by Dr Mecherl Lim
MD (MA) Naturopath (ND), Holistic Kinesiology
In 2006, researchers Dr Sue Shepherd & Professor Peter Gibson from Monash Uni, linked several highly fermentable but poorly absorbed short chain carbohydrates and polyols to symptoms associated with IBS, including wind & diarrhoea, as well as to the increased intestinal permeability associated with Crohn’s disease.
These fermentable aligo-di-and monosaccharides and polyols are now known collectively as FODMAPs. They comprise oligosaccharides (fructans and galactans), disaccharides (lactose), monosaccharides (fructose) and polyols, which is the technical word for sweetener. In the 2006 study, 74 per cent of patients with IBS and fructose/fructan diet such as the FODMAP diet.
HOW DOES THE LOW-FODMAP DIET WORK?
Research shows that FODMAPS in meals are poorly absorbed in the small intestine and increase the delivery of water to the colon-suggesting the catalyst for diarrhoea in some people. Breath test show that eating a low-FODMAP diet reduces hydrogen production (in both healthy volunteers and patients with IBS), linking the short chain carbohydrates with bloating, abdominal distension and pain and excessive flutulence.
Since the first study, research has consistently tied global restriction of FODMAPs (rather than restriction of individual components) with reduced symptoms of IBS. In a challenge trial (in which participants restricted fructose/fructans-containing foods and then restored the foods to the diet) showed a return of symptoms after the foods were reintroduced.
In those with Crohn’s disease, sweeteners such as sorbitol, maltitol and isomalt are absorbed, but the digestibility of the other nutrients in the foods is reduced because these polyols cause an osmotic load, meaning that more water remains in the intestine, leading to watery stool.
FODMAP group had reduced bloating, 87 per cent enjoyed less flatulence and 85 per cent experience a reduction in abdominal pain.
The researchers concluded that the low-FODMAP diet is more effective than standard dietary guidelines for symptom control of IBS.
FODMAPS AFFECT HEALTHY PEOPLE TOO
It’s interesting to note the research has also uncovered information about how FODMAPS are digested by healthy participants. We know, for example, that fructans (polymers of fructose found in asparagus, leeks, garlic, onions and onions and wheat) and galacto-oligosaccharides (lactose from cows milk) are always fermented by intestinal flora, and cause wind production and flatulence in healthy people too. The effects are merely worsened in those with hypersensitivity and motility disorders as found in IBS.
READY TO TRY IT
The low FOD-MAP diet eliminates sugars that can’t be fully digested and absorbed in the small intestine. When following this diet, journal ling is critical. Be sure to keep accurate records of what you eat, when and how your body responds.
After following the diet until all of your symptoms have disappeared, the goal is to reintroduce foods to determine whether they are a trigger for your symptoms. When doing so, add one food back at a time and wait 72 hours to determine that symptoms haven’t re-appeared before moving on to the next food.
This way of eating is not as restrictive as some other prescription diets, but if you are interested in following it, you are wise to get nutritional guidance from an expert so you are sure to get all of your health-supportive nutrients. You may have to use vitamin and mineral supplementation to be sure to meet nutrient requirements, particularly in the elimination and re-challenge phases.
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