What is the FODMAP Diet Used For?

Understanding the FODMAP Diet  

The term FODMAP was introduced in the 2000’s by Dr. Sue Shepherd and Dr. Peter Gibson at Monash University in Melbourne, Australia. They created the FODMAP diet, which is an elimination diet that attempts to improve symptoms of functional gastrointestinal disorders such as irritable bowel syndrome (IBS). 

Overview of Short-Chain Carbohydrates  

FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These are all short-chain carbohydrates and sugar alcohols that are osmotically active and rapidly fermentable (able to be broken down by gut bacteria). 

• Oligosaccharides are commonly found in foods like onions, garlic, wheat, and legumes.

• Disaccharides are mainly found in milk and other dairy products such as cheese and yogurt.

• Monosaccharides are fructose found in fruits and/or honey.

• Polyols are sugar alcohols that are found in some fruits, vegetables, and artificial sweeteners.

What Does a Diet Low in FODMAP Consist of

A low FODMAP diet involves eliminating high FODMAP foods and slowly reintroducing them one at a time to see which ones cause abdominal problems. Once the FODMAP foods (types of carbohydrate) that cause IBS symptoms have been identified, you can avoid or limit those foods high in FODMAPs that are troublesome and enjoy everything else without problems. A FODMAP diet is thus a discovery process that can greatly improve your quality of life if you have IBS.

Why FODMAPs Affect Digestion  

FODMAPs are poorly absorbed by the human small intestine and move to the large intestine undigested. Bacteria in the colon ferment these carbohydrates, leading to gas production. As a result, people with irritable bowel syndrome (IBS) experience distressing digestive symptoms after eating certain foods that contain these types of carbohydrates.

What Is The Purpose of a FODMAP Diet?  

The purpose of a FODMAP diet is to manage irritable bowel syndrome (IBS). IBS is a common condition that affects 10-15% of Americans. Yet, only 1 in 4 people with IBS seek treatment for their condition. While IBS is not life-threatening and does not cause serious health problems, it can be a difficult condition to live with. 

The symptoms of irritable bowel syndrome may include gas production (flatulence), bloating (distension), cramping, stomach pain, diarrhea, constipation, and changes in bowel movements (color and consistency of stool).

Phases of FODMAP Diet

Step 1: Elimination Phase

The elimination phase of the FODMAP diet should be done under the guidance of a dietitian for 2 to 6 weeks. During this phase, you eliminate high-FODMAP foods one by one and continue eating low-FODMAP foods. The dietician can guide you on swapping one food for another, for example, bananas and oranges instead of apples and pears, chives instead of onions, and almond milk instead of cow’s milk. This can help prevent nutritional deficiencies.

Step 2: Reintroduction Phase

The next phase of the FODMAP diet involves slowly reintroducing FODMAP foods back into your diet in a stepwise manner to identify which high FODMAP foods trigger IBS symptoms and which do not. Again, this step is also best completed under the supervision of a dietitian who can advise you when and how to reintroduce foods (the amount of food to eat and in what order to reintroduce foods). You will also need to allow a few days between reintroducing different foods to prevent confusing crossover effects. The reintroduction phase usually takes 6 to 8 weeks. Learn about the symptoms of IBS in women.

Step 3: Personalization Phase

The third phase of the FODMAP diet is when you establish a long-term personalized FODMAP eating plan that works for you. Personalization and ongoing consultations with your dietician are necessary because FODMAP tolerances can change with time. So, you may find that you no longer tolerate foods that you previously tolerated, or you can now tolerate foods that you didn’t tolerate in the past. Personalization is, therefore, an ongoing phase that you continue lifelong.

Who Should Consider Following It  

A low FODMAP diet is recommended for people with irritable bowel syndrome (IBS). The diet is designed to help figure out the foods that cause symptoms like gas, bloating, and stomachache in people with IBS.

You should consider following the FODMAP diet if you suffer from irritable bowel syndrome and would like to try making dietary changes to control your IBS symptoms. 

A low FODMAP diet is increasingly being accepted as a standard treatment for irritable bowel syndrome. Research has shown it can reduce IBS symptoms in almost 9 out of 10 people with IBS. However, a diet containing low FODMAP foods can be challenging to follow, especially initially. That’s why it’s important to work with a registered dietitian or doctor. This will help ensure the FODMAP diet is implemented successfully while also maintaining adequate nutrition.

Foods to Eat and Foods to Avoid on a Low FODMAP Diet  

List of Foods to Eat: What Are Some Low FODMAP Foods?

If you want to keep your IBS symptoms under control, you should plan your meals to include low-FODMAP foods such as:

• Meat

• Eggs

• Almond milk or other lactose-free alternatives

• Hard cheeses like cheddar, brie, camembert, and feta

• Grains such as oats, quinoa, rice

• Fruits like oranges, grapes, strawberries, pineapple, bananas, blueberries

• Vegetables like potatoes, cucumbers, tomatoes, eggplant, zucchini, bok choy

• Nuts and seeds like pine nuts, almonds, peanuts

List of Foods to Avoid: What Are The Worst High FODMAP Foods?

Some of the worst culprits that cause digestive symptoms in people with IBS include:

• Lactose in dairy products such as milk, yogurt, cheese, ice cream

• Fructans in wheat-based products such as bread, cereals, crackers

• Galactans in lentils, legumes, pulses, and beans (black-eyed peas, broad beans, butter beans)

• Fructose and fructans in vegetables such as asparagus, artichokes, onions, garlic

• Fructose in fruits such as cherries, peaches, pears, apples

• Polyol’s additives in artificial sweeteners and high fructose corn syrup

It is worth noting that high FODMAP foods are not unhealthy as such. Some of these foods contain substances that stimulate the growth of healthy gut bacteria. Many are good for overall health as part of a balanced diet. But when people with IBS eat one or more of these foods, they can cause digestive symptoms that disrupt daily life.

Sample Meal Ideas and Recipes 

FODMAP Breakfast Ideas

• Waffles and pancakes made with oat flour and lactose-free milk served with maple syrup

• Egg white muffins with spinach, bell peppers, bacon, and cheddar cheese

• Scrambled eggs with a side of potato wedges

• Steel-cut oats prepared with lactose-free or almond milk and served with pecans, walnuts, strawberries, blueberries, and bananas.

FODMAP Lunch and Dinner Ideas

• Spiced quinoa garnished with almonds and feta cheese

• White rice and lettuce wrap stuffed with zucchini, carrots, and ground beef

• Baked salmon served with a spinach and kale salad

• Roasted vegetables and miso roasted tofu

• Grilled chicken quesadillas made using gluten-free wraps

• Quinoa bowl with sauteed vegetables like zucchini, carrots, and bok choy

FODMAP Dessert and Snack Ideas

• Peanut butter on sourdough bread

• Blueberry scones

• Orange cranberry muffins

• Home-made cakes, cookies, and energy bars made using oat flour

• Sorbets

• Sugar-free ice cream made using coconut milk

Tips for Maintaining Nutritional Balance  

It’s best to work with a dietitian to help you navigate the FODMAP diet and gradually add foods back over time. Here are some general guidelines for nutritional balance on a low FODMAP diet:

• Balance your plate and fill half with vegetables, a quarter with protein, and a quarter with carbohydrates. 

• Choose healthy fats like hard cheeses, avocado, nuts, seeds, and extra-virgin olive oil. 

• Add fiber by including foods like oats, nuts, and seeds. Find out how much fiber you should have a day.

• Include protein like chicken, beef, lamb, pork, eggs, fish, tofu, quinoa, canned chickpeas and lentils, nuts and seeds.

• Select low-FODMAP carbohydrates like brown bread, brown rice, quinoa, and gluten-free pasta. 

How to Follow a Low FODMAP Diet  

Structuring Meals with FODMAP-Friendly Foods  

Here are some tips for structuring meals with FODMAP-friendly foods: 

• Choose a protein for each meal and aim for a piece about the size of your hand. Some protein options include shredded chicken, hard-boiled eggs, canned tuna, chickpeas, lentils, and tofu. 

• Add vegetables and aim for at least 2-3 vegetables with your main meals. Vegetables should ideally make up about half of your plate. Some low FODMAP vegetables include spinach, bell peppers, carrots, zucchini, potato, and sweet potato. 

• Choose carbohydrates with one main carbohydrate per meal. Some low FODMAP carb options include brown rice, potatoes, rice noodles, and gluten-free rolls and wraps. 

• Swap out triggers by replacing foods that trigger your IBS with low-FODMAP alternatives. For example, eat a banana instead of an apple or use chives in your recipes instead of onions. 

Planning and Preparation Tips  

Here are some tips for planning and preparing meals on a low-FODMAP diet: 

• Make a shopping list of low-FODMAP foods like fresh vegetables, fruits, gluten-free grains, lactose-free dairy, and lean proteins. 

• Read food labels when shopping and check for ingredients that are high in FODMAPs. 

• Plan meals for the week and write them down in a journal, on your phone, or on a whiteboard. You can also use a meal planner app. 

• Prepare meals in advance so you always have healthy low-FODMAP meals available in your freezer for busy days. 

• Check servings: Verify low FODMAP foods and serving sizes using resources such as the Monash University app. 

Common Challenges and Solutions  

Reduced Diversity of Gut Microbiome 

A low FODMAP diet is a restrictive diet and can reduce the diversity of the gut microbiome (the variety of friendly or helpful gut bacteria). Taking a probiotic may help to lower this risk.

Nutritional Deficiencies

A low FODMAP diet can also impact nutrient intake and the overall quality of your diet by excluding certain fruits, vegetables, carbohydrates, and dairy products. It’s important to follow the elimination phase for 2 to 6 weeks only and then slowly reintroduce foods back to prevent nutrient deficiencies.

Complexity

Another common challenge is that a low FODMAP diet is complex to follow. If you are struggling to follow this diet, consider working with a dietitian to help you plan your diet, track symptoms, and identify problematic foods. 

Challenging for Vegetarians

Many high-FODMAP foods are staples in a vegetarian diet. A low FODMAP diet can, therefore, be especially challenging for vegetarians and vegans to follow. Long-term restrictions on eating healthy fruits, vegetables, nuts, and seeds that are high in FODMAP can lead to vitamin and nutritional deficiencies. It is important to talk to a doctor or dietitian who can provide medical advice, diagnosis, or treatment before starting a FODMAP diet for IBS.

Risks and Benefits of a Low FODMAP Diet  

Other Health Benefits of a Low FODMAP Diet

SIBO

The FODMAP diet is a meal plan that can help people with irritable bowel syndrome. It has also shown some benefit in other gastrointestinal disorders, such as small intestinal bacterial overgrowth (SIBO). SIBO is a condition in which bacteria that grows in other parts of the gut start growing in the small intestine.

Inflammatory Bowel Diseases

Some advocates of the FODMAP diet say it can also alleviate symptoms of inflammatory bowel disease (ulcerative colitis, Crohn’s disease). It is believed to help because a FODMAP diet eliminates carbohydrates such as lactose and fructose, which fuel problematic or harmful bacteria in the gut. 

Arthritis

Some dieticians recommend a low FODMAP diet to patients with arthritis. More research is needed, but following this diet for a couple of months could possibly reduce inflammation in the body due to an improved balance between good and bad bacteria in the gut. Therefore, going on a low FODMAP diet for a couple of months may be worthwhile to see if it improves arthritis symptoms such as joint inflammation.

Keep in mind that there is no strong scientific evidence that a low FODMAP diet improves any health conditions besides irritable bowel syndrome (IBS). This meal plan should, therefore, be started with caution. 

Understanding the Risks: What Are The Negatives of the FODMAP Diet?

The negatives of a FODMAP diet are that it restricts many nutrient-dense foods. These foods contain nutrients that have anti-inflammatory properties and are necessary for overall health. Eliminating these important foods from your diet for a long time can have negative effects on the diversity of gut bacteria. It can also lead to nutritional deficiencies. Professional guidance from a gastroenterologist and licensed nutritionist or dietitian can help to lower these risks. 

How Long Should You Follow a Low FODMAP Diet?

Experts recommend that a diet low in FODMAPs should be a temporary measure. They do not recommend following the elimination phase of the diet for more than two to six weeks and the reintroduction phase for six to eight weeks. In other words, this is not a diet you should follow long-term or indefinitely. 

As noted, the FODMAP diet is a discovery process in which you eliminate food items one by one. This is to find out which are the foods that trigger symptoms of IBS. 

A low FODMAP diet is highly restrictive, especially in the early phase when most high FODMAP foods are prohibited.

Frequently Asked Questions about FODMAP Diet  

What Are FODMAP Foods To Avoid?  

Some high FODMAP foods to avoid include lactose in dairy products; wheat-based foods like bread, cereals, and pasta; legumes, pulses, and beans; vegetables like onions, garlic, asparagus, and artichokes; fruits like apples, pears, cherries, and peaches; food additives and artificial sweeteners such as high fructose corn syrup.

What Is Included In The FODMAP Diet?

Low FODMAP foods are included in the FODMAP diet. These are foods that do not contain certain fermentable carbohydrates, which are difficult for people with irritable bowel syndrome (IBS) to digest. 

What Do Low FODMAP Foods Do?

Low FODMAP foods help to manage IBS symptoms by minimizing the intake of carbohydrates that are poorly digested in the small intestine and cause digestive distress, such as abdominal pain, gas, and bloating. These foods can, therefore, improve the quality of life of people with digestive disorders like irritable bowel syndrome.

Is FODMAP for Weight Loss? 

A low FODMAP diet is not for weight loss. However, because it eliminates many foods, a low FODMAP diet may cause some weight loss. But it can also cause nutritional deficiencies, which can be especially dangerous in people who are already underweight. 

Is FODMAP the Same as Gluten?

No, FODMAP is not the same as gluten. Although many of the same foods that contain gluten are also high FODMAP, they are separate things. People with celiac disease who do not benefit from a gluten-free diet can try a low FODMAP diet to see if it helps.