*Geek Box: The Low FODMAP Diet
The acronym FODMAP stands for: Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols, which are a group of carbohydrate compounds defined by the short-chain length. These compounds may require specific enzymes to digest that certain individuals may lack, and they also undergo fermentation in the colon, which may contribute to distension and bloating.
The Low FODMAP Diet [LFD] is an intervention for an individual with IBS and may be divided into three distinct phases. Phase 1 is ‘Restriction’, which requires strict adherence to the LFD for a period of 4-8 weeks, and during which the individual would be guided to maintain nutritional adequacy while replacing FODMAP foods with alternatives. If no symptom improvement occurs during the Restriction phase of the LFD, the diet is discontinued.
However, if the Restriction phase provides symptom relief, then the individual enters the Phase 2 ‘Reintroduction’ period. This period is particularly important, because FODMAPs appear to exhibit a dose-dependent effect and the onset of symptoms often relates to the total dietary exposure of individual FODMAPs and their combinations.
For example, while an individual with IBS may be able to consume some milk in coffee, or have a single apple, if they ate a bowl of ice cream or if they had an apple with 2 slices of toast, this may trigger symptoms.
Therefore, the goal of the Reintroduction phase is the systematic use of food challenges with FODMAP foods, under the guidance of a nutrition professional, to test individual tolerance to different FODMAP foods and establish a personal threshold for tolerance, for example, 1 slice of bread or 200ml milk, within which the individual does not experience increased symptoms.
The aim of the Reintroduction phase is to transition to long-term individual management, where the patient is aware of their own personal tolerance levels to specific FODMAP foods. Thereafter, Phase 3 is ‘Long-term Management’, with the aim of helping the individual patient find a balance between symptom management and minimising dietary restrictions. This results in an individualised modified diet to the patients particular needs, the exact composition of which for FODMAP foods will differ from person to person.