"FODMAP" ia a type of diet recommended for people with irritable bowel syndrome (IBS), whose main objective is to avoid the consumption of foods that can cause intestinal discomfort.
Generally, the types of food that are avoided are those that contain fructose, lactose, fructo-oligosaccharides (FOS), galacto-oligosaccharides (GOS) or sugar alcohols, found in carrots, beets, apple, mango or honey.
FODMAP foods are known to be poorly absorbed in the small intestine and end up being highly fermented by the gut bacteria, which worsens the symptoms of IBS. However, it's important to note that IBS symptoms can vary greatly from person to another, and so it's important to try and identify other foods that can be triggering discomfort, and remove them from the diet.
How to start the FODMAP diet
To start the FODMAP diet you should remove all foods that are included in the list below for a period of 6 to 8 weeks, and monitor for any improvement in symptoms. If there is no improvement, the diet can be stopped after eight weeks and a new treatment should be started.
If the symptoms do improve, after eight weeks you should gradually reintroduce each food again, starting with one group at a time. For instance, you can start by introducing fruits first, such as apples, pears or watermelon, and see if the intestinal symptoms return.
This slow reintroduction of foods is important in order to identify foods that can worsen bowel symptoms, and that should be avoided or consumed in very small quantities.
Precautions
The FODMAP diet can lead to a low intake of important nutrients, such as fibers, carbohydrates or calcium. Thus, it's important for a doctor and a registered dietitian to supervise the diet to ensure the person remains in good health.
In addition, it's important to remember that this diet is effective for about 70% of patients with IBS. For those that do not benefit from this diet, a different treatment approach should be considered.
List of FODMAP foods
FODMAP foods that should be avoided can be classified into five different groups:
| FODMAP Type | Natural Foods | Processed foods |
|---|---|---|
| Monosaccharides (fructose) | Fruits: apple, pear, peach, mango, green beans and beans, watermelon, preserves, dried fruits, fruit juices, and cherries. | Sweeteners: corn syrup, honey, agave nectar, and fructose syrup, which may be present in some foods, such as cookies, sodas, pasteurized juices, etc. |
| Disaccharides (lactose) | Cow's milk, goat's milk, sheep's milk, cream, ricotta, and cottage cheese. | Cream cheese, ice cream, yogurt, and other foods that contain milk. |
| Fructooligosaccharides | Fruits: persimmon, peach, apple, lychees, and watermelon. Legumes: artichokes, asparagus, beetroot, brussel sprouts, broccoli, cabbage, anise, garlic, onion, peas, abelmosk, shallot, red chicory. Cereals: wheat and barley (in big quantities) and couscous. | Foods with wheat flour, pastas with wheat, cakes, cookies, ketchup, mayonnaise, mustard, processed meats such as sausages, nuggets, prosciutto, and mortadella. |
| Galactooligosaccharides (GOS) | Lentils, chickpeas, tinned chickpeas, beans, peas, soy whole grains. | Products that contain these foods |
| Polyols | Fruits: apple, apricots, peach, nectarine, suckling pig, pear, plum, watermelon, avocado, and cherry. Vegetables: cabbage, mushrooms, and peas. | Sweeteners: xylitol, mannitol, maltitol, sorbitol, products with glycerine, erythritol, lactitol and isomalt |
It is also very important to pay attention to the list of ingredients on processed food labels, since they may contain some of these foods.
What can you eat
The foods that can be included in this diet are:
- Grains without gluten, such as rice and oats;
- Some fruits such as tangerines, oranges, strawberries, grapes, raspberries, lemons, ripe bananas, and melons;
- Some vegetables such as pumpkin, olives, red bell pepper, tomato, potato, carrot, cucumber, and sweet potato;
- Milk products without lactose;
- Meat, fish, and eggs;
- Chia seeds, flaxseed, sesame seeds, pumpkin seeds, and sunflower seeds;
- Nuts such as peanut, walnuts, Brazil nut;
- Rice, tapioca, cornflour, or almonds.
In addition, your dietitian may consider the use of probiotics as a complement to regulate the bowels, as it's proven that people who suffer from irritable bowel syndrome sometimes have an imbalance in gut bacteria. Some studies show that probiotics can help to directly relieve symptoms.
FODMAP diet meal plan
The following table gives an example of a three-day meal plan for a FODMAP diet:
| Meal | Day 1 | Day 2 | Day 3 |
|---|---|---|---|
| Breakfast | Banana smoothie: 200 ml of chestnut milk + 1 banana + 2 tablespoons of oats | Grape juice + 2 slices of bread without gluten with mozzarella cheese and egg | 200 lactose-free milk + 1 tapioca with egg |
| Morning Snack | 2 watermelon slices + 7 cashews | yogurt without lactose + 2 teaspoons of chia seeds | 1 mashed banana with a tablespoon of peanut butter |
| Lunch/Dinner | Chicken risotto and vegetables: tomato, spinach, zucchini, carrot, and eggplant | Rice pasta with minced duck and tomato sauce with olives + lettuce, carrot, and cucumber salad | Boiled fish with vegetables: potato, carrot, leek and cabbage |
| Afternoon Snack | Pineapple juice + banana and oat cake | 1 kiwi + 6 gluten-free oat cookies + 10 chestnuts | Strawberry smoothie with lactose-free milk + 1 slice of gluten-free bread with cheese |
It's important to remember that you must monitor for foods that trigger bowel symptoms. This diet needs to be followed for six to eight weeks, under the supervision of a doctor or nutritionist.
The quantities included in the above plan may vary according to age, gender, physical activity and associated health conditions. Ideally, you should visit a registered dietitian for a thorough assessment in order to develop a more individualized meal plan according to your needs.
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