If you’re one of the 60 million Americans with a digestive disorder, you may be used to approaching each meal with a sense of dread.
Simply snacking on a piece of fruit can leave you gassy, bloated or in pain. In my case, a couple of pieces of cauliflower can puff up my stomach like a balloon.
I have endometriosis, an inflammatory condition in which uterine cells grow outside of the womb, sparking symptoms like abdominal cramping and bloating. Ditching dairy and meat relieved many of my worst digestive woes. But as I entered my 30s, it seemed as if every bite of food became a gamble.
Some doctors suggested I take probiotic supplements loaded with healthy bacteria, but each pill gave me gas pain. One diet I tried suggested smoothies made of vegetables like kale, peas and garlic. After one souplike shake, I thought my stomach was going to explode.
Then another doctor suggested something I’d never heard of: the low-FODMAP diet.
FODMAP is an acronym for fermentable oligosaccharides, disaccharides, monosaccharides and polyols — certain carbohydrates prevalent in a variety of fruits and vegetables as well as milk and wheat, among other things. These carbs are poorly absorbed in the small intestine and rapidly fermented by bacteria in the colon, causing a wide range of abdominal woes, especially in people with sensitive guts, like those with irritable bowel syndrome (IBS).
“What’s going on when you’re eating a high-FODMAP diet is you’re getting this osmotic effect in the bowel,” said Bethany Doerfler, a clinical registered dietitian at Northwestern Memorial Hospital. “That means that you’re eating all of these sugars and fibers that are feeding gut bacteria, and they’re causing water to get pulled into the intestine.”
The result can be cramping, diarrhea, bloating and those stomach noises even your co-worker three desks down can hear.
Researchers at Australia’s Monash University created the low-FODMAP diet in 2005 to alleviate symptoms in patients with IBS, but it’s recently been gaining traction with others (like me) who are digestively challenged. Companies such as Nestle have even introduced low-FODMAP products like ProNourish, a nutrition drink.
“I think this is probably the first diet that we’ve had that has excellent data behind it to say manipulating carbohydrates actually helps change your symptoms,” Doerfler said. “Before that, it was a little anecdotal.”
Those wanting to try a low-FODMAP eating plan should talk to their doctor and consult a dietitian familiar with the diet; it’s important to make sure you’re getting enough nutrients since you’ll be cutting out or reducing important food groups.
Low-FODMAP followers start by eliminating high-FODMAP foods from their diet, often for a few weeks, before gradually reintroducing them. The idea is to keep a close eye on symptoms to figure out which foods you can tolerate. You might only have a problem with one category, and lower portions of some foods could be fine.
If you eat something problematic, it may take a couple of hours or a day for your gut to get back to normal.
“I remind people that if they have a symptom flare, they’re not in danger — they just feel crummy,” Doerfler said.
What foods should low-FODMAP followers avoid?
• Forgo dairy products with large amounts of lactose, a disaccharide. This means no ice cream, milk or yogurt. Humans can’t digest lactose without the help of lactase, an enzyme many people stop producing as they age. Products with low-lactose levels — butter and feta and cheddar cheeses — tend to be well-tolerated. Almond-based milks and desserts are dairy-free alternatives.
• Watch out for wheat. If you get gassy after eating bread or drinking beer, you could be reacting to the fructans — an oligosaccharide — not the gluten protein. Don’t just switch to artificially gluten-free products, which can still be hard on the gut. Try sourdough bread. The fermenting process breaks down some of the fibers for you.
• Raw onions and garlic are also high in fructans. If you’re sensitive to garlic, you can still use garlic-infused oil. For onions, substitute the green parts of scallions or leeks.
• Most beans need to be avoided, but you can try a quarter cup of canned chickpeas or a half cup of canned lentils. The canning process leaches out some of gas-producing elements.
• Fructose is another red flag. These are the single sugars, or monosaccharides, found in fruit. It becomes a problem when the amount of fructose is higher than the amount of glucose. Opt for fruits like bananas and blueberries instead of apples and cherries.
• Limit your intake of sugar alcohols, or polyols. They occur naturally in foods like mushrooms, watermelon and cauliflower and are used to make artificial sweeteners. If you need to add a little sweetness, try table sugar or stevia instead. Avoid any sugar ending in “ol.”
In my case, I realized I’d been eating high-FODMAP foods throughout the day. I put artificial sweetener in my coffee, had whole-wheat toast for breakfast and black beans for lunch. My usual afternoon snack — a nutrition bar — was chock-full of things on the high list.
I now have steel-cut oats with natural peanut butter and a banana in the morning. Lunch is sourdough bread, tofu and carrots. For dinner, I make sure to cook all my food.
“Heat is a great natural digestive enzyme,” Doerfler said. “I think that for some of these vegetables that might be too difficult to do raw, it’s a wonderful option to have them cooked.”
After the first week, I lost 2 pounds and my post-meal balloon belly had all but disappeared. After three months, I have an even stronger grasp on my problem foods. I still have bloating issues if I dine out, but at least I know my triggers.
For an updated list of high-and-low FODMAP foods, download Monash University’s app. It’s $7.99 at the Apple App Store and $9 on Google Play.
Other helpful resources can be found at MyGiNutrition.com (which receives funding from Nestle Health Science) and KateScarlata.com, a site run by a Boston-based dietitian by the same name.
If you’re looking for a guidebook with recipes, check out “Healthy Gut, Flat Stomach: The Fast and Easy Low-FODMAP Diet Plan” by Danielle Capalino ($17.95, Countryman Press).