What is FODMAP?

What is FODMAP? Our dietitian Sofia explains what FODMAP means and how the treatment helps with IBS.

FODMAP* is a dietary treatment and the most effective treatment we have for IBS. The word FODMAP is a name for a group of fermentable carbohydrates that are extra difficult to break down for those who have IBS. But what makes FODMAP so special? Well, the method helps 75 percent of all those who suffer from IBS through dietary changes alone, completely without medication. It is not a fad diet and therefore will not make you slimmer, but on the other hand I almost dare to promise that you will have a calmer stomach.

*Fermentable, Oligo-, Di- and Monosaccharides and Sugar Alcohols

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FODMAP categories

FODMAPs are different types of dietary fiber and sugars that people with IBS have difficulty breaking down and handling. Instead of being easily digested and absorbed, they become like fast food for our intestinal bacteria, which party hard in the large intestine. The result is symptoms such as gas, noise and fluid disorders, in other words, general discomfort.

FODMAPs are divided into four categories (see below) and the treatment is done in three stages and is based on the traffic light system:

• Elimination phase: Eat only green marked foods.
• Reintroduction of restricted foods: Add orange marked foods.
• Reintroduction of prohibited foods: Add red marked foods

By first removing the foods that we know cause symptoms in most people, and then adding them back in a controlled manner, you get a clear picture of what is causing it in your stomach. You can then control your symptoms through conscious food choices. If you choose something on the red list, you will have trouble, but you will know about it and then the symptoms will not be as difficult to deal with. The goal of FODMAP is that after 6–12 months you should have identified 10–15 foods that you know you feel better avoiding.

The 4 FODMAP categories

1. Fructose: Fruit sugar found in certain fruits and vegetables, such as mango, and in honey.
2. Lactose: Milk sugar in milk from cows, goats and sheep.
3. Oligosaccharides: Fiber parts in cereals, legumes, onions and garlic, among other things.
4. Sugar alcohols: Sweeteners such as xylitol and sorbitol in chewing gum and throat lozenges. They are also found naturally in avocados, mushrooms and cauliflower.
   A complete list of raw materials can be found in Sofia’s app Bellybalance.

The bucket

You can think of your stomach as a bucket. When you eat foods that contain troublesome carbohydrates, FODMAPs, the bucket fills up because the intestines have difficulty breaking them down. When the bucket is full and overflows, you get symptoms. By only eating allowed foods, you keep the bucket

empty and in this way you can create space to eat foods with FODMAPs without getting symptoms. You can imagine that the bucket empties about once a day depending on the speed of your stomach.

When do the symptoms come?

The most natural thing may seem to be to feel how your stomach feels after eating, if it doesn’t feel good, you conclude that what you just ate was not good. But it’s not really that simple. The food ends up in the stomach, but it is only down in the large intestine that IBS symptoms come. The food you just ate pushes the food further through the intestinal system. Therefore, you need to start thinking about what you ate one, two or even three meals ago and which has now made it down to the large intestine. This is where it gets a little complicated.

My tip: Keep a food and symptom diary for a couple of weeks to see what is causing the symptoms.

Low-FODMAP is not No-FODMAP

The FODMAP diet is a process, a process that takes place in several steps. By increasing the intake of foods with FODMAPs, you understand what tolerance there is for the different groups and you can thus control your symptoms. At the same time, the intestinal bacteria get the nutrition they need and the diet does not become unnecessarily restrictive. The diet should therefore not consist of foods and food completely free of FODMAPs forever.

A low content of FODMAPs is often good, such as a little honey, a piece of avocado or onion in a broth. As long as the amount in total does not become too high, then the bucket overflows. Once you have figured out which category or categories are doing better or worse, you can eat foods that contain little FODMAPs. Then life will be so much easier and you can choose the occasions when you may want or need to eat more FODMAPs.

How do you get a happy stomach?

You can try FODMAPs regardless of whether you have been diagnosed with IBS or just have an upset stomach, but before you start, it’s a good idea to check that you don’t have celiac disease (gluten intolerance), then you’re free to start. If you’ve had long-term stomach problems, you should always see a doctor.

Gluten or FODMAP?

Gluten is the protein part of wheat, barley and rye and cannot ferment in the stomach. So it’s not the cause of a balloon stomach. Period. However, it’s easy to draw that conclusion when you skip the bread and your stomach is suddenly as calm as a bowl of fil. What happens then? Well, when you remove bread and pasta, gluten disappears, but also the fiber parts (oligosaccharides, a FODMAP) and it is these fibers that ferment in the stomach and make it bubble and rumble. Gluten itself does not provide any nutrition for us humans, but it makes the bread so wonderfully fluffy.

Spelt has a different gluten composition than wheat and is healthier. In addition, spelt does not contain as many FODMAPs (oligosaccharides) as wheat. Therefore, spelt bread is a good alternative for you with IBS, and it is even better if it is baked with sourdough. Both gluten and oligosaccharides are partially broken down when baking with sourdough. What we should really avoid is pure wheat gluten, which is often added to industrially baked bread to get fluffy, easy-to-handle and quick-rising dough. Good for the bakery, but that kind of gluten is not the best for your gut.