Many patients who are considering the Low-FODMAP Diet have concerns that they may be embarking on a bland-food regimen to obtain symptom relief, and that spicy foods such as chiles (chile peppers) will trigger symptom flare-ups. While many types of chiles have a low-FODMAP serving size, they have been found to contain the compound capsaicin, a natural compound that gives chiles their spicy quality.
To clarify, capsaicin is not a FODMAP. Individual tolerance levels for capsaicin vary and should be taken into consideration when preparing meals with chiles. (Source: Monash University Department of Gastroenterology).
“Many studies have shown that spicy food is associated with IBS symptoms in some people, and potentially more so in women with IBS,” said Kate Scarlata, MPH, RDN, and New York Times–bestselling author specializing in gut health and nutrition. “Capsaicin, found in hot peppers, may be the primary culprit. The science is a bit mixed in this area; however, it appears that capsaicin can increase GI transit and contribute to IBS-associated pain.
“Interestingly, capsaicin-induced pain appears to occur more commonly in individuals who don’t eat it often,” she continued. “It’s possible that regularly eating spicy foods actually desensitizes receptors in the gut associated with IBS pain. As with most food-related issues in IBS, it is not ‘one size fits all.’
People living with IBS should listen to their body and adjust diet triggers as needed. GI dietitians are best suited to help guide patients in detecting diet triggers for IBS symptoms. The least-restrictive diet to help manage symptoms is the goal to allow and foster a healthy relationship with food.”
The diet does not mean no FODMAPs. Instead, it’s a food plan based on serving sizes per meal in which foods that have tested to contain low levels of FODMAPs are encouraged for patients to consume, particularly during the beginning phase of the plan. High-FODMAP foods such as wheat-containing products and some chile peppers also have lesser, low-FODMAP portions. (Source: Department Of Gastroenterology Monash University, Online Patient Course).
Food swaps are also implemented. For example, white bulbs of onion have tested to be high-FODMAP and can be substituted with low-FODMAP green parts of scallions, chives and green parts of leeks.
Phase 1—Elimination
During this phase, patients consume low-FODMAP portions of foods. Jalapeño peppers were tested by Monash University, which maintains one of the largest FODMAP-tested food databases in the world.
Researchers found that fresh, raw jalapeño peppers are high-FODMAP at one medium-sized pepper per meal; however, one tiny jalapeño is considered to have a low-FODMAP rating and is compliant in the beginning elimination phase of the diet.
Phase 2—Reintroduction
Once the patient’s symptoms are under control, they methodically reintroduce moderate-FODMAP levels of foods. These are called food challenges, with three-day breaks between challenges. Patients test their tolerance to higher FODMAP consumption by eating low-FODMAP foods while introducing each subgroup (fructan, fructose, GOS, lactose, sorbitol, mannitol) separately, at moderate FODMAP levels to determine which trigger symptom flare-ups and those that do not. Patients can track their symptoms through a food journal to ensure the process is completed successfully.
Jalapeños contain fructose and have a moderate-FODMAP rating at one small pepper (slightly larger than tiny) per sitting. If symptoms are not triggered at this first serve size, patients may proceed to trial a higher-FODMAP serving size of one medium-sized jalapeño. If the challenge results in symptoms, patients then stop and try again later, in smaller amounts.
Phase 3—Personal Maintenance
While adding small amounts of trigger foods, patients identify their personal tolerances and develop a long-term, less restrictive dietary approach.
With regard to chiles, patients may choose to trial individual tolerance of serranos, cayenne powder, chipotle powder, and other spicy foods as they establish their personal balance.
Serrano chiles, cayenne powder and chipotle powder have low-FODMAP portion sizes. Fresh poblano peppers, fresh mild green chiles (including Hatch, Colorado Green, Anaheim, and Chiles Verde Del Norte) and canned mild plain green chiles have tested to contain low-FODMAP levels. (Source: Depart- ment Of Gastroenterology Monash University Smartphone App Database).
The Low-FODMAP Diet is not a lifetime food regimen. Millions of people following the diet find that in the reintroduction and personal maintenance phases they can tolerate varying portions of high-FOD- MAP foods and previous triggers. Personal sensitivities can change over time, opening countless possibilities in enjoying spicy, robust dishes such as fajitas, spicy tofu bowls and jalapeño poppers while maintaining calm digestion.
It is important for patients to be medically diagnosed with IBS by their gastroenterologist and work with a registered dietitian and healthcare professional when starting the Low-FODMAP Diet to tailor the plan to their particular sensitivities.
