What are FODMAPs, and why should I care?
In this episode of the Discover Health Podcast, Dr. Trish Murray and Health Coach Trish Chaput discuss FODMAPs.
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Hey, everybody! This is Dr. Trish Murray from Discover Health Functional Medicine Center, and we’re going to be doing a podcast with Health Coach Trish. There’s Dr. Trish and there’s Health Coach Trish – don’t get confused! We’re going to be talking today about what are FODMAPs, and why should I care? Okay? FODMAPs is important information that you’re going to need to know if you have IBS. More letters! The bottom line is you need to be paying attention if you’ve got bowel problems, diarrhea, constipation, bloating, or gas then you better be paying attention to this presentation.
I’m Dr. Trish Murray – physician, best-selling author, and the Health Catalyst Speaker. Again, I’m here today talking with Health Coach Trish from Discover Health Functional Medicine Center. Hey, Trish! How are you today?
Good, how are you?
Good! Let’s get right into this with FODMAPs. What is it? Is it a word? Is it an acronym? What does it mean? Help people understand.
Sure! So, this question comes up a lot because sometimes people hear about FODMAPs and don’t really know what they are. FODMAPs is a classification of fruits and vegetables and some other foods. I’m going to share my screen. It is an acronym. There is a lot kind of to it. If that’s okay, I’ll share my screen. I’ve got a little slide to show you on what FODMAPs are.
There we go!
There we go!
So, FODMAP stands for fermentable, oligosaccharides, disaccharides, monosaccharides, and polyols. That doesn’t necessarily help people understand what that is, but if you think about those words…fermentable – something that ferments. Oligosaccharides, disaccharides, and monosaccharides are sugars. Same with polyols. You might have heard saccharide before. That word might give people a clue a little bit of what we are talking about. These are sugars that are carbohydrates, that aren’t absorbed properly in the gut, and for some people, as you said, they trigger symptoms of IBS (irritable bowel syndrome). It’s not something that’s added to food. It’s not like a toxic chemical or some kind of sugar that’s, you know, added in as a sweetener necessarily. It’s found naturally in many foods but also in some food additives. It’s just something that exists out there in the wild! This classification of fruits and vegetables for some people can be problematic.
If you look on the slide you’ve got the low FODMAPs and the high FODMAPs that have been broken down into categories. These are the common lists. There’s a link there for Monash University. We’ll talk about that a little bit more as we get into what do people do about this if they think they are sensitive to FODMAPs.
Let me get a few moments here, Trish and everybody, on why should you care. Why is FODMAP, these fermentable sugars…why should you care and why are they important to you? Well, if you’ve been told that you have irritable bowel syndrome or IBS or you haven’t even been to a medical provider and have not been diagnosed with anything but you deal with (on a regular basis) bloating, diarrhea or constipation (that might wax and wane), or you might feel fine for a few weeks and then all the sudden and you don’t even know why you’re feeling more bloated, more constipated, or you can’t even leave your house because you have to move your bowels every ten minutes or if you eat something it runs right through you. Bottom line is, folks, those are symptoms of irritable bowel syndrome (IBS), and the FODMAP diet is one of the main diets that are recommended for anyone who has IBS to try.
The other thing is, you know, what are the foods that fit into these categories of high FODMAP? If you look on this slide, you will see eliminate the red area. Of course, red is X – don’t do it! Eliminate foods containing high FODMAP. You’ll see there are also five columns here because there are five categories of high FODMAP foods. You notice fructose, lactose, fructans, galactans, and polyols. Now, if you get into those categories, each of the different ones and you start looking at the fine print and you see different foods that are in there, you’ll be like, “Wait a minute! Some of these foods are good for me!” Right, Trish?
“I thought I was supposed to eat vegetables.” Trish, go over some of the vegetables that really with the FODMAP diet you might actually be thinking you’re eating something healthy, but you want to avoid it because you are sensitive to high FODMAP sugars. Trish, why don’t you point out some in that regard.
Sure. Yeah. So, things especially in the vegetable category or the fruit category…there are some things on here that are clearly not that healthy like different added sweeteners or something. Nobody would say that’s a health food. But artichokes, asparagus, beetroot, brussels sprouts, broccoli (we’re always told to eat our broccoli), cabbage, onion, garlic (garlic has some really good healthy properties; we even did a study with fermented black garlic because of the health properties of that in treating inflammation and high cholesterol, high blood sugar potentially having some good benefits), apples, pears, mango – those kinds of things. None of those things are unhealthy foods. Avocado in the fruit category as well. Even though they’re healthy foods, somebody could still be reacting to them in an unhealthy way.
Exactly! I will tell you; I’ll raise my hand. I’m someone who experiences this. Years ago, when I started getting into functional medicine, I had heard of the FODMAP diet, but I had so many things I was learning that it wasn’t on the top of the list for me to be researching yet and understanding fully. Of course, a patient came in on the FODMAP diet with irritable bowel syndrome so that bumped this whole concept right to the top of my pile. I started researching it, and I was like, Oh. I suffer from IBS-like symptoms and I eat apples just about every day. I eat broccoli all the time because it’s a wonderful detoxifying vegetable and helps your body optimize your detox system. I eat onions all the time! I ate many of these foods. I ate beans on a regular basis. I looked at this list and went, Oh. Wow. No wonder I suffer with IBS!
I literally went on the elimination of all high FODMAP foods for four to six weeks, which is the recommended amount of time to initiate a low FODMAP or eliminating FODMAP food diet as a trial. You want to see if it’s going to be successful. Within a week to ten days my IBS symptoms were gone! I have remained low FODMAP for many years. Now, again, I just said you want to be on the diet for four to six weeks very, very strictly. You would eliminate all five categories, and you would do a definitive elimination diet of all high FODMAPs.
Then, after that you could start rechallenging your foods systematically in the same way that people who do the Whole30 or people who do my program called the Detox Plus Program. You might rechallenge systematically. Let’s say looking at the excess fructose column and start out by just challenging higher fructose foods and see if you react negatively. If you do, then you need to stay away from that category. Then you might rechallenge the fructans category and you may notice, Hey! I don’t really have a problem with sprouts or broccoli or brussels sprouts or cabbage. It seems that category fructans I’m not sensitive to. Which would be great because then you can expand your diet again back into that particular category. You’ll be able to identify which of the categories are your main problems. Then you continue to avoid those.
So, this is the way you get into how you eliminate. Trish, elimination diets are out there a lot. Help people understand elimination diets – first of all, what are they in general? Why would one do it? Why do they help? And then also, how do we know how long to stay on it? What’s a difference between a food sensitivity and a high FODMAP? We’ll kind of go over that together, but why don’t you start out with those other topics.
Sure. We were talking about this, just you and I, recently and I think it’s a great point. Sometimes people come and they don’t know for sure, that’s one of the reasons why they’re working with us. The comprehensive elimination diet that we do in our Detox Plus Program is really helpful not only for FODMAPs but for any other food sensitivities because you don’t always know that that’s what’s bothering you until you do this process.
The process for the comprehensive elimination diet of foods in general not just FODMAPs is twenty-one days of eliminating the highest inflammatory, the highest allergen foods. For some people, what we’ve done is we have done a low FODMAP version of that. The elimination diet takes out things like citrus and nightshade vegetables which is another category of healthy vegetables for most people, but some people do react to them. So, if you’ve got joint pain and other kinds of inflammatory things, you might be reacting to nightshades. It’s not that those things aren’t healthy, it’s just that they don’t fit for some people. You get rid of dairy, sugar, alcohol, caffeine, things like that on the elimination diet. For some people, we also do low FODMAPs.
What we would suggest for anybody doing a low FODMAP version of the elimination diet, the Detox Plus Program, you would leave the FODMAP foods for your reintroduction until the end. You would start putting back and testing other foods after the twenty-one days, one at a time, three days at a time. Check for any symptoms. Then once you’ve worked through the foods that are not high in FODMAP, you can start testing, as Dr. Trish said, these different categories of FODMAPs because by that time four to six weeks have elapsed as you mentioned and the FODMAP problems should be cleared up, out of your system. That’s what we’ve got here.
Yeah, so let’s make sure people understand. There are many different things that people can be reacting to in your environment. Food is one of the top things because it’s something we put in our mouths twenty-four seven (not twenty-four hours a day typically) but the bottom line is that’s our fuel. When you put foods in your mouth, everybody’s different. There’s no black and white to identify what everyone should do. We don’t all fit in the same box. We have our own genetics and our own metabolism and our own microbiome.
The bottom line is there are food sensitivities which means your immune system is reacting with an antibody reaction particularly an IgG antibody reaction to a particular food, usually caused because of leaky gut. Meaning if you have leaky gut and something leaks through the wall of the lining of your intestines and your immune system sits right behind there and reacts to a foreign invasion, if you will. It reacts with an IgG antibody which might come up right away, but it could also take a day or two for you to realize you’re having a reaction. IgE is more of an allergy reaction. People can also be allergic to foods. You could be allergic to a food, you could be sensitive to a food, and that is when you usually want to do what’s called a comprehensive elimination diet where you’re going to eliminate the top ten triggers in our Standard American Diet. Again, our Detox Plus Program gives you a twenty-one-day comprehensive elimination diet, the guidebook, and videos to support you to be able to be successful.
The issue is that if someone has irritable bowel syndrome you may be sensitive to these foods or the issue with these FODMAP foods again is that they’re fermentable sugars. That fermenting process happens more aggressively, if you will, in your colon as an IBS-er and with high FODMAPs you end up with more gas, more bloating. Again, then that’s irritating your bowel and throwing off your microbiome, or the bugs that live there are causing this in the first place, and so you’re having these GI complaints. With some people, it is beneficial to do the comprehensive elimination diet with a FODMAP overlay, and that’s what this slide says. “For those who need to cut out FODMAPs, we have updated our Comprehensive Elimination Diet guide to accommodate this.” You can do both at the same time.
Yeah. I think one of the things you talked about there makes a point jump out for me. A key point here – the difference between a food sensitivity and sort of a FODMAP issue with IBS often times is quantity for many people, right? Once people have quieted everything down and they’ve eliminated things and they start reintroducing things and they find things will work for them. It might be in a smaller quantity then they were used to, right? So, I know from personal experience for myself and I used to have IBS. I no longer have those symptoms, but I can only take so much of certain foods. Beans, for instance, or cruciferous vegetables like broccoli. I can eat them no problem, I don’t have any symptoms if I do, but if I go overboard on them, I’m going to have some issues. It’s not that I have a food sensitivity to them, it’s just like too much of a good thing.
I have noticed with that Monash University link that I mentioned, they have an app and for FODMAPs in particular, they’ve measured in the lab how much of a particular food hits the threshold of low FODMAP versus high FODMAP. It was really interesting and eye opening to me. It was like, Oh! Now I see. Within this threshold of this food a quarter cup is fine, or a half cup is fine, but if you go to a cup, you’re now in high FODMAP territory. It’s not necessarily that your immune system is reacting to the food as you pointed out Dr. Trish. It’s more, Oh. Now I’ve got so much of that fermentable sugar in my gut. It’s creating a bad situation. I thought that was very interesting as a differentiation.
Absolutely. Again, originally four or six weeks in the beginning I was very, very strict to avoid anything FODMAP at all! After that, I started rechallenging systematically, as I said, the different categories. Then I started realizing that – yeah, I might be able to get away with a little broccoli let’s say every couple of weeks and not have a significant reaction. Your gut also will change because of course what you feed the bugs that live in your colon that also are the ones fermenting these vegetables, the more you either will produce bugs that will deal better with these substances and digest them better (because a lot of it is fiber and sugar) or you’ll keep modifying your diet and over time you’ll find what works for you. That also may shift over time.
Now, the other thing though is what I want to mention is that if you Google FODMAP diet and you look at a lot of different sources, people come in to me sometimes and they get really frustrated because different sources contradict each other. One thing might be listed on this source and not listed on another one. So, just realize that we have found (and this is a great tip for you) at Discover Health that with the research the Monash University app and our list are coinciding with each other. We help to streamline this confusion for you. People that stick to what we provide them, they don’t get complicated, they don’t get confused. It’s pretty straight forward.
Trish, how are some ways other than that tip I just gave – what are some other ways to help people be successful and optimally be able to determine whether they have IBS and whether the FODMAP diet is going to be successful for them and be optimal in implementing it?
Yeah, that’s a great question. I think one of the challenges as you pointed out is there’s so much information out there. People get information overload; they don’t know where to start. Also, because the body is such a complex system and there are oftentimes delayed reactions, people are like, “I don’t know. I ate this thing for two days and it was fine and then on day three I didn’t feel good. I don’t even know what it is.” I’ve been there and done that and I know you have as well, right? You feel like everything you eat makes you feel sick or sometimes you eat it and it’s fine. Sometimes you eat it and it’s not. You just don’t even know where to start.
So, going through the comprehensive elimination diet is a great process to really get a handle on things. Also, people find that sometimes overwhelming to do on their own. We do one-on-one coaching. I work with people to individualize the approach to this to help them make it practical and feasible for them and their lifestyle. We look at – what are you already eating? What are you already like? What are your go-to kind of things that you’re now going to have to cut out, and how do we swap those? We do that one-on-one. Or we do classes. Right now, we’re just about to get into our fifth week of the Detox Plus Program class where people are helping each other as well. They’re like, “Oh my gosh! What am I going to do without onions and garlic?” Or “How do I cut out this food? What do I replace it with?” We help each other with recipes and suggestions and tips and the whole group is going through that process together. I’ve heard from a number of people that say either they tried to do it on their own and when they did it with the group, they found it much easier, they stuck with it, and they found it more enjoyable and had less cravings partly just because they knew other people were doing the same thing. Having that group support has been really helpful for some people. For other people, having the one-on-one being able to work with me individually that’s worked well. Either one of those has, I think, helped a number of people be successful getting through this process and figuring out what works for them.
Absolutely. Also, if, again, to know the program overall to do whether you’re going to do a comprehensive elimination diet or the FODMAP overlay. Again, if you go to our website www.discoverhealthfmc.com and go to the shop, you will see the Detox Plus Program. With that program you get a guidebook that’s written that you download. You also get five videos done by me, Dr. Trish, to support you through the whole process: step 1, step 2, step 3…and be able to help you be successful. Of course, as we’ve said, if you need more assistance or you want assistance at least you have questions, Coach Trish is there for you. Coach Trish, as she said, does online groups. You’re just finishing one.
Also, you’ve started a regular program where people that are completed let’s say that class or completed the Sugar Busters Class you’ve run, now also have…is it once a week or is it every other week that continued support as a group?
Yeah, once a week accountability group. We started it after we did the Sugar Busters Class. We’re going to be inviting the folks as they finish the Detox Plus and anyone who’s finished either one of those classes even in the past who has done it and wants to touch base and come back in. We meet once a week on Monday nights via Zoom so you can be doing that from anywhere. I would also open it up to people who have done our Nutrition Healthy Habits Class. Those three classes or if you’ve worked with me individually and you just want a little accountability and you want the support of a group. You don’t have to come every week. It’s not like a set curriculum in that way. It’s a monthly thing and we meet weekly. If you can make two meetings a month and that works for you or you want to meet every week that works for you that’s great! We have started that.
The other thing before anybody starts doing this many times what they find really helpful as well is to have a one-on-one appointment with you, Dr. Trish, if they’re suffering and having a lot of these symptoms. For those who are in our local area coming and working with you as their functional medicine provider, I know gets folks squared away in terms of, what direction do I need to go in? Is this the type of thing I need to do? Because you’ve got the online Detox Plus Program, people can access that from anywhere. There’s a great variety of options for folks, I think.
Absolutely. I hope this has helped folks. What is a FODMAP anyhow and why should I care? Bottom line is FODMAPs are fermenting different types of sugars: oligosaccharides, disaccharides, monosaccharides, and polyols. Trish, if you could bring up your last slide that we haven’t brought up yet.
The one thing I want to make sure we want to end with is a positive. You know, we all emphasize what we have to eliminate. Oh, my goodness! I have to eliminate this and that and that and this. You want me to eliminate something else? Well, you know what, folks? There is always a substitute. Let’s focus instead on what I get to eat because I can’t tell you how wonderful I love my diet. I mean, I eat delicious natural foods. When you get rid of all the processed crap and all the fake sugars, the natural sugars of the fruits and the vegetables are so good! I feel so satisfied and so beneficial and healthy even after every single meal. It’s not about what I can’t eat – it’s about what I can and the fact that I’m so happy that I’ve learned not to be sick. I’ve learned to be healthy and be able to transform my life and control my life so that I feel good most of the time. We all get sick here and there, but I feel good a majority of the days of my life. Thank goodness! That’s the way I want to live my life! How about you, Trish?
Oh yeah! I feel better now than I did when I was in my twenties. I was struggling with IBS and GERD and all kinds of acronyms and symptoms and joint pain and brain fog and all the kind of stuff because I wasn’t eating right. I didn’t realize the damage it was doing along with stress and not sleeping enough and all the stuff that I know now. I’ve had to give up things. I’ve been gluten and dairy-free for five years. I eliminate certain FODMAP foods still that are problematic. I don’t eat a huge amount of those particular foods. I feel great! I don’t get those symptoms anymore; I don’t feel like I’m deprived. I eat delicious food; I have lots of things to choose from, and I feel good which makes a huge difference. It’s so much easier to do when you feel this way. You don’t feel deprived; you feel like, oh, I’m doing the right thing. I feel healthy and good and have energy. Yeah, so much better.
Absolutely! I’m going to take one category and emphasize some of the things that I’ve learned to eat out of it that I never even knew before. Trish, why don’t you do that at the end, and we’ll finish with that. For example, vegetables. I grew up in a meat and potatoes Irish Catholic family and we ate carrots, and we ate green beans. We ate meat and we ate potatoes. I was just like, what the heck is bok choy? Or escarole or chives or daikon radishes. Now I know what these things are. Talk about expanding my horizons, not reducing them! Again, this doesn’t have to be negative; it doesn’t have to be, oh my god, I don’t know what to eat! At first, you’re going to feel that way. Believe me, I’ve been there myself. What do I do? If you get the sources and the resources we give you, you’re going to learn that – wow! There’s a whole new world! Wow – does it taste good!
Trish, what category would you pick? Pick out a few things that you weren’t necessarily familiar with when you were having your problems in the past.
Yeah. A lot of ones that you just mentioned. Some of those vegetables for sure. Then even things have gotten more common that didn’t exist back then, right? There wasn’t any such thing as almond milk yogurt when I have to give up dairy. If there was it was really hard to find, you’d have to go to some specialty food store. Now they’re carrying it in big tubs – almond milk unsweetened yogurt. No sugar. I can put in my own fruit. Coconut milk yogurt, things like that so I don’t feel deprived.
I was an ice cream fiend when I was younger. I loved ice cream and had it like every day through my youth and my probably twenties, thirties. You can get almond milk ice cream, cashew milk ice cream, coconut milk ice cream. You can make your own with fruit – bananas or whatever. I don’t ever feel deprived even though I don’t eat gluten and dairy which are on the high FODMAP list. Yeah.
Lately I’ve been making the frozen banana…you take a banana and peel it, put it in the freezer, then put it in a food processor with let’s say some cocoa powder, a nut butter, frozen berries, and some almond yogurt and food process it and get it to the consistency of ice cream. Oh. My. Goodness! It is the best thing! With that, folks, it doesn’t have to be negative. You don’t have to focus on what you can’t have. Let’s focus on what you can have and help you get rid of the symptoms, get rid of the bloating, get rid of the diarrhea, so that you can feel better.
Thanks for participating, everybody! This is Dr. Trish and Health Coach Trish. Thanks, Trish!
Thanks! See you later, everybody!
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