- Meet Consumers/Patients
|Nutrition and You: FODMAPs|
FODMAPs is an acronym for “fermentable oligo-, di- and mono-saccharides and polyols.” FODMAPs are short-chain, small molecular weight carbohydrates that are poorly absorbed in the GI tract. As a result, they are rapidly fermented by normal bacteria in the intestine, causing GI distention, increased gas production, pain, and fluid delivery to the GI tract.
People with irritable bowel syndrome (IBS) and some other GI disorders have used a diet low in FODMAPs to treat symptoms with great success. The diet includes eliminating or limiting certain foods containing fructose, fructo-oligosaccharides (fructans and galacto-oligosacccharides), lactose, and polyols (sugar alcohols). Modification of the diet to limit FODMAPs (less than 4 gm/day) has been shown to be effective in decreasing symptoms in 75 percent or more IBS patients. After four to six weeks, higher FODMAP foods are re-introduced, carefully and systematically, as tolerated.
So how does this affect you as an Oley consumer? If you are receiving tube feeding and you have noticed bloating or diarrhea that you cannot seem to manage and cannot attribute to another cause, it might be too many FODMAPs in your formula. If you are a home parenteral nutrition (HPN) consumer and you get these GI symptoms after eating, it may be because you have consumed too many FODMAP foods.
FODMAP DietManaging FODMAPs food intake is a little tricky. You need to work with a registered dietitian who has expertise in this area. While primarily problematic for people with IBS, some of these foods can be troubling for anyone with a compromised GI tract.
For the most part, protein is not a culprit unless the protein is associated with higher lactose content. When supplementing, look for protein with low or zero lactose, like brown rice protein, egg protein, or whey protein isolate. Fat also is not usually a problem—just not too much! Food sources of FODMAPs are more pronounced in “real food” or blenderized formulas, so check the formula label and consider the contents.
Carbohydrates in tube feedings that can cause symptoms are most often associated with the fiber components. Some examples of the high FODMAPs fibers are inulin (chicory root extract), fructo-oligosaccharides (FOS), trans galactooligosaccharides, and raffinose, which is a fiber from legumes. Added fiber may be good for most people, but depending on your GI system you may need to limit these types of fibers. These fibers have been added to enteral (tube feeding) formulas because they have a shorter chain and do not increase the viscosity (thickness) of the formula. However, formulas supplemented with FOS have been associated with increased gas and stool frequency. This will not happen for everyone, but it is something to consider if you aren’t tolerating your formula when everything else looks right.
Bottom line: What you eat matters, whether it is administered through a tube or as a supplement to HPN. Keep in close contact with your dietitian, who can assist you in managing GI symptoms.
Carol Ireton-Jones, PhD, RDN, LD, CNSC FASPEN; reviewed by Laura Matarese, PhD, RDN, LD, CNSC, FASPEN.
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Oley exhibit at A.S.P.E.N.'s Clinical Nutrition Week