Low-FODMAP and retail pharmacy: what you need to know

June 7, 2018By Focus on the Pharmacy Front End Blog, Independent Pharmacy, Step into Natural

by Jen Johnston, CHHC, senior marketing services account manager, for the Step into Natural blog series

According to the International Foundation for Functional Gastrointestinal Disorders (IFFGD), Irritable Bowel Syndrome (IBS) affects between 25 and 45 million people in the United States, and about two in three IBS sufferers are female.

One way of eating that is bringing relief to IBS sufferers is called low-FODMAP. This diet was created over 10 years ago at Monash University out of Australia by Professor Peter Gibson and his research team at the Department of Gastroenterology. The idea of low-FODMAP has come into popular U.S. culture over the last five years as the topic has appeared on TV shows like Dr. Oz and magazines like Shape, with more M.D.s “prescribing” this way of eating to patients.

FODMAP is an acronym for the following:Low-FODMAP

Fermentable: This refers to the process through which gut bacteria degrade undigested carbohydrates to produce gases including hydrogen, methane, and carbon dioxide. FODMAPs pull more water into the gut to get broken down by bacteria in a process called “fermentation.” This produces more gas in the intestines and can cause discomfort.

Oligosaccharides: Oligosaccharides are made of fructans and galacto-oligosaccharides (GOS). Fructans are found in foods like wheat, rye, onion, and garlic and galacto-oligosaccharides (GOS) are found in legumes and pulses. They are poorly absorbed by people and can trigger gastrointestinal upset.

Disaccharides: This refers to carbohydrates composed of two sugars (called “monosaccharides”). Lactose is a common disaccharide found in dairy products like milk, soft cheese and yogurt. Many people are intolerant to lactose because they don’t have the lactase enzyme present in their gut to help break it down.

Monosaccharides: Monosaccharides include simple sugars such as fructose and glucose. Fructose is absorbed optimally in the presence of enough glucose. Consuming foods that are high in fructose but low in glucose (for example, honey, apples, and high-fructose corn syrups) can cause fructose malabsorption.

Polyols: Polyols are sugar alcohols (for example, sorbitol and mannitol) that are found in some fruits and vegetables. They are often extracted and used as artificial sweeteners.

In the food space, brands have popped up that specifically market to the low-FODMAP audience, such as Fody Foods and FODMAPPED for You! Others are choosing to get certified as FODMAP friendly or bear MONASH University’s Low-FODMAP certification.

Non-food brands are also getting in on the low-FODMAP trend. One example of this is Stellar Labs Nutrition who has a low-FODMAP line of supplements. There are also smartphone apps that can help your low-FODMAP patients which are listed here.

You may wish to learn more about FODMAPs so that you can counsel patients experiencing digestive difficulties and understand which OTC, supplement, and prescription ingredients are FODMAPs. Influencers in the low-FODMAP arena include Kate Scarlata, R.D. and Patsy Catsos, M.S., R.D.N., L.D., both whom maintain popular online blogs for IBS sufferers.

Tim from fodmapfriendly.com had this advice for pharmacists, “In some instances, patients may experience IBS type symptoms after consuming medications for other ailments, and in these circumstances it would be of assistance for the pharmacist to be aware that it may have been the high FODMAPs in that medication that contributed to the ailment and then alternative medications suitable for that patient could be recommended.”

Kate Scarlata, R.D. said, “FODMAP ingredients can lurk in many OTC medications. Polyols impart a sweet flavor and can be found in cough syrups, fast acting medications, chewable medicines, and vitamins. Chicory root or FOS (oligosaccharides) are added fiber or prebiotic ingredients found in some probiotics and fiber supplements, and these FODMAP ingredients can lead to troublesome gas and pain in individuals with IBS.  Supplements to minimize digestive symptoms with the ingestion of beans can contain mannitol, a FODMAP ingredient.” For more on hidden FODMAPs, see this blog post written by Scarlatta.

How else can you make your pharmacy a destination for those who follow the low-FODMAP plan? Consider partnering with a low-FODMAP dietitian near you and team up on in-store wellness initiatives. You can also offer snack bars and OTC items that are low-FODMAP. Keeping FODMAPs in mind demonstrates that you are up to date on cutting edge research regarding troublesome IBS which may affect so many of your patients.