How the FODMAP approach could help your gut symptoms

Posted on August 5, 2020 by

Athletes who experience symptoms in their gut such as abdominal pain, cramping, diarrhoea, constipation or bloating know how frustrating it can be to live each day not knowing what their stomach is going to do.

If this is you and you have unexplained gut symptoms, it is something that should be investigated by your doctor and dietitian.

There are several potential causes including:

  • Food intolerances
  • Allergies
  • Stress
  • Other serious clinical gut conditions
One factor which could be considered when faced with unexplained gut symptoms is irritable bowel syndrome (IBS). Irritable bowel syndrome is a condition diagnosed via exclusion of other conditions and using the gut symptoms presented.

IBS is known to affect at least 7-15% of the global population, with many more thought to be undiagnosed. It’s a condition that doesn’t discriminate, so addressing symptoms is important to ensure athletes can consistently train and compete at their best.

Symptoms of IBS might lead to discomfort or malabsorption of food, which may result in fatigue or lethargy that can impact athletic performance.

Furthermore, frequent visits to the bathroom can take the athlete away from valuable training time.

Identifying the source or contributing factors to irritable bowel syndrome or gut symptoms can be done through what is called the FODMAP approach.


The FODMAP diet

It can be easy for athletes to identify what a protein or carbohydrate-rich food is. However, carbohydrates come in different types, and some are deemed ‘fermentable carbohydrates’ which might impact your gut.

The term, “FODMAP”, stands for Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols (you can see why it needs an acronym). This refers to a group of fermentable carbohydrates found across a wide variety of foods including fruit, vegetables, grains, nuts, seeds and dairy.

See the table below for examples of foods that are both high and low in FODMAPs:

  • Apple
  • Pear
  • Watermelon
  • Onion
  • Garlic
  • Mushrooms
  • Cauliflower
  • Bread (wheat-based)
  • Pasta
  • Falafel
  • Baked beans
  • Cashews
  • Cow’s milk
  • Yoghurt
  • Honey
  • Fruit juice
  • Orange
  • Banana
  • Kiwi fruit
  • Green capsicum
  • Tomato
  • Potato
  • Carrot
  • Cucumber
  • Spelt sourdough bread
  • Gluten-free pasta
  • Rolled oats
  • Rice
  • Quinoa
  • Lactose-free milk
  • Maple syrup
  • Peanut butter

*Note: some foods may be tolerated in small amounts but not large amounts.


How are FODMAPs relevant in IBS?

There is strong evidence demonstrating a link between FODMAP intake and the occurrence of gut symptoms in susceptible people who are unable to successfully digest these types of carbohydrates.

There are six different types of FODMAPS:

  • Lactose
  • Fructose
  • Fructans
  • Mannitol
  • Sorbitol
  • Galacto-oligosaccharides

Individuals may be intolerant to one or more of them.

FODMAPs play a role in IBS due to their poor absorption and/or fermentation in the intestines, which can both independently produce IBS symptoms. Therefore, by reducing or eliminating FODMAP intake, symptoms may be alleviated. Research has found that adhering to a low FODMAP diet can reduce IBS symptoms in up to 80% of IBS sufferers.


How does the FODMAP diet work?

As IBS symptoms may be induced by one or several of the FODMAPs, determining which FODMAP/s are the triggers is important to ensure dietary diversity can be maximised. This can be achieved through an elimination and reintroduction process.

The initial phase entails eliminating all FODMAPs from the diet for 3-6 weeks until symptoms are reduced. If symptoms don’t change after the initial elimination, it is unlikely that FODMAPs are the cause. However, if they do, the next phase involves a reintroduction process via “challenging” each FODMAP in high doses and monitoring symptoms – if gut symptoms occur, it indicates an intolerance.

It is important to note that a low FODMAP diet is not a long-term dietary approach, but merely a diagnostic tool. Due to its restrictive nature, following a chronically low FODMAP diet can result in nutrient deficiencies and a sub-optimal gut microbiome (both bacteria diversity and richness). Therefore, once the specific FODMAP triggers are identified, it is important to liberate the diet and reintroduce those groups that were tolerated well. An Accredited Practising Dietitian can guide you through this process.


Why should athletes consider FODMAP intake?

FODMAPs are found in carbohydrate-rich foods so it may feel confusing that not all carbs are good to include for performance. As carbohydrates are a fundamental component of the athlete’s diet to fuel training and competition, it is important that athletes with IBS are aware of low FODMAP carbohydrate options to support performance and recovery.

Following this approach needs extra time and attention to preparation and making sure appropriate food is available when you need it. When travelling for sport specifically, it is crucial to ensure appropriate low FODMAP options are accessible while commuting and at the destination.

We advise athletes work with an Accredited Sports Dietitian to ensure the IBS is managed appropriately, nutrient quality is maximised and performance is optimised if FODMAP elimination is indicated and make sure this is the right approach for you to take to manage any gut issues.


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