Fodmap Diet - Banish Pain and Bloating

The fodmap diet was first introduced in 1999 in Australia and the idea of reducing fodmaps in the diet to treat the symptoms of functional bowel problems like IBS is now spreading around the world.

Read on to find out how this diet could help you and the basic principles behind its introduction.

Who Developed the Low Fodmap Diet?

The low fodmap diet was developed by researchers of the gastroenterology department at Monash University in Melbourne Australia to help people with functional bowel disorders like irritable bowel syndrome.

What does Fodmap Mean?

The word FODMAP is an acronym which stands for:

  • F-Fermentable,
  • O-Oligosaccharides   (O)
  • D-Disaccharides       (D)
  • M-Monosaccharides  (M)
  • A-And
  • P-Polyols                 (P)

These are all types of sugars which are found in many kinds of foods. They are short chain carbohydrates.

Most starches in our diet are long chain carbohydrates meaning that they are composed of many sugars linked together. Fodmaps only have one or two sugars and so are 'short chain'.  The sugars are split into two groups:

Group 1

Sugars from Monosaccharides, Disaccharides and Polyols

High Fructose (M)

Lactose (D)

Sorbitol, Mannitol, Maltitol, Xylitol, Isomalt (P)

These are only partly absorbed in the small intestine.

Group 2

Sugars from Oligosaccharides

Fructans

Galacto-oligosaccharides (GOS)

These are not absorbed at all.

Why Do Fodmaps Cause Problems?

As you can see from the groups above these sugars are either only partially absorbed or not absorbed at all in the small intestine where other foodstuffs are absorbed. Poor absorption is normal and anybody can have symptoms. For example many people suffer from excess gas when they eat beans!

Some people with irritable bowel syndrome and other bowel problems seem to be extra sensitive to the effects of these sugars and suffer more symptoms than other people.

When these special sugars are not absorbed in the small intestine they pass into the large intestine where they meet the bacteria living there which causes them to ferment and produce gas.

This can cause the inside of intestine to distend causing pain and bloating. In people with IBS this could be because the nerves in their large intestine are over sensitive.

They also cause fluid to be drawn into the gut which can contribute to diarrhea.

It has been found that some people produce more methane which slows down the gut and some people produce more hydrogen which speeds up the gut.

In one study, people with IBS have been shown to produce more hydrogen than healthy people, thanks to the fermentation by bacteria in their colon. This difference was much more pronounced when they were given a high fodmap diet. The IBS sufferers had a range of gastrointestinal symptoms and lethargy, whereas the healthy people only had increased gas.

The higher fodmap diet did not change the amount of methane produced by the IBS sufferers.

Tests

Lactose malabsorption or intolerance can be tested for using the lactose hydrogen breath test. Lactose intolerance is common throughout the world as in fact it is normal for adults to have problems digesting milk which was not designed for them!

Northern Europeans are the odd ones out as they retain the enzyme lactase, which babies are born with, into adulthood.

Fructose malabsorption can be tested for using the fructose hydrogen breath test.

Tests are also available for sorbitol sensitivity.

These tests can be done in the doctors office or in some countries home testing kits are available.

Who Can Benefit From A Low Fodmap Diet?

Many people suffer from digestive problems and if you are sensitive to fodmaps then you will have bloating, pain, gas, constipation or diarrhea. So anybody with these symptoms could benefit from a diet low in fodmaps but you must check first with your doctor that your symptoms are not being caused by anything more worrying.

This diet was first formulated with irritable bowel syndrome sufferers in mind and it has been shown that 50-75% of people with IBS see a reduction in symptoms if they reduce fodmaps in their diet.

This applies whether your symptoms are predominantly diarrhea or constipation.

If you suffer from bacterial overgrowth in the small intestine (SIBO) you could also benefit.

Studies have also shown a benefit to people with inflammatory bowel disease.

People who suffer from Gastroesophageal Reflux Disease and acid reflux.

Which Foods Are High in Fodmaps?

High Fructose

Apple, Artichokes, Asparagus, Banana (ripe), Cherries, Canned Fruit, Dessert Wine, Dried Fruit, Fruit Juices, High Fructose Corn Syrup, Honey, Mango, Molasses, Rum, Sugar Snap Peas, Watermelon.

Lactose

Buttermilk, Cheese (soft unripened like cottage, cream, mascarpone, ricotta), Custard, Ice Cream, Milk (not lacto free), Milk Chocolate, White Chocolate, Yoghurt.

Polyols

Apple, Apple Juice, Apricot, Avocado, Blackberry, Cauliflower, Celery (1/4 stalk ok), Cherries, Isomalt, Maltitol, Mannitol, Nectarine, Mushroom, Pear, Pear Juice, Plum, Prune, Snow Peas/Mangetout, Sorbitol, Watermelon, Xylitol.

Fructans

Barley, Beetroot/Beets, Brussel Sprouts, Cabbage, Camomile, Chicory, Corn/Sweetcorn, Fennel, Fructo-oligosaccharides, Garlic, Globe Artichoke, Instant Coffee, Inulin, Jerusalem Artichoke, Leek, Onion, Peach, Persimmon, Rye, Shallots, Spring Onion/Scallion (white part), Watermelon, Wheat (bread, couscous, pasta etc.).

GOS

Beans (Legume beans like baked, borlotti, fava/broad, kidney, lima/butter etc.) Broccoli, Carob, Cashew Nuts, Chickpeas, Lentils, Pistachio Nuts, Soy Nuts, Soy drinks (whole bean), Sugar Snap Peas.

The above foods are relatively high in fodmaps and are the main foods to watch out for. There are other foods which have moderate amounts or low amounts but it is the overall load which counts and some people can tolerate more than others. This is partly to do with heredity and ethnicity.

Usually foods in the fructans, polyol and GOS groups have to be restricted but not always those in the fructose and lactose groups.

N.B. High Fructose means that there is a more fructose than glucose in the food. People with IBS do not seem to react to glucose.

Fodmap Diet and Processed Foods - The Hidden Traps

Be aware that many processed foods like carbonated drinks, sauces, condiments, stock cubes, processed meats and basically anything made in a factory often contain fructose sugars, particularly high fructose corn syrup as it is cheaper than other sugars.

Some processed foods now also have prebiotics like inulin and fructo-oligosaccharides (FOS) added. 

Read all the labels of processed foods carefully.

The Noughts and Crosses of the Low Fodmap  Diet - What Can I Eat?

Strawberry with Green Tick
Fodmap Diet - Onion with Red Cross
Oats with Green Tick
Toasted White Bread with Red Cross
Low Fodmap Diet - Tomatoes with Green Tick
Garlic with Red Cross
Fodmap Diet - Leeks with Red Cross
Fodmap - Hard Cheese
Low Fodmap Diet - Orange with Green Tick

It may be daunting to think about following this diet and sometimes it can seem like a game of strategy as there are so many foods to exclude or reduce.

I know this only too well as my mother cannot tolerate onions or any food from that family. This is the commonest fodmap intolerance and it makes things difficult when eating out as so many recipes start with "take one onion". At family gatherings we always have to make extra onion and garlic free versions of dishes. "We don't mind Mum!".

So where to start. Well you are safe with all meats, fish, eggs, tempeh and tofu so that takes care of protein. Oils and fats are low in fodmaps although some people find that they get gut symptoms if they have too much fat.

For some areas of your diet you will need to go shopping for some alternative products.

Get prepared and see below for things to include on your grocery list:

Dairy

  • Alternatives to milk like rice milk, coconut milk (only half a cup for those sensitive to sorbitol), soy milk (if made from protein only, not whole beans)
  • Butter
  • Hard and aged cheeses like Camembert, Cheddar, Brie, Feta, Swiss and others
  • Lacto-free milk and yoghurt

Drinks

  • Beer
  • Coffee (not instant) some people find their gut speed is altered by coffee
  • Drinking chocolate
  • Gin
  • Tea, black, green, mint, white (not camomile or fennel)
  • Vodka
  • Whiskey
  • Wine (not dessert wines)

Please note that although the above alcohols are permitted in small amounts on the low fodmap diet alcohol is an intestinal irritant so take it easy. For more information on this subject please see Diarrhea after drinking.

Fruit

  • Banana (only unripe)
  • Berries, like blueberry, cranberry, dried goji, raspberry, strawberry
  • Breadfruit
  • Citrus fruits, like clementine, lemon, lime, mandarin, orange,
  • Coconut
  • Dragonfruit
  • Feijoa
  • Grapes
  • Guava
  • Kiwi
  • Melons, like cantaloupe (rockmelon), honeydew (not watermelon)
  • Pineapple
  • Rhubarb

Grains

  • Arrowroot
  • Buckwheat flour
  • Cornflour, cornmeal
  • Gluten free breads, cakes and biscuits (because gluten free products are made with alternative flours to wheat, rye and barley)
  • Gluten free pasta
  • Maize tortillas
  • Millet
  • Oats/Oatmeal
  • Polenta
  • Quinoa
  • Rice
  • Rice cakes
  • Rice noodles
  • Rice vermicelli
  • Sago
  • Soba noodles
  • Sorgum
  • Sourdough spelt bread
  • Taco shells
  • Tapioca

Herbs, Spices and Condiments

  • Basil
  • Cayenne pepper
  • Chives
  • Cilantro/Coriander
  • Curry leaves
  • Curry powder
  • Fish sauce
  • Five Spice
  • Ginger
  • Lemongrass
  • Miso paste
  • Mustard seeds
  • Oregano
  • Paprika
  • Parsley
  • Pepper
  • Rosemary
  • Saffron
  • Salt
  • Shrimp paste
  • Star Anise
  • Tamarind paste
  • Thyme
  • Vinegar - balsamic, red wine, white wine

Seeds and Nuts

  • Almonds (<10 nuts)
  • Chia seeds
  • Egusi
  • Flax seeds
  • Hazelnuts
  • Macadamia nuts
  • Nut butters
  • Peanuts
  • Pecans
  • Pine nuts
  • Sesame seeds
  • Sunflower seeds
  • Walnuts

Stick to small numbers of seeds and nuts.

Sweeteners

  • Aspartame
  • Glucose
  • Maple syrup
  • Splenda
  • Stevia
  • Sugar - sucrose
  • Treacle

Vegetables

  • Bell pepper
  • Bok Choy
  • Carrot
  • Celeriac
  • Chilli
  • Eggplant/Aubergine
  • Galangal
  • Green beans
  • Kale
  • Olives
  • Parsnip
  • Potato
  • Rutabaga/Swede
  • Salad vegetables like leaves, cucumber, radish, tomato
  • Scallion/Spring onion (green bit only)
  • Spinach
  • Sprouts and shoots
  • Taro
  • Turnip
  • Yam
  • Zucchini/Courgette

Only limited quantities of butternut squash, okra and sweet potato.

The above list of fodmap diet friendly foods is not exhaustive as Monash University is testing new foods all the time.

How to Get Flavor Into Your Food When You Can't Eat Onions and Garlic

It can be tough to get flavor into your food without the help of onions and garlic but unfortunately they are the number one foods to avoid if you have a problem with fodmaps.

Here are some tips to help you prepare tasty low fodmap food:

  • Asafoetida powder made with rice flour
  • Celeriac and carrot mixture diced is a good start to a stew or casserole
  • Chilli peppers
  • Chives/garlic chives - the only member of the allium family low in fodmaps
  • Garlic infused oil. The fructans in garlic are water soluble so they do not transfer into the oil. Either buy it ready made or simmer a peeled clove of garlic in oil for five minutes and then discard
  • Green part only of scallions/spring onions
  • Herbs and Spices, especially basil, cayenne, chilli flakes, cilantro/coriander, oregano, paprika, parsley, rosemary, thyme
  • Soy sauce (gluten free only)
  • Vinegar - balsamic (up to one tablespoon), red wine, white wine

Can I Introduce the Diet On My Own

This diet can be quite complicated as initially large groups of food need to be excluded and then re-introducing during a monitoring phase. For this reason it is recommended that your progress is assessed by a qualified dietitian who is trained to help with this type of diet.

Is The Fodmap Diet For Life?

Yes and no. A strict low fodmap diet should only be followed for 6-8 weeks. During this time all the different high fodmap foods should be excluded from your diet to see if it helps.

As foods high in fodmaps are common across the main food groups, the diet cannot be followed strictly for too long. This is because there is a danger of malnutrition. For example some people have developed low vitamin D levels on this diet. Talk to your dietitian about supplementation.

Foods should be re-introduced one at a time and symptoms monitored. Most people find that after the strict phase of the diet their symptoms calm down and in the long term they only need to exclude some of the high fodmap foods.

Often they can eat small quantities of these or even whole groups. Each person has to find their own tolerance levels.

How Long Will It Take Before I Feel Better?

If the fodmap diet is going to work for you then if you follow the strict restriction phase to the letter you should start to feel the benefit right away.

When you move to the maintenance phase you will have a period of trial and error until you find your individual diet.

If you have symptoms that you think might be helped by the low fodmap diet then first get a proper diagnosis of your problem. If you have a diagnosis of IBS or SIBO then a trial period will tell you if you are likely to be helped by this diet.

Low Fodmap Diet - The Future

The dilemma is that many high fodmap foods are also prebiotic foods which are good at feeding the friendly bacteria in our guts. By reducing them in our diets we can reduce our symptoms but it could be that we are not doing the good bacteria in our intestines any favors. We may be treating the symptoms but are we treating the cause?

Research is on going and more needs to be known about the normal composition of the healthy gut. This could point the way to help for some people. If we could re-balance our gut flora perhaps some of us could tolerate more fodmaps. This is only a theory at the moment.

Australia has introduced a government backed 'Fodmap Friendly' food labelling system which hopefully may spread to other countries around the world.

New information is coming out all the time as the Monash University tests more foods in their lab. More information and help can be found by downloading the Monash University low fodmap smartphone app.

This includes a food guide, traffic light system, recipes and shopping list.

The fodmap diet is not a cure and it can be difficult to follow but many people are motivated to comply with the restrictions it places on their lifestyle by being rewarded with a calm and well behaved gut!

DiarrheaNurse hopes this quick guide to the low fodmap diet has been useful and that you will find relief from your symptoms.

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Go to What is Irritable Bowel Syndrome?

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Return to IBS Symptoms - The 7 Main Things to Look Out For


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Images Attribution:

Garlic By Dubravko Sorić SoraZG on Flickr [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons

Leek By Mgmoscatello (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

Onion © User:Colin / Wikimedia Commons, via Wikimedia Commons

Orange By freestock.ca [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

Strawberry by Jeff Cobina https://www.flickr.com/photos/kubina/528669878

Tomatoes By Softeis (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0/)], via Wikimedia Commons


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