The term “FODMAP” is an acronym, deriving from “Fermentable, Oligo-Di-Mono-saccharides and Polyols”.  Besides being fun to say, FODMAP describes short chain carbohydrates or sugars, (oligosaccharides), disaccharides, monosaccharides and related alcohols that are poorly absorbed in the small intestine. These include short chain (oligo-) saccharide polymers of fructose(fructans) and galactose (galactans), disaccharides (lactose), monosaccharides (fructose), and sugar alcohols (polyols) such as sorbitol, mannitol, xylitol and maltitol. (source: Wikipedia).

Currently many parents are already aware that “high fructose corn syrup” (HFCS) is bad for us and for our children, and in fact high fructose corn syrup is essentially found as commonly used sweetner created by various types of corn syrup that has been processed to convert the sugars glucose and fructose to produce a desired sweetness that we taste in processed foods and beverages. HFCS is most likely found in sodas, juices, and other processed beverages, any processed foods, breakfast cereals, and a variety of baked goods and snacks. Dr. Mark Hyman has an excellent blog on 5 Reasons HFCS Will Kill You.

Back to FODMAP. Why is this important? Since these short chain sugars are universally poorly absorbed by everyone’s small intestines, it just passes then into the large intestine, where the sugars ferment and this leads to bloating and excessive gas production. It has been found that adults who suffer from Irritable Bowel Syndrome or other digestive problems, respond well and have less symptoms when they follow a low or elimination FODMAP diet. The low FODMAP diet was developed by Dr.Peter Gibson, a gastroenterologist, and Dr. Susan Shepherd, a nutritionist, in Melbourne in the early 2000′s and has been well know by gastroenterology specialists and even nutritionists.(References 1,2,Wikipedia)   As I reflect on “A Healthier Wei” and the message I share with my patient families every day, I have been advocating for essentially a modified FODMAP diet change for children. It is likely that our children’s gastrointestinal system suffers from the same issues as adults when it comes to poor absorption of highly processed foods and beverages, and as the National Digestive Disease Information Clearinghouse (NDDIC) reports, about 60 to 70 million Americans suffer from digestive diseases with the most most common digestive conditions being chronic constipation, gastrointestinal infections, inflammatory bowel disease, irritable bowel syndrome and pancreatitis. These are all conditions that can be worsened after eating certain foods.  I have long noticed that children who are picky eaters, and love and eat mostly carbohydrates like pasta and breads, as well as dairy, suffer from terrible and chronic constipation.  It’s easy to understand that since these are the same kids who lack adequate fresh fruits and vegetables and fiber in their daily diet.  We must be concerned that these will be the same children who will likely grow up as adults with the same continued health issues and symptoms?

Basically, the FODMAPs in our diet are as follows:

 Fructose (fruits, honey, high fructose corn syrup (HFCS), etc)
 Lactose (dairy)
 Fructans (wheat, onion, garlic, etc)
 Galactans (beans, lentils, legumes such as soy, etc)
 Polyols (sweeteners containing sorbitol, mannitol, xylitol, maltitol, stone fruits
such as avocado, apricots, cherries, nectarines, peaches, plums, etc)

A Healthier Wei focuses on two changes, eating times as well as what our children eat and drink. I definitely do not recommend complete elimination of dairy as only 1% of children are truly ALLERGIC to cow milk protein and we all want our children to get adequate calcium and vitamin D in their diet. As a busy full-time working mother myself, I have found that it is really not realistic nor effective to ask mothers to follow complicated diet restrictions for their children unless there are specific medical conditions or food allergies that makes such drastic diets necessary.

Let’s talk about the list of FODMAPs above and what you can eliminate easily from your child’s diet.

 Fructose (fruits, honey, high fructose corn syrup (HFCS), etc).  I would not recommend eliminating fresh fruits from your child’s diet, however, don’t give them “fruit cups” which are always marinating in HFCS and we know that our children love drinking that syrup along with the processed and preserved fruit.  Convenience is no reason to ruin your child’s health.  To minimize your child’s consumption of HFCS, it’s unlikely that all of us will stop buying breakfast cereal, but consider making healthy muffins for breakfast or making steel cut oatmeal on weekends with leftovers for the weekday mornings when we’re in a rush to get everyone ready and out the door.  Many children appreciate a hot breakfast, so eggs, oatmeal, toasts, etc are all great options.  Watch out for juices and beverages that mimic juice. Every day I have conversations with mothers who say to me, “But it says 100% juice and “No sugar added” “!  I remind moms daily that you must read the sugar content on the bottle, even without added sugars it’s amazing how much sugars are in juices.    The American Academy of Pediatrics recommend no more than 4 oz of juice per day for young children, and I have learned from countless parents who unknowningly allow their children to consume juice and juice drinks without limit.  I have not bought Capri Sun or any other pouched drinks for our home in the past 3 years, but Claire is allowed to have an apple juice and/or rarely Horizon organic milk/chocolate milk when we are out (Starbucks or the rare drive through in times of desperation).   Apple juice absolutely Claire’s favorite, but is so high in sugar that I never have it in the house except when Dave uses it to spray on his pork shulders for pull pork!

 Lactose (dairy).  We do not need as much dairy as we are led to believe. Children in the public school system are forced to choose milk or chocolate milk for lunch, and if they are drinking milk at breakfast and there are other items like yogurt and cheese in their diet, that’s enough.  Don’t be seduced by those white mustache commercials with gorgeous atheletes and celebrities.  A Healthier Wei suggests switching to water for dinner and afterwards and certainly eliminating dairy and sugar as much as possible in the evenings or consume them well before bedtime. No “Milk and Cookies” before bed!

 Fructans (wheat, onion, garlic, etc). I have not found myself needing to ever ask a mother to reduce wheat intake if the child does not have celiac disease, as most children prefer white to wheat  and I know many of us try to substitute whole wheat flour and pasta whenever possible in order to increase fiber intake for ourselves and our families. Genetically Modified Organism (GMO) wheat is another topic in itself, and currently GMO wheat is not approved or grown in North America.  As for onion and garlic, I cook with them routinely, and other than knowing about murmurs amongst nursing mothers that eliminating onion and garlic may reduce their baby’s gas (blamed for increased colic), I certainly do not ask families to eliminate either.

 Galactans (beans, lentils, legumes such as soy, etc). I have not made any recommendations to reduce intake of any of these items. Being new to Florida, I have learned that many of our central and latin American families feed their children rice and beans as a part of their daily diet, and being of Asian descent certainly I am accustomed to soy and soy products like tofu.  I believe that we have to be careful and respect that cultural and genetic make up influence how our bodies respond to what we put in our mouths, and there simply should not be uniformly prescribed good or evil diets for any population.

 Polyols (sweeteners containing sorbitol, mannitol, xylitol, maltitol, stone fruits such as avocado, apricots, cherries, nectarines, peaches, plums, etc ).  I have no comment nor reason to ask parents to eliminate stone fruits, especially given the great source of nutrition for toddlers and everyone. Recent research shows absorption of two key carotenoid antioxidants—lycopene and beta-carotene—increases significantly in the presence of fresh avocado (or avocado oil) when added to salad.  As for the sweetners, you can find a list of what foods contain sorbital, mannitol, xylitol, and maltitol here. (scroll down).

In summary, I think the point to be made is that it’s never too early to start paying very close attention to what our children are eating and drinking. Please read the food labels, and if you see any HFCS in the list or if you think about how much sugar is in each serving of any beverage or processed foods you’re about to purchase, think again and look around for better choices.  Our children’s health today and for the rest of their lives, and the health of our nation, depends on us each and every day.

References:

  1. ^ “FODMAPs”King’s College, London. Diabetes & Nutritional Sciences, Research Projects]]. Retrieved 18 March 2012.
  2. Jump up to:a b c d e f Gibson, PR; Peter R Gibson and Susan J Shepherd (2010).“Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach”Journal of Gastroenterology and Hepatology 25 (2): 252–258. doi:10.1111/j.1440-1746.2009.06149.x.PMID 20136989.

 

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Dr. Julie Wei is a pediatric ear, nose, and throat specialist and the author of A Healthier Wei. As a mother herself, Dr. Wei is a passionate advocate for improving children's health through better diet and dietary habits. She has been committed to helping parents learn how to eliminate their child's ear, nose, and throat problems simply by reducing excessive sugar and dairy intake, as well as minimizing habitual late night snacking. She hopes to raise awareness for the need for accountability by both medical professionals and parents to ensure that children are not prescribed or take unnecessary medications long term.

When she is not in the clinic, operating room, or conducting research, you will find her in the kitchen preparing food with love along with her daughter Claire. If you sit next to her on the plane, she will likely share with you information about how to minimize choking hazards in young children, and many other tips for improving your child's health.