FODMAP diet is clinically recommended for the management of irritable bowel syndrome (IBS).
What Are FODMAPs?
FODMAP stands for fermentable oligo-, di-, mono-saccharides and polyols
FODMAPs are found in a wide range of foods in varying amounts. Some foods contain just one type, while others contain several.
The main dietary sources of the four groups of FODMAPs include:
Oligosaccharides: Wheat, rye, legumes and various fruits and vegetables, such as garlic and onions.
Disaccharides: Milk, yogurt and soft cheese. Lactose is the main carb.
Polyols: Certain fruits and vegetables including blackberries and lychee, as well as some low-calorie sweeteners like those in sugar-free gum.
Reduced Digestive Symptoms
IBS digestive symptoms can vary widely, including stomach pain, bloating, reflux, flatulence and loose bowel movement.
Stomach pain is one of the main symptoms of the condition, and bloating has been found to affect more than 80% of people with IBS, Needless to say, these symptoms can be debilitating.
However, both stomach pain and bloating have been shown to significantly decrease with a low-FODMAP diet.
Who Should Follow a Low-FODMAP Diet?
You should only follow A low-FODMAP diet if you have been diagnosed with IBS.
This is because most FODMAPs are prebiotics, meaning they support the growth of good gut bacteria.
If you have IBS, you should consider this diet, if you:
Have ongoing gut symptoms.
Haven't responded to restricting alcohol, caffeine, spicy food and other common trigger foods
This diet may benefit other conditions, including diverticulitis and colitis. it's not recommended to try it for the first time while traveling or during a busy or stressful period.
How to Follow a Low-FODMAP Diet.
A low-FODMAP diet is more complex than you may think and involves three stages.
Stage 1: Restriction
People who follow this diet often think they should avoid all FODMAPs long-term, but this stage should only last about 3–8 weeks. This is because it's important to include FODMAPs in the diet for gut health.
Some people notice an improvement in symptoms in the first week, while others take the full eight weeks. Once you have adequate relief of your digestive symptoms, you can progress to the second stage.
If by eight weeks your gut symptoms have not resolved, refer to the What If Your Symptoms Don't Improve?
Stage 2: Reintroduction
This stage involves systematically reintroducing high-FODMAP foods.
The purpose of this is twofold:
To identify which types of FODMAPs you tolerate. Few people are sensitive to all of them.
To establish the amount of FODMAPs you can tolerate. This is known as your "threshold level."
In this step, you test specific foods one by one for three days each.
It is worth noting that you need to continue a low-FODMAP diet throughout this stage. This means even if you can tolerate a certain high-FODMAP food, you must continue to restrict it until stage 3.
It is also important to remember that, unlike people with most food allergies, people with IBS can tolerate small amounts of FODMAPs.
Lastly, although digestive symptoms can be debilitating, they will not cause long-term damage to your body.
Stage 3: Personalization
It is important to progress to this final stage in order to increase diet variety and flexibility. These qualities are linked with improved long-term compliance, quality of life and gut health
Two Things to Do Before You Get Started
There are two things you should do before embarking on the diet.
1. Make Sure You Actually Have IBS
Digestive symptoms can occur in many conditions, some harmless and others more serious.
Unfortunately, there is no positive test to confirm you have IBS. For this reason, it is recommended you see a doctor to rule out more serious conditions first, such as celiac disease, inflammatory bowel disease and colon cancer
Once these are ruled out, your doctor can confirm you have IBS using the official IBS diagnostic criteria
Recurrent stomach pain: On average, at least one day per week in the last three months.
Stool symptoms: These should match two or more of the following: related to defecation, associated with a change in frequency of stool or associated with a change in the appearance of stool.
Persistent symptoms: Criteria fulfilled for the last three months with symptom onset at least six months before diagnosis.
2. Plan Ahead
The diet can be difficult to follow if you are not prepared. Here are some tips:
Find out what to buy: Ensure you have access to credible low-FODMAP food lists. See below for a list of where to find these.
Get rid of high-FODMAP foods: Clear your fridge and pantry of these foods.
Make a shopping list: Create a low-FODMAP shopping list before heading to the grocery store, so you know which foods to purchase or avoid.
Read menus in advance: Familiarize yourself with low-FODMAP menu options so you'll be prepared when dining out.
A Low-FODMAP Diet Can Be Flavourful
Garlic and onion are both very high in FODMAPs. This has led to the common misconception that a low-FODMAP diet lacks flavour.
While many recipes do use onion and garlic for flavour, there are many low-FODMAP herbs, spices and savoury flavourings that can be substituted instead.
It is also worth highlighting that you can still get the flavour from garlic using strained garlic-infused oil, which is low in FODMAPs.
This is because the FODMAPs in garlic are not fat-soluble, meaning the garlic flavour is transferred to the oil, but the FODMAPs aren't.
Other low-FODMAP suggestions: Chives, chili, fenugreek, ginger, lemongrass, mustard seeds, pepper, saffron and turmeric.
Can Vegetarians Follow a Low-FODMAP Diet?
A well-balanced vegetarian diet can be low in FODMAPs. Nonetheless, following a low-FODMAP diet if you are a vegetarian can be more challenging.
This is because high-FODMAP legumes are staple protein foods in vegetarian diets.
That said, you can include small portions of canned and rinsed legumes in a low-FODMAP diet. Serving sizes are typically about 1/4 cup (64 grams).
There are also many low-FODMAP, protein-rich options for vegetarians, including tempeh, tofu, eggs, Quorn (a meat substitute) and most nuts and seeds.
A Sample Low-FODMAP Shopping List
Many foods are naturally low in FODMAPs
Here is a simple shopping list to get you started.
Protein: Beef, chicken, eggs, fish, lamb, pork, prawns and tofu
Whole grains: Brown rice, buckwheat, maize, millet, oats and quinoa
Fruit: Bananas, blueberries, kiwi, limes, mandarins, oranges, papaya, pineapple, rhubarb and strawberries
Vegetables: Bean sprouts, bell peppers, carrots, choy sum, eggplant, kale, tomatoes, spinach and zucchini
Nuts: Almonds (no more than 10 per sitting), macadamia nuts, peanuts, pecans, pine nuts and walnuts
Seeds: Linseeds, pumpkin, sesame and sunflower
Dairy: Cheddar cheese, lactose-free milk and Parmesan cheese
Additionally, it's important to check the ingredients list on packaged foods for added FODMAPs.
Food companies may add FODMAPs to their foods for many reasons, including as prebiotics, as a fat substitute or as a lower-calorie substitute for sugar.
The Final say -
The low-FODMAP diet can dramatically improve digestive symptoms, for those people with IBS.
However, not everyone with IBS responds to the diet. What's more, the diet involves a three-stage process that can take up to six months.