An Introduction to the Low FODMAP Diet for Irritable Bowel Syndrome

The following information provides an introduction to the low FODMAP diet for Irritable

Bowel Syndrome (IBS), however it is not intended to replace counselling by a Registered

Dietitian on the low FODMAP diet approach for IBS symptom management. Registered

Dietitians who are experienced or trained in the low FODMAP diet approach can individualize

the low FODMAP diet to help achieve best results and ensure your diet is nutritionally

adequate.

What is the low FODMAP diet?

The low FODMAP diet is a diet that limits consumption of foods that are high in FODMAPs.

FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) are a

group of carbohydrates and sugar alcohols found in food that are highly fermentable. The

fermentation of FODMAPs by bacteria in the bowel (also known as the production of gas), is a

normal and healthy part of digestion. For people with IBS however, eating foods high in

FODMAPs may trigger symptoms such as excess gas, bloating, heartburn and abdominal

discomfort. FODMAPs also tend to attract water into the bowel. This may trigger symptoms

such as bowel urgency and diarrhea for some people with IBS. Reducing the amount of high

FODMAP foods in the diet is an approach that may help improve IBS symptoms for some

people.

Can avoiding foods with FODMAPs cure my IBS?

While avoiding foods that are high in FODMAPs may improve your symptoms, this is not

considered a cure for IBS. Research to date indicates that about 3 out of 4 people with IBS can

experience some degree of improvement in their symptoms by following a low FODMAP diet.

What are examples of FODMAPs?

The following are considered FODMAPs:

1) Lactose

2) Fructose

3) Fructans

4) Galacto-oligosaccharides (GOS)

5) Polyols

Tolerance of FODMAPs and IBS

Tolerance of foods that are high in FODMAPs can vary for people with IBS. Some people with

IBS can tolerate a greater amount of food high in FODMAPs in their diet, while others may find

that consuming even a small amount of food that is high in a FODMAP will trigger IBS

symptoms.

Tolerance of two FODMAPs in particular, lactose and fructose, can vary depending on your

ability to absorb them. For example, lactose is often only an issue for people with IBS if lactose

is poorly absorbed (lactose malabsorption). The degree to which fructose is tolerated by

people with IBS, is also influenced the ability to absorb fructose. About 40% of people with IBS

poorly absorb lactose, and about 40% of people with IBS poorly absorb fructose. If you do have

lactose and/or fructose malabsorption, these FODMAPs may be the most difficult to tolerate.

To help illustrate the effect of consuming FODMAPs when you have IBS, think of your digestive

system as a cup (Figure 1.). All the FODMAPs you consume go into this same cup. If you

consume too much FODMAP, resulting in too much fermentation and water accumulation, your

cup can overflow and symptoms can occur (figure 2). Different people with IBS can have

different sized cups. One persons cup may overflow if they consume just one food that is high

in a FODMAP. Another persons cup may not overflow until they consume several foods in a

day that are high in FODMAPs. If FODMAPs are in fact a trigger for your IBS symptoms, it may

take a bit of trial and error to determine what your tolerance level is (i.e. at what point your cup

overflows) for high FODMAP foods.

The low FODMAP diet

Figure 2.

Figure 1.

The following table lists foods that are high in FODMAPs and foods that are low in FODMAPs.

Some foods are not listed in the table as information on their FODMAP content is not yet

available.

You can try choosing low FODMAP foods while limiting or avoiding high FODMAP foods to see if

your IBS symptoms improve. Some symptom improvement may be seen within a week of

following a low FODMAP diet, however it may take up to 4-6 weeks of following this diet to see

the full benefit. In some cases, IBS symptoms may not improve significantly on the low

FODMAP diet (i.e. approx. 1 out of 4 people with IBS see limited or no improvement with a low

FODMAP diet).

A strict low FODMAP diet is not considered a long-term diet for most people. If you notice a

significant improvement in your IBS symptoms after following a low FODMAP diet for a few

weeks, it is recommended that you seek a referral with a dietitian experienced or trained in the

low FODMAP diet approach for further counselling. A dietitian that is experienced or trained in

the low FODMAP diet approach can help you determine which FODMAPs are most problematic,

help you re-introduce FODMAPs to increase the variety of foods in your diet, and ensure that

your diet is nutritionally adequate.

In the meantime, are there certain foods that appear to trigger your IBS symptoms more than

others? If certain foods are better tolerated, you can try adding these back into your diet and

see how your IBS symptoms respond.

Food Type

Choose Low FODMAP Foods

Limit/Avoid High FODMAP Foods

Fruits

Limit large servings of fruit. It is recommended to limit low FODMAP fruit to 1 serving at a time and separate each fruit serving by at least 2 hours. One fruit serving equals 1 small/medium sized fruit or 1/2 cup. Limit dried fruit, and concentrated fruit products. If you consume juice, it is recommended that you limit the serving size to 1/3 cup.

apple apricot avocado blackberries canned packing juice cherries dried fruit dried fruit bars figs, dried longon lychee

banana blueberries* cantaloupe cranberries grapefruit* grapes** honeydew melon* kiwi lemon lime orange papaya passion fruit pineapple raspberries** rhubarb strawberry* tangelo

* These are foods with a moderate amount of FODMAPs limit portions if they cause symptoms (e.g. use portion size). ** There is some conflicting data on the FODMAP content limit quantity or avoid if they cause symptoms.

mango nectarine peach pear persimmon plum, prunes rambutan watermelon

Vegetables

alfalfa bamboo shoots bean sprouts bok choy carrots chives choko choy sum cucumbers eggplant fennel* green beans green bell pepper lettuce okra

artichoke asparagus beetroot broccoli Brussels sprouts cabbage cauliflower celery garlic leeks mushrooms onions shallots snow peas tomato paste (tomatoes are

parsnip potatoes radish red bell pepper silver beet spinach spring onion (green part only) squash sweet potato* tomato turnip water chestnut zucchini

* These are foods with a moderate amount of FODMAPs limit portions if they cause symptoms (e.g. use portion size).

allowed) tomato sauce tomato juice

Grain Products

amaranth flour arrowroot flour buckwheat, buckwheat flour corn meal, corn thins, corn flour

(note: avoid whole sweet corn) gluten-free breads* gluten-free cereals* millet, millet flour oats, oatmeal quinoa rice (rice cakes, rice pasta/noodles,

cream of rice cereal, rice crackers, rice paper), rice flour

tortilla chips *May not be tolerated by some people, therefore use with caution - check labels for any high FODMAP ingredients.

barley* muesli/muesli bar rye flour*, rye flour products sweet corn (corn flour and

corn meal are allowed) wheat*, products with large

amounts of wheat: breads pasta/noodles couscous cereals cakes, baked goods,

pastries, cookies crackers, biscuits breadcrumbs, batter flours

* Small/trace amounts of wheat, rye, barley can likely be tolerated (low in FODMAPs).

Milk and Alternatives

almond milk butter certain cheeses only (Cheddar,

buttermilk cream (light cream, half and

half, whipping cream)

Edam, Limburger, Mozzarella, Romano, Swiss, Parmesan, Provolone, Brie, and Camembert)

coconut milk custards and puddings made with

lactose-free milk ice cream substitutes (e.g. gelato,

sorbet) lactose-free milk lactose-free yogurt rice milk

cream sauces cream soups evaporated milk feta cheese fresh cheeses (e.g. Ricotta,

Cottage) ice cream kefir malted milk milk powder, whey powder processed cheese, cheese

spreads puddings, custards regular and low-fat milk

(cow, goat, sheep) regular and low-fat yogurt sherbet sour cream soy milk sweetened condensed milk

Meat and Alternatives

eggs fish low FODMAP nuts (limit portion to

small handful at a time): o almonds* o hazelnuts* o pine nuts o peanuts o pecans o macadamia nuts o walnuts

peanut butter (limit to 1-2 tbsp at a time)

poultry (chicken, turkey) red meat seafood seed butters (e.g. tahini, sunflower

seed butter) (limit to 1-2 tbsp at a time)

seeds (e.g. sunflower seeds, pumpkin seeds) (limit portion to a small handful at a time)

legumes (e.g. chick peas*,

lentils*, red kidney beans, baked beans, navy beans, lima beans, butter beans, barlotti beans, mixed beans, split peas, soy beans)

pistachio nuts cashews

*Canned beans and legumes have a

lower GOS content than cooked dried

beans and legumes. Small portions

of canned lentils (1/2 cup) and

canned chick peas (1/4 cup) may be

well tolerated

tofu * These are foods with a moderate amount of FODMAPs limit portions if they cause symptoms (e.g. use portion size).

Oils and Fats

all vegetable oils (including soybean

oil) butter margarine mayonnaise products (most are low

in FODMAPs, however check label for any high FODMAP ingredients)

cream cheese cream sauce sour cream

Caution (check ingredients): commercial salad dressings may contain ingredients that are high in FODMAPs

Sweeteners

artificial sweeteners not ending in

ol (e.g. aspartame, Splenda) glucose golden syrup maple syrup regular corn syrup table sugar (sucrose)

The following are different names of low FODMAP sugars:

cane sugar confectioner's sugar granulated sugar superfine sugar naturally milled organic sugar sugar syrup cane syrup evaporated milled cane juice organic cane syrup organic sugar beet sugar bar sugar berry sugar castor sugar

agave syrup crystalline fructose fructose glucose-fructose,

glucose/fructose (this is high fructose corn syrup)

high fructose corn syrup (HFCS)

honey molasses polyols (e.g. sorbitol,

mannitol, xylitol, maltitol and isomalt)

Caution (check ingredients): sugar-free products (e.g. sugar-free gum) may contain added polyols Caution (check ingredients): the following may contain added glucose/fructose (high fructose corn syrup) soft drinks, fruit drinks, sweetened beverages, candies, sweetened cereals,

icing sugar refined sugar cane juice crystals invert sugar

Use low FODMAP sugars in moderation

syrups, condiments

Herbs, Spices and Condiments

chives ginger root salt pepper lemon and lime juice soy sauce vanilla extract, real or imitation most varieties of vinegars (check

ingredient labels for any high FODMAP ingredients)

Most spices are low in FODMAPs, but use caution with large amounts of spices

barbeque sauce chutney garlic powder ketchup onion powder plum sauce relish unfiltered apple cider vinegar

Other Food Ingredients

ingredients that are not derived

from foods listed under High FODMAP Foods

FOS (fructo-oligosaccharides) GOS (galacto-

oligosaccharides) inulin

Caution (check ingredients): the following may contain FOS or inulin fibre supplements, yogurts, probiotics, meal replacement supplements

Other

beer coffee tea unsweetened spirits (vodka, gin) red and white wine (dry) sherry (dry) water

fortified wine: port, sherry

(sweet) rose wine rum white wine (sweet) some alcoholic cocktails (pina

colada, margaritas, sours)

Nutrient data used to classify foods in the FODMAP food table was obtained from published studies, USDA nutrient database and the NUTTAB database. In some cases, FODMAP data was not available. In these cases, foods were classified based on estimates from The Low FODMAP diet: Reducing poorly absorbed sugars to control gastrointestinal symptoms booklet (2012) prepared by the research team in the Dept. of Gastroenterology, Central Clinical School, Monash University, Australia.

Low FODMAP sample menus and snacks

Four days of low FODMAP menus have been provided to help you plan meals and snacks while

trying a low FODMAP diet.

Day 1 (low FODMAP menu)

Breakfast

Puffed millet cereal

- 1 cup of almond or rice milk for cereal

1 small banana for cereal topping

1-2 hard-boiled eggs

Lunch

2 4 plain rice cakes

Canned tuna on plain rice cakes with small amount of melted cheddar cheese (or peanut butter on rice cakes as an alternative)

Small salad of low FODMAP vegetables with homemade dressing (e.g. oil and balsamic vinegar)

Afternoon snack

cup grapes

1 cup of almond or rice milk

Supper

Stir-fry

1 cup of cooked quinoa (rice can be used as an alternative)

Sliced chicken or turkey

Vegetables (see low FODMAP vegetables)

Olive oil

Herbs (to flavour/garnish)

Evening snack

Small handful of walnuts

Day 2 (low FODMAP menu)

Breakfast

Oatmeal

- 1 cup of rice or almond milk for cereal

cup cantaloupe or raspberries

Lunch

Corn (or rice) pasta with cooked low FODMAP vegetables, shrimp

tossed with olive oil, parmesan cheese and herbs

Afternoon snack

Small banana with peanut butter or seed butter

Supper

Baked potato and carrots

Tilapia or other fish (baked, broiled) seasoned with olive oil and herbs

Margarine

1 cup of almond or rice milk

Evening snack

Shake (Almond or rice milk and low FODMAP fruit mixed in blender)

Day 3 (low FODMAP menu)

Breakfast

Gluten-free cereal (or oatmeal)

- 1 cup of almond or rice milk for cereal

Orange wedges

Lunch

2 slices of gluten free bread

Salmon salad filling for sandwich (mayonnaise, lettuce, red bell peppers)

Small salad of low FODMAP vegetables with homemade dressing (e.g. oil and balsamic vinegar)

Afternoon snack

cup pineapple

Small handful of sunflower seeds

Supper

Baked red bell pepper and zucchini with olive oil and herbs

Baked turkey breast with salt and herbs

Mashed/baked potato with margarine

Evening snack

1 cup of almond or rice milk and rice crackers

Day 4 (low FODMAP menu)

Breakfast

Scrambled eggs with tomatoes, spinach and herbs

Hash brown potatoes

cup papaya or grapes

Lunch

Tossed green salad of low FODMAP vegetables with shrimp/tuna and homemade salad dressing (e.g. olive oil and lemon juice)

Rice crackers or rice cakes

1 cup of almond milk or rice milk

Afternoon snack

Small banana with peanut butter or seed butter

Supper

Corn or rice pasta served with chicken and low FODMAP vegetables

(season with olive oil and low FODMAP herbs)

1 cup of almond or rice milk

Evening snack

Small handful of pecans

Other foods that may trigger IBS symptoms

In addition to high FODMAP foods, other dietary triggers of IBS symptoms can include caffeine,

alcohol, greasy foods (e.g. deep-fried foods, fast foods) and large meals. You may also want to

try limiting these foods to help improve your IBS symptoms.

Additional Instructions

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Niagara Health System 2012. This document can be reproduced in its entirety without alterations (NHS logo/credit retained) for non-commercial use