American College of Gastroenterology
Advancing Gastroenterology, Improving Patient Care

Low-FODMAP 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.

  • 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:

    .

    Food

    Avoid

    Suitable

    Polyols

    Fruit

    Apples, apricots, avocados, cherries, lychee, nectarines, peaches, pears, plums, and watermelon.

    Bananas, blueberries, grapefruit, kiwi, lemons, limes, passion fruit, raspberries, cantaloupe, honeydew, and strawberries

    Vegetables

    Artichoke, asparagus, brussel sprouts, cabbage, cauliflower, green beans mushrooms, snow peas sprouts, and summer squash.

    Bean sprouts, bell peppers, bok choy, carrots, celery, chives, cucumbers, eggplant, kale, lettuce, potatoes, pumpkin, radishes, spinach, tomatoes, winter squash, yams, and zucchini.

    Artificial Sweeteners Sorbitol, mannitol, isomaltose, malitol, xylitol, polydextrose, hydrogenated starch Aspartame, sucralose, saccharin. Commonly found in various gum and candy as well.
    Lactose Dairy whey and high-lactose containing milks such as cow, goat, sheep, chocolate, buttermilk, and condensed milk, and whipped cream. Ice cream, cow’s milk-based yogurt, brie, cottage cheese, ricotta, and sour cream. Gelato or sorbet (though watch fructose content) and lactose-free yogurts. Aged hard cheeses tend to be easier to tolerate. Cheddar, Colby, parmesan, and mozzarella. Greek yogurt.
    Limit: Butter, margarine, sour cream, half and half, cream cheese, Swiss cheese, goat cheese, feta cheese, cheddar, parmesan, and mozzarella contain lactose, although at lower amounts.
    Non-Dairy Milk Alternatives Soy milk contains galactans and should be avoided as well, coconut milk, soy products, hummus, beans, and lentils. Lactose- free or lactaid milk, rice milk, almond milk, almond butter, and cashew milk.
    Fructose / Sweeteners Honey, agave, apples, cherries, dates, guava, honeydew melon, lychee, mandarin oranges, mangoes, peaches, pears, persimmons, star fruit, canned fruit in natural juices, dried fruits and less ripe fruits, corn syrup, high fructose sweeteners, coconut milk, fruit pastes (i.e. chutney, plum sauce, barbeque sauce, ketchup), rosé wine, port, and sherry Maple syrup, jams, marmalades, vegemite, table sugar, bananas, blackberries, blueberries, boysenberries, cranberries, grapefruit, kiwis, kumquats, lemons, limes, passion fruit, raspberries, and strawberries.
    Limit: grapes, oranges, papaya, pineapple, and watermelon.
    Fructans
    Starches Bread, pasta, semolina, flour tortillas, wheat-based bread and breadcrumbs. Wheat-based cereals, crackers, cookies, cakes, pasta, and pastries. Beer. Corn breads, gluten- free breads, pastas, cereals, as well as corn flakes, oatmeal, potato-based breads, rice-based noodles and breads, and wheat-free rye bread.
    FruitGrapes, mangoes, peaches, persimmon, pineapple, watermelon, and bananas. Grapefruit, lemons, limes, papaya, raspberries, strawberries, and blueberries.
    Vegetables Artichokes, asparagus, beets, broccoli, Brussel sprouts, cabbage, chicory, garlic, leeks, lettuce, okra, onions, radicchio, scallions, shallots, snow peas, and zucchini. Bean sprouts, bell peppers, bok choy, carrots, celery, chives, cucumber, eggplant, potatoes, pumpkin, radishes, spinach, tomatoes, turnips, winter squash, and garlic-infused oil.
    Galactans Plant based proteins such as beans, black-eyed peas, chick peas, kidney beans, lentils, lima beans, pinto beans, soy products, broccoli, Brussel sprouts, cabbage, green beans, and yellow beans. Eggs, nuts, quinoa, seeds, bean sprouts, bell peppers, bok choy, carrots, celery, chives, cucumbers, eggplant, potatoes, pumpkin, radish, spinach, and tomatoes.

Author(s) and Publication Date(s)

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

External Links

  • Monash University website and Phone App
    www.monashfodmap.com
  • Researchers at Monash University developed the low FODMAP diet and a corresponding smartphone App to assist patients and providers in implementing the diet. Additionally, they maintain an informative and up-to-date low FODMAP blog.
  • Stanford University: “The Low FODMAP Diet”
    Low FODMAP Diet
  • Kate Scarlata’s Website and Books
    www.katescarlata.com
  • My Nutrition Health
    www.myginutrition.com
  • A comprehensive website for both patients and providers explaining the low FODMAP diet. Complete with videos, recipes, and FAQs.

Michigan Medicine Low FODMAP Resources