FODMAP Sensitivity - The Most Annoying Food Restriction
“What in the hell is a FODMAP?”
This was my question after hearing from a doctor that FODMAPs may be the cause of my mysterious, years-long digestive struggles.
Now seven years after my FODMAP awakening, I am here to proclaim that I think it is the most annoying and trickiest food restriction to manage. No disrespect to my lactose and gluten intolerant brothers and sisters out there, but at least most restaurants these days have alternate menus or symbols that signify what you can and can’t eat. When I ask waiters if they have any dishes without garlic or onions, they usually laugh or roll their eyes.
But let me start at the beginning…
My challenges started in my early twenties. I started to feel very bloated very often. This bloating was accompanied with pain and an urge to use the restroom but without results. The bloating and constipation would last for hours and even days. I was getting quite discouraged.
I didn’t get it. I was eating healthy - mostly fruits, vegetables and meats. Finally, after feeling generally shitty for a few years, I decided to see my primary care physician (PCP). This guy came to the conclusion, in under five minutes and without any testing, that I needed to use probiotics. So I started taking probiotics daily. This alleviated some symptoms for a while, but after a year of still feeling not great, I decided to go back to the same doctor. This time, he concluded, again in under five minutes with no tests, that I had too much acid in my stomach. So he told me to take Prilosec (an anti-acid, heartburn medication) every day. So I did that. For another year. Yet again, after some initial pain relief, my symptoms returned.
I decided to seek medical help again, but this time ditched the (former) PCP for a specialist - a gastroenterologist (GI). He first had me test for SIBO (small intestinal bacterial overgrowth) - finally someone willing to test for an issue rather than just throw a random “solution” at me. Unfortunately (fortunately?), I tested negative, so my issue remained a mystery. It was then that he concluded that I had Irritable Bowl Syndrome (IBS).
At last, someone had a diagnosis. Excited to finally be on the right track, or at least a track, I asked about the cause of IBS and how to cure it. Well…it turns out that there is no known cause or cure. Fantastic.
But, the nice enough GI doc recommended the low-FODMAP diet.
So…what in the hell is a FODMAP?
FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols) encompass a group of fermentable short-chain carbohydrates (sugars). They are classified into four main categories: oligosaccharides, disaccharides, monosaccharides, and polyols. Each category can be broken down into subgroups that consist of specific types of sugars and fibers that can be poorly absorbed in the small intestine by some people notoriously triggering digestive symptoms such as bloating, gas, and abdominal pain. These subgroups include (with some examples of foods where they’re found):
Oligosaccharides:
Fructans: Found in garlic, onions, wheat, rye, leeks, asparagus, artichokes, and some legumes.
Galacto-oligosaccharides (GOS): Present in legumes like chickpeas, lentils, and beans.
Disaccharides:
Lactose: Found in dairy products such as milk, yogurt, and soft cheeses.
Monosaccharides:
Fructose: Present in honey, apples, pears, mangoes, watermelon, and high-fructose corn syrup.
Excess Fructose: When the ratio of fructose to glucose is high, it can be problematic. Foods with excess fructose include certain fruits like apples, pears, and sweeteners like honey and agave nectar.
Polyols:
Sorbitol: Found in stone fruits like cherries, peaches, and plums, as well as some sugar-free gums and mints.
Mannitol: Present in mushrooms and cauliflower, and can also be used as a sweetener in some sugar-free products.
Some people, like yours truly, have a tougher time digesting a variety of these FODMAPs than others. The only way to figure out which of the FODMAPs you’re sensitive is to do a very restrictive elimination diet where you cut out all FODMAPs, then to start reintroducing potential trigger foods one FODMAP at a time. It sucks. But, it doesn’t suck nearly as a bad as being constantly bloated.
So after going through my elimination diet, I determined that I really only had an issue with one subgroup - fructans. That means I can eat lactose, fructose, sorbitol, mannitol and (some) galacto-oligosaccharides pain free! Great news, right?
Yes, but fructans are in a variety of fruits, vegetables, legumes and grains, and the main two villains in this category for me are onions and garlic. This was devastating news to my Greek tastebuds. Not only because I LOVE onions and garlic, but also because they are in EVERYTHING.
Most sauces and condiments contain one or both (this includes garlic and onion powder). Don’t believe me? Go to the grocery store and try to find a condiment, salad dressing, marinade, etc. without one or both. Good luck.
So that was challenge number one, but I’ve learned to cook at home without my former favorite staples (more on that later).
The second and much more difficult challenge is eating out. It is such a pain both physically and emotionally. As mentioned before, the look, laugh, or eye roll I get from waiters when I ask if they can make a dish without onions or garlic is tough enough, but the real soul crusher is when I finally receive that beautiful looking bowl of bolognese over pappardelle and find it to taste rather…bland.
You might think, “Well yeah, Michael, you were ordering food at an Italian restaurant. Surely there are other types of cuisines that aren’t known for heavy garlic and onion use.”
Oh yeah? Which ones?
Mexican - sure, easy enough to ask sin cebollas, but good luck finding a pico de gallo sin cebollas. Or a salsa. Or any meat that hasn’t been marinated with garlic.
American - sandwiches, salads, and burgers are sometimes ok. Just don’t count on that tasty dressing, or the cold cuts, or that crunchy onion on top of the burger. And this is assuming the burger is prepared without using onions/garlic.
Japanese - sushi is doable, just make sure to ask no onions/garlic. Forget about ramen.
Mediterranean/Indian/Chinese/Thai/Middle Eastern - lol
You get the point. It’s hard. But I’m not here just to complain.
If you determine that you are also fructan sensitive, there is a way forward!
First, with cooking at home - learn how to flavor dishes without onions and garlic. It might seem tough at first, but here are two cheat codes for you:
Fructans don’t transfer in oil, so if you sauté onions/garlic in oil but then remove the onions/garlic, your oil will retain the flavor without the fructans. Enjoy! If you are trying to save time, you can buy oil that is pre-infused with the flavor. My favorite is Garlic Gold.
The green part of green onions, chives and leeks are safe to eat, but do not use the white and bulb parts. This way you can infuse some onion flavor into your dishes without the pain.
Second, with eating out - don’t be discouraged by the reactions of the wait staff. Be confident and steadfast about what you can’t eat. I know it’s tough, and I know you think you can just suck up the pain, but don’t do it! My hope is that if more of us start to vocalize our sensitivity then restaurants and society will begin to take notice. One day we might have our own symbols on the menu to signify what’s safe for us to eat. (If you find yourself out and simply unable to avoid eating trigger foods, you can try this digestive enzyme powder. I use it every once in a while when in a pinch. It’s not perfect, but it definitely helps)
I’ve learned that with my particular sensitivities, if I avoid onions and garlic, I feel pretty great about 95% of the time. While that’s about way better than I used to feel, it’s not 100%.
I am still on the hunt for a cure. I’ve tried probiotics, prebiotics, sporebiotics, celery juice, hot lemon water, apple cider vinegar, just to name a few.
I haven’t found the magic bullet yet, but I will. Until then, my slightly restricted diet will have to do.
If you’re having similar struggles and haven’t found a solution, please reach out. I’d love to share more of what I’ve learned and hopefully help find you some relief.
As always, Live With Pine.