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Learning About the Low-FODMAP Diet for Irritable Bowel Syndrome (IBS)

What is the low-FODMAP diet?

A low-FODMAP diet is a way to find out what foods give you digestion problems. You stop eating certain high-FODMAP foods for about 2 months. Then you add them back to see how your body reacts.

This is called a "challenge diet." A dietitian or doctor can help you follow this diet.

FODMAPs are carbohydrates. They are in many types of foods. FODMAP stands for the following:

  • Fermentable
  • Oligosaccharides
  • Disaccharides
  • Monosaccharides
  • And
  • Polyols

If you have digestive problems, some of these foods can make your symptoms worse. When you are on this diet, you can still eat certain fruits and vegetables. You can also eat certain grains, meats, fish, and lactose-free milks.

What is it used for?

If you have irritable bowel syndrome (IBS), you can ease your symptoms by not eating some types of foods.

High-FODMAP foods can be hard to digest. They pull more fluid into your intestines. They are also easily fermented. This can lead to bloating, belly pain, gas, and diarrhea.

The low-FODMAP diet can help you figure out what foods to avoid. And it can help you find foods that are easier to digest.

This diet can help with symptoms of some digestive diseases. But it's not a cure. You will still need to manage your condition.

How does it work?

You will work with a doctor or dietitian when you start the diet.

At first, you won't eat any high-FODMAP foods for a few weeks.

Go to www.monashfodmap.com to learn more about this diet. You'll also find links to an app for your phone or other device. You'll find low-FODMAP cookbooks there too.

Reintroducing certain foods in steps helps you to work out how your body responds to individual FODMAPs and eventually a mix of FODMAPs. A healthcare provider can help you work out the type and amount of foods to reintroduce, and help you to track your progress.

Keep a food journal. You can write down the foods you try and note how they make you feel.

After a few weeks, you may have a better idea of what foods you should avoid and what foods make you feel your best.

What are the risks?

There is some risk of not getting all of the vitamins and nutrients you need on the low-FODMAP diet. These include:

  • Folate.
  • Thiamin.
  • Vitamin B6.
  • Calcium.
  • Vitamin D.

Your dietitian or doctor can help you find other sources of these if needed.

This diet may limit your fibre intake. Try to plan your meals to include other sources of fibre.

What foods are on the low-FODMAP diet?

Here is a guide to foods that you can eat, plus the foods that you should avoid, when you are on the low-FODMAP diet.

Grains

Okay to eat: Foods made from grains like arrowroot, buckwheat, corn, millet, and oats. You can also eat potato, quinoa, rice, sorghum, tapioca, and teff. Cereals, pasta, breads, corn tortillas and baked goods made from these grains are also okay. (These grains may be labelled "gluten-free.")

Avoid: Grains like wheat, barley, and rye. Avoid ingredients such as bulgur, couscous, durum, and semolina. And avoid cereals, breads, and pastas made from these grains. Avoid chickpea, lentil, and pea flour.

Proteins

Okay to eat: Most meat, fish, and eggs without high-FODMAP sauces. You can have small amounts of almonds or hazelnuts (10 nuts). Macadamia nuts, peanuts, pecans, pine nuts, and walnuts are also okay. You can also eat chia and pumpkin seeds, tofu, and tempeh.

Avoid: Beans, chickpeas, lentils, and soybeans. Avoid pistachio and cashew nuts. And some sausages may have high-FODMAP ingredients.

Milk and alternatives

Okay to eat: Lactose-free milks. Rice beverage and almond beverage are okay. So are lactose-free yogurts, kefirs, ice creams, and sorbet from low-FODMAP fruits and sweeteners. (These are often labelled "lactose-free.") You can have small amounts (2 Tbsp) of cottage, cream, or ricotta cheese. Hard cheeses like cheddar, Colby, Parmesan, and Swiss are okay. So are small amounts (30 g) of aged or ripened cheeses like Brie, blue, and feta.

Avoid: Milk, including cow, goat, and sheep. Avoid condensed or evaporated milk, buttermilk, custard, cream, sour cream, yogurt, and ice cream. Avoid soy beverage. (Check sauces for dairy ingredients.)

Vegetables

Okay to eat: Bamboo shoots, bell peppers, bok choy, up to ½ cup of broccoli or cabbage (red or white), and cucumbers. Eggplant, green beans, lettuce, olives, parsnips, and potatoes are okay to eat. So are pumpkin, rutabaga, seaweed, sprouts, Swiss chard, and spinach. You can eat scallions (green part only) and squash (not butternut). You can eat tomatoes, turnips, watercress, yams, and zucchini. You can also have small amounts of artichoke hearts (from can, 30 g), carrots, corn (½ cob), and sweet potato (½ cup).

Avoid: Artichokes, asparagus, Brussels sprouts, savoy cabbage, cauliflower, and celery. And avoid garlic, leeks, mushrooms, okra, onions, scallions (white part), shallots, and peas.

Fruits

Okay to eat: Bananas, blueberries, cantaloupe, coconut, grapes, and honeydew. Kiwi, lemons, limes, oranges, passion fruit, papaya, and pineapple are also okay. You can eat plantain, raspberries, rhubarb, star fruit, strawberries, tangelo, and tangerine. You can also have small amounts of dried banana chips (up to 10 chips), dried cranberries (1 Tbsp), and shredded coconut (up to ¼ cup).

Avoid: Apples, applesauce, apricots, avocados, blackberries, boysenberries, and cherries. Also avoid dates, figs, grapefruit, guava, lychee, and mangoes. Don't eat nectarines, peaches, pears, persimmon, plums, prunes, tamarillo, or watermelon. And limit most canned and dried fruits.

Oils, spices, condiments, and sweeteners

Okay to eat: Vegetable oils (including garlic infused), butter, ghee, lard, and margarine (no trans fat). You can have most fresh herbs like basil, chives, coriander, ginger, parsley, rosemary and thyme. You can have salt, jams made from low-FODMAP fruits, mayonnaise, and mustard. Soy sauce, hot sauce (no garlic), tamari, and vinegar are also okay. Sweeteners that are okay include sugar (sucrose), powdered (confectioner's) sugar, brown sugar, glucose, and maple syrup. You can also have some sugar substitutes like aspartame, saccharine, and stevia.

Avoid: Chutneys, hummus, jellies, garlic sauces, and gravies made with onion or garlic. Avoid pickles, relish, some salad dressings and soup stocks, salsa, and tomato paste. And avoid sauces and other foods with high fructose corn syrup, honey, molasses, and agave. Avoid sugar substitutes (isomalt, mannitol, malitol, sorbitol, and xylitol). Avoid corn syrup solids, fructose, fruit juice concentrate, and polydextrose.

Other foods and drinks

Okay to have: Water, soda water, tonic, soft drinks sweetened with sugar, ½ cup of low-FODMAP fruit juice, and most teas and alcohols. You can also eat foods made with baking powder and soda, cocoa, and gelatin.

Avoid: Juices from high-FODMAP fruits and vegetables. And avoid fortified wines, chamomile and fennel teas, chicory-based drinks and coffee substitutes, and bouillon cubes.

This list doesn't include all high and low FODMAP foods. For a complete list, please refer to the FODMAP diet app.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Where can you learn more?

Go to https://www.healthwise.net/patientEd

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