The Low FODMAP Diet

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Researchers at Monash University in Australia developed the low FODMAP Diet, which aims to reduce or eliminate foods that have certain carbohydrates. These are characterized as Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols (FODMAP). These short-chain carbohydrates (sugars) have been shown to induce the IBS symptoms of diarrhea, bloating, abdominal pain, and gas due to their poor absorption, their ability to hold water in the intestinal tract, and rapid fermentation.1,2

Professor Peter Gibson, Director of Gastroenterology at The Alfred Hospital and Monash University and Dr. Jane Muir, Head of Translational Nutrition Science at Monash University led the first group in the world to measure the majority of FODMAPs in food. The team now has a comprehensive database of FODMAP content in food that has been generated out of their laboratory at Monash University.

Research suggests that symptoms from irritable bowel syndrome (IBS) in one quarter of patients may be exacerbated by one or more dietary components, and dietary components may play a role in the causation of IBS in some patients.3 Several studies show a benefit in diets that eliminate or reduce certain foods that tend to exacerbate IBS symptoms, and most patients with IBS believe that diet plays a significant role in their symptoms.3,4

FODMAPs – Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols

When foods that are high in FODMAPs are eaten, they are not easily disgested by the body. These foods cause more water to be pulled into the intestines. In addition, because they aren’t absorbed in the small intestines, they act as fuel for the bacteria in the large intestines. The bacteria ferments these FODMAPs and produce gas. The excess water and gas cause the intestines to expand and cause abdominal pain.1

Foods that are high FODMAPs that are to be reduced or eliminated in the diet include:

  • Fructose (found in fruits, honey, high fructose corn syrup)
  • Lactose (found in dairy)
  • Fructans (found in wheat, garlic, onion)
  • Galactans (found in legumes such as beans, lentils, soybeans)
  • Polyols (found in sweeteners and stone fruits such as avocados, apricots, cherries, peaches, etc.)5
  • The following is not a complete list but gives an idea of what foods are low in FODMAPs and those that are high in FODMAPs. Foods high in FODMAPs are to be avoided.5 Patients should consult with a dietician or their health care provider for more information on the diet. It should be noted that there is no one diet that fits all IBS patients.

    Food
    Low FODMAPs (good)
    High FODMAPs (avoid)5
    Eggs, Meats, Poultry, Fish
    Beef, chicken, eggs, fish, lamb, pork, turkey
    Limit any made with high fructose corn syrup
    Dairy
    Any lactose-free dairy
    Low lactose dairy: cream cheese, half and half, hard cheeses (cheddar, parmesan, swiss), soft cheeses (brie, feta, mozzarella), sherbet, Greek yogurt, whipped cream
    High lactose dairy: milk (cow’s, goat’s, sheep’s, condensed, evaporated), buttermilk, chocolate, creamy or cheesy sauces, custard, ice cream, sour cream, soft cheeses (cottage cheese, ricotta)
    Meat, Non-Dairy Alternatives
    Milk alternatives (almond, coconut, rice, soy made from soy protein), nuts (walnut, macadamia, peanut, pecan, pine), nut butters, tempeh, tofu
    Nuts (cashews, pistachios), beans, black eyed peas, bulgur, lentils, miso, soybeans, soy milk made from soybeans
    Grains
    Made with gluten free/spelt grains (corn, oats, potato, quinoa, rice, tapioca, etc)
    Made with wheat/barley/rye when it’s the major ingredient, gluten free/spelt grains made with foods to limit, chicory root
    Fruits
    Bananas, blueberries, cantaloupe, cranberries, grapes, honeydew, kiwi, lemon, lime, mandarin, orange, pineapple, raspberries, strawberries, tangerine
    Apples, applesauce, apricots, blackberries, canned fruit, dates, dried fruits, figs, guava, mango, nectarines, papaya, peaches, pears, plums, prunes, watermelon
    Vegetables
    Bean sprouts, bamboo shoots, bell peppers, bok choy, carrots, cabbage, cucumbers, eggplant, green beans, kale, lettuce, pumpkin, potatoes, radishes, seaweed, spinach, squash, tomatoes, zucchini
    Artichokes, cauliflower, mushrooms, sugar snap peas

    Resources for Patients

    Monash University has developed a smart phone application (app) to help people with IBS follow the Low FODMAP diet. [http://www.med.monash.edu/cecs/gastro/fodmap/iphone-app.html] The app is available for a small fee for the iPhone, the iPad and for Android phones. The app includes information about FODMAPs, a food guide that details the FODMAP content for hundreds of foods, a recipe book, a shopping list for organizing low FODMAP foods, and a one-week challenge to trial and monitor a strict FODMAP diet.1

    view references
    1. Low FODMAP diet for irritable bowel syndrome, Monash University. Accessed online on 4/4/16 at http://www.med.monash.edu/cecs/gastro/fodmap/.
    2. Barrett JS. Extending our knowledge of fermentable, short chain carbohydrates for managing gastrointestinal symptoms. Nutr Clin Pract. 2013 June;28(3):300-306. Published online 7 May 2013 at http://ncp.sagepub.com/content/28/3/300.
    3. Heizer WD, Southern S, McGovern S. The role of diet in symptoms of irritable bowel syndrome in adults: a narrative review. J Am Diet Assoc. 2009 Jul;109(7):1204-14.
    4. Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology. 2014 Jan;146(1):67-75.e5.
    5. Stanford University Medical Center, Digestive Health Center, Nutrition Services. The Low FODMAP Diet. Accessed online on 2/26/16 at https://stanfordhealthcare.org/content/dam/SHC/for-patients-component/programs-services/clinical-nutrition-services/docs/pdf-lowfodmapdiet.pdf.
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