Joanna Baker is a foodie, Dietitian and Registered nurse, who is passionate about digestive health. She now works exclusively on IBS and food intolerance, dividing her time between consulting as an advisor to FODMAP Friendly and Everyday Nutrition, her Melbourne based private practice.

FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols)

Where was the low FODMAP diet developed? A group of researchers from Monash University in Melbourne, including Dr Sue Shepherd, began by researching dietary treatments for IBS. It had long been known that certain short chain carbohydrates could induce abdominal symptoms similar to those experienced by people with IBS.

The researchers made these carbohydrates the focus of their research. By 2006 they had developed a well structured and defined diet that limited FODMAP carbohydrates that were malabsorbed in the small bowel.

They found that this diet provided symptom relief for up to 76% of people with IBS by reducing osmotic load and gas production in the lower gastro-intestinal tract. They called this diet the low FODMAP diet.

The Monash research team published their research, sparking global interest and further research.

What is a low FODMAP diet used for?

The low FODMAP diet was initially developed specifically for people with IBS. It is now the most researched and well evidenced way of managing functional gastro-intestinal disorders (FGID). It is now listed as the recommended diet for FGIDs in the NICE (UK National Institute for Clinical Excellence) guidelines, the BDA (British Dietetic Association) guidelines and the NZ best practice guidelines.

There is evidence for its use in:

• People who have IBD and continue to get symptoms when they are in remission
• People who have coeliac disease and have ongoing symptoms despite following a gluten free diet
• People who are thought to have non coeliac gluten sensitivity
• Women who have endometriosis
• Ileostomates with high output
• Mothers of breastfed babies with colic (this is one small study but it will be interesting to see more research in this area)

What are FODMAPS?

FODMAPs are groups of short chain carbohydrates or sugar molecules, which for one reason or another, are not fully absorbed in the small intestine. This means they continue their path along the digestive tract to the large intestine for excretion. During this process two events occur:

• FODMAPs are very osmotic and readily draw water into the bowel. This can affect how fast the matter moves through the bowel and contribute to diarrhoea. FODMAPs provide fuel for the healthy bacteria that live in the large intestine. When these healthy bacteria ferment the
• FODMAPs, they create gas which contributes to bloating and excess wind. This also stretches the wall of the large intestine and irritates nerve endings creating painful sensations.

What foods contain FODMAPS?

FODMAPs are abundant in our food supply.

Since fats, oils, hard cheeses and fresh cuts of meat, poultry and fish do not naturally contain carbohydrates, these foods are naturally low FODMAP.

Is added table sugar a problem in a low FODMAP diet?

Table sugar is a disaccharide made up of equal amounts of glucose and fructose. Since glucose aids absorption of fructose in the digestive tract, only fructose that is in excess of glucose is high FODMAP.

Table sugar does not contain excess fructose and is therefore low FODMAP.

How has the trend toward foods with artificial sweeteners instead of sugar affected the food choices of people following a low FODMAP diet?

People on a low FODMAP diet (“FODMAPPERs”) are wary of artificially sweetened foods because of the potential for the presence of sugar alcohols (polyols).

The increase in products sweetened with sugar alternatives means they need to take extra care to avoid polyols, which can often be present in quite large amounts.

For example, one sugar-free mint contains 2-4g of sorbitol and the cut off for a food to be considered low FODMAP (for sorbitol) is around 0.2-0.3g.