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What causes new stomach pains on the low FODMAP elimination?

When you start the low FODMAP diet elimination phase, you should have already worked with your doctor to eliminate the possibility of digestive conditions like Crohn’s disease or celiac disease.  Once ample testing has been done with no answers, then it is time to strip your diet of FODMAPs to help rid of uncomfortable digestive symptoms. However, sometimes symptoms may still arise during this phase. Read below to find out why this may be and what you can do about it.

All about the elimination phase

A low FODMAP diet is an eating plan that cuts out foods that contain FODMAPs, or:

Fermentable

Oligosaccharides

Disaccharides

Monosaccharides

And

Polyols

This acronym may be confusing, so let’s talk about what foods belong to this group.  First, oligosaccharides are a complex carbohydrate found in certain foods that contain chains of the sugars galactose and fructose. Such foods include onions, garlic, artichokes, asparagus, as well as legumes like black beans, lentils, and soybeans. Any foods or drinks that are made of such foods like hummus from chickpeas or soy milk from whole soybeans, should also be avoided.

Next are disaccharides, or double sugars. The most common disaccharide is lactose, or milk sugar. Therefore, on the low FODMAP diet you should avoid high lactose foods like milk, soft cheeses like ricotta and cream cheese, cream, ice cream, and buttermilk.

Monosaccharides, or single sugars, should also be avoided on the low FODMAP diet elimination phase. Foods high in fructose, glucose, and galactose such as high fructose corn syrup, apples, honey, certain dairy products, and beans should be avoided.

Finally, you should cut out foods that contain polyols, or compounds that have multiple hydroxyl groups. Foods high in polyols include sugar alcohols such as mannitol, sorbitol, erythritol, and xylitol. These compounds are found in sugar-free and low sugar products such as drinks, candies, and gum.

For more comprehensive information on the low FODMAP diet, visit the Casa de Sante website.

Causes of symptoms during elimination phase

So, what happens if after several weeks of the elimination diet, you start to experience digestive symptoms?  Shouldn’t the low FODMAP diet make the symptoms go away?  Well, in most cases symptoms severity and frequency should improve. However, there are some reasons why the low FODMAP diet may not be completely working for you.

  1. There may be hidden FODMAPs in some foods you are eating. Sometimes processed food products may have trace amounts of FODMAPs in them. Common examples are fast foods marinated or flavored in onion and garlic powders, honey used as a sweetener in restaurant sauces, or apple or pear concentrates used to flavor juices or smoothies. A dietitian may be able to help you figure out what trigger foods may be causing your symptoms.
  2. Lifestyle factors may be wreaking havoc on your gut. Stress is a big trigger for symptoms in those with irritable bowel syndrome. When you get stressed or anxious, it can cause inflammation in the body that can increase risk of physical health issues. Therefore, find ways to manage your stress such as therapy, yoga, exercise, meditation, or talking with loved ones.  When you are stressed, this can also affect your sleep.  When you do not get enough sleep, this can also affect your digestive health.  Talk to your healthcare provider to seek treatment options and to see if your sleep issues may be related to another health issue like sleep apnea.
  3. Other health issues may be causing your symptoms. If treatment options do not seem to be working for your digestive symptoms, then you may have another underlying health issue. In this case, it is important to see your healthcare provider for further testing. Gallstones, stomach ulcers, or diverticulitis are some examples of conditions that could cause digestive symptoms.

Take home message

The low FODMAP diet can be a great way to reduce digestive symptoms for those with irritable bowel syndrome and other related digestive issues. However, it is not always the answer to 100-percent of symptoms.  Lifestyle factors like stress management, sleep, and physical activity should also be part of your digestive symptom treatment for comprehensive relief. And if that is not enough, then it is important to visit a qualified healthcare provider to get tested for other possible causes of your symptoms.

 

Written by Staci Gulbin, MS, RD a Board-certified dietitian.


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