- Sugars and sweeteners Boston University
- Low-FODMAP diet Shepherd Works
- The Monash University Low-FODMAP Diet Monash University
- Rao SS et al, 2015, Systematic review: dietary fibre and FODMAP-restricted diet in the management of constipation and irritable bowel syndrome PubMed Central
- Magge S et al, 2012, Low-FODMAP Diet for Treatment of Irritable Bowel Syndrome PubMed Central
- Easter special: What is the FODMAP content of chocolate? Monash University
- Low FODMAP diet University of Virginia School of Medicine
What are FODMAPs?
The term FODMAPs refers to Fermentable Oligo-, Di- and Monosaccharides And Polyols. FODMAPs are poorly digestible carbohydrates, which are less readily absorbed in the small intestine, so they reach the large intestine where normal intestinal bacteria break them (ferment) into absorbable nutrients, for example, short-chain fatty acids or SCFAs) and gases.
- Oligosaccharides: fructo-oligosaccharides (FOS), galacto-oligosaccharides (GOS), isomalto-oligosaccharides and mannan oligosaccharides
- Disaccharides: lactose
- Monosaccharides: fructose
- Sugar alcohols or polyols: isomalt, lactitol, maltitol, mannitol, polyglycitol syrup (hydrogenated starch hydrolisates or HSH), sorbitol and xylitol
FODMAPs Side Effects
In the small intestine, FODMAPs attract water from the intestinal wall, which may result in loose stools or diarrhea. In the large intestine, normal colonic bacteria break FODMAPs into gases, which may cause bloating.
Some people, mainly those with fructose malabsorption and irritable bowel syndrome (IBS) may experience abdominal bloating or pain, excessive burping (belching), excessive gas (flatulence) and loose stools or diarrhea after consuming even small amounts of FODMAPs.
Who may benefit from a low-FODMAP diet?
Individuals with fructose malabsorption, lactose intolerance, small intestinal bacterial overgrowth (SIBO) and irritable bowel syndrome (IBS) with a positive breath test with fructose or lactose are most likely to benefit from a low-FODMAP diet [4,5].
Picture 1. Examples of foods high in FODMAPs
Chart 1. A Low-FODMAP Diet Plan
FOODS TO AVOID
|Fruits (fructose)||Agave, apple, apricot, avocado, blackberries, dates, figs, lychee, mango, nashi fruit, nectarines, papaya, peach, pear, persimmon, plums, prunes, quince, raisins, star fruit, sultana, sweat cherries, watermelon and related fruit juices, jams, compotes||Banana, berries (except blackberries), grapefruit, grapes, honeydew melon, lemon, lime, mandarin, orange|
|Sweeteners and food additives||Agar-agar, agave syrup, carob powder , fructose, high fructose corn sugar (HFCS), isomalt, honey, lactitol, maltitol, mannitol, sorbitol, polydextrose, polyols or sugar alcohols, xylitol||Acesulfam-K, aspartame, cane sugar, demerara, dextrin, erythritol, glucose (dextrose), hydrogenated starch hydrolysates (HSH), invert sugar, isomaltulose, maltodextrin, muscovado, pectin, polydextrin, saccharin, sucrose (saccharose), stevia, sucralose, tagatose, turbinado; syrups: glucose, corn, barley malt, brown rice, grape, maple, molasses, palm sugar, polyglycitol|
|Legumes (GOS)||Beans, lentils, peas, soy|
|Cereals (FOS)||Wheat, barley and rye products (bread, pasta); sweet corn, sweetened baked products: bagels, biscuits, cookies, pastries, energy bars||Buckwheat, cornmeal, oats, popcorn, rice|
|Vegetables (FOS, GOS, fructose)||Artichokes, asparagus, broccoli, cabbage, cauliflower, chicory root, garlic, leek bulb, mushrooms, onions||Eggplant, lettuce, potatoes, spinach, sweet potatoes, Swiss chard, tomato, yam and other vegetables not listed in the left column|
|“Sugar-free” or “low-calorie” foods||Certain brands of sugar-free chewing gum and candies (see sweeteners to avoid above)||Foods sweetened with allowed sweeteners (see above)|
|Beverages (fructose, HFCS)||Soft drinks, energy drinks, coconut water, beer, liquers||Water (tap, mineral), mineral water, soft drinks sweetened with allowed sweeteners (see above)|
|Dry mixes||Powdered drinks, soups, spices, mashed potatoes|
|Animal foods||Milk products that contain lactose (milk, yogurt, ice cream, custard, milk chocolate, soft cheeses: cottage, ricotta), processed meats (hamburger, hot dog, pizza)||Unprocessed meats, poultry, fish, shellfish, eggs, hard cheese, butter|
Chart 1 sources: [1,2,3,7] Legend: FOS = fructo-oligosaccharides; GOS = galacto-oligosaccharides; HFCS = high fructose corn syrup. Alcoholic and caffeinated beverages may aggravate IBS. NOTE: The list is very strict but not complete. The foods highest in FODMAPs are in bold.
How to start a low-FODMAP diet?
First, try to get a diagnosis on the basis of a breath test from an experienced gastroenterologist. Next, try to find an experienced registered dietitian who will likely recommend you to avoid all foods high in FODMAPs for several weeks and later a less strict diet to determine how much of foods high in FODMAPs you can tolerate.
Frequently Asked Questions
1. Does cooking reduces the FODMAP content of foods?
Cooking, canning and pickling may reduce the amount of FODMAPs but not enough that we could recommend them as methods to avoid FODMAPs.
2. I started a low-FODMAP diet but I still experience bloating and diarrhea. Why?
If you have fructose malabsorption, elimination of FODMAPs should result in improvement of symptoms within few days; complete resolution of symptoms may last for several weeks. If you have irritable bowel syndrome (IBS), a low-FODMAP diet may help you or not. A low-FODMAP diet can improve symptoms in small intestinal bacterial overgrowth (SIBO), celiac disease and Crohn’s disease, but not completely, so the underlying diseases need to be treated.
3. Except FODMAPs, which other food ingredients commonly trigger gastrointestinal symptoms?
- Insoluble fiber in whole grain cereals, legumes, guava, avocado may worsen symptoms of irritable bowel syndrome.
- Gluten triggers diarrhea in celiac disease.
- Allergens from milk, soy, nuts, wheat, fish, shellfish, other foods, supplements or drugs can trigger allergic reactions in sensitive individuals.
- Certain amino acids and polysaccharides are harmful for individuals with certain genetic disorders of metabolism.
- Some foods may not agree with you from psychological reasons or from no apparent cause.
4. Any tips to easier follow a low-FODMAP diet?
Try stop eating all sweet foods and milk products. This way you may avoid craving for sugar.
Common Causes of Bloating and Diarrhea
- Lactose intolerance
- Fructose malabsorption
- Irritable bowel syndrome
- Small intestinal bacterial overgrowth (SIBO)
- Food poisoning: rotavirus (stomach flu), staph infection, salmonella, intestinal parasites
- Side effects of vitamin/mineral supplements or drugs
- Vitamin deficiencies
- Hydrogenated starch hydrolysates (HSH)
- Fructo-oligosaccharides (FOS)
- Galacto-oligosaccharides (GOS)
- Human milk oligosaccharides (HMO)
- Isomalto-oligosaccharides (IMO)
- Mannan oligosaccharides (MOS)
- Raffinose, stachyose, verbascose
- SOLUBLE FIBER:
- Acacia (arabic) gum
- Beta mannan
- Carageenan gum
- Carob or locust bean gum
- Fenugreek gum
- Gellan gum
- Glucomannan or konjac gum
- Guar gum
- Karaya gum
- Psyllium husk mucilage
- Resistant starches
- Tara gum
- Tragacanth gum
- Xanthan gum
- INSOLUBLE FIBER:
- Chitin and chitosan
- Aspartic acid
- Glutamic acid
- FATTY ACIDS
- Alpha-linolenic acid (ALA)
- Eicosapentaenoic (EPA) and Docosahexaenoic acid (DHA)
- Arachidonic acid (AA)
- Linoleic acid
- Conjugated linoleic acid (CLA)
- Short-chain fatty acids (SCFAs)
- Medium-chain fatty acids (MCFAs)
- Long-chain fatty acids (LCFAs)
- Very long-chain fatty acids (VLCFAs)
- Vitamin A - Retinol and retinal
- Vitamin B1 - Thiamine
- Vitamin B2 - Riboflavin
- Vitamin B3 - Niacin
- Vitamin B5 - Pantothenic acid
- Vitamin B6 - Pyridoxine
- Vitamin B7 - Biotin
- Vitamin B9 - Folic acid
- Vitamin B12 - Cobalamin
- Vitamin C - Ascorbic acid
- Vitamin D - Ergocalciferol and cholecalciferol
- Vitamin E - Tocopherol
- Vitamin K - Phylloquinone
- Flavanols: Proanthocyanidins
- Flavanones: Hesperidin
- Flavonols: Quercetin
- Flavones: Diosmin, Luteolin
- Isoflavones: daidzein, genistein
- Caffeic acid
- Chlorogenic acid
- Tannic acid
- Alcohol chemical and physical properties
- Alcoholic beverages types (beer, wine, spirits)
- Denatured alcohol
- Alcohol absorption, metabolism, elimination
- Alcohol and body temperature
- Alcohol and the skin
- Alcohol, appetite and digestion
- Neurological effects of alcohol
- Alcohol, hormones and neurotransmitters
- Alcohol and pain
- Alcohol, blood pressure, heart disease and stroke
- Women, pregnancy, children and alcohol
- Alcohol tolerance
- Alcohol, blood glucose and diabetes
- Alcohol intolerance, allergy and headache
- Alcohol and psychological disorders
- Alcohol and vitamin, mineral and protein deficiency
- Alcohol-drug interactions
- Moderate, heavy, binge drinking
- Alcohol intoxication
- Alcohol poisoning
- Alcohol and gastrointestinal tract
- Alcoholic liver disease
- Long-term effects of excessive alcohol drinking
- Alcohol craving and alcoholism
- Alcohol withdrawal