Is low FODMAP the new gluten free?

A couple of weeks ago I attended the annual DAA (Dietitians Association of Australia) conference. I noticed a few products in the exhibition hall bearing the low FODMAP certification logo. I also attended a few talks on the topic of the low FODMAP diet in the management of IBS (irritable bowel syndrome). One of the speakers, Dr Joanna McMillan mentioned the fact that “low FODMAP” is becoming trendy and might be the new “gluten-free”. Is that the case?

What are FODMAPs

In short, they are types of carbohydrates that can be fermented by our gut bacteria. The acronym stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols.

The fermentation of FODMAPs in our intestine generates gas, among other things. The gas can cause bloating and discomfort in some people, particularly those who already have an inflamed gut, such as people with IBS and IBD (inflammatory bowel disease)

Where do FODMAPs come from?

FODMAPs are present in many common foods, such as (Whelan et al, 2018):

• Oligosaccharides
  • Fructans (oligofructose, inulin, fructo-oligosaccharides): Wheat, rye, onion, garlic, artichoke, low fat dairy products
  • Galacto-oligosaccharides (raffinose, stachyose): Pulses, legumes, some nuts
• Disaccharides
  • Lactose: Milk and milk products
• Monosaccharides
  • Fructose (in excess of glucose): Mangoes, figs, honey, fructose corn syrup, sweetener in dairy products, jam
• Polyols
  • Sorbitol: Stone fruits, apple
  • Mannitol: Cauliflower, mushroom
  • Lactitol, xylitol, erythritol, maltitol: Sugar-free gum

What is the low FODMAP diet?

It is a therapeutic diet designed for managing symptoms in people with FODMAP intolerance. It is important to note that:

• It’s normal to have some gas in the gut as a product of digestion
• Food intolerance is not food allergy – people with intolerance to particular food components are able to tolerate those components up to a certain threshold before symptoms occur
• The low FODMAP diet is not intended to be followed for life. It should look like this:
  1. A low FODMAP phase to determine whether FODMAP-containing foods are an issue and to achieve a symptom-free baseline
  2. A reintroduction phase to determine the tolerance to each food
  3. A long-term personalised diet with avoidance of only foods which cause significant issues. Tolerance to particular foods can change over time, so this diet should be revised periodically.

Is low FODMAP the new gluten-free?

I made a couple of comparisons to answer this question:

1. I compared the number of gluten-free vs FODMAP-friendly products in Australia’s main 2 supermarkets. There is a big difference in the number of products that are labelled with either claim. Gluten-free is still a popular buzz health claim but it’s still early days for products marketed as FODMAP-friendly.

   

2. Next, I ran a Google Trends comparison between “gluten free” and “low FODMAP”. Again, the former is many times more popular than the latter. I’ve included the interest per region and top searches, too.

I think it will take a while for “low FODMAP” or “FODMAP-friendly” products to become trendy and they might not ever reach the level of popularity of their “gluten-free” counterparts. In part is because it’s way easier to make something gluten free than to make it low FODMAP. By the same token, it is less likely for asymptomatic people to eat a low FODMAP diet just because it’s perceived as healthier.

I mentioned the low FODMAP logo before. This is an Australian certification (same as low GI), which means people are less likely to come across certified products in the supermarket, as I would guess a significant percentage of products come from overseas. Also, companies choose to certify their products based, in part, on the size of the market they are looking to attract, which at the moment is not large.

Is a low FODMAP diet inherently healthy?

The short answer is no. While a low FODMAP diet can certainly help relieve IBS/IBD symptoms, there is no evidence that following a low FODMAP diet makes any difference in healthy individuals. Moreover, if not overseen by a knowledgeable dietitian, people following a low FODMAP diet might develop nutritional deficiencies, e.g. calcium (important for bone health and many other functions in the body) and fibre (for a healthy microbiome).

Want to know more?

Here are some resources for you to read:

• FODMAPs and IBS: What’s the deal?
• About FODMAP and IBS
• Whelan K., Martin L. D., Staudacher H. M. & Lomer M. C. E. (2018) The low FODMAP diet in the management of irritable bowel syndrome: an evidence-based review of FODMAP restriction, reintroduction and personalisation in clinical practice. J Hum Nutr Diet.31, 239–255

[Top photo by Goh Rhy Yan on Unsplash]

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