FODMAPS: Are they a solution to a common problem in elite sport?
By Dr Sharon Madigan, Head of Performance Nutrition, Sport Ireland Institute, @madigan_sharon.
Reprinted with permission from British Association for Sport and Exercise Sciences (BASES) magazine.
Irritable bowel syndrome (IBS) is a chronic gut disorder which affects significant numbers of people in the general population (Lovell & Ford, 2012) with athletes not immune and many also reporting Gastrointestinal (GI) symptoms. Functional gastrointestinal symptoms such as abdominal pain, bloating, distension, constipation, diarrhoea and flatulence have been reported in varying degrees of severity by individuals with IBS. For elite or sub-elite athlete’s symptoms such as these can have a serious effect on training and competition never mind the day-to-day impact. Training the gut to deal with significant increases in carbohydrates and the overall volume of food can help some athletes overcome some symptoms but for others, underlying symptoms still prevail which in turn can lead to further anxiety which does not help the underlying IBS. A real vicious cycle.
IBS has been linked to a number of lifestyle choices and for some dietary manipulation can play a major role in symptom management. Many sufferers report problems with specific foods, most commonly implicating milk and milk products, wheat products, caffeine, cabbage, onions, peas/beans/lentils, hot spices, fried food and smoked products as the most common offending foods. As a consequence, many individuals including athletes who suffer will limit or exclude foods that they perceive as problematic from their diet (Monsbakken et al. 2006; Lis et al. 2014)
Carbohydrates are an essential macronutrient and are especially important in the dietary practices of elite athletes. For most athletes, dietary advice for performance will focus on the manipulation of carbohydrate intakes especially around training and competition. A number of short-chain carbohydrates are poorly absorbed so that a significant portion of the ingested carbohydrates enter the small bowel and colon. There they increase the osmotic pressure and provide a great fuel for bacteria to ferment. This in turn results in gas production, distension leading to abdominal discomfort or pain.
These carbohydrates were given the acronym “FODMAP” by the Monash group in Australia in 2004 (Gibson 2017) and include fructose, lactose, sugar alcohols (sorbitol, maltitol, mannitol, xylitol are examples), fructans and galactans. Fructose and lactose are present in apples, pears, watermelon, honey, fruit juices, sports gels and bars, dried fruits and milk and milk products. Polyols are used in low calorie food products and some sports supplements. The increase in these sugar alcohols has in part been as a result of the popularity of sugar free products of which often they are added to. Galactans and fructans are present in such common dietary constituents as wheat, rye, garlic, onions, legumes, cabbage, artichokes, leeks, asparagus, lentils, inulin, soy, Brussel sprouts and broccoli. Where there has been a restriction of the intake of foods high in FODMAPs this can reduce the amount of fermentation, gas production, and excess fluid in the gut.
Not so many years ago the gluten free lifestyle was reserved for a small percentage of the population who were diagnosed with coeliac disease and who had to ensure the limited choice of foods that were available to them. The choices were poor and they often tasted worse. Nowadays there are more palatable gluten free foods available to buy in all outlets more people are choosing the gluten free lifestyle. For some athletes following a gluten free diet trying these foods to see if they can tolerate them can prove useful and they can certainly increase the variety of the diet and help meet the energy demands of training.
