This helpful guide to FODMAPs has been put together for those, or their family members, instructed to start the FODMAP diet. Maybe your feeling overwhelmed with information overload. Perhaps, you’re here to get a better understanding of this diet and what it means and ultimately how it works.
This is a helpful guide for everyone starting or already on the FODMAP diet, as well as those catering for someone on the FODMAP diet. What it’s about, how it works, what to avoid, recipes and other tips have been pulled together for you for an easy read to refer back to when needed.
What The FODMAP Diet Is
The FODMAP diet was created by Monash University in Melbourne, Victoria, Australia. It is used to identify what foods upset the gut. It is not a long term diet, but more of an investigation diet.
FODMAPs are a group of sugars that are not completely digested or absorbed in our intestines. When FODMAPs reach the small intestine, they move slowly, attracting water. When they pass into the large intestine, FODMAPs are fermented by gut bacteria, producing gas as a result. The extra gas and water cause the intestinal wall to stretch and expand. Because people with IBS have a highly sensitive gut, ‘stretching’ the intestinal wall causes exaggerated sensations of pain and discomfort
Helpful Facts of IBS
As a result, IBS is the most common reason to be on the fodmap diet, and IBS is categorized into 3 types: IBS – D, IBS – C and IBS – mixed.
IBS – D is diagnosed if the person suffers mostly diarrhea symptoms. It can react to lactose predominantly as the body’s lack of lactase renders the body’s ability to digest the lactose non-existing. Meaning lactose travels all the way through the gut and into the intestines unable to be absorbed and draws water through the intestinal walls. This creates irritability and painful cramps in the gut and results in diarrhea. This can happen very quickly between 6 hours and 48 hours after consumption.
IBS – C is diagnosed for those that suffer constipation. It is where substances that don’t get digested properly sit in the gut and ferment, causing a build-up in the large intestine and ultimately constipation.
IBS – Mixed is people who suffer from both diarrhea and constipation at different times due to different foods they consume.
FODMAP is an acronym for the carbohydrates or short-chained sugars, that the body sometimes reacts badly to found in food.
The process through which gut bacteria ferment undigested carbohydrate to produce gases
Fructans & GOS – found in foods such as wheat, rye, onions, garlic and legumes/pulses.
Lactose – found in dairy products like milk, soft cheeses, and yogurts.
Fructose – found in honey, apples, high fructose corn syrups, etc.
Sorbitol and Mannitol – Found in some fruit and vegetables and used as artificial sweeteners.
A Guide to Where FODMAPs are Found
FODMAPs are found in a wide range of foods, such as fruits, vegetables, breads, cereals, nuts, legumes, and confectionery. It is impossible to guess the FODMAP content of the food. Instead, careful laboratory analysis is needed to understand the FODMAP content of the food. The team at Monash University are experts at measuring the FODMAP content of foods. They distribute this information about the FODMAP content of food using their mobile phone app, the Monash University FODMAP Diet App. The app uses a simple traffic light rating system to indicate whether foods are low, moderate or high in FODMAPs.
Symptoms that can Improve
A low FODMAP diet has been shown to:
- Reduce pain and discomfort
- Reduce bloating and distension
- Improve bowel habit (reduce diarrhea or constipation)
- Improve the quality of life.
These benefits are usually seen within 2-6 weeks of following a low FODMAP diet.
Of course, the diet does not cure IBS symptoms, it just helps people to live more comfortably with their condition.
A low FODMAP diet also does not improve symptoms in ALL people with IBS. In fact, 1 out of 4 people with IBS find their symptoms do not improve on the diet. In these people, other diet therapies may be needed in addition to, or replacement of a low FODMAP diet. Other IBS therapies to consider include stress reduction, gut-directed hypnotherapy, over-the-counter medications such as laxatives, fiber supplementation, or prescription medications. Talk to your doctor about which other therapies you should trial.
The FODMAP Phases
Step 1. Low FODMAP
This is to be commenced under the supervision of a dietitian for a period of 2-6 weeks. During this phase, you would use the Monash University Low FODMAP Diet App to choose
foods with a ‘green’ serving size. This means that you only eat foods in a low FODMAP serve.
But remember, a low FODMAP diet is not an elimination diet. Rather, it is a substitution diet,
whereby you swap one food for another, e.g. switch your daily apple for an orange or swap
an onion for chives.
Step 2. Reintroduction
This step involves reintroducing foods back into your diet in a methodical way to determine
which foods and FODMAPs trigger symptoms and which do not. Each FODMAP subgroup
should be reintroduced separately while your background diet remains low in FODMAPs. The
reintroduction step is also best completed under the guidance of a dietitian, who will advise
you on when to reintroduce; which foods to reintroduce with (e.g. honey to test your
tolerance to excess fructose); the amount of the reintroduction food to have, and the order of reintroducing foods. Remember to have a break of a few days between the reintroduction of foods to avoid any crossover effects. A dietitian will also help you to interpret your responses. It takes most people around 6 to 8 weeks to complete the reintroduction step.
Step 3. Personalization
The third step of the diet involves establishing your longer-term, personalized FODMAP diet. Once your dietitian has interpreted your food triggers and tolerances, you can begin to reintroduce foods and FODMAPs that were tolerated well and avoiding ONLY the foods that triggered your symptoms. It is important to remember that FODMAP tolerance can change over time, so if there are foods you didn’t tolerate as well, try again in a few months to see if anything has changed.
A Helpful Guide to Codes in packaged Food Ingredients
While most food additives have not been studied specifically in people with IBS, there are several that have known gut side effects.
Ultimately, the most well known include sugar polyols, which are widely used as ‘sweeteners’ in foods, but can also be found in certain medications (particularly those in liquid form). Some examples of common sugar polyols used as food additives include:
- Sorbitol (E420/420)
- Mannitol (E421/421)
- Isomalt (E953/953)
- Maltitol (E965/965)
- Lactitol (E966/966)
- Xylitol (E967/967)
The sugar polyols, glycerol (E422/422), is easily absorbed in the small intestine (upper gut), so they do not have the same effects in the body as other larger sugar polyols. Erythritol (E968/968) may be the other exception, as it also appears to be well absorbed in the small intestine.
What do polyols do?
Certain sugar polyols are well known for their ‘laxative’ effects, even in people without IBS – that is, when eaten in large enough amounts, they can cause gut symptoms. This is because they:
- Cause extra water to be dragged into the gut, which can make stools more liquid or soft and result in diarrhea.
- They can be poorly absorbed in the small intestine. Unabsorbed sugar polyols then reach the large intestine where they are digested by the bacteria that live there, resulting in gas production – this can lead to symptoms like bloating, cramps, flatulence, and tummy pain.
The important thing to remember is that everyone with IBS will tolerate sugar polyols differently. In fact, people with constipation-predominant IBS (IBS-C) may actually find the laxative properties of sugar polyols useful for improving their constipation (when consumed in the right dose for them).
A Helpful Guide to Cook for Someone on the FODMAP Diet
Living with someone with IBS
Endeavor to learn as much as you can about IBS and the low FODMAP diet – attend dietitian appointments with your loved one, if you can, to offer support and improve your understanding of the 3-phase diet process. Make sure you also have a copy of key resources like the Monash low FODMAP diet booklet or App, especially if you are responsible for the family cooking. Remember – a strict low FODMAP diet is NOT permanent but for 2-6 weeks only. Your family member will also require ongoing support during the re-challenge and reintroduction phases of the diet.
Use low FODMAP recipes as a base and cook key high FODMAP ingredients (like onion, garlic or vegetables) separately. Stir these through for the rest of the family at the end of cooking after removing the low FODMAP portion.
Swap key high FODMAP ingredients out of your family’s favorite recipes for similar, low FODMAP alternatives (i.e. swap honey for maple syrup, wheat noodles for rice noodles, etc. Refer to the Monash FODMAP App for more swap ideas!)
Only buy and use costly low FODMAP staples (like low FODMAP bread, breakfast cereal, and pasta) for the family member with IBS. This will reduce costs associated with following the diet and minimize unnecessary restrictions on the rest of the family.
Keep low FODMAP bread in the freezer and remove slices as required. This will prevent other family members from using this bread and prevent unnecessary waste through spoilage as a result.
Serve more low FODMAP grain varieties like quinoa and brown rice with main meals. These are nutritious options that the whole family can enjoy!
Hosting for someone with IBS
If you are cooking for someone with IBS, ask them for a list of foods that they need to avoid – key ingredients to avoid in cooking include onion, garlic, and wheat-based products. Importantly, ask for a list of foods that they CAN eat! This will really help you to brainstorm suitable recipes and snack ideas to offer.
Ask your friend/family member if they have any recipes or resources that you can use, or alternatively, visit the Monash FODMAP recipe index for ideas.
Remember, don’t be afraid to ask for advice! If you have an idea in mind, run it past your friend/family member with IBS to check if it is OK or ask them for suggestions about how best to create a low FODMAP version. If in doubt, ask, ask and ask again! Your friend/family member with IBS will really appreciate the effort you are putting in to make the meal suitable and enjoyable for them.
FODMAP Label Reading Guide
Reading food labels can assist you to recognize suitable foods on a low FODMAP diet. The table below describes common, FODMAP containing ingredients and products where these ingredients may be found.
Remember, that ingredients on food labels are listed in order of weight. Meaning the first ingredient listed is in the highest quantity and thus the last ingredient listed is in the lowest quantity. However, when you are starting to re-introduce higher FODMAP foods, you may choose to try products that have high FODMAP ingredients such as garlic powder listed as minor ingredients. You just then need to monitor your tolerance.
NOTE: Whilst label reading is helpful, high FODMAP ingredients cannot always be identified. As a result, some foods which may appear to be low FODMAP according to ingredients, may, in fact, be high FODMAP. So even if you find a product that looks like it would be safe, use trial and error to confirm that you are able to tolerate it.
Helpful FODMAP Table
|Common ingredients to avoid||Potential sources|
|Fructose||Soft drinks, sports drinks, |
muesli bars, breads, jams
|High fructose corn syrup||Soft drinks, muesli bars, |
|Honey||Sweetened products, muesli |
bars, breakfast cereals,
|Sorbitol||Chewing gums and mints, |
artificial sweetened products,
|Mannitol||Chewing gums and mints, |
artificial sweetened products,
|Xylitol||Chewing gums and mints|
|Isomalt||Chewing gums and mints|
|Garlic. Or garlic products e.g. garlic salt, garlic powder||Flavoured products e.g. |
pasta sauces, tomato pastes,
stocks, flavoured biscuits/chips,
|Onion. Or onion products e.g. onion salt, onion powder||Flavoured products e.g. pasta |
sauces, tomato pastes, stocks,
flavoured biscuits/chips, dips
|Wheat when it is a main |
ingredient (i.e. listed first to
third on the ingredient list)
|Breads, breakfast cereals, biscuits, pasta|
|Rye when it is a main ingredient (i.e. |
listed first to third on the
|Breads, breakfast cereals, biscuits|
|Fructan||High fibre foods|
|Fructooligosaccharides (FOS)||Protein powders, sports products|
|Fruit juices e.g pear juice, apple juice||Muesli bars, breakfast cereals, |
|Fruit pieces which make up a |
significant portion of the food
|Fruit yoghurts, muesli bars, |
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