What is a low FODMAP diet, and who should follow it?

Digestive disorders have become increasingly common these days, thanks to our unhealthy and untimely meals. However, following the low FODMAP diet — which restricts foods high in certain carbohydrates that have been shown to significantly alleviate symptoms of irritable bowel syndrome (IBS) and other functional gastrointestinal disorders — can help a great deal.

What is the low FODMAP diet?

“FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols — types of short-chain carbohydrates that can be poorly absorbed in the small intestine leading to fermentation and production of gas. The goal is to identify and avoid specific foods that trigger gastrointestinal symptoms such as bloating, gas, abdominal pain, diarrhea, and constipation,” explained Abhilasha V, chief clinical nutritionist, Cloudnine Group of Hospitals, Bengaluru, HRBR layout.

FODMAP components

Oligosaccharides: Found in wheat, onions, and garlic.
Disaccharides: Found in milk, yogurt, and soft cheese (lactose).
Monosaccharides: Found in apples, honey, and high-fructose corn syrup (fructose).
Polyols: Found in stone fruits (e.g., plums), cauliflower, and artificial sweeteners.

Dr Piyush Ranjan, senior consultant, department of gastroenterology, Sir Ganga Ram Hospital said abdominal pain, bloating, flatulence, and alterations in bowel habits are seen in some individuals due to consumption of such carbs.

More than a dieting pattern, it’s an elimination diet, said Dr Sharad Malhotra, Akash Healthcare, Dwarka. Two categories of foods are considered in the FODMAP diet. The first are those that need to be eaten more and the other is foods need to be limited, said Dr Malhitra. “The category where you have to eat more food include vegetables like lettuce and carrot, fruit such as strawberries, pineapples, and guavas, proteins such as chicken, eggs, fish, fats such as oils, butter, peanuts, sunflower butter, and other starches and cereals and grains. The foods that need to be limited are vegetables such as garlic, beans, and onions, fruits such as blackberries, watermelon and peaches, proteins such as meats which are breaded, fats such as almonds, avocado, and pistachios and starches, cereals and grains which are gluten-based bread, muffins and beans,” shared Dr Malhotra.

Here’s what FODMAP diet is all about (Source: Getty Images/Thinkstock)

Effectiveness of the diet

The importance of the FODMAP diet lies in its potential to improve the quality of life for individuals suffering from functional gastrointestinal disorders. “By reducing the intake of these fermentable carbs, patients often experience a noticeable reduction in digestive distress, allowing for a better overall daily functioning and well-being, stressed Dr Adil Farooq Malik, senior consultant, gastroenterology, Fortis Hospital, Shalimar Bagh.

Phases of the FODMAP Diet

Elimination Phase: Involves strictly avoiding all high-FODMAP foods for a period, typically 4-6 weeks. This phase helps to reduce symptoms, explained Abhilasha.

Reintroduction Phase: Gradually reintroduce FODMAPs, one at a time, to identify which types cause symptoms.

Personalisation Phase: Involves creating a long-term eating plan that avoids only the specific FODMAPs that trigger symptoms.

Experts suggest that many individuals with IBS find relief from symptoms by following a low-FODMAP diet. It is often recommended to work with a dietitian to ensure nutritional balance and proper implementation of the diet.

Examples of Low and High FODMAP Foods:
Low FODMAP Foods:
Proteins: Eggs, meat, fish
Vegetables: Carrots, spinach, zucchini
Fruits: Bananas, blueberries, strawberries
Grains: Rice, oats, quinoa
Dairy alternatives: Lactose-free milk, almond milk

High FODMAP Foods:
Vegetables: Onions, garlic, cauliflower
Fruits: Apples, pears, watermelon
Grains: Wheat, rye
Dairy: Milk, yogurt, soft cheeses
Sweeteners: Honey, high-fructose corn syrup

How to adapt it to Indian diet pattern

Dr Vivek K Singh, honorary consultant, gastroenterologist, hepatologist, Holy Family Hospital, Bandra said that successful adaptation of the low-FODMAP diet in India involves strategic substitutions and customisation.

For example:
*Replace wheat with rice or quinoa.
*Substitute high-FODMAP pulses like chickpeas with lentils in moderation.
*Use asafoetida powder instead of onions and garlic to achieve similar flavours.

Considerations

The prevalence of food intolerances in the West has led to the identification of FODMAP and gluten as common culprits, said Dr Pavan Dhoble, junior consultant, gastroenterology, P. D. Hinduja Hospital and Medical Research Centre. “While low-FODMAP and gluten-free diets alleviate IBS symptoms, their efficacy varies, and concerns persist regarding individual needs. Recent research underscores the challenge of adapting these diets to diverse dietary practices, such as those in India, where cuisine varies widely across regions and populations,” said Dr Dhoble.

Consultation with a healthcare provider or dietitian is essential before starting the FODMAP diet to ensure it is done correctly and to avoid nutritional deficiencies. “Since it restricts a wide range of foods, there’s a risk of inadequate intake of essential nutrients. Additionally, long-term adherence can be challenging. Therefore, it’s recommended that the FODMAP diet be followed under the guidance of a dietitian or a gastroenterologist to ensure it’s done safely and effectively,” said Dr Malik.

Dr Singh mentioned that there are concerns about potential long-term effects, such as microbial dysbiosis and nutritional deficiencies in calcium, iron, vitamins D, B1, B2, and B9, as well as constipation due to a lack of dietary fibre which is addressed by professional dietitians along the way.

Carbohydrates are cut out of the diet for a brief period of time (Source: Freepik)

Who is it not for?

According to Dr Abhilasha, the diet is not for the following set of people and needs careful guidance when implemented

Children

*Children have unique nutritional needs for growth and development. A restrictive diet like the low-FODMAP diet could potentially lead to nutrient deficiencies.

Supervision: If a low-FODMAP diet is considered for a child, it should be under the strict supervision of a healthcare provider or a pediatric dietitian to ensure their nutritional requirements are met.

Adolescents

Growth and Development: Similar to younger children, adolescents are still growing and developing. A restrictive diet may impact their nutritional intake.

Supervision: Adolescents should only follow a low-FODMAP diet under professional supervision to avoid potential nutritional deficiencies and ensure balanced growth.

Pregnant and Breastfeeding Women:

Pregnancy and breastfeeding increase nutritional needs. A restrictive diet may make it difficult to meet these needs without careful planning.

Supervision: Any dietary changes during pregnancy and breastfeeding should be overseen by a healthcare provider or dietitian.

Elderly Individuals:

Older adults often have multiple health conditions and may be on various medications, making dietary changes more complex.

Supervision: The elderly are at a higher risk for malnutrition, so any restrictive diet should be closely monitored to ensure it meets their nutritional needs, said Abhilasha.

Individuals with Eating Disorders

Those with a history of eating disorders may find a restrictive diet triggering, potentially worsening their condition, said Abhilasha.

Mental Health

Dietary changes for individuals with eating disorders must be managed by a healthcare professional, including a dietitian and mental health professional.

Overall, while the FODMAP diet can help manage IBS symptoms, it requires careful consideration and professional guidance, particularly for vulnerable populations.

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