Irritable bowel syndrome, or IBS, is a medical condition affecting the functioning of our bowels and is one of the most common functional gastrointestinal disorders seen in children. Pain or cramping in the abdomen, bloating, constipation, diarrhea, straining, and soiling are the typical symptoms associated with IBS. In children with irritable bowel syndrome, certain foods can trigger their symptoms.
In that case, pediatricians often recommend following a low-FODMAP diet. This article will address what FODMAPs are, how a low-FODMAP diet can help children with IBS, and its risks.
What Are FODMAPs?
FODMAP is an acronym coined by scientists at Monash University, Australia, which stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These are carbohydrates, or sugars, found in the food we eat.
FODMAP sugars include oligosaccharides (fructans and galactooligosaccharides), disaccharides (lactose), monosaccharides (fructose), and polyols (sorbitol and mannitol).
Scientists have found that our small intestines find these carbohydrates hard to absorb or digest. This leads to drawing more water into the gut, which means carbohydrates are osmotically active.
Later, the sugars reaching the colon get rapidly fermented, producing more gas. The excess fluid and gas may cause symptoms including abdominal pain, cramps, flatulence, diarrhea, bloating, and constipation.
FODMAPs are not unhealthy, but they have the potential to worsen symptoms in people with sensitive digestive systems.
What Foods Are High And Low In FODMAPs?
Most food items, including fruits, vegetables, grains, plant-based proteins, and dairy, contain FODMAPs. Below are some of the foods that are high and low in FODMAPs.
- High FODMAP: Avocados, apples, peaches, watermelon, pears, and mangoes contain high fructose, sorbitol, and mannitol content.
- Low FODMAP: Grapes, strawberries, oranges, bananas, blueberries, pineapple, and kiwi are healthy alternatives with low FODMAP content.
- High FODMAP: Cauliflower, mushrooms, garlic, green peas, and onions are high in FODMAPs.
- Low FODMAP: Green beans, carrots, potatoes, tomatoes, bell peppers, broccoli, eggplants, cucumber, kale, lettuce, radish, zucchini, etc. contain very low FODMAPs.
- High FODMAP: Cow’s milk, yogurt, heavy cream, and any product with milk as the main ingredient contain high lactose content.
- Low FODMAP: Hard cheeses, lactose-free milk, feta cheese, and lactose-free yogurt are low-FODMAP alternatives.
- High FODMAP: Wheat, rye, and barley are high FODMAPs.
- Low FODMAP: Gluten-free bread, pasta, oats, rice, quinoa, soba noodles, and tortillas are low-FODMAP alternatives for grains.
Low-FODMAP diet and its role in managing IBS symptoms in children
The low-FODMAP diet focuses on limiting the intake of high-FODMAP foods. This diet is recommended for people, including both adults and children, with digestive disorders like IBS. It consists of three phases, namely elimination, reintroduction, and personalization.
Phase 1: Elimination
In this phase, you would be advised to stop giving your child foods high in FODMAP for about 2 to 6 weeks. And we expect improvement at the end of this period. Sometimes it may take longer to notice the changes. In that case, doctors would extend this by 1 or 2 weeks more.
Phase 2: Reintroduction
If the symptoms improve, we move on to the second phase, which is reintroduction. As the name suggests, doctors recommend the reintroduction of one FODMAP at a time. This allows them to identify which one of the FODMAPs is causing the symptoms.
If your child’s symptoms get worse with any of the FODMAPs, doctors would suggest taking a break before reintroducing another one. At the end of this phase, we will get to know which food items our child can tolerate and which ones cause digestive distress.
Phase 3: Personalization
Once we have identified the foods that trigger the symptoms, doctors will then chart a diet according to your child’s needs. Doctors may limit or recommend completely avoiding the FODMAP group that created the problems. This allows your kid to enjoy the others without worrying about the symptoms.
According to the reports, about 80 percent of the children with IBS and other digestive illnesses have shown noticeable improvements with low-FODMAP diets.
Risks Of Low-FODMAP Diets
The major risk of a low-FODMAP diet is nutrient deficiency. As kids are constantly growing, limiting certain foods in their diet can be a concern. That is why we should consider working with doctors or registered dieticians to chart a healthy diet for your child.
The carbohydrates present in FODMAP are often hard to digest, osmotically active, and rapidly fermented. In children with gastrointestinal and digestive disorders like IBS, these carbohydrates are said to cause several digestive issues.
Under such circumstances, doctors recommend low-FODMAP diets to alleviate the symptoms. However, it is detrimental to follow such restrictive diets in kids who are already healthy or are underweight. Hence, it is always best to talk to your child’s physician before making any changes in their diet.