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Low FODMAP diet

Irritable bowel syndrome - low FODMAP diet

People with irritable bowel syndrome (IBS) have abdominal pain and diarrhea and or constipation. A diet low in FODMAPs, which are types of carbohydrates in foods, may help some people with IBS manage their symptoms.

Understanding FODMAPs

FODMAP stands for fermentable oligo-saccharides, disaccharides, mono-saccharides, and polyols. These are types of short chain carbohydrates--sugars, starches, and fiber--found in a variety of foods that are poorly absorbed in the small intestine and absorb water and ferment in the colon.

The following types of carbohydrates are FODMAPS:

Fructans - found in garlic, onions, and wheat

Fructose - found in fruits, honey, and high fructose corn syrup

Galactans - found in beans and legumes

Lactose - found in dairy

Polyols - found in fruits with pits, such as apples, avocados, or cherries and in sugar alcohols

Most people can eat high-FODMAP foods without any problem. In fact, many of these foods can encourage good bacteria to grow in the intestines. However, people with IBS may tend to be more sensitive to foods high in FODMAPs.

FODMAPS are not easily absorbed in the small intestine. They move through slowly, and take on water. In the bowel, bacteria rapidly ferment the FODMAPs, causing gas. The excess gas and water can cause bloating, pain, and diarrhea in people with IBS. The low-FODMAP diet can help identify which foods trigger your IBS symptoms. Avoiding these foods may help you manage your condition.

How to Follow a LOW FODMAP Diet

A low FODMAP diet should only be used by people who have been diagnosed with IBS by a doctor. It is an elimination diet used to help find which foods cause IBS symptoms.

Here is how the diet works:

  • You will stop eating all foods that are high in FODMAPs. (Below see the list of some high-FODMAP foods.) Over time, you may notice that your symptoms improve.
  • After about 6 weeks, your provider will have you add back foods, one at a time, to see what foods trigger symptoms. Not all foods will bother every person.
  • After you find the foods that cause symptoms, you can limit or stop eating those foods, and resume eating the foods that don't bother you. (For a list of some low-FODMAP foods, see below.)

It's important to work with your health care provider or a dietitian if you want to try the FODMAP diet.

  • It's not easy to tell what foods are high in FODMAPs, so you'll need help to know what foods to avoid and what to eat.
  • Because the diet is restrictive, your provider will ensure that you continue to get the proper nutrients.

The low FODMAP diet may not help everyone with IBS. You may need other types of treatment, such as lifestyle changes and medicines to better manage your IBS.

High FODMAP Foods

This is a partial list of the foods you should avoid while following the low FODMAP diet. This is not a complete list.

VEGETABLES

  • Garlic, garlic salt, garlic powder, pickled garlic - avoid entirely if possible
  • Onions, onion powder, pickled onions - avoid entirely if possible
  • Artichoke
  • Asparagus
  • Broccoli
  • Brussels sprouts
  • Cabbage
  • Cauliflower
  • Green and yellow beans
  • Leeks
  • Mushrooms
  • Sugar snap peas
  • Summer squash

FRUITS

Fruit can be high in fructose, so it's best to avoid eating a lot of any fruit.

  • Apples, applesauce, apple juice
  • Apricots
  • Avocados
  • Bananas
  • Blackberries
  • Canned fruit in fruit juice
  • Cherries
  • Dried fruit (raisins, currants, dates, figs, prunes)
  • Fruit juice
  • Grapes
  • Lychee
  • Mango
  • Nectarines
  • Peaches
  • Pears
  • Pineapples
  • Plums
  • Watermelon

BEANS AND LEGUMES

  • Beans
  • Black-eyed peas
  • Chick peas
  • Lentils
  • Lima beans
  • Kidney beans, cannellini beans
  • Pinto beans
  • Soy beans
  • Split peas

MEAT, POULTRY, AND SEAFOOD

Many marinated or processed meats have high FODMAP ingredients such as garlic and onion. So you should avoid:

  • Marinated meat, poultry, or seafood
  • Sausages and salami
  • Some processed meats

DAIRY AND DAIRY ALTERNATIVES

  • Cow, goat, and sheep milk and milk products
  • Coconut milk
  • Custard
  • Ice cream
  • Soft unripened cheeses and fresh cheeses –brie, cottage cheese, cream cheese, ricotta, sour cream
  • Soy milk
  • Yogurt

GRAINS

Check food labels and avoid breads, cereals, pastas, cookies, snack bars, and pastries made with:

  • Barley
  • Rye
  • Wheat

NUTS

  • Cashews
  • Pistachios

SWEETENERS

  • Agave
  • High fructose corn syrup
  • Honey

SUGAR SUBSTITUTES

Many sugar-free gums and candies contain these sugar substitutes:

  • Isomalt
  • Lactitol
  • Maltitol
  • Mannitol
  • Sorbitol
  • Xylitol

FIBER SUPPLEMENTS

  • Inulin

BEVERAGES

  • Beer
  • Chamomile, chia, dandelion, fennel, and oolong tea
  • Port
  • Rosé wine
  • Sherry
  • Soft drinks made with high-fructose corn syrup

Low FODMAP Foods

You can eat the following foods while on a low-FODMAP diet. This is not a complete list. Be sure to work with your health care provider or a dietician to make sure you get a balanced diet while on the low FODMAP diet.

VEGETABLES

  • Bell peppers
  • Bok choy
  • Carrots
  • Celery
  • Chives
  • Cucumber
  • Eggplant
  • Green beans
  • Kale
  • Lettuce
  • Potatoes
  • Pumpkin
  • Radishes
  • Spinach
  • Tomatoes
  • Winter squash
  • Yams
  • Zucchini

FRUITS

  • Blueberries
  • Cantaloupe
  • Grapefruit
  • Kiwi
  • Lemons
  • Limes
  • Papaya
  • Passion fruit
  • Pineapple (limit)
  • Raspberries
  • Strawberries

MEAT, POULTRY, AND SEAFOOD

  • Plain cooked meat: beef, chicken, lamb, pork, turkey
  • Canned fish (check ingredients)
  • Fresh fish and seafood
  • Frozen fish and seafood (as long as nothing else is added)

DAIRY, DAIRY ALTERNATIVES, AND EGGS

  • Almond milk
  • Eggs
  • Aged hard cheeses
  • Cashew milk
  • Lactose-free milk
  • Lactose-free yoghurt
  • Rice milk

NUTS AND SEEDS

  • Almond butter
  • Macadamia nuts
  • Peanuts
  • Seeds
  • Walnuts

BREADS, CEREALS, AND PASTA

  • Bread, pasta, cereal, pastries, and flours made from corn, potato, rice, oats, quinoa, or spelt

SWEETENERS AND SWEETS

  • Dark chocolate
  • Maple syrup
  • Table sugar (sucrose)
  • Rice malt syrup

SUGAR SUBSTITUTES

  • Aspartame
  • Saccharin
  • Sucralose

BEVERAGES

  • Coffee
  • Diet soda
  • Teas (other than chia, chamomile, dandelion, fennel, and oolong)

When to Call the Doctor

Call your provider if:

  • You develop a fever
  • You have gastrointestinal bleeding
  • You have bad pain that does not go away
  • You lose over 5 to 10 pounds (2 to 4.5 kilograms) when you are not trying to lose weight

References

American College of Gastroenterology. Low-FODMAP diet. gi.org/topics/low-fodmap-diet/. Updated March 2021. Accessed April 28, 2021.

Barrett JS. How to institute the low-FODMAP diet. J Gastroenterol Hepatol. 2017 Mar;32 Suppl 1:8-10. doi: 10.1111/jgh.13686. PMID: 28244669 pubmed.ncbi.nlm.nih.gov/28244669/.

Dugum M, Barco K, Garg S. Managing irritable bowel syndrome: The low-FODMAP diet. Cleve Clin J Med. 2016 Sep;83(9):655-62. doi: 10.3949/ccjm.83a.14159. PMID: 27618353 pubmed.ncbi.nlm.nih.gov/27618353/.

Ford AC, Talley NJ. Irritable bowel syndrome. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 122.

Monash University. High and low FODMAP foods. www.monashfodmap.com/about-fodmap-and-ibs/high-and-low-fodmap-foods/. Accessed April 28, 2021.

  • Irritable bowel syndrome

    Irritable bowel syndrome

    Animation

  •  

    Irritable bowel syndrome - Animation

    Are your off again, on again, bathroom habits affecting your daily life? If so, you may have Irritable Bowel Syndrome, or IBS. IBS is a problem that causes abdominal pain, cramping, and changes in your bowel movements. IBS is known as a functional bowel disorder, and is not considered a disease. What I mean by that, is when a doctor passes a colonoscope into the colon to look around, everything may look perfectly normal - but yet, Your colon may not be not be acting normal at all! Symptoms of IBS can range from mild to severe. The main symptoms are diarrhea, constipation, or both. And you will probably experience abdominal pain, bloating, and gas. These symptoms often will temporarily improve after having a bowel movement, and that instant relief of course feels good. But, the important thing to understand is that the root of the problem often isn't here (abdomen), its here (head). IBS is a classic example of your mind affecting your bowels. It's rarely seen in folks who are not stressed, anxious, or depressed. It's often hard to determine why people get IBS. It has been found that IBS is twice as common in women as it is in men, and can develop at any age, but most get it as teenagers or in early adulthood. Diet can also cause IBS. Foods that often cause IBS symptoms are Fatty foods, such as French fries, or any drink containing caffeine like coffee and tea. One great idea is to keep a Food Diary. Write down what you're eating and when, and include the symptoms you experience after you eat. This information can be helpful to your doctor in identifying if you have IBS. The way most doctors diagnose IBS is by gathering your history and ruling out other things like lactose intolerance, gluten intolerance or some sort of bowel infection. Your doctor might recommend a colonoscopy just to make sure the colon looks okay. But remember, there is no specific test to diagnose IBS. So, how do you manage IBS? For some people, symptoms can reduce their ability to work, travel, and attend social events, and some may have to deal with IBS the rest of their life. There are several ways to manage your IBS. Large meals can make your symptoms worse. Try eating 4 to 5 smaller meals per day. Extra Fiber can bulk up your stools to help with diarrhea or help draw in extra water to help with constipation. Laxatives can help with difficult constipation. Drugs like Hyoscyamine help to calm down an overactive digestive tract. Lastly, since stress, depression and anxiety can fuel IBS, work on ways to relax. Perhaps, try exercise, meditation or yoga - and if that doesn't work, consider trying an antidepressant drug to help improve your mood. Oh, and keep in mind that blood in your stool or significant weight loss are not part of IBS, so be sure to let your doctor know if that ever shows up. Remember that the mind and the body are interconnected. You can't expect to feel good here (head), without feeling good down here (abdomen), and vice versa.

  • Digestive system

    Digestive system - illustration

    The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

    Digestive system

    illustration

  • Irritable bowel syndrome

    Irritable bowel syndrome

    Animation

  •  

    Irritable bowel syndrome - Animation

    Are your off again, on again, bathroom habits affecting your daily life? If so, you may have Irritable Bowel Syndrome, or IBS. IBS is a problem that causes abdominal pain, cramping, and changes in your bowel movements. IBS is known as a functional bowel disorder, and is not considered a disease. What I mean by that, is when a doctor passes a colonoscope into the colon to look around, everything may look perfectly normal - but yet, Your colon may not be not be acting normal at all! Symptoms of IBS can range from mild to severe. The main symptoms are diarrhea, constipation, or both. And you will probably experience abdominal pain, bloating, and gas. These symptoms often will temporarily improve after having a bowel movement, and that instant relief of course feels good. But, the important thing to understand is that the root of the problem often isn't here (abdomen), its here (head). IBS is a classic example of your mind affecting your bowels. It's rarely seen in folks who are not stressed, anxious, or depressed. It's often hard to determine why people get IBS. It has been found that IBS is twice as common in women as it is in men, and can develop at any age, but most get it as teenagers or in early adulthood. Diet can also cause IBS. Foods that often cause IBS symptoms are Fatty foods, such as French fries, or any drink containing caffeine like coffee and tea. One great idea is to keep a Food Diary. Write down what you're eating and when, and include the symptoms you experience after you eat. This information can be helpful to your doctor in identifying if you have IBS. The way most doctors diagnose IBS is by gathering your history and ruling out other things like lactose intolerance, gluten intolerance or some sort of bowel infection. Your doctor might recommend a colonoscopy just to make sure the colon looks okay. But remember, there is no specific test to diagnose IBS. So, how do you manage IBS? For some people, symptoms can reduce their ability to work, travel, and attend social events, and some may have to deal with IBS the rest of their life. There are several ways to manage your IBS. Large meals can make your symptoms worse. Try eating 4 to 5 smaller meals per day. Extra Fiber can bulk up your stools to help with diarrhea or help draw in extra water to help with constipation. Laxatives can help with difficult constipation. Drugs like Hyoscyamine help to calm down an overactive digestive tract. Lastly, since stress, depression and anxiety can fuel IBS, work on ways to relax. Perhaps, try exercise, meditation or yoga - and if that doesn't work, consider trying an antidepressant drug to help improve your mood. Oh, and keep in mind that blood in your stool or significant weight loss are not part of IBS, so be sure to let your doctor know if that ever shows up. Remember that the mind and the body are interconnected. You can't expect to feel good here (head), without feeling good down here (abdomen), and vice versa.

  • Digestive system

    Digestive system - illustration

    The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

    Digestive system

    illustration

Self Care

 

Review Date: 5/18/2021

Reviewed By: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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