Tuesday, November 8, 2011

Could FODMAPs be related to GP?

A few months ago this strange acronym meant nothing to me and could have referred to some foreign language for all I knew.  My first introduction was when a doctor in Seattle mentioned the possibility of fructose intolerance after discussing the symptoms of gastroparesis.  I did a bit of research but was going downhill fast with my weight and forgot about it after being distracted with the placement of the feeding tube.  During this time, my good friend studying nutrition insisted I try it out but I felt too overwhelmed to even think about it.
Recently, however, it seems to be popping up everywhere and I'm getting more and more information that justifies a significant link to IBS (which many doctors are now considering), that are also similar to the main symptoms of GP.

What are FODMAPs?
Fermentable Oligo-, Di- and Mono-saccharides and Polyols refer to the short-chained carbohydrates and sugar alcohols found in many common fruits, vegetables, sweeteners such as honey, milk (lactose) and grains, including wheat and rye.
Why can they cause problems?
When foods containing FODMAPs are digested by those who are intolerant are not absorbed by the small intestine and instead provide substrate for rapid bacterial fermentation.  This in turn creates gas and expands the volume in our digestive tract, literally distending and creating the symptom we know as bloating.  The increased volume and bacterial growth lead to a number of digestive problems.
What are the signs of FODMAP intolerance?
Bloating, diarrhea and/or constipation, stomach pain and spasms, vomiting, flatulence, depression and fatigue.
Sound familiar?!

What really intrigued me was an article I read relating SIBO (small intestine bacterial overgrowth) to gastroparesis, which can be caused overtime by the volume of bacteria increasing in the gut.  In the study they found 60% of the patients with GP to also test positive for SIBO.  For details read the article at http://www.ncbi.nlm.nih.gov/pubmed/20027008.

Now for the hard part, the FODMAP diet.  After years of trying what I thought was elimination overload I feel like I'm up for any challenge.  If course, easier said than done.  There are many lists out there with what foods are "good" and "bad" so feel free to do your research.  Kate Scarlata, author of The Complete Idiots Guide to Eating Well with IBS, wrote a fantastic article relating FODMAPs to IBS called Successful Low-FODMAP Living and can be very helpful in understanding where to begin. Here is a list that is reliable and up to date: http://blog.katescarlata.com/fodmaps-basics/fodmaps-checklist/

There are doctors and dietitians that can run a test called hydrogen breath testing.  They are hard to find but I did have some luck in Seattle and plan on getting tested soon*.  In the meantime I am trying to limit my intake of FODMAPs and have already noticed a decrease in some symptoms, especially related to garlic, onions, apples and pears.

My Journey Challenge!  Follow the food guide above eating only Safe to Eat foods for 3 days and see if you notice a difference.  Keep a food diary and note how you feel when eating FODMAP foods after 3 days.  If you have positive results then extend to 7 days and then 30.  It's possible some foods may be re-introduced with less irritation down the line so if it works don't give up!

Lets help each other.  Please comment if you think this might be related to GP or if you have any experience with FODMAPs.

Also, a good additional link to read: http://online.wsj.com/article/SB10001424052970204554204577023880581820726.html

Thank you for reading and I hope this reaches out to those looking for possible answers.

*Updated post about my trip to Johns Hopkins for SIBO breath testing and a visit with a well informed GI specialist, Dr. Gerard Mullin.  

**Updated FODMAP post with a detailed GP FODMAP handout!


  1. Excellent write up- good link. This is information that should be common knowledge but unbelievably, is not. Along with all the other additives in food nowadays that people don't know about (i.e. soy, etc..) I also follow WSJ and some universities on Twitter for good articles. Thanks for sharing!!

  2. I was asked an interesting question that I want to address regarding ingredients in my feeding tube formula. It is gluten and lactose free with corn maltodextrin as the sugar source all of which are FODMAP friendly. The only questionable ingredient is soy lecithin which is usually tolerated by those with soy allergy because it is derived from soybean oil rather than the actual protein.
    In addition, while I find the information and research valuable I'm still following my own intuition with what works for my body. At this time they just happen to mostly agree with the FODMAP diet!

  3. I've been visiting this very possibility this past week when my pear muffins and veggie stirfry (with well cooked gp friendly veggies) gave me terrible cramping and diarrhea. I already am lactose intolerant and am celiac, already avoid the gassy foods, so I'm thinking that leaves me with fructose issues. I am very sensitive to fiber and fats. Under the direction of my GI doc I did a liquid diet this weekend and I will start reintroducing foods this week to see if that will help give some answers. I'm saving the fructose foods for last and will be very careful with the veggies. Thanks for sharing.

    1. Fellow fructose malabsorber and IBS suffererFebruary 15, 2012 at 11:47 PM

      Pears were probably the culprit, onion too if you had any with your vegetables, plus the wheat in the muffin.

  4. Someone recently pointed out to me that gluten is not in fact an actual FODMAP, however wheat and rye are. Just wanted to make this clear to everyone and the post has been updated to reflect the correct information.
    If you continue to experience issues without FODMAPs I would suggest being tested for gluten intolerance, as it can cause many similar digestive troubles.

  5. I have fructose malabsorbtion (and lactose and histamine intolerance) and my dietician made me aware of fodmap last year. Most things of the fodmap I was already avoiding due to the fructose intolerance. But I am now trying to stay away from wheat. I read that spelt (which is a very old type of wheat) is agreeable with the fodmap diet. Luckily, here in Austria you can get just about anything made from spelt :-).

  6. That's great your nutritionist brought that up, few seem to know about it here in the states. I used spelt before going completely gluten free and found it to be a great replacement for wheat flour. I would make spelt cornmeal pancakes and no one even knew the difference. In fact I may be able to create a GP friendly version of it so thanks for the reminder!

  7. Hi Stehphanie, a fellow GPer just told me about your blog--great information! I am anxious to see the GP friendly version of the Low FODMAPS diet that you are creating. My son is 20 and has had idiopathic GP for 4 years--we have been trying to "merge" the Low Fodmaps and GP-friendly diets at home but it has been very hard! He is in the middle of a terrible flare-up with vomiting, diarrhea and constipation! His doctor thinks he has SIBO so he started my son on an antibiotic. He's lost a lot of weight. We are having food allergy testing done next week.Again, your site is terrific and look forward to seeing your "merged" diet!

  8. Thanks Linda, it warms my heart that you found this site so great :)
    Your son must be having a hard time being diagnosed at such a young age. It can be very frustrating but there is hope and ways to manage GP, even when it comes to additional complications such as SIBO. I will be dedicating my work as a health coach to a spectrum of motility disorders and food intolerances. I hope he is under the care of a good doctor who is monitoring weight loss and nutrient levels, which is so important. In June when I begin working with individuals and groups I will have some helpful resources available to help support those like your son (and myself!) with what may seem like an impossible diet. Tell him not to give up and stay strong (you too!), the key to feeling our best with what we have.

  9. Johns Hopkins Gastroenterology in Baltimore offers both a fructose and lactulose breath test to check for bacterial overgrowth. They also do a smart pill that can measure for GP. I was just diagnosed for both GP and for bacterial overgrowth. Doc told me to take a month of antibiotics and go on FODMAPs. I've been gluten free for 11 years already, but was still dealing with problems. Hoping this will help.

    1. also forgot to say that for GP doctor recommended at least 500mg ginger capsules and digestive enzymes.

  10. Ladydi115,
    Thanks for sharing your experience. I was gluten free prior to GP as well, though believe some of those GF "foods" were much worse for me in the long run. Interesting you mentioned Johns Hopkins and SIBO, and very helpful for those in the area! I actually make a trip there to see Dr. Mullin last August and probably have the same sort of treatment plan. Ginger is great, take 1500 gm/day. Here is the post I wrote about the visit...http://mygastroparesisjourney.blogspot.com/2012/08/post-johns-hopkins-great-visit-test.html
    Good luck with your endeavors and keep us posted!

  11. I had no gastroparesis, largescale food malabsorptions, or heavy duty constipation before I had surgery at age 68 for paraesophageal hernia. Subsequently got all three. Am currently beginning detective work after weeks of cleansing diet for Lactose-Fructose; am using FODMAP diet plus systematic addition of suspect foods. It will take me months.

    P.S. Got microscopic colitis before surgery; have been taken off PPIs, which I took for over 10 yrs.; this has elminated the problem, for now at least.