The FODMAP Diet and Gut Health: An inside look and Q&A with Kate Scarlata, RDN
Food – while delicious, nutritious, and wonderful – can also be a very common trigger for digestive issues, particularly for individuals living with irritable bowel syndrome (IBS). For some sensitivities, dietitians and doctors recommend restricting certain foods from your diet, particularly ones low in fermentable carbs known as FODMAPs.
But not many know exactly what a FODMAP is…
To answer all your FODMAP questions, we reached out to Boston-based registered dietitian Kate Scarlata. Kate is a world-renown digestive health expert who specialized in treatment for IBS, celiac disease, inflammatory bowel disease, small intestinal bacterial overgrowth (SIBO) and more.
The following responses were shared with FLIK via e-mail.
Tell us about your background and career path that led you to where you are today.
I have been working in the field of nutrition as a registered dietitian for over 30 years. I absolutely love my job! I have worked in a variety of settings from inpatient to outpatient hospital work, to corporate wellness, to ultimately owning my own consultation practice. I have been an invited speaker nationally and internationally. I have written and co-written a number of books and am fortunate that one of them is a New York Times Best Seller! Early in my career, I was a bit of a jack of all trades dietitian—working in disease prevention and management. This afforded me a solid foundation of nutritional science. After I experienced a small intestinal resection while pregnant with my now, 24 year old son, I became personally and professionally invested in the gut and digestive health space. This area of nutrition and health is very complex, extremely interesting and I believe, all dietitians should be following this science. What we eat plays a key role in what gut microbes inhabit our colon and ultimately how they impact gut health and beyond.
The FODMAP diet is something that is becoming increasingly well known to the general public. Can you explain what FODMAPs are and how the FODMAP diet works?
The low FODMAP diet is a 3 phase nutritional approach utilized in individuals with irritable bowel syndrome (IBS). It is a treatment strategy to help manage debilitating digestive symptoms. The term FODMAP stands for:
F-ermentable (creates gas)
O-ligosaccharides (small fibers found in wheat, onion, garlic)
D-isaccharides (lactose, milk sugar)
M-onosaccharide (fructose when in excess of fructose in a food; examples: honey, mango, agave syrup)
P-olyols (sugar alcohols-such as mannitol and sorbitol found in sugar free gum and mints as well in food naturally such as in peaches, plums, cauliflower, button mushrooms)
FODMAPs are small carbohydrates that are commonly malabsorbed in the small intestine. They can pull water into the gut and are rapidly consumed by our gut microbes resulting in lots of gas! The water and gas can lead to stretching of the gut which can trigger pain, cramping and alteration in bathroom habits—key features of IBS. The 3 phases of the low FODMAP diet are outlined here:
For a quick overview of the low FODMAP diet 101, check out this handout.
Who should be following a FODMAP diet and what recommendations do you have for someone who thinks they might benefit from it?
The diet is geared toward the 15-20% of Americans that have severe digestive distress with irritable bowel syndrome (IBS). Not all individuals with IBS will benefit from the diet--- about 50-70% of those with IBS will experience significant benefit in their gut symptoms. Most Americans (about 85%) do not need to modify FODMAPs because they do not have IBS. In fact, FODMAP carbohydrates are found in many innately healthy foods that should be enjoyed if they don’t bother you! It’s also important to note that the low FODMAP diet is fairly restrictive and is not indicated in someone that already struggles significantly with food fears or an eating disorder.
Gut health is a trending topic and it seems like more and more products are becoming available to consumers that tout the connection to improving gut health. Can you talk a little bit about why gut health is so important and how nutrition is related?
More and more scientific studies are linking the types of microbes and their activities in our gut to health or conversely to disease. The balance of the types of microbes and the overall diversity of microbes appear to be related to positive health outcomes and less risk for disease. Consuming a variety of plant-based foods (whole grains, nuts, seeds, fruits and vegetables) to provide a variety of fibers and prebiotics (food for our healthy promoting gut microbes), appears to play a key role in maintaining a good balance of healthy microbes as well as keeping our intestine in good health (help maintain a protective barrier layer).
If you’re someone looking to include pre- or probiotics in the diet, are there certain foods that are better than others?
Prebiotics by definition are food for our probiotic (healthy promoting) microbes. This science is a full of nuances and recommendations--and ultimately will likely be individualized in part because we each have our very own, ‘fingerprint’ of microbes in our gut. I dive a bit deeper into this topic here. As a general rule fructans, found in wheat, garlic and onion, galacto-oligosaccharides found in beans, cashews, pistachio nuts, and resistant starch found in unripe banana, cooked and cooled rice or potato, and uncooked oats (think overnight oats or energy bites), are key prebiotic fibers to incorporate into your diet per your personal tolerance. Note: beans, cashews and pistachio nuts are sources of FODMAPs.
If you decide to include a probiotic supplement, how do you know which type to choose? Is it better to get probiotics from food or from supplements (or both)?
I always favor foods over supplements when it comes to nutrition—but this area is a bit more difficult to tease out. Personally, I tend to go for Greek yogurt as my prime probiotic source. But it is important to note, some bacteria used to ferment food—may not fit the definition of probiotic. Not because they are not healthy for us—but simply because we don’t have data on many of the wild forms of microbes used in fermented foods. And by definition a probiotic microbe is known (i.e. has science to back its benefit) to confer a health benefit. For supplement sources of probiotics, my go to resource for probiotic selections is this site.
As more and more probiotic supplements hit the market, you might think that eating a probiotic-containing food at every meal would become more of a reality for most people. In other words, you could be drinking kombucha at breakfast, eating sauerkraut at lunch, and snacking on kimchi at dinner. Are there diminishing returns at a certain threshold?
Good question and we don’t know. I do believe that we will see more definitive research in this area. I provided a recent post on the science and potential nutrition benefits of fermented foods here. I do believe there is a health promoting role of fermented foods—as fermentation can enhance the nutrition, may offer probiotics and in some cases such as in slow-leavened sourdough bread, may make the final product easier to digest by reducing some FODMAP carbohydrates. There are other considerations that fermented food lovers should be mindful of—some fermented teas contain a fair amount of sugar, some sauerkrauts and fermented vegetables can provide a hefty sodium dose, and like most things in the nutrition realm—we don’t know the impact of over ingesting live microbes.
What do you think is the most important thing someone can do to improve his or her gut health?
- Eat a variety of colorful plants per day—we know the polyphenols have a positive impact on our gut microbiome. Polyphenols are the plant components, often function as antioxidants and can have prebiotic functions too.
- Choose whole grains over refined when possible to boost a variety of fibers
- Incorporate fermented foods at least a few times per week
- Enjoy prebiotic rich fibers such as resistant starch (cooked and cooled rice, unripe banana, uncooked oats such in muesli, overnight oats or energy bites, fructans (wheat, onion, garlic, leeks) and galacto-oligosaccharide (beans and nuts) containing foods to your gut’s content. (Note: during the low FODMAP diet stick with resistant starch for the potential prebiotic effect as fructans and galacto-oligosaccharides are FODMAPs)
As with most nutritional interventions, the low FODMAP diet is best implemented with a registered dietitian nutritionist (RDN) with expertise in this approach. An RDN can provide personalized low FODMAP nutrition education from meal planning, grocery shopping and label reading. Moreover, a RDN can ensure all 3 phases of the low FODMAP diet are applied to allow for the most liberal diet that manages symptoms effectively.
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