Gassy? Bloated? Constipation? How to Treat - The FODMAP Diet

This article is a transcribed edited summary of a video Bob and Brad recorded in February of 2021. For the original video go to https://www.youtube.com/watch?v=22NHTTkQtr4&t=52s


Bob: I'm Bob and this is Mike, who's joining me today. He's going to help me out here because we both have had experience with this title today, Gassy, bloated, constipated, how to treat. And we both, individually went on the FODMAP diet. Let's just say right at the start here, Mike, we're not dieticians, or nutritionists.


Mike: I'm a PT assistant who's worked with Bob, so that's how we know each other.


Bob: And I'm a physical therapist. So we're not experts on this but we're here to tell our personal experiences, and our approach about using the FODMAP diet, and I think it could be very helpful to you in the end.


Mike: Yeah.


Bob: So, Mike, what do you want to talk first about? I want you to tell me what your symptoms were and why you even looked at the FODMAP diet.


Mike: So for me personally, it was a lot of uncomfortable amount of bloating and gas, and it would get worse throughout the day. So I've done different eating styles over the years. When I was young I didn't really know what caused it. It wasn't terrible, I just thought I was a gassy person.


Bob: You've had it a long time.


Mike: Yeah, and then when I got older, I was eating more cleaner foods, but still getting a lot of gas. And the joke is, you know, when you're eating more protein, it's protein farts, when you're a kid. But honestly, it's not that at all, when you start to look into it.


Bob: No its not.


Mike: It's carbohydrates fermenting in your stomach. So for me, it was never like IBS symptoms or anything terrible like that, or like I don't coeliac disease or anything. But for me it was just, it gets uncomfortable. And if you live with someone they really don't want to be around you, you know, if you're having all this gas basically.


Bob: Yeah, and I think this is a good time to say here, Mike too, this isn't about eating healthy versus non-healthy. There's a lot of healthy, almost all our FODMAPs are healthy foods.


Mike: Yeah, there's a wide range of foods which are good to eat or not good to eat. And then everyone's going to be different, which foods they can and can't eat.


Bob: Now, my symptoms came on like over a period of like two or three months, and just recently.


Mike: Yeah.


Bob: So it was a way different situation than Mike's. But it would like every day around two o'clock, it seems like it would start picking up.


Mike: You had a time?


Bob: Well I did, and I don't know if my mind started creating that time but it would go until almost till bedtime. I thought it was miserable, Mike. I mean, it's the same symptoms you had, But I mean, I was like, who can live like this? I couldn't lie on my stomach, like when I would read, I couldn't really concentrate really very well either.


Mike: Yeah, it's very distracting.


Bob: It is.


Mike: And it's like, you almost have to plan not to be around people as the day goes on, if you're having gastrointestinal issues like that.


Bob: It definitely can increase anxiety and stress. Like, I would start getting stressed out around two o'clock, that's true, because I knew what's coming on.


Mike: Yeah, and this can happen from like people that are eating, you know a standard American diet can have it, people eating you know, any style that you want, low carb, high carb, it doesn't matter. Some of these FODMAP foods are in every genre. It's not just like, only this does it, only that does it, like there's a list of foods. You can do numerous diets and do FODMAPs, I should say.


Bob: Yeah, so you could be a vegetarian and do FODMAP, a little more difficult, but you certainly can do it. Let's talk about what FODMAP is. First off, it's basically your body is not processing carbs very well.


Mike: Yep, they're fermenting in your stomach essentially. Do you want me to read what it is?


Bob: Yeah, why don't you read that.


Mike: So this is from Monash university. They are basically the university in Melbourne Australia that coined the term FODMAP. You can go to their site, they also have an app. According to their site, FODMAPs are a group of sugars that are not completely digested or absorbed in our intestines. So when FODMAPs reach the small intestine, which is right after the stomach, it goes into the small intestine, they move slowly attracting water. When they bypass into the large intestine, which is also known as your colon, if you're curious. FODMAPs are fermented by gut bacteria producing gas as a result. So the extra gas and the water cause the intestinal wall to stretch and expand. So this is known as bloating for us. Because people with IBS have a highly sensitive gut, stretching the intestinal wall causes exaggerated sensations of pain and discomfort. So this is commonly used for people with IBS.


Bob: What you should say is Irritable bowel syndrome.


Mike: Yeah, which we're not diagnosed with IBS.


Bob: It's hard to be diagnosed with it actually. Sometimes it’s by omission, you know that it wasn’t another things, so they call it IBS. So, and inflammatory bowel disease, same thing.


Mike: Yeah, there's a lot of these stomach issues, FODMAP come help. Like I know people with Crones have also looked at it, SIBO.


Bob: S-I-B-O.


Mike: It's another one.


Bob: Gastro intestinal sensitivity.


Mike: Yeah.


Bob: Just like what you kind of alluded to. Well right now we should tell you though, the studies had showed that it helped like 85% of the ones with IBS. So I mean, there's a good chance this is going to help you. It definitely helped us two. And my daughter had stomach issues for years I actually was thankful that I got this because I passed it onto her. And she's finally, she says, it's the best it's felt in years. It's finally getting over it, so.


Mike: They do say like 15% of the world's population has IBS.


Bob: That's one out of seven, yeah.


Mike: And then like they said, you know typically three out of four people have success. So, you know, there is like a small percentage of people that don't find a lot of benefit, but it helps most people.


Bob: So obviously there's different numbers out there because I had said 85% and I also saw three out of four too.


Mike: Oh yeah, I mean, 75, 80% of that.


Bob: Right, I think part of it is that, all people that have IBS don't even know it sometimes.


Mike: Yeah, I mean, I didn't know what it was called. I just thought I was a gassy person.


Bob: I mean, you know, it's miserable. It really is. I can't say that enough. I just thought it really affects your life. It affects whether you go out, it affects your anxiety levels. So, why don't we talk about what FODMAP stands for? F-O-D-M-A-P, I can start with the F. It's the fermentation. So you're fermenting the carbs and they give off carbon dioxide, methane and hydrogen, which is gas, gas, gas.


Mike: Yeah.


Bob: So, yeah, again, for me, I felt like I always had to go, have a bowel movement.


Mike: Oh really?


Bob: Yeah.


Mike: Mine didn't feel like that.


Bob: And I never would. You know, I'd go on to the toilet and it would just be gas.


Mike: Yeah.


Bob: So, all right. How about the O?


Mike: So the O stands for oligosaccharides. Oligosaccharides are known as fructans or galactans. So these are typically found in wheat, rye, legumes, various fruits and vegetables, such as garlic and onions. So all these saccharides, they're going to be numerous of them. Oglio means there's a few. The next one is disaccharides. Di Means two. So disaccharides is the D, that is lactose.


Bob: Yeah, that's mainly lactose, I think they kind of talked about, was this sucrose too, was that?


Mike: That's a different one.


Bob: That's a different one, okay. There was one other thing that really wasn't a problem though.


Mike: Yeah, lactose, you know, that's in your milk, your yogurt, your soft cheese, most people know that's lactose intolerant. This is technically part of FODMAP. Next would be monosaccharides. So this is fructose, found in various fruits including figs, mangoes, sweeteners, such as honey, Agave Nectar, where fructose is your main carb source.

Bob: The other one is high fructose corn syrup which is, I'd be honest, you shouldn't be eating any way. I mean, that's one ingredient you should avoid all the time from a health standpoint. But, yeah, that's the one you'll have to look for in the ingredients.


Mike: So now we're on letter A, that just for and.


Bob: And there we go.


Mike: P is polyols. So this is known as sorbitol or mannitol. Those you often see ingredients in like sugar-free gum or mints like that. They're also found in stone fruits or they're also known as drupes. But they include stuff like avocados, peaches. A stone fruit is typically a fruit that has a large pit, essentially, if you want to look into that.


Bob: So yeah, polyols are sugar alcohols, but it's basically any ingredient with the itol. You know, mannitol, xylitol, sorbitol, right. So, you know, we should say right now like, well, all these foods, how am I going to know what to do? Now, you put down in the comments a list, I mean, you can Google it too. You're going to find a list.


Mike: Yeah, you just look up low FODMAP, is what you want to eat if you have these problems and high FODMAP are the foods you typically want to avoid. So what they recommend is sticking to the low FODMAP foods for four to six weeks, roughly and then try to add certain high FODMAP foods back in that you like and see how your body reacts because some of those high FODMAP foods aren't going to affect everyone the same. So it's like, it's an elimination at first. And then you put back in what doesn't cause these symptoms, essentially.


Bob: Yeah, and you have to watch portion control too. That's very difficult. And I want to say right here, Mike, that a lot of times you're going to find discrepancies and people saying how much they should use and should not use. I always relied on Monash as the reliable authority. They are they're the ones that had done the testing on it. They actually have an app, you just look up Monash in the app. And I got the app. It was definitely worth it. My daughter got it. It's on your phone then no matter where you're at you can just push on it, it has fruits, vegetables, everything in there you can find it really. It's got recipes in there. It tells you exactly how much you can have. Like almonds is a good example. There are galactans and you can have 10 almonds.


Mike: Yeah, some of them are limited. So like, for me, I primarily eat keto now. So there's not as many options on keto, so that just naturally helped a lot of these FODMAP issues. But there are some foods I eat that are high FODMAP. Like I eat almonds and cashews and stuff. I eat nuts. They don't really bother me. Avocado is technically a high FODMAP, and that is a pretty big staple in my diet. So all I do is I like half or one at a time. I may get a little bloating, but it's not like I'm uncomfortable. It's like a natural amount. And even if I produce gas from it, it doesn't have like an odor.


Bob: The methane.


Mike: Yeah, the methane odor is what happens with FODMAP.


Bob: When you really have a smell and it's likely the methane, a byproduct that's not getting absorbed. And so, you know, one thing you should know about this too is that relief is fairly rapid. If you start this, you're going to be motivated to continue on it. Because I started getting some relief within a day or two, and then I wasn't being really strict. And it was same with my daughter, she wasn't being really strict. And so it was like just kind of hanging in there yet. And then I got really strict and then it went away. I mean, you know I don't know you're going to be 100% better in seven days, but you're going to be so much better.


Mike: Yeah, I believe on their site on Monash site, it said typically within two weeks, people will notice a lot of change. And when you do reintroduce foods, they say, just do one. Don't like try to add three things, because you're not going to know which one causes the problem.


Bob: And you also, this is one thing I found out and this kind of messed with my daughter, is that, if the food is affecting you, it's not going to affect you like right after the meal. It's going to take like four to six hours. So it's something that you ate four to six hours ago or even a day before. If it's affecting you right after the meal, that's not FODMAP, that's something else. You might have some type of sensitivity or something, some issue going on but it's definitely not FODMAP. So again, you can also go online make a copy of the foods, or you can get the app.


Mike: Yeah, and they're broken down into every category, so it'll be, you know, fruits, vegetables, grains, oils, meats, whatever, milk and stuff. And they'll have like alternatives to say you have something you really like, it'll give you alternative options as well.


Bob: Yeah, now like we said, it's a two phase thing, the elimination phase. I had a book, Mike, that actually talked about just doing the elimination phase for like seven days even. So, I mean, you don't necessarily have to go the six to eight weeks, but you know you can experiment. I think I went like three to four.