Move Over Gluten-Free: Should You Be Avoiding FODMAPs?

Following a low-FODMAP diet may be the solution to gastrointestinal symptoms.. istockphoto

Making dietary changes is increasingly becoming an important strategy for managing a variety of conditions and symptoms, including thyroid and autoimmune diseases. The right food choices can help heal or improve a number of health conditions, reduce symptoms, or even help reduce or eliminate your need for certain medications.

One of the most popular -- some might say trendy -- food choices is eliminating gluten from your diet, known as following a “gluten-free diet.” There is evidence that celiac disease and gluten sensitivity play a role in triggering autoimmune reactions and conditions, including autoimmune thyroid diseases like Hashimoto’s thyroiditis and Graves’ disease.

Nutritional and integrative health experts are, therefore, increasingly recommending that thyroid patients – even those who test negative for celiac disease -- consider a trial of a gluten-free diet to see if they experience relief from symptoms.

Some experts are now claiming that the real benefit for a subset of the population is not in going gluten-free, but in avoiding something called FODMAPs.

What are FODMAPs?

The acronym FODMAP stands for Fermentable, Oligosaccharides, Disaccharides, Monosaccharides, And Polyols. All are short-chain carbohydrate (oligosaccharide) molecules found in food, and prevalent in the average Western diet, that are poorly absorbed in the small intestine in a subset of the population.

The low FODMAP diet was developed at Monash University in Melbourne. There, Peter Gibson, MD and Susan Shepherd, Ph.D. found that restricting FODMAPs from the diet has a beneficial effect on people with irritable bowel syndrome and other types of gastrointestinal disorders.

Not only are these foods poorly absorbed, but the bacteria in the gut ferment them quickly, which increases gas, and causes abdominal bloating and discomfort. According to these experts, physicians, the low FODMAP diet helps reduce symptoms, including pain in the abdomen, gas and bloating, constipation, diarrhea, and nausea.

Which Foods are High and Low-FODMAP?

At least one high-FODMAP food–high fructose corn syrup – is a no-brainer that any remotely health-conscious person should give up, some high-FODMAP items fall into the category of otherwise healthy foods. Beans, certain grains (including wheat, rye, and barley), stone fruits like apples, cherries, etc.), and a variety of vegetables, including broccoli and Brussels sprouts all fall into the high-FODMAP category. 

Some other high FODMAP foods that should be avoided on a low-FODMAP diet include: 

  • other vegetables including garlic, onions, shallots, scallions, artichokes and cauliflower
  • certain beans, including kidney, lima, mung, soy, and red kidney
  • mushrooms
  • peas 
  • many fruits, including apples, apricots, avocados, berries, cherries, grapefruit, mango, pears, plums, and watermelon
  • sausages and processed meats
  • most products containing wheat 
  • other grains, including amaranth, barley, and spelt 
  • most dairy products

So, which foods are low-FODMAP?

Meats, poultry, eggs, fish, wheat-free grains, quinoa, non-stone fruits, and a variety of vegetables.

Here’s a helpful FODMAP food chart for reference, and a list of other FODMAP food reference charts.

Would a Low FODMAP Diet Help You?

To determine if you are sensitive to high-FODMAP foods, you can do a self-test. Start by eliminating high-FODMAP foods entirely for 8 weeks.

At that point, reintroduce one food every 4 days, and gauge your response and symptoms. If you have a reaction, wait another week before reintroducing another food.

It’s a challenge to eliminate foods from your diet. And the FODMAP diet is more restrictive than most. But if you have gastrointestinal symptoms, it may be worth trying the FODMAP diet and keeping close tabs on how you feel afterward.

Meanwhile, for recipe guidance, a recommended resource is the book, The Complete Low-FODMAP Diet, co-authored by Drs. Gibson and Shepherd.

Latest Developments

Results of a clinical trial -- the first of its kind in the United States -- were reported in May of 2016 that  the low FODMAP diet helped more than half of the people studied overcome symptoms of irritable bowel disorder. 

More Information

Eswaran, Shanti, Chey, William et. al. A Low FODMAP Diet Improves Quality of Life, Reduces Activity Impairment, and Improves Sleep Quality in Patients With Irritable Bowel Syndrome and Diarrhea: Results From a U.S. Randomized, Controlled Trial. Gastroenterology, 2016; 150 (4): S172 DOI: 10.1016/S0016-5085(16)30665-5

Gibson, Shepherd, et al. “Evidence-based Dietary Management of Functional Gastrointestinal Symptoms: The FODMAP Approach” J Gastroenterol Hepatol. 2010;25(2):252-258. Abstract

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