Do you suffer from chronic bloating, abdominal pain and altered bowel habits?
If yes, then it’s likely you’ll benefit from the Low FODMAP diet.
Discover what exactly FODMAPs are, how to follow the Low FODMAP diet, and the importance of methodically reintroducing FODMAP foods into your diet below.
What Are FODMAPs?
FODMAPs are a group of food compounds that are eliminated on the Low FODMAP diet. The Low FODMAP diet created by Sue Shepherd and her team in Melbourne, Australia, is a temporary elimination diet that aims to reduce symptoms of Irritable Bowel Syndrome (IBS).
The acronym FODMAP stands for:
● Fermentable – these types of compounds are broken down (fermented) by bacteria in the large intestine
● Oligosaccharides – “oligo” means “few” and “saccharide” means sugar. These molecules are made up of individual sugars joined together in a chain
● Disaccharides – “di” means two. This is a double sugar molecule
● Monosaccharides – “mono” means single. This is a single sugar molecule
● And Polyols – these are naturally occurring and manmade sugar alcohols
All FODMAPs are short-chain carbohydrates which ferment in your large bowel if they’re poorly digested. This results in many common symptoms of IBS including bloating, pain, and abdominal distention. As the fermentation process draws in water and produces carbon dioxide, hydrogen, and/or methane gas.
Originally created to relieve digestive symptoms in sensitive individuals, it may also play a role in the treatment of other conditions including:
● Forms of Functional Gastrointestinal Disorder (FGID)
● Small intestinal bacterial overgrowth (SIBO)
● Potentially rheumatoid arthritis, multiple sclerosis or eczema
● Frequent migraines potentially triggered by certain foods
List of FODMAP-Containing Foods
There are 5 overarching types of FODMAPs found in a variety of different foods. They include:
● Fructose: A natural sugar found in most fruits and some vegetables.
● Lactose: A natural sugar found in dairy foods like milk, yoghurt and some cheeses.
● Fructans: The most common problematic FODMAP found in many vegetables and grains.
● Galactans: Found primarily in legumes and beans.
● Polyols: Sugar alcohols like xylitol, sorbitol, maltitol and mannitol. Commonly found in chewing gum or “no sugar” food and drinks.
● Vegetables: artichoke, garlic, onion, asparagus, cauliflower, leek, mushrooms, sugar snap peas
● Fruits: mango, apples, blackberries, cherries, figs, grapefruit, nectarine, peach, pear, plum and watermelon
● Grains and Cereals: wheat, pumpernickel, kamut, rye, barley, spelt, and wheat noodles.
● Dairy: cream cheese, sour cream, custard, ice cream, cow’s milk, and yoghurt.
● Legumes, Nuts & Seeds: cashews, pistachios, baked beans, black beans, broad beans, chickpeas, fava beans, split peas.
● Added Ingredients & Sweeteners: inulin (chicory root), natural flavours, high fructose corn syrup, agave, honey.
Be sure to read the ingredients list on the nutrition label of each product for any FODMAPs, including those added ingredients.
The Elimination Phase
This strict phase of the Low FODMAP diet is not a long-term solution. It’s an elimination phase only.
The Low FODMAP diet should be followed for 2-6 weeks, depending on how you respond. All FODMAPs are strictly limited from your diet in order to see a reduction in symptoms.
If and when the diet has successfully reduced your symptoms, you may then move into the next phase of the diet.
The Reintroduction Phase
During this phase you begin methodically reintroducing each FODMAP type one at a time, to determine which ones trigger your symptoms. For example: reintroduce a fructose only containing food such as fruit, followed by a FODMAP-free “washout” period, before trying a different FODMAP type.
FODMAPs often have a dose-dependent relationship with symptoms, so varying amounts of each food should be tested – remember the goal of the diet is to help ensure you are not unnecessarily eliminating beneficial foods from your diet.
If you have no symptoms from one type of FODMAP at a certain amount, this food can be trialled in higher amounts. If after one week of including the food in your diet with no symptoms, then that food is safe for you to eat.
If symptoms arise, you should end the trial of that FODMAP type and return to a baseline low FODMAP diet until symptoms settle/at least 3 days. Record how much, if any of that food you are able to eat before getting symptoms. You can try the same food at a lower dose if you think you have started too high, or you can move on to trying the next type of FODMAP.
Sometimes you might not be able to eat half an avocado, but 1/4 might be fine!
If you have no symptoms after reintroducing a FODMAP type, it’s important to still have the 3-day baseline low FODMAP diet break between trialling another type, as symptoms can occur days after consumption.
The initial reintroduction phase is complete once you have tried all 5 main types of FODMAPs. However, the aim is to reintroduce as much variety as possible, so if symptoms returned for one or more FODMAP types, you can also trial individual foods within the FODMAP types to assess your tolerance levels of those individual foods.
The process of trialling individual foods is the same as the original reintroduction phase. Once you have identified your problem FODMAPs, you can continue to limit or eliminate those foods to manage your symptoms long term.
How to Reintroduce FODMAPs
Reintroducing FODMAPs doesn’t have to be complicated. You should aim to do it in the comfort of your home, where you can control what you eat (and be close to amenities if required).
Each individual FODMAP group should be tested using a food that is solely high in one FODMAP type. If you use a food that is high in two or more FODMAP types, then you won’t know which is causing your symptoms.
You can either:
A) Reintroduce a FODMAP food by consuming it at the same time you eat a regular low FODMAP meal i.e. a teaspoon of the FODMAP at the same time you eat your dinner OR
B) Combine the FODMAP food into your meal or snack i.e. soup or salad.
Option A allows you to easily take note of the portion size you consumed so that you can easily increase the amount during testing. Option B allows you to enjoy the food as part of your regular meal but makes it a little more difficult to know how much you consumed.
There is no right or wrong time to test. It’s up to you, depending on when you can and the typical scenarios for when you would eat the food you’re testing. If you’re anxious about symptoms returning, do it in the evening when you’re home without any other commitments.
A Low FODMAP Meal Plan
A sample low FODMAP meal plan may look something like this:
2 slices spelt sourdough
1 small tomato
1 handful of baby spinach, sauteed in olive oil
1 small coffee with lactose-free milk
30g mix of walnuts, macadamia nuts and pecans
Tuna Nicoise salad with potato, tuna, green beans, cherry tomatoes, olives, mustard and olive oil.
1 tbsp natural peanut butter
Chicken breast with brown rice, roast Jap pumpkin, carrot, potato, capsicum, broccoli, and zucchini.
Why the Low Fodmap Diet Isn’t a Permanent Solution
As the Low FODMAP diet is an elimination protocol and very restrictive in its nature, it’s important to highlight that the full Low FODMAP diet should not be considered a permanent option. You do need to reintroduce foods at some stage, to allow for plenty of variety from a range of different food groups.
The diet gives your gut time to heal and your gut bacteria a chance to re-establish a healthy balance, but it’s important, despite how good you may feel, to not stay on the strict diet forever.
Emerging research shows eliminating FODMAPs over the long-term can hinder your gut health and cause more harm than good. It’s important to identify the FODMAPs that cause you symptoms, and in what amounts, so that you know how much you can tolerate, without having to avoid certain FODMAP foods completely.
It’s also important to reintroduce the FODMAPs back into your diet sooner rather than later to help decrease the chances of making your food intolerance worse.
Research on the Low FODMAP Diet
The Low FODMAP diet has been the main focus of research. In particular, its ability to help those with IBS.
IBS is a chronic disorder of the gastrointestinal system that results in symptoms including abdominal pain, bloating, excessive gas, diarrhoea and/or constipation. It is believed to affect 12–30% of people globally. 70% of people with IBS respond well to the Low FODMAP diet.
Much more research is required to determine if the diet is an effective treatment for other conditions. However, according to the latest systematic review of the evidence, the Low FODMAP diet improves quality of life and reduces the severity of symptoms in those with IBS and should be used as the primary treatment for this chronic digestive condition.
Larina Robinson is a Wholefood Dietitian, author and founder of The Body Dietetics. Specialising in gut health, food intolerances and alternative diets, Larina empowers people to embrace a diet unique to their own dietary needs and supports them to find freedom from long-term digestive complaints.