The FODMAP Diet

“FODMAP” is actually an acronym representing a diet protocol now being used to treat irritable bowel syndrome, gas and bloating.

So what exactly is a FODMAP, who should follow a low FODMAP diet, does it actually work, and is there any reason a cancer patient should follow a low FODMAP diet?

 

What are FODMAPS and what is the FODMAP diet?

FODMAPs are different types of short-chain carbohydrates that are readily fermented in the gut. FODMAPs also have the ability to draw water into the intestinal tract. For people with sensitive gastrointestinal (GI) tracts, some or all of the FODMAPs may cause discomfort, gas and bloating.

 

What does FODMAP stand for?

• Fermentable
• Oligosaccharides
• Disaccharides
• Monosaccharides
• And
• Polyols

The FODMAP diet is an elimination diet. It involves temporarily eliminating all FODMAP-containing foods and then systematically reintroducing foods from each individual group to see which, if any, are responsible for GI problems.

People with gas and bloating can also use FODMAPs as a tool. After keeping a careful food diary, if foods from one individual FODMAP group in particular seem to be GI triggers, one can eliminate the one group to see if symptoms are alleviated, as opposed to eliminating all groups at once.

 

Types of FODMAPs and the foods they are found in

• Fructose – A sugar found in apples, pears, watermelon, mangoes, grapes, blueberries, tomatoes, and all dried fruits; vegetables like sugar-snap peas, sweet peppers and pickles; honey; agave; and jams, dressings and drinks made with high-fructose corn syrup
• Lactose – A sugar found in cow, sheep, and goat milk and dairy products.
• Fructans – Soluble fibers found in bananas, garlic, onions, leeks, artichokes, asparagus, beets, wheat and rye
• Galactans – Complex sugars seen in peas and beans, soybeans, soy milk, broccoli, cabbage and Brussels sprouts
• Polyols – Sugar alcohols (sweeteners) isomalt, mannitol, sorbitol and xylitol, present in sugar-free gum, certain artificial sweeteners, and stone fruits like avocado, cherries, peaches, plums and apricots

Some people are just sensitive to one or some of the individual “FODMAPs” and not necessarily every FODMAP. For example, some people are sensitive to fructose and lactose but can tolerate fructans, galactans and polyols just fine. Working with a registered dietitian and keeping a food diary can help determine individual intolerances.

 

FODMAPs and the cancer patient

The FODMAP diet is not routinely utilized for people with cancer. However, people who have signs of severe gas and/or bloating of an unknown etiology, a history of IBS, or small intestinal bacterial overgrowth, may benefit from trying the FODMAP protocol. Working with a registered dietitian is critical to prevent unnecessary diet restrictions and possible micronutrient deficiencies.

 

Does the diet work?

The FODMAP approach can be effective at reducing GI symptoms and improving quality of life in patients for whom the diet is appropriately prescribed. Patients should work closely with their registered dietitian and doctor throughout the process. The ultimate goal is to find a broad range of foods that are healthy to eat and do not create gut discomfort.

Want to learn more? Stanford University Medical Center has a PDF guide with high- and low-FODMAP foods, along with sample meals.

 

References

[i] Biesiekierski JR, Newnham ED, Irving PM, Barrett JS, Haines M, Doecke JD, et al. Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Am J Gastroenterol 2011 Mar; 106(3):508-14.  http://www.ncbi.nlm.nih.gov/pubmed/21224837

[ii] Muir J, Gibson P. Advances in Nutrition: The Low FODMAP Diet for Treatment of Irritable Bowel Syndrome and Other Gastrointestinal Disorders. Gastroenterology & Hepatology Volume 9, Issue 7 July 2013 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736783/

[iii] Scarlata K. The FODMAPs Approach—Minimize Consumption of Fermentable Carbs to Manage Functional Gut Disorder Symptoms. Today’s Dietitian. August, 2010. Vol. 12 No. 8 P.30 http://www.todaysdietitian.com/newarchives/072710p30.shtml Accessed November 13, 2014.

[iv] The Low FODMAP Diet. Digestive Health Center Nutrition Services. Stanford Hospital & Clinics of Stanford University Medical Center. January, 2014.  http://stanfordhealthcare.org/content/dam/SHC/for-patients-component/programs-services/clinical-nutrition-services/docs/pdf-lowfodmapdiet.pdf  Accessed November 13, 2014.