A major aspect of the meteoric rise in the study of the microbiome is our understanding of FODMAPs and their role in a number of digestive disorders, including IBS, SIBO, Celiac Disease, Crohn’s disease, Ulcerative Colitis, chronic constipation and more.
There are a number of conditions that have dysbiosis present even if their symptoms are not primarily digestive in nature, such as obesity, diabetes, neurodegenerative conditions and eczema.
Turns out that FODMAPs are a very important piece of the conversation in folks that have any type of dysbiosis – an imbalanced microbiome – underlaying their digestive concerns. It turns out a LOT of conditions have dysbiosis as a major factor.
Dysbiosis can mean too few good guys, too many “frenemies” – guys that can go either way depending on the context, frank infection with bad bacteria, yeast or parasites, or translocation of flora to places they don’t belong (like the small intestine). Dysbiosis creates enough of a disruption in the landscape of your microbiome to change the ecology and function of it and to give you undesirable symptoms.
FODMAPs is simply an acronym for Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols. These are fancy words for certain carbohydrates/starches that are fermentable to an imbalanced, dysbiotic gut flora.
There are a few things to keep in mind about FODMAPs before we continue this discussion:
- FODMAPs are not inherently bad for everyone (don’t take what is true for some and generalize to the many)
- FODMAPs are found in a broad range of vegetables, fruits, nuts, grains, beans and dairy products. They are not found in things that don’t have starches (meats, eggs)
- Many times, as you re-balance the microbiome, heal the gut and soothe the Second Brain, some or most FODMAPs can be challenged back in the diet and often reincorporated.
When something is fermentable, it creates gas.
Excessive gas, leading to increased belching, farting, feeling bloated and distended, and pain as the intestines fill with air. This in turn can disrupt motility: speeding up your poops, slowing them down, or both.
Wait, What? Why don’t we all have IBS then?
Here’s the thing, though. We all eat lots of high-FODMAP foods, we all make gas, so why don’t we all have IBS or problems from FODMAPs?
One, we don’t all have a disrupted microbiome that is over-fermenting these foods. Two, we don’t all have an imbalanced Second Brain. The Second Brain is also known as the Enteric Nervous System (ENS) and it is responsible for monitoring and managing all aspects of digestion. Including motility (those with IBS often struggle readily here), but also with pain perception.
Consequences of IBS and Dysbiosis & Second Brain Dysfunction
Folks with IBS or other dysbiotic conditions, because of this two-pronged imbalance of the microbiome (your healthy bacteria) and the ENS (your Second Brain)…
…Make more gas that those with dysbiosis. The imbalanced flora are often much higher fermenters than “normal” flora.
…May not move gas as well as those without IBS. Normally, if a large amount of gas is present in the bowel, the body will take steps to get it moving down and out so it can be expelled. The body will use the abdominal wall in this endeavor, and folks with IBS may not be able to “recruit” the help.
…May not compensate for gas as well as those without IBS. Your Second Brain, when gas is present, will normally tell your abdominal wall to tighten up so that your belly doesn’t stick out and hurt. Along with this, it will tell your diaphragm to relax, so there is more room for the extra air. With the disruption of the Second Brain in IBS, the diaphragm contracts, making your belly stick out and hurt more. The reflex to contract the abdominal wall is often weak as well.
…Tend to have a lower pain threshold than folks without IBS. This is not tolerance for pain (those of you with chronic pain are warriors in my book, often with a much higher pain tolerance than the average bear), this is simply the fact that the Second Brain will register pain from distension and a sensation of bloating faster than someone without. Pain signals fire faster.
…Often have disrupted signals from the digestive tract. We know that our perceptions can greatly color how we interpret sensations. Higher stress/anxiety situations mean that we would more readily interpret a signal as pain. With a Second Brain in disarray, we both send and receive signals to and from the gut that are more painful.
Not only do we have disrupted pain signaling, but the signals for motility can get mixed up too, slowing us down, spending us up, or doing a combination of the two.
More gas plus motility disruption plus increased pain perception is a sure fire recipe for digestive distress.
Using a low-FODMAP approach for IBS & Dysbiosis is Key
The most important first step in healing and managing IBS and other dysbiotic based conditions is to adopt a low-FODMAP diet. Going low(er) FODMAP not only helps reduce the overall amount of gas produced in your gut, it also helps change the landscape of your dysbiotic gut flora to a more balanced one, most especially if you use other gut restoration practices alongside your low-FODMAP diet.
Not all FODMAP foods are created equal. Some are quite high in their offending agent (remember, there are different categories of FODMAPs!), others not so much. Some foods are higher in fructans (an Oligosaccharide), but might be lower in fructose (a Monosaccharide). This is often a reason for conflicting FODMAP lists you may see in books or the Internet, some lists will go into extreme detail.
In general, to the newbie low-FODMAP eater, I find this amount of detail to be confusing because it can leave us spinning our wheels and confused and aggravated.
To start, it is better to minimize high-FODMAP foods, incorporate gut restoration measures, and then challenge the foods back in so you know what is what, rather than trying to figure out a list of foods highest in fructose and how that cross-references to their fructan content, and correlate that all with your symptoms. Nah, it’s better to simply minimize globally, rather than try to sort things out in the beginning when you are all flared up and your gut is irritated and you are feeling frazzled. At that point, simplicity is what you need!
I would be amiss if I did not mention individual sensitivity as well. Even within these lists – which are meant as a guide – you will likely find foods you can either tolerate well or cannot tolerate at all. Listen to your body?s wisdom and experience.
I recommend going low(er) FODMAP – aiming for 85% compliance – for 3 months. During these three months you should do gut restoration practices and Second Brain balancing techniques and exercises, so you can shore up your digestive ability and the health of the lining of your gastrointestinal tract, too.
After three months, you systematically challenge foods back in, one at a time, to see how your body responds. It could be that you react to only one ?category? of FODMAP, or a smattering of foods from different categories. Figuring this out is important, so you know what foods your body reacts to, what to order at restaurants or when you’re traveling, or if you’re going to eat a food you are sensitive to, you can at least eat it with eyes wide open, fully understanding the consequences. This is infinitely preferably to you stumbling around in the dark, not knowing what is bothering you, because it seems like everything is. Plus, once you know what bothers you, it could be that you take some extra enzymes and get extra-hydrated if you intentionally or accidentally eat some.
The goal is to never be overly restrictive if you do not have to be.
Examples of high-FODMAP foods
The list of foods that contain high FODMAPs is pretty random. You will recognize a lot of healthy foods within these example lists. It is very important to keep in mind that FODMAPs are not inherently bad, but for folks with dysbiosis and disruption of their second brains, these foods will create and maintain symptoms. Not necessarily forever. Until you sort things out.
This is NOT an exhaustive list! That would make this post pretty long and burdensome.
Here, I’m just getting you started. Glance through these abbreviated lists and see if there are foods you eat a lot of. Quite likely, there are. It is entirely possible that these are creating and maintaining your digestive distress.
High-FODMAP veggies: asparagus, avocado, artichoke, broccoli, brussels sprouts, cabbage, garlic, onion, peas
High FODMAP fruits: apples, blackberries, cherries, figs, mango, peach, plums, watermelon
High FODMAP grains: gluten is KING FODMAP, so gluten containing grains and their products – wheat, barley, rye
High FODMAP legumes: azuki beans, baked beans, black beans, lentils, lima beans, soy and soy products
High FODMAP nuts: cashew, pistachio
High FODMAP dairy: lactose is another KING FODMAP. Milk, ice cream, soft cheeses like cream cheese, cottage cheese, ricotta cheese, yogurt
I have found that there are doctors and coaches out there with good awareness of Dysbiosis and a low-FODMAP approach, but very few addressing the Second Brain, and fewer incorporating the two in a long-term gut restoration process.
It’s up to you!