
Download the table HERE for free.
The first list provides a lot of detailed information, for example, on amounts. The abbreviated list provides a good overview and is suitable for sticking on your fridge door or taking with you while shopping for groceries.
FODMAP level in processed products
The FODMAP level in processed food can be estimated based on the list of ingredients. A nutritional specialist can elaborate on this for you. Please note that not all products labelled as gluten-free and lactose-free are also low FODMAP foods.
Special case - bread: The FODMAP level in bread is difficult to estimate from the list of ingredients. One reason for this is that the FODMAP level of flour plays a role here. There are certain differences, sometimes within the same type of grain such as spelt or wheat. If the bread is made from various flours, the ratio of their quantities is often not known. For example, the effective proportion of wheat flour cannot be seen from the list of ingredients. On the other hand, the type and amount of leavening agent (e.g. how much yeast or sourdough were used) and the time during processing (e.g. dough rest period) also need to be considered because these factors contribute to a certain degree to the breakdown of FODMAPs present in the dough. These imponderabilities and uncertainties impede reliable estimations on the FODMAP level of bread.
Why is it important to have an individual nutrition consultancy?
A low FODMAP diet is a therapeutic diet applied in the case of digestive disorders, e.g. irritable bowel syndrome. Prior to changing a diet, a careful medical check-up is important. Experts as well as the developers of the FODMAP concept recommend applying the FODMAP concept only when accompanied by a specifically trained nutritionist.
There are three good reasons for that:
The FODMAP concept involves many changes in diet and many guidelines and recommendation have to be followed.
Nutritionists know whether the FODMAP concept is right for you and will arrange for further assessment before you start. They recognize the factors that are relevant for you, set priorities and identify solutions that will fit into your daily routine in the long run.
Nutritionists make sure that the diet not only remedies any problems but also that it is balanced and nutritious. For example, they recognize unnecessary limitations or the risk of lack of nutrients. They suggest alternatives, encourage trying certain foods and recommend supplements, if needed.
The FODMAP concept is a relatively new type of diet and subject to ongoing research. Information and lists provided in books or on the internet are often outdated or incomplete.
Nutritionists can provide you with the latest information such as lists, records and tips and tricks. They are familiar with the daily life situation of the person concerned. You can benefit from the experience and expertise of a nutritionist.
One key to success for the FODMAP concept is that the link between diet and disorders are recognized and understood.
Nutritionists can explain details of the FODMAP concept and complex relationships. They can answer your questions and support you in the implementation into practice and your daily life schedule. This not only increases your motivation but also improves the chance of a successful outcome.
Nutritionists instruct you on how to determine your personal FODMAP tolerance. This allows you to personalize nutrition recommendations and to prevent unnecessary restrictions.
Nutritionists also take other aspects of your health into consideration and are able to combine the low FODMAP diet with other dietary measures, if needed.
Beatrice Schilling and FODMAP
The first time I read about FODMAP was in 2006 – and ever since then, the term was on my mind. For quite some time, I had the feeling that the commonly provided nutritional recommendations for people suffering from irritable bowel syndrome at that time were not helping very much.
However, back then it was difficult to get any information on FODMAP at all. There were neither food lists nor detailed recommendations or other tools available. Added to that, all information was in English, while I lived in a German-speaking country.
This is why I collected all the available facts in the published studies and drafted my first, rudimentary food list in German. I then started to test the new diet to the best of my knowledge and in agreement with my patients.
It was clear, even in these first few years that there was a large potential inherent in the new findings around FODMAPs. Suddenly, there was an explanation as to why certain food causes problems. Many people who suspected that gluten was the cause of their symptoms felt better after they limited their FODMAP intake because apart from staying away from wheat, they also reduced other high FODMAP foods in their diet.
During this time, I developed more tools for implementation as well as guidance materials. I It was important that the information should not only be on food rich in FODMAPs but also on low FODMAP alternatives and the healthy implementation of the FODMAP concept into the daily diet. For the resulting consultation concept “Low FODMAP Diet”, I received the Nestlé Nutrition Award for Nutrition Communication and Consultation in 2005.
At a very early stage, I found out that background information and detailed knowledge are decisive for nutritionists to understand and correctly implement this complex diet. This is why I dedicated a lot of my time to researching and exchanging information with other FODMAP pioneers from all over the world. Very soon, I began sharing my know-how with professional colleagues by delivering lectures and holding seminars on FODMAPs.
Over the past few years more and more food products have been analyzed for their FODMAP levels. The experiences in applying this type of diet and professional exchanges on this subject have been growing.
Today, many people are seeking specific nutritional advice in order to try the FODMAP concept: Patients who not only suffer from irritable bowel syndrome but also from other digestive disorders, for example caused by inflammations or surgery of the abdomen or from chronically inflammatory bowel disorders and celiac disease.
Many of these patients have been able to reduce their symptoms by this (additional) change of diet and regain wellbeing. This makes me happy and content, over and over again.