Friday, April 1, 2011

The FODMAP diet




"Functional gut" symptoms (bloating, wind, abdominal distension, discomfort, pain, altered bowel habits) can be controlled by diet, but most theories of how exactly food components are linked to symptoms are lacking consistency. In 2005, Peter Gibson and Susan Shepard gave us food for thought by defining highly fermentable but poorly absorbed short-chain carbohydrates and polyols as an important dietary factor contributing to these symptoms ( see their original article that coined the term FODMAPs - Fermentable Oligo-, Di- and Mono-saccharides And Polyols).

Their studies of different patient groups (Irritable Bowel Syndrome, Irritable Bowel Disease, celiac disease, fructose malabsorption, patients who underwent colectomy, etc) showed that reduction of the intake of FODMAPs may help to reduce symptoms, depending on other things these people usually eat.

FODMAPs are types of sugars and fiber, found in wheat-based and other foods:

Fructans and Galactins Polyols
Fructose
Lactose
Fructooligosaccharides
Galactooligosaccharides
Sorbitol
Mannitol
Xylitol
Maltitol

There is a cumulative effect of these foods, of their osmotic (water moving) and fermentative (bacteria feeding) actions, on IBS symptoms such as  abdominal pain, bloating, gas, altered bowel movements and lethargy. Irritable Bowel Syndrome symptoms could result from many different (and independent) reasons including  low absorptive capacity of the small intestinal epithelium, increased sensitivity of the bowel, rapid transit through the small bowel, and bacterial overgrowth in the distal small bowel.

This means that you may eat some of the problem foods listed in the tables and still fill fine. It's not about the foods eaten in isolation, it's about hundreds of food components that are adding up. To follow the right diet, you need to identify your individual sensitivities and dietary combinations.


For informational purposes only, we are listing candidate dietary components contributing to osmotic load and rapid fermentation thus increasing luminal pressure and distension, along with common high and low FODMAP foods - as listed in scientific publications. Red and green tables were compiled by a FODMAP-sensitive IBS sufferer based on his own experiences - check his post: "Printable FODMAP Diet Chart for your Convenience".  Another FODMAP list compiled by trial and error can be found here.



Fruits: 
•  Serving size is ½ cup 
•  Limit to 1 to 2 servings per day.  
•  Fresh or fresh frozen fruit may be better tolerated than canned fruit. 
•  Keep in mind tolerance may depend on the amount you eat at one time.  
•  Limit concentrated sources of fruit--such as dried fruit and fruit juices  
•  Avoid eating large amounts of any fruit. 

Intestine Friendly Avoid if
FODMAP Intolerant
Questionable
May Need to Limit
Bananas (could be gas forming), blackberries, blueberry, grapes (if half a serving or less than 10), grapefruit, honeydew, kiwifruit, lemons, limes, mandarin orange, melons, oranges, papaya, passion fruit, pineapples, raspberries, rhubarb, strawberries, tangelos
Apples, apple cider, apple
juice, applesauce, apricots,
cherries, dates, grapes,
lychee, mango, peaches,
pears, pear juice, plums,
prunes, watermelon
Other fruit juices or
drinks, sugar-free
jam/jelly, dried fruit,
canned fruit in heavy
syrup, other fruits


                                                     Vegetables:
•  Serving size is ½ cup (most vegetables) or 1 cup of leafy green vegetables
•  Limit to 1 ½ to 3 servings per day.
•  Cooked vegetables may be tolerated best as cooking causes a loss of free sugars.
•  Keep in mind tolerance may depend on the amount you eat at one time.

Intestine Friendly Avoid if
FODMAP Intolerant
Questionable
Bamboo shoots, bok choy, carrots, cauliflower (gas forming), celery, cucumber (gas forming), eggplant (gas forming), green beans (gas forming), green peppers (could be gas forming), leafy greens, parsnip, pumpkin, spinach, sweet potatoes, white potatoes, other root vegetables Artichokes, asparagus,
some beans (baked beans,
chickpeas, kidney beans,
lentils) beetroot, broccoli,
Brussels sprouts, cabbage,
cauliflower, fennel, garlic,
sugar snap peas, leeks, soy
products, okra, onions,
peas, shallots


Avocado, corn, mushrooms, tomatoes,
other beans

Other
Intestine Friendly Avoid if
FODMAP Intolerant
Questionable
Meat, Fat, Yogurt and hard cheeses, Eggs, Aspartame (Equal®
and Nutrasweet®),
Saccharin (Sweet ‘n Low®),
Sucrose (table sugar), Glucose, Maple syrup
Honey, Flavorings with fructose or sorbitol,
Desserts (ice cream, candy, cookies, bars, popsicles) sweetened with fructose or sorbitol,
Cereal or other processed foods with sorbitol or fructose on the label, Wheat,
Sherry and port wine, Sweeteners such as sorbitol, mannitol, xylitol, maltitol, and isomalt used in sugar-free gum, candies and mints

High-fructose corn syrup,
Lactose


And here are two more tables with foods already listed above, just to show why they are problematic for FODMAP-sensitive people.

Note that some of the foods listed as intestine friendly may be less friendly for some people inducing functional gut symptoms. Inulins - often included in prebiotic supplements - are longer chain fructans thus are expected to be more intestine-friendlier than fructans with low degree of polymerization.  Yet inulins often lead to increased wind.




    Scientific publications:

    Gibson PR, Shepherd SJ. Personal view: food for thought--western lifestyle and susceptibility to Crohn's disease. The FODMAP hypothesis. Aliment Pharmacol Ther. 2005 Jun 15;21(12):1399-409. Review.  


    Barrett, J.S., Gibson, P.R.  Nutrition issues in Gastroenterology, Series # 52  Clinical Ramifications of Malabsorption of Fructose and Other Short-chain Carbohydrates.  Practical Gastroenterology 2007 XXXI:51-65


    Gibson PR, Newnham E, Barrett JS, Shepherd SJ, Muir JG. Review article: fructose malabsorption and the bigger picture. Aliment Pharmacol Ther. 2007 Feb 15;25(4):349-63. Epub 2007 Jan 8.


    Gibson, P. & Shepherd, S. Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. Journal of Gastroenterology and Hepatology 2010 25:252-258.

    Biesiekierski JR, Newnham ED, Irving PM, Barrett JS, Haines M, Doecke JD, Shepherd SJ, Muir JG, Gibson PR. Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Am J Gastroenterol. 2011 Mar;106(3):508-14. Epub 2011 Jan 11

    Rangnekar AS, Chey WD. The FODMAP diet for irritable bowel syndrome: food fad or roadmap to a new treatment paradigm? Gastroenterology. 2009 Jul;137(1):383-6. Epub 2009 May 29. 


    Other links:

    33 comments:

    S.D. said...

    Since starting to watch out for FODMAP foods, I found out that these foods affect me in different ways. Sometimes it's enough to have just a small piece of wheat bread, but I'm Ok with asparagus. Deffinitely, common advice about eating more fiber is NOT to follow

    Anonymous said...

    It's good to see more information about FODMAPS getting out there. Another good source of info not on your list is the yahoo group 'fructose malabsorption australia'.

    Aurametrix company said...

    Thanks for your comments! The fructose malabsorption support group is now included in the list here. A new blog will tell more about fiber.

    April said...

    I would like to use one of these charts in my research paper for my biology class but I need to be able to site it properly. Can you tell me where to find the red chart "eliminate foods containing fodmaps" in it's original place please.

    Thank you.

    Aurametrix company said...

    April, this chart was compiled by a prolific yet anonymous member of the IBS group. It can be cited as follows:

    "Common Response", Printable FODMAP Diet Chart for your Convenience,
    Irritable Bowel Syndrome Self Help and Support Group, March 26, 2011.

    casey.s.watts said...

    What source is the Inulin/Oligofructose chart from? :)

    Aurametrix said...

    This chart is from Moshfegh et al, Presence of Inulin and Oligofructose in the Diets of Americans J. Nutr. 129: 1407S–1411S, 1999

    FMN said...

    Hey, good compilation of resources all in one place. Thanks!

    Sarah said...

    Great post! I follow the FODMAPs diet too and it has been a huge help in managing my IBS. x

    Supplement Reviews said...

    So cute lol Since long I have never read anything as refreshing as this one. ^_^ I am so glad that I read this. I may post this on my facebook account so that others read this and enjoy it like it did…: D

    Michelle said...

    At this exact moment, my husband is drinking "the drink" to prepare for a colonscopy he is getting tomorrow. My point is, he has been diagnosed with IBS and has a history of colon cancer in his family. And even still, refuses to eat more fiber...because it makes him "go" more. I'm afraid he falls into the majority of the population that does nothing but contribute to more diseases and health issues by eating fast food and refined carbs.

    His father has type 2 diabetes and only recently is he starting to acknowlege that he needs to start adding fiber to his diet. I appreciate your article and really like the chart. It will just back-up my research to get him on the fiber boat.

    Stew said...

    As to whether aspartame safe during pregnancy is still a problem with information I have yet to digest as there are so many conflicting information on the web.

    Anonymous said...

    Michelle, you may want be careful before pushing your husband towards more fiber. After a year of suffering my doctor told me to cut back on that, and it helped greatly. Not everyone is the same. Some of us don't tolerate it well.

    Anonymous said...

    Michelle, you may not want to push your husband toward more fiber. It is not good for every single person. In my case, I had a year of suffering until my doctor figured out that fiber was actually the problem. Not everyone handles it well. The colonoscopy is what will protect him.

    Lucy Finley said...

    After getting these diets from FODMAP, I feel myself healthier and lighter.

    Jamie Parker said...

    These diets are a great alternative to detoxifying. Some deem maintaining a diet as a hassle so they take other procedures like colon hydrotherapy south melbourne. But for some of us who still have the will, taking a high fiber diet wouldn't be much of a trouble.

    Farham Erikson said...

    Our long island weight loss program have showed this diagram to us and I must say, it's a great guide to staying fit and healthy.

    Sabina Orrico said...

    I recently found out that some of these diets aren't really the way to go when you're having the best work out supplement but I guess it would still be better if you consult a dietician.

    Robert West said...

    "Reduction of the intake of FODMAPs may help to reduce symptoms, depending on other things these people usually eat." - This makes perfect sense. Your food intake directly affects your health, moreso in the abuse of certain food types within FODMAP. What can help you out though is excercise - which not all people give a much credit to. I break my bones and stretch those muscles as hard as I can, then take sierrasil to relieve myself from it. No matter where you look at it, your health - and figure - relies on your actions, or lack thereof.

    Tim Arellano said...

    Well, aside form my freezing fat cells option, maybe I'll try following FODMAP diet. I don't drink milk (which is bad if you want to be healthily fat) cause I have lactose intolerance, but I think it doesn't matter anyway cause I still feel bloated.

    Ellie Coaldrake said...

    Do you have a diabetic friendly diet? I want to give a list of food that my mother can try because she is bored with meals that she cooks for herself.

    Kendrick Gibson said...

    When I'm buying food products, I always make it a point to check its nutritional facts. This is to make sure that what I am going to buy is good for my system.

    Sue Gibson said...

    Hi everyone! I've been doing a research now about artificial sweeteners like aspartame because, my wife is an expectant mother. I really want to know if taking aspartame is safe during pregnancy?

    Gary Oakland said...

    This is the kind of information everyone of us should read and to take note of. Knowing this info will prevent us from getting into any trouble.

    Cyrus Gilmore said...

    Natural remedies to help normal bowel movement are various fruits and vegetables. If that doesn't work, then it's the only time one should go after health products. But as much as possible, doctors wouldn't advise that. They would stick to the all-natural remedy instead.

    Jerry Stewart said...

    That is the reason why I always make it a point to read first the product label before buying it. This is to make sure that what I am buying is what I need for my health.

    Jean Raizel Gonzales said...

    One way to regulate bowel movement is through a good exercise. Everyone needs body movements that can help proper circulation of blood flow, breathing and proper waste movement. Prepare for diet and meal plans that include high-fiber food and less saturated or trans fat. In short, start living healthy!

    Sara Ritchard said...

    I've been having problems with my bowel movement last week. My doctor said there's something wrong with my diet, so he referred me to a nutritionist. I was advised to take more fluids and fiber-rich foods. As usual, it's what works for everyone.

    Selena Melendez said...

    Once it happens, I just a generic anti-motility at the drugstore and go for a basic porridge to sustain me through the day. It's important to hydrate yourself, too.

    Eugene St. Helens said...

    There goes another reason to keep up with the fruits and whole wheat bread. Too bad milk and apples have been listed as FODMAPs; if it so happened that I had stomach problems, I'd had to drop the apples entirely.

    Anonymous said...

    If 'grape' is friendly and 'grapes' are to be avoided, does that mean that one grape is OK but not more?

    Aurametrix said...

    Good point! Grapes are usually listed as FODMAP-friendly fruit, but in most cases tolerance threshold is only 10 grapes or less. It's clarified now.

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