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Thu, Jul 2 8:14am · What exactly is the FODMAP diet? Dr. Wang explains in Gastroenterology & GI Surgery

Mayo Clinic Connect member and volunteer mentor, Teresa @hopeful33250, was recently advised by her GI doctor to start on the FODMAP diet due to her IBS symptoms. She reached out to the Mayo Connect Community, and a robust discussion ensued.

What exactly is the FODMAP diet?  Mayo Clinic gastroenterologist, Dr. Xiao Jing (Iris) Wang explains that “the FODMAP diet is used to eliminate foods with high levels of FODMAP components. Patients who were diagnosed with irritable bowel syndrome and those with functional diarrhea or constipation may benefit from trying the FODMAP diet. However, these diagnoses are often difficult to confirm.”

FODMAPs are certain carbohydrates found in food that do not digest completely and can cause gas, bloating, diarrhea due to the bacteria in the digestive tract causing the FODMAPs to ferment. FODMAPs are carbohydrates that are:

FODMAP chart

Dr. Wang explains that “there are two ways to try the FODMAP diet—one is what is called a ‘Top Down’ approach, which is where all FODMAPs are eliminated from the diet for a full 6 week period. Then, food groups are reintroduced one by one to assess for return of symptoms. Another is the ‘Bottoms Up’ approach, where groups are eliminated one at a time based on prior experience with offensive food (i.e. if milk caused symptoms in the past, start with eliminating lactose). I would recommend the ‘Bottoms Up’ to avoid any unnecessary dietary limitation which can lead to poor nutrition.”

Dr. Wang also recommends that while following the FODMAP diet, patients should monitor themselves “for symptomatic improvement…There should not be any additional or new GI symptoms from dietary elimination of these certain food groups.”

The question was raised in the discussion about patients who have had their gallbladder removed and the role that bile flow has in the digestion process. Mayo Clinic Gastroenterology Fellowship graduate, Dr. Priya Vijayvargiya, who focused her research on bile acids, explains that “Bile is a substance synthesized by your liver and stored in your gallbladder. Upon eating, the gallbladder contracts and releases the stored bile into the small intestine. Its main role is to help absorb fat. Fat is not water soluble which makes it problematic to be absorbed. The bile surrounds the fat to help make it easier to absorb within the intestine.

“Once the gallbladder is removed, the liver will constantly release bile into the small intestine. Having your gallbladder removed typically does not have any significant impairment in fat absorption. Patients may notice some diarrhea, particularly after a high fat meal, but the bile in the intestine is sufficient to absorb most fat.”  Dr. Wang further explains that, “If patients eat a meal with high fat content, there may not be enough bile sent down to the intestines to help digest all of those fats. These fats can then travel down to the colon and cause diarrhea.”

In addition to patients diagnosed with irritable bowel syndrome, Mayo Clinic registered dietician Jaclyn See explains that patients with celiac disease may also benefit from following the FODMAP diet if they are following a strict gluten-free diet and still experiencing symptoms. Patients with celiac disease should discuss this option with their physician who may want to do further testing to ensure their symptoms are not due to uncontrolled celiac disease, a pancreatic disorder, or colitis.

In addition to consulting their physician, Ms. See recommends that patients work with a registered dietician who can make sure they are following the FODMAP diet correctly as well as ensure patients are eating a balanced diet and getting the proper nutrition.

There have been studies that show that people with NCGS (non-celiac gluten sensitivity) may actually be sensitive to FODMAPs rather than gluten. One such study was cited in a 2016 article in The Guardian, “Could sourdough bread be the answer to the gluten sensitivity epidemic?” This article was also shared via Mayo Clinic Connect in April 2016. This study was conducted at Monash University in Australia.  In 2011, this university conducted the study that started the “gluten-free” movement in which patients with IBS were found to feel better when they followed a gluten-free diet. Two years later, in 2013, they did a follow-up study in which patients with NCGS eliminated gluten and FODMAPs from their diet. Once these subjects started feeling better, researchers gave some of them gluten, and there was no adverse reaction. This suggested that FODMAPs may be the cause of their sensitivity rather than gluten. Then why is that so many people believe that gluten is the culprit and have never heard about FODMAPs?  In this same article in The Guardian, Mayo Clinic gastroenterologist and celiac disease expert, Dr. Joseph Murray explains that by the time the 2013 study results were published “it was too late to stop this gluten sensitivity train: it had left the station.”

Connect with other patients talking about FODMAP, digestive health issues, and more:

Mon, May 25 12:05pm · Your health and wellbeing matter in Gastroenterology & GI Surgery

Safety priority

The Division of Gastroenterology and Hepatology at Mayo Clinic is committed to provide care for all of our patients need even in these uncertain and challenging times.  Our teams are here for you, and together we will work to maximize your health and wellbeing.  Our outpatient clinics and procedure practices are open, and we are able to provide the care you need. We want to let you know what you can expect when you arrive in Rochester, Minnesota as well as on our campus.

Mayo Clinic is working with local businesses that serve our patients and caregivers in order to create a safe community for those who travel to Mayo Clinic for care.  When you arrive at Mayo Clinic you will notice that there are enhanced precautions in place to ensure the safety of our patients, visitors, and our staff so that we can reduce the risk of COVID-19 transmission.  Some of these precautions are:

  • Strict limits to the number of people on campus
  • Carefully monitored entrance points and screening of all patients for symptoms and possible COVID-19 exposure before entering our buildings
  • Universal masking required for everyone on campus
  • Waiting areas are designed for social distancing
  • Frequent deep cleaning of all clinical areas

For patients coming for endoscopic procedures, there are a number of specific precautions we are taking to ensure a safe environment. Two or three days prior to your procedure our appointment schedulers reach out to patients to pre-screen them, and this includes a PCR test to identify symptomatic and asymptomatic carriers.  The PCR test analyzes a sample of mucus from a person’s nose or throat to detect the genetic material of coronavirus.  PCR (polymerase chain reaction) causes an amplification of viral genetic material if it is present, and is considered the most reliable test currently to test for COVID-19.  Upon arrival at the check-in desk, further screening is done before patients are allowed back into the procedure area.

Enhanced cleaning of all entrance lobbies, the intake areas, dressing rooms, and procedure rooms (including air exchanges in between procedures), as well as the recovery rooms is completed.  Staff who care for patients in Gastroenterology and Hepatology are required to use protective eyewear as well as masking.  All staff in the procedure rooms don appropriate PPE.

Additionally, all Mayo Clinic staff who work on campus are required to monitor their health by taking their temperature twice per day and practice social distancing.

Mon, May 4 8:30am · Our Mission Continues: Providing Compassionate Care in a Safe Environment in Gastroenterology & GI Surgery

Mayo GI Open for Business

Though times and circumstances have changed due to the COVID-19 pandemic, one thing has not changed, and that is Mayo Clinic’s Division of Gastroenterology and Hepatology’s dedication and ability to provide compassionate care. We have protocols in place to ensure that every precaution is taken to ensure that this care is provided in a safe environment for our staff and for our patients. Initial modeling projected that there would be a surge that would exceed our capacity, and we had limited knowledge of how COVID-19 transmits. This was the basis for limiting visitors in our hospitals and clinics, deferring elective procedures, and triaging patient appointments so that we could continue to care for emergent and urgent patient needs. Mayo Clinic also implemented universal masking, testing and screening protocols for staff and patients. Additionally, we as an institution as well as the community of Rochester are also abiding by all social distancing and executive orders and we are experiencing a flattening of the curve. Because of this, we are well equipped to care for patients with COVID-19 in the long term without exhausting our resources, and we are ready now to see our patients whose care was deferred as well as able to see new patients who need access to Mayo Clinic.

Because the projected peak of COVID-19 lessened and the plateau extended, and working within strict adherence to federal and state executive orders, we are able to open our doors and care for our patients. With extended COVID-19 testing capabilities, protocols in place to support appropriate conservation and management of personal protective equipment (PPE) supplies, and the implementation of numerous safety measures we are confident in our abilities to safely care for our patients.

Mayo Clinic established a Safety Management and Resource Team (SMaRT) to focus on safely ramping up our practice. In following the protocols put in place by this team, our current environment allows us to safely care for patients face-to-face in our subspecialty clinics, surgical teams increased emergent and urgent volumes, and our procedural and diagnostic practices are seeing higher volumes of patients. For patients who are not able to travel we continue to offer telemedicine options and successfully see patients via video and telephone connections. However, we do expect to operate in a COVID-19 environment for the next year or longer, and we know that our patients need personal care. There are limitations to what we can do through telemedicine. Opening access to care for more patients is in the best interest for our patients, our staff, and for the future of Mayo Clinic.

We acknowledge that bringing patients back to our campuses may cause some uneasiness, but we want to assure our patients and staff that Mayo Clinic is following mandates from the Centers for Disease Control and Prevention along with the advice of the experts on our staff to ensure the safety of our patients, staff, and community. During this time of distress and uncertainty, Mayo Clinic aims to be a place for hope and healing.

Connect with other patients talking about digestive health issues, COVID-19, telemedicine and visiting Mayo Clinic in these online support groups: