Low FODMAP Diet Guide

What is FODMAP?

Fodmap Meaning Definition –

FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols

FODMAP is a term coined by researchers at Monash University in Melbourne to describe a group of sugars that can be poorly absorbed, contributing to the onset of symptoms of stomach issues like irritable bowel syndrome (IBS).


What is the FODMAP Diet?

The low FODMAP diet was developed by a team of researchers at Monash University in Melbourne, Australia.

They noticed that some types of carbohydrates (or sugars) were poorly absorbed in the small intestine, triggering gas, bloating and loose stools in some people.

They called these sugars ‘fermentable carbohydrates’ or FODMAPs.

They found that by eliminating FODMAPs from the diet, patients with IBS and digestive disorders felt much better, and experienced fewer symptoms.

In fact, research shows that around 76% of patients who have seen a FODMAP-trained dietitian feel an improvement in symptoms after following the diet.

The FODMAP diet is generally divided into 4 phases

FODMAP STEP 1 – Take a Breath Test

Before you start the low-FODMAP diet, you may want to have a breath hydrogen test, to check whether you have fructose or lactose malabsorption or both. This Test should be arranged by your local doctor/hospital

FODMAP STEP 2 – Eliminate High FODMAP FOODs

Eliminate ALL HIGH FODMAP Foods for 2 Months

FODMAP STEP 3 – Re-Introduction FODMAPS

Reintroduce the FODMAPs Group, one at a time, to determine which contribute to your symptoms and how much of each you can tolerate.

FODMAP STEP 4 – ONGOING MAINTENANCE PHASE

During the Maintenance Phase, You should be aware both of your key triggers and the FODMAPs that don’t cause your symptoms, you can experiment.

Continue to monitor your symptom response in the ongoing future by testing different FODMAPS Group and portion sizes.


What does FODMAP stand for?

FODMAP Acronym

Fodmap Stands For:

FODMAP is an acronym that stands for:

Fermentable Oligo-saccharides Di-saccharides Mono-saccharides And Polyols


What are FODMAPS?

F ermentable

+

O ligosaccarides

+

D isaccharides

+

M onosaccharides

+

A nd

+

P olyols       

= FODMAP!

FODMAPs are a group of naturally occurring sugars that are not absorbed in the small intestine; instead, they travel down the rest of the digestive tract and arrive into the large intestine, where bacteria are present (which is normal and healthy).

These bacteria use the unabsorbed sugars (FODMAPs) as a food source.

When the bacteria munch on the FODMAPs, they ferment them, and this results in the release of gas, which can lead to excessive flatulence, gassiness, bloating, and abdominal distension and pain.

The FODMAPs can also change how quickly the bowels work, so can lead to constipation or diarrhoea (or a combination of both) in susceptible people.

how do fodmap work?

How do Fodmap work in your Body?

These FODMAP sugars include:

  1. Fructose – found in fruit, honey, juices.
  2. Lactose – found in milk and milk products.
  3. Sugar polyols – Such as sorbitol and mannitol – found in some fruits and vegetables and as an artificial sweetener.
  4. Fructans – found in wheat, rye, onions, garlic.
  5. Galacto-oligosaccharides (GOS) – found in legumes such as chickpeas, kidney beans or baked beans.

Why are some people affected by FODMAP foods?

EVERYONE eats HIGH & LOW FODMAPS. 

For most people, FODMAPS go though intestine without an issue.

When they reach the far end of the intestine, they get fermented by the gut bacteria that reside there. This is not a bad thing. It is actually how dietary fibres feed the friendly gut bacteria.

However, in some individuals, foods containing FODMAPs are poorly digested, which means that they reach the end of the intestine, and begin to produce gasses as a result of fermentation.

This can lead to fodmap symptoms like wind, bloating, stomach cramps, pain and constipation.

The main aim of a low FODMAP diet is to avoid harmful compound, to prevent unwanted discomfort as a result.


What are some Fodmap symptoms?

Common Issues with High FodMap

Common Issues with High FodMap

  • Diarrhoea
    When these sugars are poorly absorbed in the small intestine increased water can be drawn into the gut, which can result in diarrhoea in some people.

 

  • Gas
    For others, the sugars travel to the large intestine where they are fermented by bacteria, producing gas.

 

  • Pain
    This gas can lead to bloating, flatulence, pain and nausea.

 

  • Constipation
    It can also cause bowel movement to slow down which can contribute to constipation.

FODMAP Treatment

“I have those symptoms.  How do I know if FODMAPS are causing them?”

Your first port of call should always be a medical practitioner or accredited practising dietitian.

There is no point in trying to guess which foods may be contributing to your symptoms; you could spend a lifetime doing this.

Take a Common FodMap Tests

Your doctor or dietitian can order a variety of tests to help figure out the cause of your symptoms.

  • Blood Tests
    It is important that you have blood tests to rule out coeliac disease or gluten intolerance. Coeliac disease is a serious genetic condition that requires a life-long gluten-free diet and is very different to FODMAP malabsorption.

 

  • Hydrogen and Methane Breath Tests
    Breath Tests can check if you are malabsorbing fructose, lactose and sorbitol.They simply involve drinking a measured amount of a sugar solution and breathing into a bag approximately every 30 minutes over the next 2-3 hours.  The amount of hydrogen and methane is measured in each breath sample.A rise in these gases indicates the sugar has been malabsorbed and that you could benefit from a low FODMAP diet.

Though all FODMAPs may trigger symptoms of IBS, there are breath hydrogen (or methane) tests available to determine individual sensitivity to certain sugars, especially fructose, lactose, and sorbitol. Breath tests are not a prerequisite for following the low-FODMAP diet but can be helpful in planning it. Ask your doctor if you are interested in having these tests run.

The tests work on the basis that bacteria in the large intestine produce hydrogen and/or methane gas by fermenting carbohydrates. Although some of the gas produced in the large intestine is passed out as flatulence, most of it is transferred across the lining of the large intestine into the bloodstream. The gases then dissolve into the blood, and the blood carries it to the lungs, where it is breathed out and can be measured.

Different testing centers have different guidelines for breath tests; however, you generally need to follow a low-FODMAP diet the day before the test to ensure that there is no hydrogen or methane already in your breath on the day of your test.

A sample of your breath is collected into a special airtight bag and is then tested for the presence of hydrogen and/or methane, measured in parts per million. This is considered your baseline breath test.

You then drink a solution containing a specific sugar (e.g., fructose, lactose, or sorbitol). Only one sugar can be tested at a time, and each sugar must be tested on a different day within the span of a month. Once you have drunk the solution, you breathe into a new airtight bag at regular intervals over a period of around three hours. Each testing centre has different criteria for defining malabsorption of sugars tested. It is also helpful to keep a record of any symptoms you experienced at the time of the test

If your tests do come back showing FODMAP malabsorption, a dietitian can guide you through the low FODMAP diet.  It may take some adjustment in the foods that you choose and the way that you cook, but how great it is to have some relief from IBS.


WHO / WHEN should I Start the LOW-FODMAP DIET?

Who – The low-fodmap diet is designed for people that have been diagnosed with IBS.

When

  1. After you have completed an initial consultation with a IBS Dietian / Doctor
  2. With your doctors assistance, eliminate the possibility of other stomach diseases like:Coeliac disease,
    Inflammatory bowel disease (IBD)
    Lactose intolerance
    Inflection
  3. Ideally, get a positive result from a Hydrogen and Methane Breath Tests
  4. Consultation with a IBS Dietian / Doctor to try the low FODmap diet
Research shows that around 75% of patients who have completed the Low FODMAP DIET have seen an improvement in symptoms
.


HOW DO WE KNOW THE LOW-FODMAP DIET WORKS?

Studies published in Clinical Gastroenterology and Hepatology showed that the improvement in these people when they used the low-FODMAP diet was due to the reduction of FODMAPs in the diet. The FODMAP concept was strongly supported.

In subsequent studies, we have supplied food to people with IBS without their knowing whether they were getting low-FODMAP meals or normal-FODMAP meals. These studies showed that the severity of symptoms experienced on a diet of low-FODMAP food was markedly reduced compared to symptoms experienced on a normal- or high-FODMAP diet.


Getting Started with the LOW FODMap Diet

Your first step should be to contact a registered dietitian who specializes in FODMAP gastrointestinal nutrition.

The FODMAP diet is generally divided into 4 phases


FODMAP STEP 1 – Take a Breath Test

Before you start the low-FODMAP diet, you may want to have a breath hydrogen test, to check whether you have fructose or lactose malabsorption or both.

If you discover that you don’t have either, you will be able to include lactose and fructose in your low-FODMAP diet, although a negative breath test for fructose and lactose does not mean you won’t benefit from restricting the other remaining FODMAPs.

If you decide not to have a breath test, we recommend you avoid all FODMAPs for the initial two months.


FODMAP STEP 2 – Eliminate High FODMAP FOODs

SUMMARY OF STEP 2

  • Aim is to identify if FODMAPs are triggers for IBS symptoms.
  • Restrict foods high in all or selected FODMAPs for six to eight weeks.
  • Monitor improvement – this should usually be seen within two weeks, with ongoing improvement in the following weeks.

The elimination phase is the first in the series of FOUR phases to get your gut back dancing and to its optimum health. In these 8 weeks, you’re going to remove all the foods that are known to be high in FODMAPS from your diet and that could be irritating your gut.

The elimination phase should be implemented for 8 weeks in order to establish the role of FODMAPs in triggering symptoms.

It’s likely you’ll see a big improvement in symptoms after 3–5 days but you should stick with it for the full 8 weeks for the best results.

It’s important to remember that FODMAPs aren’t all bad. They are good for gut health, producing short-chain fatty acids which are partly used as food for beneficial bacteria. So after 8 weeks, it is time to move on to the next phase and reintroduce some FODMAPs into your diet.

To keep your symptoms under control, The FODMAP recommend that you follow the low-FODMAP diet strictly by avoiding all FODMAPs for at least two months.


FODMAP STEP 3 – Re-Introduction FODMAPS

SUMMARY OF STEP 3

  • Liberalize your diet so that it’s not unnecessarily restricted.
  • Eat a greater variety of foods while maintaining symptom control.
  • Commence this step in consultation with your dietitian, ideally at your review appointment, after assessing your symptom response to the strict phase (Step One).
  • Reintroduce FODMAPs in a controlled way with foods that contain only one type of FODMAP at a time.
  • Learn which FODMAPs you can include by exploring: first, whether you can tolerate a whole FODMAP group that you previously cut out; and secondly, whether you can tolerate larger servings of foods containing these FODMAPs.
  • Determine the types and amounts of FODMAPS you can tolerate while still enjoying symptom relief.

The second phase is the reintroduction phase, or “rechallenge” phase.

All FODMAPs can cause IBS symptoms, and if they are eaten together, their effect is cumulative.
However, if your symptoms have improved after this time, it is recommended to gradually reintroduce one FODMAP group at a time to see if you tolerate it. This is easier to do with the help of a registered dietitian, who will review your symptoms and suggest the best approach.

Once you have followed the low-FODMAP diet for two months and have seen an improvement in your symptoms, you can reintroduce the FODMAPs, one at a time, to determine which contribute to your symptoms and how much of each you can tolerate. This process is called a food challenge.

That is not to say that the low-FODMAP diet is difficult to manage, but it will mean significant diet and lifestyle changes

Here are some guidelines for FODMAP food challenges

Reintroducing the FODMAPs one at a time

All FODMAPs can cause IBS symptoms, and if they are eaten together, their effect is cumulative. Any meal is likely to contain a variety of foods and, therefore, a complex mixture of carbohydrates, which includes FODMAPs. The low-FODMAP diet aims to reduce the intake of all FODMAPs so that IBS symptoms are reduced as much as possible.

While all FODMAPs are potential triggers for IBS symptoms, which FODMAP has the greatest effect on you will depend on how much and how often you consume foods that contain them. In many cultures, fructose and fructans are the most widespread and frequently eaten FODMAPs. Lactose, GOS, and polyol intake can vary significantly. Intake can also vary seasonally: Sorbitol intake is likely to be higher in summer when stone fruits are in abundance. Indian and Mexican cuisines, which are based largely on lentils and beans, will have a higher GOS content.

Once you have followed the low-FODMAP diet for two months and have seen an improvement in your symptoms, you can reintroduce the FODMAPs, one at a time, to determine which contribute to your symptoms and how much of each you can tolerate. This process is called a food challenge.

Here are some guidelines for FODMAP food challenges:

  1. Test only one FODMAP subgroup at a time.
  2. Choose an amount of food that reflects a normal portion size.
    You will gain no useful information about your tolerance of a FODMAP group if you challenge yourself with a very large—or unreasonably small—intake in your trial dose. Any food consumed in excessive amounts is likely to induce symptoms.
  3. Where possible, choose a food that contains only one type of FODMAP, to enable a more accurate interpretation of your response.
  4. Continue to restrict all other FODMAPs until your tolerance (or intolerance) is confirmed.
  5. Maintain a consistent intake of caffeine and alcohol, or of any other foods you know are a problem for you.
  6. Challenge with one FODMAP per week.
  7. Eat the challenge food at least twice during the test week (or until symptoms are triggered).
1 week FODMAP Challenge Printable

1 week FODMAP Challenge Printable

Although it is recommended to spend 2 months restricting all FODMAPs, most people following the diet are able to add various foods—sometimes in limited quantities—back into their diet.


FODMAP STEP 4 – ONGOING MAINTENANCE PHASE

Keep in mind that the low-FODMAP diet is highly individualized.

During the Maintenance Phase, You should be aware both of your key triggers and the FODMAPs that don’t cause your symptoms, you can experiment.

Continue to monitor your symptom response in the ongoing future..

If you don’t get symptoms:

  • Increase the number of foods that contain the FODMAP you are testing, and assess your response
  • Or maintain the amount and type of food you have tested, and then undertake the next FODMAP challenge.

If you do get symptoms:

  • Wait until you are symptom-free, then reduce the serving size to half and challenge again
  • Or assume the FODMAP is a problem for you. It is recommended to continue to restrict the FODMAP and to try the suggestions that follow.
    • Try another food from within the same FODMAP group to confirm the result of the challenge.
    • The dose of FODMAPs is vital when challenging foods. We suggest you halve the amount of food and try again when you are symptom-free. It is unlikely you will have to omit the FODMAP completely.
    • We encourage you to challenge again in the future, as your sensitivity to FODMAPs may change over time.

The goal of the diet is not to restrict your menu to the point that you are eating bland or repetitive meals; the goal is to help you enjoy your food without gastrointestinal symptoms!


Common FODMAPS Questions:

Which FODMAPs should I avoid?

When you start the low-FODMAP diet, you should avoid all FODMAPs—fructans, GOS, lactose, excess fructose, and polyols. If you know you can completely absorb fructose, however, you need not restrict your excess fructose intake, and if you know you can completely absorb lactose, you need not restrict your lactose intake.


Will I lose Weight with the FODMAP DIET?

Although it has the word “diet” in its name, the low-FODMAP diet is not intended for weight loss


How much fruit can I eat at one sitting, and how do I limit my fructose load?

You should eat no more than one serving of suitable fruits per meal or sitting. One serving is usually one cup of cut-up fruit or one whole piece of fruit, such as one orange or banana. You can enjoy many fruit servings each day, but you should allow two to three hours between each serving.


Can I eat “table sugar”?

Table sugar (also called sucrose or cane sugar) should not cause symptoms if eaten in moderation. Sucrose is a double sugar made up of one part glucose and one part fructose.


How do I balance my glucose and fructose intake?

If you need to avoid excess fructose, then consuming glucose at the same time as fructose could reduce the severity of your symptoms. You should be aware, however, that this strategy is not recommended if you have diabetes. Glucose sources include glucose powders and tablets, which are available in the sports-drink section of the supermarket and some health-food stores. How much glucose you need to consume with an excess of fructose will depend on how much of the food you are eating and what other foods you have recently consumed or are consuming at the same time. The best way is to use trial and error to establish how much glucose you require to remain free of IBS symptoms while consuming a food that has an excess of fructose. This strategy is unlikely to help when eating foods with excess fructose and other FODMAPS.


What about fats and protein foods?

Fats and oils do not contain FODMAPs, nor do animal-based protein foods, such as meat, fish, chicken, and eggs. However, plant-based protein foods such as legumes do contain FODMAPs, and you may need to restrict your intake of these foods. FODMAPs typically occur in carbohydrate-based foods.


How do I avoid FODMAPs if I’m a vegetarian? What if I’m a vegan?

Vegetarians often consume large amounts of legumes as an important source of protein. Tofu and tempeh are low in FODMAPs, but legumes generally contain GOS and fructans. As there is a risk that your vegetarian or vegan


Must I really avoid wheat products?

If you follow the low-FODMAP diet, you must avoid eating wheat, rye, and barley in large quantities. This means you should avoid breads, cereals, pasta, and cookies, but you can still enjoy such things as a bread-crumb coating on fried chicken or cookie pieces in ice cream. A registered dietitian knowledgeable about the low-FODMAP diet can help assess your individual intolerance to wheat and rye products.

You will find speciality gluten-free alternatives in the health-food aisle of your supermarket and in health-food stores.


Do I really need to avoid onions and garlic?

Onion is one of the greatest contributors to IBS symptoms. We recommend that you strictly avoid onion for at least two months.

 Garlic also contains fructans, though if you like the flavour, one to two cloves per recipe (which serves four to six people) can often be tolerated by IBS sufferers. An even better way to enjoy the taste of garlic without the fructans is to use garlic-infused oil.


Does organic matter to FODMAP?

No, the FODMAP levels of the food are not affected by the origin of the food (i.e. organic or non-organic). The FODMAP sugars are contained in and around the food but are not impacted by the sourcing/method of food harvesting overall. As mentioned, there may be some differences between foods of the same nature due to seasonal changes.


Is alcohol FODMAP friendly?

We would love to say yes, however alcohol in excess is a known gut irritant. Stick to one or two drinks every now and then if you do drink, and don’t mix, to help reduce the chance of symptoms. The most common potential problem with alcohol is the fructose load of drinks, most notably mixers such as fruit juice; rum and sweet, sparkling and dessert wines, so make sure to avoid those.


WHAT IF THE LOW-FODMAP DIET DOESN’T WORK FOR ME?

The low-FODMAP diet doesn’t cure IBS; rather, it is an effective treatment to minimize symptoms. It works to make IBS symptoms manageable in the majority of people who try it. Around 75 to 80 percent of those who go on the low-FODMAP diet are happy with their symptom response.


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