Low-FODMAP (Fermentable, Oligo-, Di-, Mono-saccharides and Polyols) Diet

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Low-FODMAP (Fermentable, Oligo-, Di-, Mono-saccharides and Polyols) Diet: Overview

• What is the Low-FODMAP diet?

  Most patients with irritable bowel syndrome (IBS) associate their symptoms with eating and many patients ease their symptoms by avoiding certain foods or using elimination diets. An elimination diet involves taking multiple foods out of your diet, followed by a period of reintroduction of these foods, in order to determine your personal food sensitivities. The most extensively studied elimination diet for IBS is the low FODMAP diet. FODMAP stands for Fermentable, Oligo-, Di-, Mono-saccharides And Polyols, and consists of groups of certain types of carbohydrates that are thought to trigger GI symptoms. The Low-FODMAP diet was conceived about 10 years ago about by Australian researchers and is the elimination diet thought to be most effective for treating IBS related symptoms.

• What effects do FODMAPS have on the digestive system?

  FODMAPs are short-chain carbohydrates (sugars) that are highly fermentable, which means that they go through chemical changes in the GI system, and are poorly absorbed during digestion. When FODMAPs reach the colon (large intestine), bacteria ferment these sugars, turning them into gas and chemicals. This stretches the walls of the colon, causing abdominal bloating, distension, cramping, pain, and/or changes in bowel habits in many patients with IBS. FODMAPs are not unhealthy or harmful, but may exacerbate GI symptoms in those with sensitive GI tracts.

• When is a Low-FODMAP diet recommended?

  Eliminating or restricting FODMAPs from the diet may greatly improve symptoms of IBS and other functional GI disease, especially in those patients who see a link between food, eating, and their IBS symptoms. The low FODMAP diet can be used alone, or side-by-side with medications for the treatment of IBS. Bloating and abdominal pain are the most likely symptoms to improve but you may see improvements in fatigue, bowel movements, and general quality of life as well.

  While the low FODMAP diet has been studied mostly in IBS, it is often used for other GI conditions as well. Many GI conditions overlap with IBS, so sometimes the low FODMAP diet can be added to treatment for inflammatory bowel disease, celiac disease, and small intestinal bacterial overgrowth if symptoms persist.

  Working with your GI provider and a dietitian familiar with GI conditions can improve the chances of getting better with this type of elimination diet strategy, but the low FODMAP diet doesn’t help everyone. Patients with a history of eating disorders, at risk for malnutrition, or who have complex medical histories may not be good candidates for this dietary strategy.

• How does the low FODMAP diet work?

  There are three phases of the low FODMAP diet: 1) Elimination, 2) Reintroduction, and 3) Personalization. During the elimination phase, which lasts 2-4 weeks, all FODMAPs are taken out of the diet. If symptoms are significantly improved with the elimination phase, patients will start the reintroduction phase, where groups of FODMAPs are added back in one at a time, monitoring for a recurrence of symptoms. Once it is determined which FODMAPs cause symptoms, many patients avoid these foods, but still ingest other FODMAPs on a regular basis. This allows for as much nutritional diversity as possible. Following this personally developed Low-FODMAP plan does not cure IBS, but it may lead to management of symptoms and better quality of life.

  Many patients are overwhelmed by the list of “Do’s and Don’ts.” Because of this, many patients find great value in working with an experienced dietitian during the elimination and reintroduction phases.

Examples of Low and High FODMAP foods

• What foods are suitable, and what should be avoided while on a Low-FODMAP diet?

  Examples of Low and High FODMAP foods.

  Not a complete list of foods. Portion size matters when it comes to FODMAPs as several foods have a specific serving size in which they would be high vs. low in FODMAP.

  *Read labels of packaged foods to ensure they do not have added high FODMAP ingredients (ex: high fructose corn syrup, wheat, onion, garlic, etc.)

  The food groups are listed below:

  	Grains	Fruits	Vegetables	Dairy / Plant-based alternatives	Proteins	Beverages
  High FODMAP	Wheat Rye Barley	Apples/apple juice, Apricot Blackberries Cherries Dates Grapefruit Mango Pear Watermelon	Artichoke Asparagus Cauliflower Garlic Leeks Mushrooms (button, portabella) Onion/shallots Sugar snap peas	Coconut milk (in the carton) Frozen yogurt, Ice cream, Milk Soft cheese Soy milk Yogurt	Most Beans/Legumes Processed meats*	High fructose containing sodas and juices Rum Tea: Chamomile, oolong, fennel, & chai
  Low FODMAP	Corn tortillas/chips Grits Gluten free- pastas crackers and breads* Oatmeal Potato Popcorn Rice Sourdough bread Quinoa	Banana (unripe) Grapes Kiwifruit Lemon Lime Mandarin orange Orange Papaya Pineapple	Bok choy Broccoli Carrots Chives Cucumber Eggplant Kale Lettuce Mushroom (oyster) Olives Radish Spinach Tomato	Almond milk*Cheese (most) Coconut yogurt Hemp milk* Lactose free- ice cream milk yogurt* cottage cheese	Beans: edamame lentils, Canned/rinsed: chickpeas Beef Chicken Egg Fish/Seafood Pork Turkey Tempeh* Tofu-firm	Alcohol: wine (most) beer spirits Coffee Sucrose- sweetened or diet soft drinks Tea (except those listed above) Water

Author(s) and Publication Date(s)

Shanti Eswaran, MD, FACG, University of Michigan, Ann Arbor, MI – Published March 2021