FODMAPs

What are FODMAPs?

The term FODMAPs refers to Fermentable Oligo-, Di- and Monosaccharides And Polyols. FODMAPs are poorly digestible carbohydrates, which are less readily absorbed in the small intestine, so they reach the large intestine where normal intestinal bacteria break them (ferment) into absorbable nutrients, for example, short-chain fatty acids or SCFAs) and gases.

FODMAPs List

• Oligosaccharides: fructo-oligosaccharides (FOS), galacto-oligosaccharides (GOS), isomalto-oligosaccharides and mannan oligosaccharides
• Disaccharides: lactose
• Monosaccharides: fructose
• Sugar alcohols or polyols: isomalt, lactitol, maltitol, mannitol, polyglycitol syrup (hydrogenated starch hydrolisates or HSH), sorbitol and xylitol

FODMAPs Side Effects

In the small intestine, FODMAPs attract water from the intestinal wall, which may result in loose stools or diarrhea. In the large intestine, normal colonic bacteria break FODMAPs into gases, which may cause bloating.

Some people, mainly those with fructose malabsorption and irritable bowel syndrome (IBS) may experience abdominal bloating or pain, excessive burping (belching), excessive gas (flatulence) and loose stools or diarrhea after consuming even small amounts of FODMAPs.

Who may benefit from a low-FODMAP diet?

Individuals with fructose malabsorption, lactose intolerance, small intestinal bacterial overgrowth (SIBO) and irritable bowel syndrome (IBS) with a positive breath test with fructose or lactose are most likely to benefit from a low-FODMAP diet ^[4,5].

Picture 1. Examples of foods high in FODMAPs

Chart 1. A Low-FODMAP Diet Plan
FOOD GROUP	FOODS TO AVOID	ALLOWED FOODS
Fruits (fructose)	Agave, apple, apricot, avocado, blackberries, dates, figs, lychee, mango, nashi fruit, nectarines, papaya, peach, pear, persimmon, plums, prunes, quince, raisins, star fruit, sultana, sweat cherries, watermelon and related fruit juices, jams, compotes	Banana, berries (except blackberries), grapefruit, grapes, honeydew melon, lemon, lime, mandarin, orange
Sweeteners and food additives	Agar-agar, agave syrup, carob powder [6], fructose, high fructose corn sugar (HFCS), isomalt, honey, lactitol, maltitol, mannitol, sorbitol, polydextrose, polyols or sugar alcohols, xylitol	Acesulfam-K, aspartame, cane sugar, demerara, dextrin, erythritol, glucose (dextrose), hydrogenated starch hydrolysates (HSH), invert sugar, isomaltulose, maltodextrin, muscovado, pectin, polydextrin, saccharin, sucrose (saccharose), stevia, sucralose, tagatose, turbinado; syrups: glucose, corn, barley malt, brown rice, grape, maple, molasses, palm sugar, polyglycitol
Legumes (GOS)	Beans, lentils, peas, soy
Nuts	Cashews, pistachios	Almonds
Cereals (FOS)	Wheat, barley and rye products (bread, pasta); sweet corn, sweetened baked products: bagels, biscuits, cookies, pastries, energy bars	Buckwheat, cornmeal, oats, popcorn, rice
Vegetables (FOS, GOS, fructose)	Artichokes, asparagus, broccoli, cabbage, cauliflower, chicory root, garlic, leek bulb, mushrooms, onions	Eggplant, lettuce, potatoes, spinach, sweet potatoes, Swiss chard, tomato, yam and other vegetables not listed in the left column
“Sugar-free” or “low-calorie” foods	Certain brands of sugar-free chewing gum and candies (see sweeteners to avoid above)	Foods sweetened with allowed sweeteners (see above)
Beverages (fructose, HFCS)	Soft drinks, energy drinks, coconut water, beer, liquers	Water (tap, mineral), mineral water, soft drinks sweetened with allowed sweeteners (see above)
Dry mixes	Powdered drinks, soups, spices, mashed potatoes
Animal foods	Milk products that contain lactose (milk, yogurt, ice cream, custard, milk chocolate, soft cheeses: cottage, ricotta), processed meats (hamburger, hot dog, pizza)	Unprocessed meats, poultry, fish, shellfish, eggs, hard cheese, butter

Chart 1 sources: ^[1,2,3,7] Legend: FOS = fructo-oligosaccharides; GOS = galacto-oligosaccharides; HFCS = high fructose corn syrup. Alcoholic and caffeinated beverages may aggravate IBS. NOTE: The list is very strict but not complete. The foods highest in FODMAPs are in bold.

How to start a low-FODMAP diet?

First, try to get a diagnosis on the basis of a breath test from an experienced gastroenterologist. Next, try to find an experienced registered dietitian who will likely recommend you to avoid all foods high in FODMAPs for several weeks and later a less strict diet to determine how much of foods high in FODMAPs you can tolerate.

Frequently Asked Questions

1. Does cooking reduces the FODMAP content of foods?

Cooking, canning and pickling may reduce the amount of FODMAPs but not enough that we could recommend them as methods to avoid FODMAPs.

2. I started a low-FODMAP diet but I still experience bloating and diarrhea. Why?

If you have fructose malabsorption, elimination of FODMAPs should result in improvement of symptoms within few days; complete resolution of symptoms may last for several weeks. If you have irritable bowel syndrome (IBS), a low-FODMAP diet may help you or not. A low-FODMAP diet can improve symptoms in small intestinal bacterial overgrowth (SIBO), celiac disease and Crohn’s disease, but not completely, so the underlying diseases need to be treated.

3. Except FODMAPs, which other food ingredients commonly trigger gastrointestinal symptoms?

• Insoluble fiber in whole grain cereals, legumes, guava, avocado may worsen symptoms of irritable bowel syndrome.
• Gluten triggers diarrhea in celiac disease.
• Allergens from milk, soy, nuts, wheat, fish, shellfish, other foods, supplements or drugs can trigger allergic reactions in sensitive individuals.
• Certain amino acids and polysaccharides are harmful for individuals with certain genetic disorders of metabolism.
• Some foods may not agree with you from psychological reasons or from no apparent cause.

4. Any tips to easier follow a low-FODMAP diet?

Try stop eating all sweet foods and milk products. This way you may avoid craving for sugar.

Common Causes of Bloating and Diarrhea

• Lactose intolerance
• Fructose malabsorption
• Irritable bowel syndrome
• Small intestinal bacterial overgrowth (SIBO)
• Food poisoning: rotavirus (stomach flu), staph infection, salmonella, intestinal parasites
• Side effects of vitamin/mineral supplements or drugs
• Vitamin deficiencies

Related Nutrients

• Sugars
• Dietary fiber
• Prebiotics
• List of carbohydrates