Living with digestive issues can be hard, especially when the reason behind the constant discomfort remains undiagnosed even after a slew of tests that come out detecting nothing. In such cases, food may seem like the worst enemy instead of a source of comfort and energy.
Irritable bowel syndrome (IBS) is one such condition where the intestinal reactions to food trigger pain, and diarrhoea. Unfortunately, bouts of bloating, nausea, and stomach pains can ruin sleep cycles that can take a toll on mental health and eventually the quality of life.
In 1999, Dr Jane Muir and Professor Peter Gibson of Monash University of Melbourne, Australia, came up with a low FODMAP diet that could help people with IBS. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These are short-chain carbohydrates or fermentable carbohydrates that are difficult to digest. This diet aims to eliminate and identify the FODMAP food that can cause distress to manage the symptoms.
FODMAP remains as confusing as the microbiome in our gut. “When one is diagnosed with gut issues, one should not start the FODMAP diet on their own and always take help of an expert,” says Ankita Debbarma, assistant dietitian at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry.
The FODMAP diet is not the usual fad diet that you come across on the internet. It is a restrictive diet aimed at helping people with severe conditions of the gut. “The information on FODMAP on the internet is not foolproof and therefore relying on them without expert guidance can be misleading and dangerous,” says Geetha Ghaliyavar, registered dietitian and sports nutritionist, International Olympic Committee, Bengaluru.
Switchbacks in FODMAP
Putting it out simply, there are three steps in a FODMAP diet. First is to eliminate all the high FODMAP foods. Debbarma lists them out as –
- Fruits like apples, avocados, watermelon, pears and blackberries
- Vegetables such as beetroot, broccoli, cabbage, cauliflower, garlic, leeks, onion, mushroom, and okra
- Cereals and millets including sweetcorn, wheat, barley and rye
- Pulses and legumes such as soy, cashew, lentils, and beans
- Dairy products like milk, ice cream, and cheese
Ghaliyavar says that it is especially difficult for Indians to follow the low FODMAP diet as the cuisine is heavy with onion and garlic. Even after eliminating all these foods, it can be confusing to identify the ingredients that cause the problem. She says, “Besides the spectrum being so vast, some of them may also be responding to lactose or gluten, which makes spotting the root of the problem difficult.”
The second step involves slowly reintroducing the high-FODMAP food into the diet. Be careful not to stack two of them together from the same group. “Overconsumption of high fodmap foods from single groups like that of fruits, such as eating both apples and watermelons together in a fruit salad can cause FODMAP stacking,” says Debbarma.
Ghaliyavar states that a dietitian can help you understand the portion sizes and quantities to take in one serving to avoid irritation. During the reintroduction phase, look out for symptoms of bloating, loose stool, diarrhoea, heartburn or any other discomfort.
The third step is to identify the ingredients that irritate your gut, so as to avoid or limit them to manage the symptoms.
The testing vortex
Medical tests can be both a boon and a bane to society. While research has given us several options for rapid diagnosis, it remains unaffordable for most people. Ghaliyavar says that those who are already vulnerable and going through a difficult condition are often put through tests that are expensive and unnecessary.
When it comes to IBS, one should be aware that allergy tests such as IgE (allergy-specific Immunoglobulin E), although expensive, are invalid in diagnosing issues in the gut. She insists that in these scenarios, the best option is to maintain a journal and start with an elimination diet with the help of an expert. While the process can be slow, the results are far more optimised.
Someone with IBS cannot luxuriously return to eating high-FODMAP food, as it can trigger symptoms. To make a low FODMAP diet work, one should not stack food such as chhole, mango and mushroom together. The better way is to plan meals to keep the symptoms at bay yet enjoy one’s favourite food one at a time.
Also, read about how to manage Irritable bowel syndrome (IBS).