Low FODMAP diet (1995)
Key points below
What are FODMAPs?
FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols. These are found in everyday foods. Some people do not digest and absorb FODMAPs well.
Eating foods that are high in FODMAPs can lead to:
- Upset stomach
- Bloating and gas
- Diarrhea or constipation
- Pain
Why does my child need this diet?
The Low FODMAP Diet is used to find which foods trigger your child’s GI symptoms. If you can figure out and stay away from those foods, it may relieve some of your child’s symptoms. Your provider may recommend this diet if your child has Irritable Bowel Syndrome (IBS). How does the Low FODMAP Diet work?Your child will not eat any high FODMAP foods for 2 to 6 weeks. If your child responds to this diet, foods are slowly added back into the diet one at a time. This will help find which foods cause GI symptoms.What are in high FODMAP foods?
Below are the types of FODMOPs and where they are often found.
F = Fermentable
Fermentation is what happens in the intestine when high FODMAP foods cause pain and bloating.
O = Oligosaccharides
Fructans are one type of sugar. Wheat, onions and garlic are the main sources of fructans.
Galactans are another type of sugar. They are found in beans, lentils and some vegetables.
D = Disaccharides
Lactose is a sugar found in milk and many milk products.
M = Monosaccharides
Fructose is a sugar found in fruit. It is also found in honey and high-fructose corn syrup (HCFS).
P = Polyols
Polyols are used as sweeteners in sugar-free products. Some polyols are found naturally in fruits.
How does my child start the Low FODMAP diet?
The provider will decide if the Low FODMAP diet may help your child. If so, it is recommended that you and your child meet with a Registered Dietitian who knows about this diet. Ask the provider to help you set up an appointment.
A dietitian can help your child find substitutes for foods that are removed. They will also make sure your child is meeting nutrient needs while following this diet.
Step 1: Eat only foods from the ‘Allowed Foods’ section
Fruits
Allowed: Bananas (firm, green), blueberries, cantaloupe, clementine, cranberries, grapefruit (limit to ½), grapes, honeydew melon, kiwi, lemon, lime, oranges, papaya, pineapple, raspberries, rhubarb, strawberries and tangelo.
*Limit to ½ cup of fruit or 1/3 cup of 100% juice per meal.
Avoid: Avocados, apples, applesauce, apricots, bananas (overripe), blackberries, cherries, figs, guava, lychee, mango, peaches, pears, persimmons, nectarines, plums, watermelon.
Dried fruits (prunes, raisins, apricots, etc.)
Vegetables
Allowed: Alfalfa, bamboo shoots, bok choy, carrots, celery, corn
(limit to 1/2 cob), cucumber, eggplant, ginger, green beans, green and red pepper, lettuce (including arugula and kale), parsnip, pumpkin, potatoes, scallions (green part only), radish, spinach, squash, sweet potatoes, tomato, turnips, zucchini.
*Limit to 3 servings per day. *Cooked vegetables are normally better tolerated.
Avoid: Artichokes, asparagus, garlic (including garlic salt or powder), beans and legumes (including pinto, black, kidney, baked beans, chickpeas, lentil, and split peas), beets, broccoli, Brussels sprouts, cabbage, cauliflower, leeks, mushrooms, onions (all varieties), onion powder, shallots, Snow peas, sugar snap peas, sun dried tomatoes, radicchio lettuce, tomato paste.
Breads, Grains, Cereals
Allowed: Cereals made of oats, rice, corn, buckwheat, quinoa, amaranth, or millet. Corn meal or corn tortillas. Gluten-free bread or gluten-free crackers (check ingredients). Noodles made of rice, corn, or quinoa. Plain oatmeal, polenta, popcorn or potato chips. Brown and white rice, tapioca, quinoa.
Avoid: Foods made with white or wheat flour, All-purpose flour, white and wheat bread, barley products, rye products, flour tortillas, pasta, cereal, crackers, cakes, cookies and muffins, biscuits made with wheat, multigrain breads, pita bread, spelt pasta, minute (Ramen) noodles, semolina, couscous, bulgar.
Meat, Poultry, Fish, Eggs, Meat Alternatives
Allowed: All forms of meat, poultry or fish without breading; eggs, tofu (firm, not silken).
Avoid: Any meat, fish or poultry that is breaded, sausage or chorizo, beans and legumes, soy beans (edamame, soy milk and other products made with whole soy bean), silken tofu.
Nuts and Seeds
Allowed: Almonds (10-15), macadamia nuts, pecans, pine nuts, walnuts, pumpkin seeds sesame seeds, sunflower seeds, peanuts
Avoid: Cashews, pistachio nuts
Milk, Cheese, Yogurt
Allowed: Lactose free milk/dairy products, almond milk, coconut milk, rice milk, hard cheeses (parmesan, cheddar, Swiss, feta), butter
*Do not reintroduce lactose if you are diagnosed with lactose intolerance.
Avoid: Cow’s milk, goat milk, soy milk, evaporated milk, sweetened condensed milk, half and half, heavy cream, yogurt, cottage cheese, ricotta cheese, sour cream, cream cheese, whipped cream, ice cream, sherbet, custard, cream based soups made with milk, chocolate, any other products with milk as a main ingredient
Sweeteners
Allowed: *Recommendation: Consume sweeteners in moderate amounts Sugar (moderate amounts), glucose, molasses, NutraSweet (aspartame), Sweet and Low (saccharine), Splenda (sucralose), stevia, pure maple syrup, brown rice syrup, corn syrup .
Avoid: Agave, fructose, High Fructose Corn Syrup (HFCS), fruit juice concentrate, honey, polyol sugar substitutes (sorbitol, mannitol, maltitol, xylitol, isomalt, polydextrose).
Condiments and Spreads
Allowed: Oil, butter, margarine, mayonnaise (without added HFCS), mustard, dill pickles, salad dressing with low FODMAP ingredients, nut butters (except cashew), vinegar, strawberry jam/jelly, soy/fish/oyster sauce, garlic infused oil
Avoid: *be sure all condiments do not contain HFCS Any condiment with HFCS, ketchup, barbecue sauce, pickle relish, salad dressing with HFCS or high FODMAP ingredients, hummus, most jams/jellies, tzatziki dip, sweet and sour sauce, gravy mix
Beverages
Allowed: Coffee (without added milk), Orange juice (limit to 1/3 cup), tomato juice, tea (black, green, peppermint)
Avoid: Apple juice & cider, pear juice, mango juice, coconut water, soda with HFCS, strong herbal tea (including chamomile), instant coffee
Miscellaneous
Allowed: Olives, glucose tablets, lemon & lime juice, dark chocolate
*Note: Too many fats can increase irritable bowel symptoms in some individuals.
Avoid: Sugar-free chewing gum, sugar-free mints, sugar-free candy, inulin, chicory root extract, milk chocolate, white chocolate
Tips
• It is important to read the ingredients on food labels. High FODMAP ingredients can be found where you least expect them.
• It is okay to have table sugar (sucrose) in small amounts. In small amounts, it should not cause symptoms. However, large amounts of sucrose at one time may cause symptoms.
• Onion is one of the most common problem foods. Eliminate onion from the diet for at least 3 months.
– Do not cook with onion.
– Do not buy foods with ‘onion’ listed as an ingredient.
– Try chives or herbs instead of onion.
• Garlic is not recommended on a low FODMAP diet. Garlic infused oil can be used in cooking.
Low FODMAP meal ideas
• Scrambled eggs with cheddar cheese, blueberries and lactose free milk.
• Oatmeal with sliced banana, almonds and brown sugar.
• Gluten free waffle with strawberries and pure maple syrup.
Lunch and dinner ideas:
• Ham and Swiss cheese on gluten free bread with mayonnaise, tomato, lettuce.
• Rice noodles tossed with garlic-infused oil, spinach and grilled chicken.
• Cheese quesadilla (cheddar cheese on corn tortilla) with the green part of a scallion, tomato and cilantro.
• Hamburger on gluten free bun with sweet potato wedges.
• Introduce one new high FODMAP food from one category for 3 days. Start with small portions. Most children will have symptoms within 48 hours if they do not tolerate a food.
• Return to a full FODMAP restriction for 3 days whether your child tolerated the new food or not. This ensures your child does not have any lingering symptoms when the next food type is introduced.
• After a 3-day full FODMAP restriction, introduce another high FODMAP food from a different category.
• As before, return to a full FODMAP restriction for 3 days before introducing another new food from a different category. If your child tolerates one food in a category, it is likely they will tolerate other foods in that category as well.
Once testing all categories, all foods successfully reintroduced and tolerated can be continued in the diet in normal serving sizes.
Foods high in FODMAPS
High Lactose
Cow’s milk, goat milk, ricotta cheese, cottage cheese, half and half, heavy cream, yogurt, sour cream, whipped cream, ice cream, sherbet, cream based soups
*Any product with milk as a main ingredient
Excess Fructose
Vegetables
Artichokes, asparagus, sugar snap peas, sun-dried tomatoes, tomato paste
Fruit
Apples, cherries, fresh figs, mango, pears, watermelon
Sweeteners
Agave, honey, High Fructose Corn Syrup (HFCS)
High Fructans/Galactans
Vegetables
Artichokes, chickpeas, garlic, garlic salt/powder, leeks, lentils, onion, onion salt/powder, red kidney beans, baked beans, shallots, soybeans (edamame, soy flour, soy milk, other products made with whole soybean)
Fruit
Apples, currants, dates, dried figs, nectarine, plums, prunes, white peaches, watermelon
Grains
Rye, wheat, barley, inulin
Pistachios, cashews
High Polyols
Vegetables
Broccoli, cauliflower, mushrooms, snow peas
Fruit
Apples, apricots, blackberries, nectarines, pears, plums, prunes watermelon
Sweeteners
Sorbitol, mannitol, maltitol, isomalt, xylitol (sugar-free gum, sugar-free mints, sugar-free cough drops, some medicines)
• 3 day full FODMAP restriction
• 3 day food introduction – small servings of yogurt reintroduced (lactose)
• 3 day full FODMAP restriction
• 3 day food introduction – small servings of broccoli reintroduced (polyols)
• 3 day full FODMAP restriction
• 3 day food introduction – small servings of honey reintroduced (excess fructose)
• Transition to all foods in diet except any category that was not tolerated
Step 3: Personalization
• Find a balance between eating better tolerated FODMAP foods you enjoy while avoiding foods you do not tolerate.
• Re-test your tolerance. Tolerance can change over time. If you did not tolerate a food during the first re-introduction period, retry after 2 months to avoid limiting too many foods.