As gluten-gate continues to dominate dinner-table conversations, it turns out another gang may have been the third force behind those stomach woes all along. Say hi to the FODMAP family.
On the roller-coaster trajectory of rising-and-falling trends, “gluten-free” is currently surfing a happy plateau somewhere alongside “athleisure”. As part of a growing free-from industry, it’s survived the wonky path of early adoption followed by mainstream fervour followed by inevitable backlash. Now we seem to be in a steady state of resigned acceptance: no, it’s not a bad idea. Yes, we know it really doesn’t suit some people. But there’s still an outside chance some people are going to judge you for it.
“Have you seen that cartoon?” laughs gastroenterologist and world authority on gut health Dr Peter Gibson, referencing a sketch first published in The New Yorker last year. “It’s a woman opposite her bored-looking dining companion and the caption reads, ‘I’ve only been gluten-free for a week, but I’m already really annoying’.” Yep, even the man who’s dedicated his career to researching coeliac disease (the bona fide gluten allergy) and irritable bowel syndrome (IBS) is in on the joke.
The main reason people get so irked by intolerance claimants is that, aside from being nightmare dinner guests, they also tend to be blundering self-diagnosers. “Our research actually indicates that most people who have self-reported gluten sensitivity do not [actually have an intolerance] — only a minority do,” Gibson says. “The situation isn’t yes or no — but it’s not as common as many believe.”
Nobody is arguing that gluten has a particular effect on the gut, but, the problem is, one woman’s carb bloat is another’s intolerance. Indeed, terms like IBS, sensitivity and intolerance are broad concepts — ones that are easy to misuse and abuse. Or in Jennifer Lawrence’s words, they become the “new cool eating disorder”: an in-vogue way to kilojoule swerve or at least a cult claim to sit nicely alongside your green juice and smoothie bowl.
But recently, we’ve noticed the breadbasket refusers and ingredient checkers aren’t citing gluten. Instead, the word being mouthed to waitresses, suggested to GPs and written across wellness blogs is the slightly less catchy F-word, ‘FODMAP’.
What the ‘F’ is FODMAP?
The acronym stands for — and heads-up, it’s a mouthful — fermentable oligosaccharides, disaccharides, monosaccharides and polyols, which are present in everything from classic gut offenders, like dairy and bread, to healthy favourites, like avo, cashews and coconut water. Over the past couple of years, these carbohydrates have slowly poked their way into the wellness lexicon following research published mainly by Gibson and his team at Monash University in Australia. There, they found that a diet low in FODMAPs helped relieve IBS symptoms in 70 percent of sufferers. The Bulletproof Diet author Dave Asprey is a low-FODMAP advocate and FODMAPs have had their 15 minutes on The Dr Oz Show.
So why do they matter? Well, these prebiotic compounds are poorly absorbed in the small intestine and, so, pass undigested into the colon to be rapidly fermented by colonic bacteria. This is a totally natural process, but if you’re prone to those IBS-type symptoms, the gas produced by these little bacterial critters can cause a world of tummy trouble, simply because, scientists believe, you’ve got a bowel that’s physiologically more sensitive to being stretched. “Additionally, colonic bacteria in people diagnosed with IBS may react more acutely to certain types of food, increasing the amount of gas produced and water content in the colon,” says Dr Majella O’Keeffe, a dietician who’s investigating the effects of FODMAPs. Stress can make matters worse too.
And here’s the interesting bit: rather than simply being the latest intolerance to lay claim to, FODMAPs may have been at the root of those self-diagnosed conditions all along. Foods like pasta, cereals and biscuits made from wheat, that have been seen as big gluten culprits, also contain FODMAP compounds.
“When we began testing IBS sufferers, many of whom had diagnosed themselves as gluten-intolerant, we found that they didn’t react to carbohydrate-depleted wheat, even though it still contained gluten,” Gibson explains.
And so the FODMAP-free movement has begun. Gibson and his colleagues have created an app, and the offshoot cookery book The Low Fodmap Diet Cookbook: 150 Simple, Flavorful, Gut-Friendly Recipes to Ease the Symptoms of IBS, Celiac Disease, Crohn’s Disease, Ulcerative Colitis, and Other Digestive Disorders (written by dietician Dr Sue Shepherd). In the US and Australia, you’ll find FODMAP-free products, including soups, sauces, ready-made meals and protein bars.
“Demand has been steadily growing as word spreads about the diet and we just launched worldwide shipping in July to accommodate requests we’ve had from the UK, Canada, Australia and New Zealand, among other countries,” says US dietician Kate Watson, who developed her FODMAP-friendly Nicer Foods range in December last year after finding relief from 20 years of IBS symptoms on a low-FODMAP diet.
Trying a low-FODMAP diet is no easy task
So will we see restaurants offering FODMAP-free alternatives? Because if the statistics tell us anything, it’s that there’s a public appetite for restrictive diets. “The problem with a lot of these diets is people use them with the misbelief that it’s going to solve all their problems,” Gibson says. “Whether it’s gluten or FODMAPs, we don’t want people to stop consuming a particular food group because they think it’s going to make them healthier. It’s not always the case.
“There are a lot of things that can be made low-FODMAP, which are nutritionally bad, but if brands write ‘low FODMAP’ on them, it gives them a sort of credibility as a healthy food. We’ve learnt a lot from the gluten-free explosion and we’re trying to avoid too much exploitation of consumers for commercial gain.”
Gibson is not selling the low-FODMAP diet as a lifestyle choice (in fact, he’s also researching the benefits of a diet high in prebiotics) and is quick to point out it’s simply unnecessary for anyone who doesn’t suffer from IBS. But then, once upon a time, the same was said for gluten. Yet, it’s transcended the IBS community, becoming a wellness mantra, shortcut to a flatter belly and catalyst to health utopia.
Similarly to non-coeliac gluten sensitivity, there is no definitive process for diagnosing a FODMAP-intolerance. “At the moment, there’s no clinical test for FODMAP sensitivity,” O’Keeffe explains. Instead, candidates, under guidance from their doctor, go through a four to six-week elimination diet and then gradually reintroduce various high-FODMAP foods to identify individual triggers and work out tolerance thresholds.
Here’s a breakdown of the most common high FODMAP foods:
- Vegetables: Asparagus, artichokes, onions, leeks, garlic, beans, lentils, chickpeas, sugar snap peas, beets, cabbage, celery, corn, avocado, cauliflower, mushrooms, Brussels sprouts, fennel, okra, peas, shallot, radicchio
- Fruits: Apples, pears, mango, watermelon, nectarines, peaches, plums, cherries,
- Dairy: Cow’s milk, yogurt, soft cheese, cream, ice cream
- Grains: Rye, wheat, semolina, couscous, bulgur
- Nuts: Cashews, pistachios
- Condiments: Honey, agave, relish, jam, tahini, tzatziki dip, hummus
- Food additives: Inulin, artificial sweeteners, high-fructose corn syrup
“Remember, though — this isn’t as simple as just cutting out one thing,” Gibson says. “You’re cutting out a huge variety of foods, many of which — apples, garlic and broccoli — are low-kilojoule and very healthy.” His point: this isn’t exactly going to appeal to the carb-dodgers the way gluten does. In fact, the list of what to restrict runs across all food groups, from fruit and vegetables to healthy alternatives like agave syrup to hidden ingredients like the soy flour used in many chips, sausages and protein bars. It’s enough to make a person nostalgic for the comparatively simple task of cutting out gluten.
Also, FODMAPs are growing in notoriety at a time when gut health – and the associated benefits of prebiotic foods — have become a major area of scientific research. Prebiotics feed the bacteria in the gut, creating a diverse ecosystem of microflora. Sounds a bit gross, but it’s a good thing. An increasing breadth of research shows that gut diversity is linked to everything from a strong immune system and fast metabolism to clear skin and mental health.
“Prebiotics are mostly FODMAPs, so the theoretical risk is that by eliminating them or cutting down on them significantly, you’re going to create an environment in your bowel where you won’t have as many health-promoting microbiota,” Gibson warns.
So, if someone mentions they’re thinking of going FODMAP-free, do them a favour and encourage them to see a GP, who can first rule out a condition like coeliac disease and point them in the direction of a dietician to supervise the tricky elimination stage.
Also, do yourself a fave: cross them off the guestlist for DIY pizza night.