When you have tummy bloating, wind, looseness and discomfort, even pain, it can be very distressing. You will have had medical care to make sure there is nothing very worrying needing further treatment. People with these symptoms often have IBS – irritable bowel syndrome. IBS can interfere greatly in how you run your life. You may be worried about being out of your house for extended time, or realise that whenever you eat out you often seem to have gut problems as a result.
FODMAPS is the name given to various small carbohydrate molecules, including fructose. If the intake of these is greater than the person can absorb at the time they ferment in the gut and can be one of the reasons for these annoying symptoms.
A diet low in these compounds can be a very useful treatment where diagnosis of fructose intolerance has been made. And in some with IBS it will reduce the discomfort of bloating and the other symptoms. The fructose overload is often described as “fructose intolerance”, and now described by some as “food intolerance”.
However the FODMAPS diet is not the full story of food intolerance and IBS. It is ‘the new kid on the block’ where diet and IBS is concerned.
Many people already know their IBS symptoms are worse after rich meals, which restaurant meals often are, or after meals with herbs or spices, Asian meals, or particular foods such as tomato, capsicum, or peppermint. This is more likely to be food chemical intolerance than FODMAPS intolerance.
Since the 1980s a diet low in additive colours, flavours and preservatives as well as natural chemicals, such as amines, salicylates and glutamates, has been used for IBS with good results when people suspected food sensitivity. When the FODMAPS diet is used it also reduces many of these chemicals. The low chemical diet has also been shown to be useful for many other symptoms that food sensitive people have such as migraine or eczema. The symptoms that respond to a low chemical diet may improve symptoms in many parts of the body, not just the gut. In IBS it is reported to reduce the crampy pain, and gut urgency which may be accompanied by the range of discomfort through to pain.
When FODMAPS was first suggested for IBS symptoms it was a specified diet based on the gut function. Now those working with IBS are commenting on supersensitivity to pain with gut change especially bloating distension, particularly related to the gut brain connection. They also now talk of individual variation in tolerance. These ideas have been useful for a long time in those working with the food sensitive people who have a variety of symptoms not just IBS.
There is a need for more research into which reactions are due to FODMAPS and which are due to food chemical intolerance. If you fill out a Family Sensitivity History which shows all the suspect food sensitivities the three generations in your family you can see whether food chemical intolerance is more likely or not. See Are You Food Sensitive? for details.
Whether we begin with a food chemical elimination diet or a low FODMAPS diet we have reduced many of the foods likely to cause reactions. It is by doing challenges or trialling foods one at a time that we can see what may be causing the reactions. If reactions to fruit occur we would not know if it is fructose or salicylates but if the reaction is to pears which are very low in salicylates fructose is the likely culprit. If reactions are to herbs or spices, capsicum, or tea, added to either diet the reaction is to salicylates. APDs can advise on high FODMAPS foods to also trial.
If you are sensitive to FODMAPS foods you will still have your own pattern of foods containing FODMAPS. Another confusing aspect is that food intolerant people can react to particular whole foods such as eggs, that are not high in suspect chemicals, or FODMAPS, nor come up as positive with allergy tests. Other suspect foods are dairy and wheat. But the reaction to dairy may not just be lactose intolerance, nor the wheat one to the FODMAPS fractions. Attending to different types of fibre or using probiotics or prebiotics are other factors that may need attention. For all these reasons, and because FODMAPS intolerance and food chemical intolerance can occur together, it is a good idea to give yourself the help of an Accredited Practicing Dietitian.
So the idea of doing what I call diet detective work is still the best way to gradually understand what is happening. A key idea understood as part of the Diet Detective Process is that of individual variation in tolerance. If you are food sensitive you will find that you have your own particular tolerances. See Are You Food Sensitive? for more information on understanding how to find the foods you personally tolerate.