Low FODMAP Diet

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It can be unbelievably frustrating to figure out which foods to choose if you suffer with IBS.  If you can relate to experiencing digestive trouble, you are not alone! Anywhere from 10-15% of Americans are diagnosed with Irritable Bowel Syndrome (IBS) and experience some combination of abdominal pain, gas, bloating, nausea, constipation, and diarrhea. Recent studies show promising evidence that following a Low FODMAP Diet may help alleviate symptoms of IBS. Gastrointestinal doctors are frequently recommending this diet to their patients and it is receiving lots of attention in popular media.

Although it is not believed that any particular foods cause IBS, eating foods your body cannot digest properly may trigger your painful digestive symptoms. Through an elimination-style diet, you can determine which of these foods your body does not tolerate, and effectively manage your IBS symptoms by adjusting your food choices.

What does it stand for?

The diet was created by a team of researchers led by Sue Shepherd,PhD and Peter Gibson, MD at Monash University in Australia. The acronym “FODMAP” stands for:

  • Fermentable
  • Oligosaccharides (fructans and galactans)
  • Disaccharides (lactose)
  • Monosaccharides (fructose)
  • And
  • Polyols (sugar alcohols)

These are fancy terms used to describe a type of carbohydrate (or sugar) found in many common foods. FODMAPs are short-chain carbohydrates known to be poorly digested in the gut.

Note: Foods that do not contain carbohydrates are not a concern for FODMAPs. These foods include: meat, poultry, fish, eggs, butter, oils and hard cheeses.

Why Do FODMAPs Cause Digestive Discomfort?

These small-chain carbohydrates pull water into your intestine. The excess fluid can lead to either diarrhea or constipation. If you experience diarrhea, the water is flushing your food too quickly through your system. If you experience constipation, this is a build-up of food & fluid within your gut.

Because FODMAPs are poorly digested, they become food for your gut bacteria. During this feeding frenzy, gut microbes ferment FOPDMAPs. The fermentation reaction creates gas, which you experience as bloating, cramping, or abdominal pain. (*Remember that gut microbes are supposed to be living in your intestine – hence the recommendation to consume pre- and probiotic foods! The microbes work to help digest food, and even create vitamins your body needs (e.g. vitamin K). The goal of limiting FODMAPs is not to eliminate the bacteria!)

In summary: when you consume high FODMAP foods that your body does not digest well, it causes an increase in water & gas that alters digestive function.

Let’s Break it Down.

Different foods contain varying concentrations of FODMAPs. Researchers at Monash University have tested foods to determine which contain high vs. low concentrations of FODMAPs. They have developed an app, that provides information on FODMAPs in foods: Low FODMAP App. I have also included a detailed list of high vs. low FODMAP foods at the end of this post.

The Low FODMAP Diet is a short-term elimination diet, which lasts around 6-8 weeks. I encourage you to work with a registered dietitian for guidance through the phases of the diet.

Phase 1: Elimination. Remove all high FODMAP foods from your diet for at least 2 weeks. This allows the inflammation and irritation in your gut to resolve.

Phase 2: Re-introduction. Working with a dietitian, introduce 1 food at a time and assess your body’s reaction. This phase moves through foods in each of the 4 categories of FODMAPs: fructans / galactans, fructose, lactose, and polyols. The goal is to gradually increase FODMAPs to a level well tolerated by your body (you want to achieve the least-restrictive diet possible!). Most people can determine a few “culprits” that need to be avoided, but tolerate other high FODMAP foods without uncomfortable side-effects.

<3 Important Note to Remember

If you are not in an emotional space with food that allows for an elimination diet, please do not force yourself. The ultimate goal of making these dietary changes it to reduce stress on the body. So regardless of the promising research, if this diet adds more stress to your life – it will not improve your overall state of health! Be gentle with yourself. Move forward with the Low FODMAP Diet only if it truly serves you.

 

 

Kate Scarlata is a Boston-based dietitian who specializes in the FODMAP Diet. She presented her work at the Spring CT Academy of Nutrition and Dietetics meeting this year and was kind enough to share the wonderful, free resources on her website. I have shared her lists of high and low FODMAP foods here, breaking them down into the 4 types: fructans / galactans, lactose, fructose, and polls. Here is a link to get her printable versions, (I recommend printing multiple copies to hang one on your fridge and bring one on your next shopping trip!):

Chart of High & Low FODMAP Foods

High FODMAP Foods

Fructans / Galactans

Fruit: currants, dates, dried figs, grapefruit, nectarine, persimmon, plumbs, prunes, white peaches, watermelons

Vegetables: artichokes, chickpeas, garlic, lentils, red kidney beans, baked beans, leaks, shallots, soy beans (edamame, soy milk, any product made with whole soybean), onion

Grains: inulin (or chicory root), barley, rye, wheat

Nuts: cashews, pistachios

Miscellaneous: chamomile/fennel/oolong teas, >2tsp carob, onion & garlic salt powders

Lactose

Milk: including evaporated milk

Cheese: cottage, ricotta

Miscellaneous: yogurt, ice cream, custard

Fructose

Fruit: apples, boysenberries, cherries, fresh figs, mango, pears, watermelon

Vegetables: asparagus, Jerusalem artichokes, sugar snap peas, sun-dried tomatoes, tomato paste

Sweeteners: agave, honey, high fructose corn syrup

Alcohol: rum

Polyols

Fruit: apples, apricots, blackberries, nectarines, pears, peaches, plumbs, prunes, watermelon

Vegetables: cauliflower, mushrooms, snow peas, sweet corn

Sweeteners: sorbitol, mannitol, maltitol, xylitol, erythritol, polydextrose, iso malt (sugar-free gum / mints / cough drops / some medications)

Low FODMAP Foods

Fructans / Galactans

Fruit: arugula, bamboo shoots, bok choy, bean sprouts, bell peppers, cabbage, carrots, celeriac, chives, collard greens, cucumber, eggplant, endive, fennel bulb, green beans, ginger root, kabocha squash, kale, lettuce, parsnip, potato, reddish, rutabaga, scallion (green shoot only), spinach, Swiss chard, summer squash, tomatoes, water chestnuts, zucchini

Breads & Grains: gluten-free bread (check ingredients), corn/rice/quinoa pasta, rice cakes, potato & tortilla chips, rice (brown/white/basmati), quinoa, oats (up to 1/2 cup cooked), sourdough spelt bread, polenta, corn tortilla

Nuts & Seeds: (*10-15 max or 1-2 TBSP) almonds, macadamia, peanuts, pecans, pine nuts, pumpkin seeds, sesame seeds, sunflower seeds, walnuts, 2 TBSP chia seeds, 1 TBSP flax seeds

Herbs: basil, cilantro, coriander, rosemary, parsley, tarragon, thyme

Miscellaneous: espresso, black/green/peppermint/white teas, firm tofu, tempeh, oil infused with onion or garlic, < 3 tsp cocoa

Moderate Fructans / Galactans: (*Limit to 1 choice per sitting) beet root <4 slices, broccoli <1/2 cup, Brussels sprouts <1/2 cup, butternut squash < 1/4 cup, green peas <1/3 cup, pomegranate <1/2 small, savoy cabbage <1 cup, snow peas <10 pods, sweet corn <1/2 cob, dried cranberries or raisins 1 TBSP, canned pumpkin <1/4 cup, buckwheat groats (kasha) 1/8 cup, canned chickpeas 1/4 cup,  canned lentils 1/2 cup

Lactose

Milk: almond milk, coconut milk (canned), hemp milk, lactose-free milk

Cheese: brie, camembert, Colby, lactose-free cottage cheese, cheddar, chèvre (goat cheese), feta, mozzarella, parmesan, Swiss

Miscellaneous: lactose-free yogurt, lactose-free ice cream, sorbet

Fructose

Fruit: (*1 medium orange or banana OR 3/4 cup berries, melon, pineapple, rhubarb) bananas, blueberries, cantaloupe, clementines, coconut, dragon fruit, grapes, honeydew, kiwis, lemons, limes, oranges, papaya, passion fruit, pineapple, raspberries, rhubarb, star fruit, strawberries

Sweeteners: brown/table sugar, pure maple syrup

Alcohol: most wine & beer; gin, vodka, whiskey

Polyols

Fruit: bananas, blueberries, cantaloupe, clementines, coconut, dragon fruit, grapes, honeydew, kiwis, lemons, limes, oranges, papaya, passion fruit, pineapple, raspberries, rhubarb, star fruit, strawberries

Sweeteners: aspartame, glucose, maple syrup, stevia, table sugar

Moderate Polyols: (*Limit to 1 choice per sitting) avocado <1/8, celery <1/4 stalk, lychee<5, sweet potato <1/2 cup

 

 

References:

Mansueto P, Seidita A, Alcamo A and Carroccio Antonio. Role of FODMPAs in patients with irritable bowel syndrome. Aspen. 2015, 30(5): 665-682.

Shepherd S and Gibson P. The complete low-FODMAP diet: A revolutionary plan for managing IBS and other digestive disorders. New York, NY: The Experiment, LLC; 2013.

Monash University. Low FODMAP Diet for Irritable Bowel Syndrome. http://www.med.monash.edu/cecs/gastro/fodmap/.

Kate Scarlata, RDN. http://www.katescarlata.com/lowfodmapdietchecklists/.

University of Virginia Health System: Digestive Health Center. Low Fodmap Diet. https://med.virginia.edu/ginutrition/patient-education/. Updated 2014.

Yoon SR, et al. Low-FODMAP formula improved diarrhea and nutritional status in hospitalized patients receiving enteral nutrition: a randomized, multi center, double-blind clinical trial. Nutrition J. 2015, 14: 116.