What are FODMAPs?
FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols. Remembering this is not important. Quite simply, FODMAP stands for a new class of carbohydrates noted to trigger gastrointestinal symptoms in irritable bowel syndrome. It can also trigger symptoms in some patients with Crohn’s disease, Ulcerative Colitis and Coeliac disease. FODMAPs are poorly absorbed and rapidly fermented in the gut, increasing water and gas delivery through the bowel.
Do I need to have breath tests in order to determine if I should follow a low FODMAP diet?
No – please don’t.
Hydrogen/methane breath testing has been used for some time to confirm or deny the possibility that malabsorption of fructose (or other sugars) is contributing to gut symptoms. Since they became commercially available, the research now demonstrates that fructose and other FODMAP carbohydrates can be symptom triggers regardless of breath test outcomes and as such we no longer recommend breath testing.
There is a role for lactose breath testing to determine if lactose is a trigger, but our dietitians can also help you conduct dietary elimination and challenges to answer this question.
Breath tests are expensive and there are many practitioners still referring their patients for up to 6 breath tests which can cost in excess of $600. So please, save your money. We can help you work out your FODMAP triggers in a much more pleasant way!
I have been diagnosed with fructose malabsorption and the advice on the internet is so confusing. What can I eat?
Firstly, fructose malabsorption is one component of the FODMAP diet. Those that require fructose restriction, almost always require restriction of other FODMAP carbohydrates. In the end most patients require an individualised form of the low FODMAP diet.
The fructose malabsorption and low FODMAP diet information available online is unreliable. The diet is still evolving, with new foods tested daily. Monash University undertake FODMAP food testing and share the results through their Monash FODMAP app, but again, this information is not to be used without dietitian guidance.
During your consultation, the dietitian will examine your usual diet, symptom type and frequency, suspected food triggers to determine the level of FODMAP restriction required. They will then educate you on a low FODMAP diet, with rechallenges to be undertaken after 2-4 weeks to learn how to relax the diet long term whilst still controlling your symptoms. It is important not to stay on a low FODMAP diet long term as there are implications for gut health, so reintroductions will be encouraged.
My breath tests for fructose and lactose malabsorption were negative. Is there anything that can be offered from a dietary point of view?
Absolutely! A positive or negative breath test does for fructose does not dictate what a dietitian recommends. Your lactose outcome will be considered and is helpful in refining your dietary approach, but your fructose breath test is not useful. The dietitian will consider fructose and other FODMAP carbohydrates within your diet and determine a low FODMAP diet individualised to you with appropriate reintroductions.