Say Goodbye to Bloating: the FODMAP diet and how to use it

Bloating and gas are quite prevalent.  To some degree that’s normal, as bacterial in our intestines need nourishment, this results in the production of small amounts of gas.  Passing small amounts of gas up to 20 times per day is considered normal and healthy.  However, this benign process can, and does, go wrong for many of us, producing the sensation of bloating, foul smelling gas, and sometimes even diarrhea or severe abdominal pain.  This is especially predominant in individuals with Irritable Bowel Syndrome (IBS).

Bloating is the sensation of gas causing your intestines to stretch more than usual.  This happens when either the mix of bacteria in your intestines are not ideal, or if your diet provides too many of the substances that bacteria turn into gasses (specifically known as “fermentable” sugars).  These are related issues, as the old saying “you are what you eat” also applies to the bacteria in your gut, and your diet will cause shifts in the bacteria.

The low FODMAP diet boils down to decreasing specific types of carbohydrates that are poorly absorbed by your intestine and thus become nutrients for bacteria.   These foods were identified as a result of research into treating IBS, and examining why the “trigger foods” caused gas and bloating.  Basically, the combination of certain poorly absorbed sugars and large populations of the bacteria that consume them (and then produce large amounts of gas), causes bloating and discomfort.

While some foods on the list to avoid with a low-FODMAP diet are obvious, others are not.  Peaches, garlic, honey, and apples have all been identified as problematic as well as cauliflower, cabbage, ice cream and baked beans, among others. But does this mean that if you are stricken with gas and bloating you need to eliminate foods on the entire list?

The quick answer is no, but it’s a bit of a process. Depending on the severity of your symptoms, we will sometimes recommend starting by eliminating the entire list.   This is designed both to make you feel better, and to help promote changes to your microbiome (the bacteria that live in your intestine).  We also may recommend a pro-biotic or pre-biotic to help adjust those bacteria.  But if it resolves your issues, we frequently will start to add foods back in, to figure out what specific sugars your body doesn’t tolerate.  Remember that the interaction between the sugar and the bacteria is somewhat specific, so you may not respond to all FODMAP foods the same.   For those of us with less severe symptoms, we will often try to eliminate the more obvious dietary triggers until the issue is resolved.  This approach is effective with up to 80% of patients showing improvement in symptoms of bloating and abdominal pain on a partial or complete low FODMAP diet.

 


Additional resources are available at:

http://www.fodmapliving.com/wp-content/uploads/2013/02/Stanford-University-Low-FODMAP-Diet-Handout.pdf