Hidden dangers

Mridula Wattas

Most people will assume a high-fibre, vegan diet that would include whole grains, all kinds of raw and cooked vegetables and fresh fruits would be healthy. Those who are disciplined enough to follow such diets, one would believe such people feel light, healthy and energetic. But, sometimes, for the followers of such a diet the results can just the opposite. They can experience bloating, gas or even diarrhoea and feel very low in energy. 

This happens because these diets contain certain short-chain carbohydrates (FODMAPs) which some people are unable to digest. FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) are a group of compounds thought to contribute to the symptoms of irritable bowel syndrome and similar gastrointestinal disorders. These undigested carbohydrates reach the far end of the intestine where the gut bacteria reside where these are consumed as fuels. As a result of this, hydrogen gas is formed which causes all sorts of symptoms of indigestion. FODMAPs can also cause diarrhoea by drawing liquids into the intestine.

But not everyone is sensitive to FODMAPs. However, people who are affected by FODMAPs should know about the foods which are high in these compounds. The affected people can lead normal healthy lives by simply avoiding certain foods. It is also possible to desensitise such people against the FODMAPs by introducing foods rich in these compounds one at a time. 

Foods high in FODMAPs and their alternatives

Milk and milk products: Milk is one of the main sources of the FODMAP lactose but milk products like curd, paneer and certain cheeses have considerably low lactose content. 

Meat and poultry: None of the foods in this group are rich in FODMAPS.

Cereals: Wheat, when consumed in excess, can be considered a high FODMAP food. Other grains like brown rice, buckwheat (kuttu atta), maize, millets (jowar, bajra and ragi), oats and quinoa have a low FODMAP content.

Legumes and pulses: All legumes and pulses are high in FODMAPs. The key FODMAP in legumes and pulses is called galacato-oligosaccharides (GOS). But interestingly the FODMAPs present in these are water soluble. We should soak the legumes and pulses and then throw away the water. Hence, a considerable amount of FODMAPs can be reduced. We can also decrease the FODMAP content of pulses by fermenting and sprouting these. 

Vegetables: In fact, vegetables contain the most diverse range of FODMAPs. This includes fructans, GOSs, fructose, mannitol and sorbitol. It's important to remember that vegetables are part of a healthy diet. So people sensitive to FODMAPs can choose vegetables with a low FODMAP content. These vegetables include capsicum, carrot, tomato, spinach, brinjal, bottle gourd and snake gourd. The high-FODMAP vegetables that should be avoided are broccoli, beetroot, cabbage, cauliflower, garlic, mushrooms, lady finger, onions and peas. 

Fruits: All fruits contain the FODMAP fructose. Some fruits also contain good amount of glucose. These have low FODMAP content. Consuming these fruits does not typically lead to gut symptoms. The fruits which predominantly have fructose in them are the high FODMAP fruits.

Low-FODMAP fruits: Bananas, blueberries, kiwi, limes, oranges, papaya, pineapple, and strawberries.

High-FODMAP fruits: Apples, apricots, cherries, figs, mangoes, peaches, pears, plums and watermelon

Sweeteners: Most sweeteners are a rich source of FODMAPs. That is why it is important to read the ingredient list in all sweetened and packaged foods 

Low-FODMAP sweeteners: Glucose, maple syrup, sucrose and Stevia. 

High-FODMAP sweeteners: High-fructose corn syrup, honey and added polyols in sugar-free mints and chewing gums.

Prebiotics and FODMAPs

For a healthy gut it is extremely important that there are certain bacteria present in our gut at all times. These help in maintaining the structural integrity of our gastro-intestinal tract and also lower its inflammation. These also reduce the incidence of chronic diseases such as cardiovascular disease, type 2 diabetes, obesity and osteoporosis. For these healthy bacteria to thrive we need certain foods which are called prebiotic foods. Unfortunately, most of the prebiotic foods are also high in FOMAPs. But there are some prebiotic foods which are low in FODMAPs and they can be liberally added to the diet of people sensitive to FODMAPs. 

Prebiotic foods low in FODMAPs: These include banana, brinjal , tomato, fermented and sprouted pulses, oats, quinoa, brown rice and buckwheat.

THE BOTTOM LINE

Some people who are sensitive to FODMAPs, may end up suffering from irritable bowel syndrome if they continue eating foods high in FODMAPs. For these people it is important to have information about low FODMAP alternatives in each food groups. Many studies have shown that most people suffering from IBS get relief from their symptoms by simply avoiding foods rich in FODMAPs. 

— The writer is former Head, Department of Dietetics, PGIMER, Chandigarh