“FODMAP” is the acronym for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols, a group of short-chain carbohydrates and sugar alcohols (polyols).1 These nutrients are ubiquitous in the diet. The key FODMAPs are:
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Oligosaccharides, such as fructans/fructo-oligosaccharides (found in grains and vegetables) and
galactans/galacto-oligosaccharides (found in legumes)
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Disaccharides, such as lactose (found in milk)
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Monosaccharides, such as fructose (found in fruit)
- Polyols, such as sorbitol (found in sweetened products)
Susceptible people can experience intestinal symptoms from ingestion of FODMAPs for a number of reasons.
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The carbohydrates are not well absorbed into the body and remain in the digestive tract for longer
periods.
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FODMAPs draw water into the intestines, which can increase bowel motions and promote diarrhea
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These carbohydrates can be metabolized by the bacteria that normally reside in the bowel, producing gas, bloating and wind.
It is not generally recommended that you follow a low FODMAP diet for life; restricting dietary intake of a wide array of foods should generally be avoided if possible to reduce the risk of nutrient deficiencies. FODMAPs are a normal part of the diet and have benefits for health, such as providing fibre and prebiotics for gastrointestinal health.
HOW TO EAT A LOW FODMAP DIET – ELIMINATION PHASE
To trial the low FODMAP diet, all high-FODMAP foods need to be eliminated from the diet for at least two weeks, until there has been a significant reduction in symptoms. Relevant symptoms should be monitored and recorded (using the diary in Appendix A) on a daily basis, to track any benefits from the dietary program.
Table 1 gives a detailed list of foods in each FODMAP category that should be avoided. Where quantities are given, these foods should be avoided only above the given dose. Many alternative foods can be consumed whilst following a low FODMAP diet. Table 2 provides a list of suitable foods which can be enjoyed.
- The reintroduction phasebe commenced after two weeks in the elimination phase, when some significant resolution of symptoms has been achieved. The goal is to systematically reintroduce each FODMAP to determine the level of individual FODMAP consumption that can be comfortably tolerated.8,9
- A five week program for the reintroduction phase is outlined in Table 3. Each week, one specific carbohydrate type is trialled, with a serving consumed on three separate days. Symptoms are monitored (using the diary in Appendix A) for 48 hours after each dose to determine if there is a possible reaction to that carbohydrate. If you believe there is no reaction over the following 48 hours you can continue with the next dose of that carbohydrate. If you experience a worsening of symptoms following the reintroduction of a specific FODMAP, then it is recommend to discontinue trialling that FODMAP and wait until symptoms resolve. Once the symptoms have resolved you can move onto the next type of FODMAP to trial.
All other FODMAP sources should continue to be avoided for the duration of the five week reintroduction phase, even if a particular FODMAP appears to be well tolerated from the rechallenge. Small doses of individual FODMAPs may have an additive effect which makes it difficult to determine the individual cause.
CREATING YOUR INDIVIDUALISED LOW FODMAP DIET
After the five week trial, it is recommended to integrate foods from all the FODMAP groups which were well- tolerated into your normal diet, to determine your tolerance of the combination of FODMAPs. Symptoms should continue to be monitored closely during the reintroduction. If there is a return of symptoms then it is recommended to eliminate those FODMAP groups again until symptoms resolve. The combination of FODMAPs should then be reintroduced at a lower dose.
For the FODMAP types which aggravated symptoms, it is recommended you continue to avoid, or significantly restrict, foods containing these FODMAPs in your diet.
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