Low Fodmaps Diet for IBS 2013

All the Rage…Low Fodmaps Diet

I received this from a dietitian at St.Micheal’s hospital last year. For anyone who hasn’t seen this version and wants to give it a go here it is.

I have found great success on this diet plan however I still struggle with IBS, the cure remains out there.

An Introduction to the Low FODMAP Diet for Irritable Bowel Syndrome (From Niagara University)

The following information provides an introduction to the low FODMAP diet for Irritable Bowel Syndrome (IBS), however it is not intended to replace counselling by a Registered Dietitian on the low FODMAP diet approach for IBS symptom management. Registered Dietitians who are experienced or trained in the low FODMAP diet approach can individualize the low FODMAP diet to help achieve best results and ensure your diet is nutritionally adequate.
What is the low FODMAP diet?
The low FODMAP diet is a diet that limits consumption of foods that are high in FODMAPs. FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) are a group of carbohydrates and sugar alcohols found in food that are highly fermentable. The fermentation of FODMAPs by bacteria in the bowel (also known as the production of gas), is a normal and healthy part of digestion. For people with IBS however, eating foods high in FODMAPs may trigger symptoms such as excess gas, bloating, heartburn and abdominal discomfort. FODMAPs also tend to attract water into the bowel. This may trigger symptoms such as bowel urgency and diarrhea for some people with IBS. Reducing the amount of high FODMAP foods in the diet is an approach that may help improve IBS symptoms for some people.
Can avoiding foods with FODMAPs cure my IBS?
While avoiding foods that are high in FODMAPs may improve your symptoms, this is not considered a cure for IBS. Research to date indicates that about 3 out of 4 people with IBS can experience some degree of improvement in their symptoms by following a low FODMAP diet.
What are examples of FODMAPs?
The following are considered FODMAPs:
1) Lactose

2) Fructose 3) Fructans 4) Galacto-oligosaccharides (GOS) 5) Polyols
Tolerance of FODMAPs and IBS
Tolerance of foods that are high in FODMAPs can vary for people with IBS. Some people with IBS can tolerate a greater amount of food high in FODMAPs in their diet, while others may find that consuming even a small amount of food that is high in a FODMAP will trigger IBS symptoms.
Tolerance of two FODMAPs in particular, lactose and fructose, can vary depending on your ability to absorb them. For example, lactose is often only an issue for people with IBS if lactose is poorly absorbed (lactose malabsorption). The degree to which fructose is tolerated by people with IBS, is also influenced the ability to absorb fructose. About 40% of people with IBS poorly absorb lactose, and about 40% of people with IBS poorly absorb fructose. If you do have lactose and/or fructose malabsorption, these FODMAPs may be the most difficult to tolerate.
To help illustrate the effect of consuming FODMAPs when you have IBS, think of your digestive system as a ‘cup’ (Figure 1.). All the FODMAPs you consume go into this same cup. If you consume too much FODMAP, resulting in too much fermentation and water accumulation, your cup can overflow and symptoms can occur (figure 2). Different people with IBS can have different sized cups. One person’s cup may overflow if they consume just one food that is high in a FODMAP. Another person’s cup may not overflow until they consume several foods in a day that are high in FODMAPs. If FODMAPs are in fact a trigger for your IBS symptoms, it may take a bit of trial and error to determine what your tolerance level is (i.e. at what point your cup overflows) for high FODMAP foods.
The low FODMAP diet
Figure 2.
Figure 1.

The following table lists foods that are high in FODMAPs and foods that are low in FODMAPs. Some foods are not listed in the table as information on their FODMAP content is not yet available.
You can try choosing low FODMAP foods while limiting or avoiding high FODMAP foods to see if your IBS symptoms improve. Some symptom improvement may be seen within a week of following a low FODMAP diet, however it may take up to 4-6 weeks of following this diet to see the full benefit. In some cases, IBS symptoms may not improve significantly on the low FODMAP diet (i.e. approx. 1 out of 4 people with IBS see limited or no improvement with a low FODMAP diet).
A strict low FODMAP diet is not considered a long-term diet for most people. If you notice a significant improvement in your IBS symptoms after following a low FODMAP diet for a few weeks, it is recommended that you seek a referral with a dietitian experienced or trained in the low FODMAP diet approach for further counselling. A dietitian that is experienced or trained in the low FODMAP diet approach can help you determine which FODMAPs are most problematic, help you re-introduce FODMAPs to increase the variety of foods in your diet, and ensure that your diet is nutritionally adequate.
In the meantime, are there certain foods that appear to trigger your IBS symptoms more than others? If certain foods are better tolerated, you can try adding these back into your diet and see how your IBS symptoms respond.
Food Type
Choose Low FODMAP Foods
Limit/Avoid High FODMAP Foods
Fruits
Limit large servings of fruit. It is recommended to limit low FODMAP fruit to 1 serving at a time and separate each fruit serving by at least 2 hours. One fruit serving equals 1 small/medium sized fruit or 1/2 cup.
Limit dried fruit, and concentrated fruit products. If you consume juice, it is recommended that you limit the serving size to 1/3 cup.
 apple  apricot  avocado  blackberries  canned packing juice  cherries  dried fruit  dried fruit bars  figs, dried  longon  lychee

 banana  blueberries*  cantaloupe  cranberries  grapefruit*  grapes**  honeydew melon*  kiwi  lemon  lime  orange  papaya  passion fruit  pineapple  raspberries**  rhubarb  strawberry*  tangelo
* These are foods with a moderate amount of FODMAPs – limit portions if they cause symptoms (e.g. use ½ portion size).
** There is some conflicting data on the FODMAP content – limit quantity or avoid if they cause symptoms.
 mango  nectarine  peach  pear  persimmon  plum, prunes  rambutan  watermelon
Vegetables
 alfalfa  bamboo shoots  bean sprouts  bok choy  carrots  chives  choko  choy sum  cucumbers  eggplant  fennel*  green beans  green bell pepper  lettuce  okra
 artichoke  asparagus  beetroot  broccoli  Brussels sprouts  cabbage  cauliflower  celery  garlic  leeks  mushrooms  onions  shallots  snow peas  tomato paste (tomatoes are

 parsnip  potatoes  radish  red bell pepper  silver beet  spinach  spring onion (green part only)  squash  sweet potato*  tomato  turnip  water chestnut  zucchini
* These are foods with a moderate amount of FODMAPs – limit portions if they cause symptoms (e.g. use ½ portion size).
allowed)  tomato sauce  tomato juice
Grain Products
 amaranth flour  arrowroot flour  buckwheat, buckwheat flour  corn meal, corn thins, corn flour (note: avoid whole sweet corn)  gluten-free breads*  gluten-free cereals*  millet, millet flour  oats, oatmeal  quinoa  rice (rice cakes, rice pasta/noodles, cream of rice cereal, rice crackers, rice paper), rice flour  tortilla chips
*May not be tolerated by some people, therefore use with caution – check labels for any high FODMAP ingredients.
 barley*  muesli/muesli bar  rye flour*, rye flour products  sweet corn (corn flour and corn meal are allowed)  wheat*, products with large amounts of wheat:  breads  pasta/noodles  couscous  cereals  cakes, baked goods, pastries, cookies  crackers, biscuits  breadcrumbs, batter  flours
* Small/trace amounts of wheat, rye, barley can likely be tolerated (low in FODMAPs).
Milk and Alternatives
 almond milk  butter  certain cheeses only (Cheddar,
 buttermilk  cream (light cream, half and half, whipping cream)

Edam, Limburger, Mozzarella, Romano, Swiss, Parmesan, Provolone, Brie, and Camembert)  coconut milk  custards and puddings made with lactose-free milk  ice cream substitutes (e.g. gelato, sorbet)  lactose-free milk  lactose-free yogurt  rice milk
 cream sauces  cream soups  evaporated milk  feta cheese  fresh cheeses (e.g. Ricotta, Cottage)  ice cream  kefir  malted milk  milk powder, whey powder  processed cheese, cheese spreads  puddings, custards  regular and low-fat milk (cow, goat, sheep)  regular and low-fat yogurt  sherbet  sour cream  soy milk  sweetened condensed milk
Meat and Alternatives
 eggs  fish  low FODMAP nuts (limit portion to small handful at a time): o almonds* o hazelnuts* o pine nuts o peanuts o pecans o macadamia nuts o walnuts  peanut butter (limit to 1-2 tbsp at a time)  poultry (chicken, turkey)  red meat  seafood  seed butters (e.g. tahini, sunflower seed butter) (limit to 1-2 tbsp at a time)  seeds (e.g. sunflower seeds, pumpkin seeds) (limit portion to a small handful at a time)
 legumes (e.g. chick peas*, lentils*, red kidney beans, baked beans, navy beans, lima beans, butter beans, barlotti beans, mixed beans, split peas, soy beans)  pistachio nuts  cashews
*Canned beans and legumes have a lower GOS content than cooked dried beans and legumes. Small portions of canned lentils (1/2 cup) and canned chick peas (1/4 cup) may be well tolerated

 tofu
* These are foods with a moderate amount of FODMAPs – limit portions if they cause symptoms (e.g. use ½ portion size).
Oils and Fats
 all vegetable oils (including soybean oil)  butter  margarine  mayonnaise products (most are low in FODMAPs, however check label for any high FODMAP ingredients)
 cream cheese  cream sauce  sour cream
Caution (check ingredients): commercial salad dressings may contain ingredients that are high in FODMAPs
Sweeteners
 artificial sweeteners not ending in ‘ol’ (e.g. aspartame, Splenda)  glucose  golden syrup  maple syrup  regular corn syrup  table sugar (sucrose)
The following are different names of low FODMAP sugars:
 cane sugar  confectioner’s sugar  granulated sugar  superfine sugar  naturally milled organic sugar  sugar syrup  cane syrup  evaporated milled cane juice  organic cane syrup  organic sugar  beet sugar  bar sugar  berry sugar  castor sugar
 agave syrup  crystalline fructose  fructose  glucose-fructose, glucose/fructose (this is high fructose corn syrup)  high fructose corn syrup (HFCS)  honey  molasses  polyols (e.g. sorbitol, mannitol, xylitol, maltitol and isomalt)
Caution (check ingredients): sugar-free products (e.g. sugarfree gum) may contain added polyols
Caution (check ingredients): the following may contain added glucose/fructose (high fructose corn syrup) – soft drinks, fruit drinks, sweetened beverages, candies, sweetened cereals,

 icing sugar  refined sugar  cane juice crystals  invert sugar
Use low FODMAP sugars in moderation
syrups, condiments
Herbs, Spices and Condiments
 chives  ginger root  salt  pepper  lemon and lime juice  soy sauce  vanilla extract, real or imitation  most varieties of vinegars (check ingredient labels for any high FODMAP ingredients)
Most spices are low in FODMAPs, but use caution with large amounts of spices
 barbeque sauce  chutney  garlic powder  ketchup  onion powder  plum sauce  relish  unfiltered apple cider vinegar
Other Food Ingredients
 ingredients that are not derived from foods listed under ‘High FODMAP Foods’
 FOS (fructo-oligosaccharides)  GOS (galactooligosaccharides)  inulin
Caution (check ingredients): the following may contain FOS or inulin – fibre supplements, yogurts, probiotics, meal replacement supplements
Other
beer coffee tea unsweetened spirits (vodka, gin) red and white wine (dry) sherry (dry) water
 fortified wine: port, sherry (sweet)  rose wine  rum  white wine (sweet)  some alcoholic cocktails (pina colada, margaritas, sours)
Nutrient data used to classify foods in the FODMAP food table was obtained from published studies, USDA nutrient database and the NUTTAB database. In some cases, FODMAP data was not available. In these cases, foods were classified based on estimates from The Low FODMAP diet: Reducing poorly absorbed sugars to control gastrointestinal symptoms booklet (2012) prepared by the research team in the Dept. of Gastroenterology, Central Clinical School, Monash University, Australia.

Low FODMAP sample menus and snacks
Four days of low FODMAP menus have been provided to help you plan meals and snacks while trying a low FODMAP diet.
Day 1 (low FODMAP menu)
Breakfast
Puffed millet cereal
½ – 1 cup of almond or rice milk for cereal
1 small banana for cereal topping
1-2 hard-boiled eggs
Lunch
2 – 4 plain rice cakes
Canned tuna on plain rice cakes with small amount of melted cheddar cheese (or peanut butter on rice cakes as an alternative)
Small salad of low FODMAP vegetables with homemade dressing (e.g. oil and balsamic vinegar)
Afternoon snack
½ cup grapes
1 cup of almond or rice milk
Supper
Stir-fry
1 cup of cooked quinoa (rice can be used as an alternative)
Sliced chicken or turkey
Vegetables (see low FODMAP vegetables)
Olive oil
Herbs (to flavour/garnish)
Evening snack
Small handful of walnuts

Day 2 (low FODMAP menu)
Breakfast
Oatmeal
½ – 1 cup of rice or almond milk for cereal
½ cup cantaloupe or raspberries
Lunch
Corn (or rice) pasta with cooked low FODMAP vegetables, shrimp
tossed with olive oil, parmesan cheese and herbs
Afternoon snack
Small banana with peanut butter or seed butter
Supper
Baked potato and carrots
Tilapia or other fish (baked, broiled) seasoned with olive oil and herbs
Margarine
1 cup of almond or rice milk
Evening snack
Shake (Almond or rice milk and low FODMAP fruit mixed in blender)

Day 3 (low FODMAP menu)
Breakfast
Gluten-free cereal (or oatmeal)
½ – 1 cup of almond or rice milk for cereal
Orange wedges
Lunch
2 slices of gluten free bread
Salmon salad filling for sandwich (mayonnaise, lettuce, red bell peppers)
Small salad of low FODMAP vegetables with homemade dressing (e.g. oil and balsamic vinegar)
Afternoon snack
½ cup pineapple
Small handful of sunflower seeds
Supper
Baked red bell pepper and zucchini with olive oil and herbs
Baked turkey breast with salt and herbs
Mashed/baked potato with margarine
Evening snack
1 cup of almond or rice milk and rice crackers

Day 4 (low FODMAP menu)
Breakfast
Scrambled eggs with tomatoes, spinach and herbs
Hash brown potatoes
½ cup papaya or grapes
Lunch
Tossed green salad of low FODMAP vegetables with shrimp/tuna and homemade salad dressing (e.g. olive oil and lemon juice)
Rice crackers or rice cakes
1 cup of almond milk or rice milk
Afternoon snack
Small banana with peanut butter or seed butter
Supper
Corn or rice pasta served with chicken and low FODMAP vegetables
(season with olive oil and low FODMAP herbs)
1 cup of almond or rice milk
Evening snack
Small handful of pecans

Other foods that may trigger IBS symptoms
In addition to high FODMAP foods, other dietary triggers of IBS symptoms can include caffeine, alcohol, greasy foods (e.g. deep-fried foods, fast foods) and large meals. You may also want to try limiting these foods to help improve your IBS symptoms.
Additional Instructions
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© Niagara Health System 2012. This document can be reproduced in its entirety without alterations (NHS logo/credit retained) for non-commercial use

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