Abdominal pain: what if FODMAP were the culprits?

Edwige FAJFER, naturopath

Translation: Imogen Barneaud

A lot of people who have digestive issues and abdominal pain after eating bread or pasta, think they are intolerant to gluten.

According to a study, published in « Gastroenterology » in November 2017, gluten may not be the cause of these digestive problems. However, fructan, which is a carbohydrate, could be the culprit. As it happens, fructan is also present in wheat, as is gluten…

Do you often feel bloated; do you get stomach cramps often? Especially after having eaten raw vegetables, fruit or grains? If so, you may be sensitive to FODMAPs.

This weird acronym stands for:

Fermentable by colonic bacteria

Oligosaccharides (fructans)

Disaccharides (lactose)

Monosaccharides (fructose)

And

Polyols (mannitol, sorbitol)

In other words: Oligosaccharides, Disaccharides, Monosaccharides and Polyols that are fermented by the gut’s flora.

Basically, FODMAPs are short chain oligo-saccharide polymers of fructose that are poorly absorbed by the intestinal tract (in the small intestine). FODMAPs are rapidly fermented by the gut’s bacteria. In essence, the gut naturally contains flora such as bacteria and micro-fungi (i.e. archea) that thrive on these carbohydrates, and during this natural fermentation process, FODMAPs produce gas. This fermentation process can cause:

-Abdominal discomfort or pain when ingesting high-FODMAP foods

-A stretching of the large intestine that causes constipation and/or diarrhea. FODMAPs are osmotic so they attract water into the intestine. They also cause flatulence.

-Abdominal discomfort and bloating

So where can FODMAPs be found and what kind of food should we be avoiding to overcome recurrent discomfort?

-Certain grains such as wheat, barley, rye and inulin

-Certain fruits: nectarines, white peaches, apricots (dried or fresh), figs (dried or fresh), grapefruit, prunes, apples, cherries, mangoes, pears, watermelon, pomegranate, grapes, melon

-Certain vegetables: cabbage, artichokes, leeks, Jerusalem artichokes, salsifies, mushrooms, snap beans,

-Condiments: garlic, onion, grey shallots

-Legumes: beans

-Dairy that contains lactose: cow’s milk, goat’s milk, sheep’s milk, ice cream, yoghurt, cream cheese and soft cheeses. Surprisingly, hard cheeses do not contain any!

-Plant-based proteins: cashew nuts, black beans, kidney beans, pistachios, silky tofu, soy.

-Sugars: agave syrup, corn syrup, honey.

-Sweetners that end with an “ol” : sorbitol, mannitol, xylitol, lactitol, erythritol, polydextrose and isomalt.

In general, you’ll want to avoid anything with glucose and fructose syrup. Look at the labels closely. You can find these syrups mostly in fruit juices, canned fruit, sirops, candy, liqueurs and sweet wines.

So what can I eat? The low-FODMAP diet

An Australian nutritionist named Sue Shepherd was the first to develop a low-FODMAP diet. The diet consists in reducing the amount of FODMAPs in your daily regimen. In 75% of cases, the symptoms improved.

Here is a list of low-FODAMP foods that are allowed:

-Breads, grains and flours: sourdough bread, gluten-free bread, quinoa, rice (white rice, basmati rice, brown rice), buckwheat, corn flour, millet, oat, polenta

-Fruit: lemons, oranges, grapefruit, tangerines, clementines, kiwis, pineapple, raisins, bananas, goji berries, raspberries, rhubarb, passion fruit

-Vegetables: carrots, lettuice, cucumbers, eggplant, palm hearts, squash, zucchini, spinach, chicory, fennel, green beans, white beans, turnips, sweet potato, bell peppers, potatoes, radishes, tomatoes

-Condiments and seasoning: capers, garlic flowers, mayonnaise, mustard, dried herbs, soy sauce, ground spices, vinegars (not too much balsamic vinegar)

-Dairy: lactose free milk, nut milks (almond, soy, hemp, oat, coconut), coconut cream, ricotta, hard cheeses, whipped cream,

-Protein: meat, eggs, fish, seafood, crustaceans, tofu, almonds, nuts and walnuts, chia seeds, sesame seeds, pumpkin seeds, chick peas, lentils (strained and rinsed)

-Carbohydrates and sweet foods: white sugar, brown sugar, fructose-free jam, cane sugar, maple syrup, dark chocolate, stevia

-Drinks: coffee, tea, coconut water, water (not fizzy), infusions

-Fats: butter, margarine, vegetable oils

If you have colopathic functional disorders such as

-Chronic digestive pain, that depend on the time of day and your whereabouts, that improve when you are less fatigued and stressed, and that get worse when you are tired and anxious

-Bloating, constipation or diarrhea

-Anorexia, nausea, acid reflux, slow digestion, feeling full, physical and intellectual asthenia, skin problems, palpitations, headaches etc, then try out the low FODMAP diet.

Warning: you may not need to eliminate all the FODMAP foods. In some cases, onions and garlic are good for your intestinal flora.

How does a low-FODMAP diet work?

There are three phases: elimination, reintroduction and stabilization.

ELIMINATION

For 6-8 weeks, you must remove the foods containing the highest amounts of FODMAPs from your diet: apples, pears, mangoes, cherries, mushrooms, cauliflower, artichokes, chick peas, cow’s milk, wheat, rye and replace them with low FODMAP foods.

REINTRODUCTION

Test the foods by slowly adding them back into your diet. You can them by family (i.e. fruits, then vegetables, then grains…). That way, you will be able to tell which ones you are most sensitive to. This phase can take a long time but FODMAP intolerance is not considered an allergy so each reaction is specific.

STABILISATION

Once you have identified the FODMAPs you’re most sensitive to, don’t eat them anymore, or try to reduce your intake.

If you have any signs of colopathy, do not hesitate to consult a nutritionist or a naturopath. These professionals will not only help you manage your eating habits and help you out with a low-FODMAP diet, they will also help you handle moments of stress that can be partially responsible for your stomach aches.

Edwige FAJFER

Naturopath and Iridologist in Biarritz

www.sonaturo.com

Edwige FAJFER est Naturopathe-Iridologue à Biarritz  www.sonaturo.com

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