Low FODMAP Diet
What Is the Low FODMAP Diet?
The Low FODMAP diet was created by a research team at Monash University in Australia.
In order to understand the Low FODMAP diet we must first understand what FODMAPs are. FODMAPs are a group of short chain carbohydrates (aka sugars) that aren’t fully digested or absorbed in our intestines. [1]
These types of sugars are fermented by the bacteria in the GI tract and gas is produced, which can cause pain, gas and bloating. [1] The FODMAPs exacerbate symptoms for people with Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD), and may also cause constipation and/or diarrhea.
FODMAPs is an acronym which stands for Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols. [1]
Oligosaccharides includes fructans and galacto-oligosaccharides. These are found in wheat, rye, onions, garlic, some nuts and seeds, beans and legumes.
Disaccharides include lactose containing foods like milk, cheese and yogurt. (See: Dairy)
Monosaccharides include fructose which is found in fruit, honey and corn syrup.
Polyols include sorbitol and mannitol which are used as artificial sweeteners and found in some fruits and veggies.
This diet has proven beneficial and is often recommended for people diagnosed with IBS and IBD because it can reduce unwanted symptoms. [3,4]
The goal of the low FODMAP diet is to remove foods that are contributing to pain, bloat and irregular bowel movements and allow the gut to heal. This is not meant to be a diet that lasts a lifetime or even years. The most restrictive period of the diet, the elimination phase, is designed to last for 2-6 weeks. [1] Once healing has taken place, it is possible to slowly reintroduce higher FODMAPs foods to determine if they are still causing symptoms or not.
Recommended Foods
The following foods are considered low FODMAP: [1,2]
Grains like corn tortillas or corn chips, gluten free pasta, oatmeal, rice and quinoa, and sourdough breads made from oat or spelt.
Healthy fats and oils, even garlic infused oils are a great option to add flavor.
Fruits like bananas (with some green), grapes, cantaloupe, kiwi, lemon, lime, oranges, papaya and pineapple.
Vegetables like broccoli, carrots, cucumber, chives, eggplant, kale, bok choy, lettuce, olives, radishes, spinach, zucchini and tomatoes.
Dairy alternatives like almond milk, coconut yogurt, hemp milk, lactose free milk and certain dairy products like brie, feta and hard cheeses.
Protein like lentils or canned chickpeas, beef, chicken, eggs, fish and seafood, pork, turkey, tempeh and firm tofu. Macadamia nuts, peanuts, pumpkin seeds and walnuts are considered low FODMAP as well.
Sweets like dark chocolate, maple syrup and table sugar.
Foods to Avoid
The following foods are considered high FODMAP: [1,2]
Grains like wheat, rye and barley, breakfast cereals and snacks
Fruits like apples and apple juice, blackberries, cherries, dried fruits like apricots or dates, grapefruit, mango, pears, plums, peaches, nectarines and watermelon.
Vegetables like asparagus, artichoke, cauliflower, garlic, onion, leeks, shallots, , green peas, mushrooms and sugar snap peas.
Dairy products like cow’s milk, ice cream, yogurt, evaporated and condensed milk
Protein foods like cashews and pistachios, most legumes and pulses, some processed meats and some marinated meats
Sweets that contain high fructose corn syrup, honey or sugar-free, artificially sweetened foods.
Lifestyle Changes
Be prepared to prepare a lot of meals at home, read labels carefully and plan ahead if you know you will be eating out. Look at the menu in advance and talk to the waiter or chef if needed.
Be sure to make use of helpful apps so you can access the information you need on the go.
Recommended Supplements
Digestive enzymes, including lactase to help with the digestion of lactose from dairy products, may be beneficial.
Pairing gut healing supplements like l-glutamine with an elimination diet like the low FODMAP diet can help promote the healing process.
The low FODMAP diet does exclude many nutrient dense foods and may be deficient in vitamins, minerals and antioxidants. Supplementing with a quality multivitamin/mineral supplement is recommended. [3]
Calcium and fiber are lacking in the low FODMAP diet as well so supplementing these may be worthwhile. Working with a dietitian to determine appropriate dosing and brands is recommended.
Certain probiotics may be a powerful counterpart to the low FODMAP diet. Probiotics can be helpful in promoting gut repair and rebuilding a balanced microbiome. For example, Visbiome is a brand that is highly recommended for those with IBS and Ulcerative Colitis.
Helpful Resources
This website offers an incredibly comprehensive guide to the low FODMAP diet. They also have an app to make shopping easier and offer dozens of recipes.
This website is created by an RD and provides even more low FODMAP recipes.
A food company that makes low FODMAP friendly pasta sauces, marinades and snacks.
A low FODMAP meal delivery service
DISCLAIMER: Before starting any supplement or medication, always consult with your healthcare provider to ensure it is a good fit for your child. Dosage can vary based on age, weight, gender, and current diet.
Low FODMAP in the Research
Low FODMAP and Gluten Sensitivity
The symptoms of non-celiac gluten sensitivity (NCGS) are very similar to those of IBS and Crohn’s disease, an IBD, which could lead to incorrect diagnoses. It is also possible that NCGS can lead to IBS. The low FODMAP diet may help improve symptoms of IBS, IBD and NCGS. [3]
Low FODMAP and Supplements
Combinations of probiotics, Lactobacillus sp, Bifidobacterium sp., and Streptococcus sp confer beneficial effects on IBS. [5]
Soluble fibers, such as psyllium, wheat dextran or acacia, are recommended for patients with irritable bowel syndrome with constipation. [5]
Global improvement in IBS symptoms and abdominal pain was seen in patients receiving peppermint oil compared to placebo. [5]
Low FODMAP Diet and Autism
In a randomized controlled study of children with ASD, the low FODMAP diet group had significant relief in some GI problems compared to baseline and the control group. [7]
In the case of Autism, the exclusion of gluten or reducing FODMAPs from the diet may be beneficial, although studies in this field are scarce and more evidence is necessary to come to stronger conclusions.[8]
In a case study with a patient with ASD and epilepsy, a low FODMAP diet produced a significant improvement in all neurological, intestinal, and metabolic symptoms and was well-tolerated. The following gut microbiota analysis showed reductions in Actinobacteria, Firmicutes, Lactobacilli, and Bifidobacteria. The alpha biodiversity was consistently increased and the Firmicutes/Bacteroidetes ratio decreased, reducing the extent of fermentative dysbiosis. Gut microbiota could be a therapeutic target to improve ASD-related symptoms. [9]
The Bottom Line
Scale: 1 - 5 Stars ★
We rate the quality and quantity of the research supporting the efficacy of the diet in improving symptoms as well as the Ease of Adherence, taking into account the cost, resources available, time required, social acclimation to the diet including options available in restaurants and grocery stores which assist both convenience and adherence
Ease of Adherence ★★★
This diet is a challenge to follow because there are many restricted foods and ingredients. However, there are great resources available for help with recipes and finding low FODMAP products in stores.
Research ★★★★★
The research is strong regarding the effectiveness of this diet for those with IBS and some forms of IBD.
Grade A
-
[1] About FODMAPs and IBS | Monash FODMAP - Monash Fodmap. Monashfodmap.com. Accessed August 20, 2022. https://www.monashfodmap.com/about-fodmap-and-ibs/
[2] Low-FODMAP diet. American College of Gastroenterology. Published August 3, 2016. Accessed August 20, 2022. https://gi.org/topics/low-fodmap-diet/
[3] Roszkowska A, Pawlicka M, Mroczek A, Bałabuszek K, Nieradko-Iwanicka B. Non-Celiac Gluten Sensitivity: A Review. Medicina (Kaunas). 2019;55(6):E222.
[4] Altomare A, Di Rosa C, Imperia E, Emerenziani S, Cicala M, Guarino MPL. Diarrhea Predominant-Irritable Bowel Syndrome (IBS-D): Effects of Different Nutritional Patterns on Intestinal Dysbiosis and Symptoms. Nutrients. 2021;13(5):1506.
[5] Patel NV. "Let Food Be Thy Medicine": Diet and Supplements in Irritable Bowel Syndrome. Clin Exp Gastroenterol. 2021;14:377-84.
[6] Lacy BE, Pimentel M, Brenner DM, et al. ACG Clinical Guideline: Management of Irritable Bowel Syndrome. Am J Gastroenterol. 2021;116(1):17-44.
[7] Nogay NH, Walton J, Roberts KM, Nahikian-Nelms M, Witwer AN. The Effect of the Low FODMAP Diet on Gastrointestinal Symptoms, Behavioral Problems and Nutrient Intake in Children with Autism Spectrum Disorder: A Randomized Controlled Pilot Trial. J Autism Dev Disord. 2021;51(8):2800-11.
[8]Aranburu E, Matias S, Simón E, et al. Gluten and FODMAPs Relationship with Mental Disorders: Systematic Review. Nutrients. 2021;13(6):1894.
[9] Bertuccioli A, Cardinali M, Di Pierro F, Zonzini GB, Matera MR. Ketogenic and Low FODMAP Diet in Therapeutic Management of a Young Autistic Patient with Epilepsy and Dysmetabolism Poorly Responsive to Therapies: Clinical Response and Effects of Intestinal Microbiota. Int J Mol Sci. 2022;23(15):8829.
