• Jasmine Blake, MS, HHP

Is a Low FODMAP Diet is Good for People with Lower Gastrointestinal Diseases?

Updated: Apr 16

What is FODMAP?


FODMAP is a diet often used to treat nutritional deficits or disease. It is an acronym that stands for Fermentable Ogli- Di- Monosaccharides and Polyols. [2]. FODMAPs are considered carbohydrates, but they are also considered a unique class. [2]. Specifically, when discussing FODMAPs, we normally refer to them by their scientific names. These names are fructose, lactose, galactans, fructans, and polyols. [2]. These specific types of carbohydrates are important because they are often related to gastrointestinal (GI) diseases and disorders. [2].


FODMAPS are fermentable when they are in the intestine and sometimes they can ferment more or less depending on the type of food being consumed. [2]. High FODMAPs are more fermentable and Low FODMAPs are less fermentable. [2]. There are many tables and charts that can help a person figure out which foods are considered high or low, but not all charts are created equal. Because of this, it is good practice to find a chart that is referenced properly and can identify the differences between low, medium, high, and really high levels of fermentation of foods.


What is a Low FODMAP Diet?


The Low FODMAP diet is a diet that specifically focuses on foods that ferment less and more slowly in the intestines. [2].


How does FODMAP play a role in the gut?


FODMAP type foods have the ability to retain water in the intestinal tract. [8;9].Retaining this water, in turn, causes foods not to be digested well. [9]. Therefore the foods we eat sit there longer. As these foods sit for a lengthy time in our gut, they begin to ferment inside the GI tract. [8].


Water is important to consume because water can help the flow of bowel and elimination. As well, it is the culprit that causes constipation when not enough is available. [8]. Not consuming enough water can cause constipation, and consuming too much or consuming it with certain types of foods can cause diarrhea. These symptoms are prevalent in GI diseases.


Also, water is essential for human life. [8]. However, when consuming High FODMAPs, it is suggested to wait to drink water at least 30 minutes after consumption. In addition, when there is less water in the track, the body's enzymes have more potency. When the enzymes are more potent, their opportunity to breakdown these foods significantly increases.


FODMAPs and Chronic Disease


Many people diagnosed with diseases such as Irritable Bowel Syndrome (IBS) and Lower Gastrointestinal diseases (LGD) experience problems in the gut. [1]. Some examples of LGD are:


  1. IBS or IBD

  2. Chronic constipation or diarrhea

  3. Hard to pass or difficult defecation

  4. Lack of voluntary controls over bowels

  5. Functional abdominal pain syndrome

  6. Hirschsprung's disease

  7. Intestinal pseudo-obstruction


People with these diseases do well on a Low FODMAP diet and the reason they do well is that their gut has to be treated delicately due to the severity of the disease. [2]. Therefore, Low FODMAP foods are more delicate than regular foods. People also do well because these foods do not pull as much water into the tract. [4].


FODMAPs and Gut Bacteria


Most people with LGD have a damaged gastrointestinal system and have an abundance of unhealthy gut bacteria. [7]. The bad or unhealthy gut bacteria have an increased ability to ferment foods. [4]. Therefore, FODMAPs undoubtedly feed these bacteria building more bad bacteria, which in turn causes more fermentation. [4]. The fermentation that occurs from this unhealthy bacteria also releases gases into the intestines. [4]. This is the bloating, pain, constipation, diarrhea, and other symptoms experienced with GI diseases. [4;7].


The bad bacteria can thrive, especially during this watery fermentation period. [4;7]. This is because these bacteria also are part of the cause of excess water in the GI tract. [7]. When thriving, however, unhealthy bacteria have the capability to decrease the individuals' capacity to digest these types of foods. [7]. Ultimately, reducing the amount of high FODMAP type foods ingested can reduce unhealthy bacterial overgrowth, resulting in an optimal balance of bacteria. [4].


Leaky Gut and FODMAPs


Leaky gut is when the lining of the intestine are damaged and particles like food are able to cross the gut mucous barrier and get into the bloodstream. [5]. Most of the time, people diagnosed with LGD have a leaky gut. [3]. Besides that, these clients usually eat the Standard American Diet (SAD). [6]. The bad thing about SAD is that it is high in processed foods such as refined sugar, artificial sweeteners, chemicals, and preservatives. Essentially, it's been concluded that SAD abuse causes leaky gut. [6].


People who already have digestive diseases who eat the SAD also have gluten and dairy food sensitivities. [3;4;5;6]. As well, these people are not drinking enough water, nor are they getting enough fiber. A large amount of inflammation that occurs in these individuals. [3;4;5;6;7]. Therefore, people with LGD should not be eating the SAD because it will worsen their condition.


Other Factors influencing FODMAP


Food sensitivities, process foods, low fiber, overhydration and dehydration, and inflammation can all be happening in unison interfering with the breakdown of certain foods. [4;5;6;7]. Also, the individual's body could be lacking the enzymes needed to break down a particular nutrient, for example, lactose or amylase. [3;4;5;6]. When missing these specific types of enzymes, the carbohydrate chain is difficult to breakdown and absorb. [3;4;5;6]. Additionally, a person's body could be low in hydrochloric acid, which could also be a reason with the interference of breaking down certain foods.


In conclusion, Low FODMAPs are suitable for people with LGD. The diet focuses on foods that cause fewer problems in the gut. These people could be experiencing leaky gut from poor eating habits, or they could be experiencing several other gastrointestinal issues. Therefore, Low FODMAPS should be the diet that people with GI diseases can rely on when searching for healthy ways of managing their gut problems.

References:

  1. Altobelli, E., Del Negro, V., Angeletti, P. M., & Latella, G. (2017). Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms: A Meta-Analysis.Nutrients,9(9), 940. https://doi.org/10.3390/nu9090940

  2. Barrett, J. S., & Gibson, P. R. (2012). Fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) and nonallergic food intolerance: FODMAPs or food chemicals?.Therapeutic advances in gastroenterology,5(4), 261–268. https://doi.org/10.1177/1756283X11436241

  3. Enck, P., Aziz, Q., Barbara, G., Farmer, A. D., Fukudo, S., Mayer, E. A., Niesler, B., Quigley, E. M., Rajilić-Stojanović, M., Schemann, M., Schwille-Kiuntke, J., Simren, M., Zipfel, S., & Spiller, R. C. (2016). Irritable bowel syndrome.Nature reviews. Disease primers,2, 16014. https://doi.org/10.1038/nrdp.2016.14

  4. Hill, P., Muir, J. G., & Gibson, P. R. (2017). Controversies and Recent Developments of the Low-FODMAP Diet.Gastroenterology & hepatology,13(1), 36–45.

  5. Hills, R. D., Jr, Pontefract, B. A., Mishcon, H. R., Black, C. A., Sutton, S. C., & Theberge, C. R. (2019). Gut Microbiome: Profound Implications for Diet and Disease.Nutrients,11(7), 1613. https://doi.org/10.3390/nu11071613

  6. Knight-Sepulveda, K., Kais, S., Santaolalla, R., & Abreu, M. T. (2015). Diet and Inflammatory Bowel Disease.Gastroenterology & hepatology,11(8), 511–520.

  7. Magge, S., & Lembo, A. (2012). Low-FODMAP Diet for Treatment of Irritable Bowel Syndrome.Gastroenterology & hepatology,8(11), 739–745.

  8. Popkin, B. M., D'Anci, K. E., & Rosenberg, I. H. (2010). Water, hydration, and health.Nutrition reviews,68(8), 439–458. https://doi.org/10.1111/j.1753-4887.2010.00304.x

  9. The Low FODMAP Diet [PDF]. (2014). Stanford Hospital and Clinics: Stanford Medical Center. Digestive Health Center Nutrition Services. Retrieved from Lecture Notes Online Web site pdf-lowfodmapdiet.pdf

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