The
FODMAP
diet
Master
Master
Plan
Name:
Dietitian:
Tel: 01 8065488
Before we begin:
If you have any of the following symptoms consult your doctor immediately:
· Unintentional and unexplained weight loss,
· rectal bleeding,
· a family history of rectal or ovarian cancer,
· if you are over 60 years old; a change of bowel habit to looser and/or more frequent stools for more than 6 weeks, or painful bloating than persists for the whole day with little relief.
Have you been fully investigated for coeliac disease?
Remember the symptoms of coeliac disease are similar to IBS, but the dietary treatment differs greatly.
Some blood tests are useful for screening for coeliac disease, but they are not always reliable.
The gold standard for diagnosis is a small bowel biopsy.
It is important that you do NOT follow the FODMAP diet if you are being investigated for coeliac disease as this may make it more difficult to detect.
Before attempting to manage your symptoms with diet it is important to fully rule out other medical conditions, and to have a diagnosis of IBS officially made by your doctor or gastroenterologist.
THE MASTER PLAN
7 steps to better digestive health
Step 1: General tips to improve digestion
(follow 2 weeks prior to progressing onto step 2).
Step 2: Eat foods that are low in FODMAPs’
Step 3: Plan ahead
Step 4: Work on your mind-body balance.
Step 5: Daily exercise plan.
Step 6: Keep a food and symptom diary.
Step 7: Re-introduction of high FODMAP foods.
Remember:
If you experience NO SYMPTOM IMPROVEMENT after 6 weeks, stop the FODMAP plan and seek advice from your GP to investigate other causes of your symptoms.
Step 1:
General tips to improve digestion.
· Eat meals at regular times of the day in a relaxed atmosphere.
· Do not skip meals or eat late at night.
· Take your time when eating meals, chew your food well.
· Schedule food at least 2-3 hours apart to give your digestive system a break.
· Take regular exercise and make time to relax.
· Try a daily probiotic capsule. If taking a yoghurt remember to take chilled, not at room temperature, or heated, as this will simply destroy all the ‘good’ bacteria.
· Try a daily multivitamin.
· Avoid gut stimulants such as nicotine, caffeine (2-3 cups maximum/day), alcohol (1-2 units/day).
· Herbal teas can be beneficial for digestion, especially after a large meal. Good choices include; ginger or peppermint. Why not try and make your own herbal tea with fresh mint or grated ginger, with a squeeze of lemon or lime, for a refreshing option.
· It may also be useful to keep a food and symptom diary. Remember symptoms may not be caused by the food you have eaten, but what you ate earlier in the day or the day before.
· And most importantly give your bowels time to adjust to any changes you have made, improvements are unlikely to be noted overnight.
Step2: FODMAPs’.
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What is IBS?
Irritable bowel syndrome is a common functional gastrointestinal (GI) disorder, meaning symptoms are caused by changes in how the GI tract works and how the body interprets pain. With IBS the gut does not become damaged. IBS is rather a group of symptoms that occur together, it is not a disease. It is estimated to impact 10-20% of adults, mostly females.
What is the FODMAP diet?
The 'low FODMAP' diet was developed in Australia and successfully adapted to the UK and Ireland for symptom management in patients with IBS, functional bloating and other gut disorders such as Crohns disease.
What does the low FODMAP diet involve?
The aim of the diet is to identify which FODMAP foods, if any, cause symptoms. It involves restricting certain foods for up to 6-8 weeks, and then re-introducing them systematically back into the diet through ‘food challenges’.
What exactly are FODMAPs?
These are short-chain carbohydrates and sugar alcohols [polyols] that are widespread in the diet, and are poorly digested in the gut. The ability to digest these varies from person to person, as do the physical symptoms experienced. These symptoms can include:
Created by BonSecours Hospital Dublin. Ilona O’Reilly, dietitian. 2015.
ü Abdominal pain/ discomfort
ü Abdominal bloating/ distension
ü Flatulence/ wind
ü Belching/ burping
ü Urgency to open bowels
ü Poor stool consistency
ü Constipation.
Created by BonSecours Hospital Dublin. Ilona O’Reilly, dietitian. 2015.
Reducing FODMAPS from the diet has proved to be effective in reducing these symptoms in up to 75% of people with IBS.
Created by BonSecours Hospital Dublin. Ilona O’Reilly, dietitian. 2015.
The “Low FODMAP diet” is not a “No FODMAP diet” and it is not a “lifetime diet.” Many people can return to their usual diet with just a few high FODMAP foods that need to be avoided
REMEMBER: FODMAPs’ do not cause the underlying functional gut disorder, but do represent an opportunity for reducing symptoms.
Effects of FODMAPs’ on the Gut
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In the intestine, the small FODMAP molecules exert an osmotic effect, which means they draw fluid into the bowel. They also are also rapidly fermented by gut bacteria and in turn can produce a lot of gas. This increase in fluid and gas distends the bowel, causing bloating, abdominal pain, discomfort, and diarrhoea. In some people, as it affects how the muscles in the bowel wall contract, it can also cause constipation.
Figure 1: Mechanisms of FODMAPs in inducing gut symptoms
Understanding Carbohydrates and the FODMAP Concept
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Carbohydrates can be present in different forms in foods, varying from long-chain carbohydrates (e.g. starch), to simple sugars (e.g. glucose). These are both easily digested and quickly absorbed to produce energy. New research shows that there are another group of shorter chain carbohydrates called, fermentable oligo-saccharides, mono-saccharides and polyols, or rather FODMAPS. FODMAP is an acronym that stands for the following:
· Fermentable
· Oligo-saccharides
· Di-saccharides
· Mono-saccharides,
And
· Polyols
There are several different types of short-chain carbohydrates that make up the FODMAP family. They are as follows:
1. Fructans and Galactans or Oligo-saccharides: These carbohydrates cannot be digested humansdo not have enzymes to break them down. Hence, they are not absorbed at all in the small intestine by anyone, and therefore, can cause problems for the majority of patients with IBS. Examples of these include; wheat, garlic, onions, and beans.
2. Polyols: include artificial sweeteners such as sorbitol.
3. Fructose: Fructose requires little digestion, however some people they lack the enzymes needed to do this. This condition can be hereditary. Fructose is found in both honey and some fruits e.g. apples.
4. Lactose: In this condition sufferers also lack the required digestive enzyme, and can also be hereditary. Lactose is mainly found in dairy foods.
The FODMAP Bucket:
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The bucket represents your unique, personal capacity to tolerate FODMAP carbohydrates from all sources.
If your FODMAP intake exceeds your personal limit for digestion and absorption in the small intestine, overflow into the large intestine occurs. This can trigger IBS symptoms in sensitive individuals.
Common Q & A:
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Does everyone need to avoid FODMAPS?
No. IBS refers to gut sensitivity and even though some FODMAPs are poorly absorbed by everyone and produce gas, they only need to be avoided if they cause symptoms.
Why?
The lining of the gut contains millions of nerve endings. The sensitivity of these nerves varies greatly from person to person, and it is believed that those with IBS have more highly sensitive nerve endings in the gut. It is these receptors that are more likely to feel the pressure from the gas produced by the bacteria and water changes in the gut. The nerve endings then send signals to the brain which it in turn interprets as pain and bloating. Other symptoms include wind, constipation and diarrhoea.
How strict do I need to be?
Try to follow the diet for 6-8 weeks as strictly as possible to improve your symptoms. There will be times when you cannot avoid some of the problem foods. Eating problem foods is not known to cause damage to your gut, but it may cause symptoms. Clinical experience shows that individuals who follow the diet more strictly have better improvements.
What about the long term?
After the initial period it is important you then re-introduce FODMAP containing foods to identify which carbohydrates/FODMAPs’ are a problem. Different individuals will be more sensitive to certain FODMAPS. Working out what you are more sensitive to helps to increase variety in your diet and widen food choices. This is especially useful when eating out. For the majority of people the diet does not need to be too restrictive in the long term.
What if my symptoms do not improve?
The low FODMAP diet is beneficial to may individuals with IBS like symptoms. If your symptoms have not improved after the elimination period then please refer to your dietitian for further advice.
What about foods not listed?
The FODMAP diet is an emerging dietary treatment and information on the FODMAP diet content of some foods is not yet known. Ask your dietitian about the suitability of foods not listed in this diet sheet as new information from the university may be available.
Created by BonSecours Hospital Dublin. Ilona O’Reilly, dietitian. 2015.