What is the low-FODMAP diet? An explainer – Toronto Star

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According to the Canadian Digestive Health Foundation, we have an unusually high number of people suffering from IBS (irritable bowel syndrome) in this country.
While the global rates of IBS are roughly 11 per cent, an estimated 18 per cent of Canadians experience this disorder: a chronic condition that involves unusually intense levels of gas, cramping and/or belly pain.
What’s up with our guts? Since IBS is associated with a number of issues from bacterial infections to abnormal nerve responses, it’s hard to say why we might have a higher incidence — if, indeed, we do. It’s possible that we just have more diagnoses because we talk about it more.
“People are definitely more aware of it these days,” said Craig Pacheco, a registered dietitian who works at the Toronto Immune and Digestive Health Institute. “I don’t know if it’s that people who have had it for a very long time are finally getting a diagnosis or if people are just getting a lot more comfortable with the term.”
Despite the fact that, in the past, some people have been reluctant to discuss their digestive problems, Pacheco has experienced an uptick in people asking him about IBS and, in particular, a diet some people use to manage their symptoms: the low-FODMAP diet (fermentable oligosaccharides, disaccharides, monosaccharides and polyols).
Don’t worry, you won’t be tested on any multi-syllabic words at the end of this story. But here’s Pacheco with an easy-to-grasp explainer:
“The FODMAPs themselves are just groups of sugars that basically are not absorbed well in the gut,” he explained. “So what happens is the gut bacteria kind of has a party with those sugars and ferments them, creating all the byproducts of gas and bloating. Also, these sugars happen to pull water into our gut, which leads to an increased loose bowel movement for some people.”
This is a completely normal process that happens to everyone with a digestive tract. For people with IBS, though, it can be unusually painful.
“One theory is that people with IBS basically have hypersensitive guts,” explained Christine Hooper, a registered dietitian who is working on launching an IBS-focused membership website, the Butterfly Effect. “When you start bloating, the tract doesn’t send any signals to the brain. For me, though, because I have IBS, it sends a pain signal to the brain, possibly because of hypersensitivity.”
So is the answer simply to avoid the FODMAPs? Unfortunately, it’s not that easy.
“They’re actually helpful to our bodies because they go into our large intestine and they ferment, and then you get your short-chain fatty acids and different things that the body needs,” Hooper said.
Hooper’s been managing her symptoms by employing a variety of strategies that include stress management, movement and avoiding “trigger foods,” which she’s identified over many years by paying close attention to what she eats, as opposed to doing the low-FODMAP diet. To be clear, though, when she got a diagnosis nearly 15 years ago, there was no such diet. At the time, even the concept of FODMAPs being challenging to some people’s digestive systems was relatively new, since it was only developed in 2005 by researchers at Australia’s Monash University.
Since then, FODMAPs have come a long way, thanks to research on the effects of limiting and restricting the dietary intake of some of the short-chain carbohydrates that cause unusual symptoms in certain people. And, thanks to that, three-quarters of people with IBS experience some improvement with the low-FODMAP diet, which helps people narrow down which sugars (and exactly how much) cause the painful symptoms.
That said, neither of the IBS specialists consulted recommend people consider trying this diet on their own. It’s a three-stage, “very involved” process that takes months of careful planning and careful record-keeping that is best done under a registered dietitian’s supervision.
“I would start with an interview to gauge what kind of lifestyle they have,” said Pacheco, who is in the process of reopening an LGBTQ-inclusive private advocacy, counselling and nutrition support practice, Queerly Nutrition. “If they say they eat a lot of high fat food or high-sugar beverages and carbonated drinks, a lot of times those are the big problems. Sometimes it’s as simple as getting people to do less coffee and less alcohol.”
Those, along with high-lactose and spicy foods, are common “trigger foods,” which people with IBS can learn to identify without necessarily going full low-FODMAP. Both Pacheco and Hooper also suggest people with IBS focus on stress management and consult experts about mindfulness, yoga and other holistic therapies, since stress is a major factor.
And, most importantly, don’t try to diagnose yourself. Although it can take a while (the Canadian Digestive Health Foundation estimates it can be an average of four years to get a proper diagnosis), this isn’t something you can figure out on your own through Google.
“You cannot diagnose yourself and start eliminating foods,” said Hooper. “There are a lot of people that will think they have a gluten intolerance thing or something else, and it’s not actually that thing at all and so they’ve been sort of denying themselves for no reason.”
The diagnosis process for IBS, she notes, also will rule out or discover other, possibly more severe, things. Symptoms of IBS, for example, could be similar to colon cancer. Even if it’s nothing serious, though, restricting our diets without good cause flies in the face of prevailing dietary advice.
Said Hooper: “Dietitians used to say, ‘Don’t eat this and don’t eat that,’ but now our real focus is trying to create as expansive a diet as we can for people.
“Because that’s what people are going to be able to stick to.”
More from the Diet Series
University of Toronto study showed those on low-glycemic diet lost weight without trying
How mindful eating can help you discover the link between food and anxiety
Beware bad diets: Here are some health regimens to watch out for
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