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T Mahmoud sultan

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Information about

Low FODMAP
Diet
To improve Irritable Bowel Syndrome (IBS)
symptom control

Rationale
Irritable Bowel Syndrome (IBS) is a common functional
gastrointestinal (GI) disorder affecting one in seven adults.
IBS is commonly characterised by GI symptoms such as
bloating and distension, excess wind (flatulence), abdominal
pain and altered bowel habits (diarrhoea and/or constipation).
These symptoms can create anxiety and stress, interfere with
busy schedules, and may compromise everyday life.
The underlying pathology of IBS is not well understood and a
number of factors may trigger symptoms.
Fermentable Oligosaccharides, Disaccharides,
Monosaccharides and Polyols (FODMAPs) are found in the
foods we eat. FODMAPs are sugars that are poorly absorbed
in the small intestine and reach the large intestine where they
produce gas and attract water.
FODMAPs are found in everyday foods including specific
dairy products, wheat and other grains, and fruits and
vegetables.
It’s important to remember FODMAPs are not the cause of
IBS, but managing them in the diet provides an opportunity
for reducing IBS symptoms.
Studies have shown that ingesting FODMAPs exacerbates
symptoms in most people with IBS, while dietary restriction of
FODMAPs improves symptom control.
However, if you are experiencing symptoms of IBS it is
important not to ‘self-diagnose’. Symptoms of IBS can also be
seen in other gastrointestinal diseases and disorders and may
require medical rather than dietary management. Changing
your diet can also mask underlying problems. It is vital that
you seek medical advice before changing your diet. Your
doctor can assess your symptoms and rule out any other
gastrointestinal diseases or more suitable eating plans.

Digestive Health Foundation

An information leaflet for patients and

interested members of the general public
prepared by the Digestive Health Foundation

SECOND EDITION 2013

Reviewed by:
Dr Jaci Barrett, APD,
Dept of Gastroenterology,
Central Clinical School, Monash University, VIC
Laura Iannelli, BBiomedSci,
MHumNutr, Deakin University, VIC
Emma Halmos, BND, PGradDipBSc, APD
Dept of Gastroenterology, Monash University, Melbourne VIC
What is the Low FODMAP Diet? How do FODMAPs affect people with IBS?
The Low FODMAP diet involves many dietary changes FODMAPs are small in size and will therefore have an
that are best reviewed in consultation with an accredited osmotic effect (draw fluid) in the gut that results in
dietitian. However a brief overview and sample meal increased delivery of water through the bowel.
plan is shown below.
FODMAPs are also poorly absorbed in the small
intestine. They continue along the digestive tract to
What are FODMAPs? the large intestine where they are fermented by
FODMAPs are a large group of dietary sugars found in bacteria in the large intestine, which produces gas.
many common foods such as specific dairy products, The gas production can lead to wind (flatulence),
wheat and other grains, and fruits and vegetables. bloating, discomfort and abdominal pain. In addition,
the large intestinal gas and increased water delivery
can alter ‘motility’ or movement, which may contribute
FODMAPs are found in many foods we commonly eat to diarrhoea and/or constipation.
and is an acronym for:

Fermentable
Do FODMAPs affect everybody?
While FODMAPs are poorly absorbed in all people,
Oligosaccharides – Fructans and galacto-
those with specific gut disorders such as IBS are
oligosaccharides (GOS)
thought to experience the uncomfortable symptoms
Disaccharides – Lactose due to the gut being unusually sensitive. Distension or
‘stretch’ in the large intestine from gas or water can
Monosaccharides – Fructose in excess of glucose trigger symptoms.
And
Diagnosis
Polyols – Sorbitol, Mannitol, Maltitol,
Xylitol and Isomalt There is no diagnostic test for IBS. Diagnosis is made
on symptoms. It is therefore important to work
FODMAPs can be classified into two groups: with medical professionals to exclude other serious
GI conditions (e.g. inflammatory bowel disease,
• Those FODMAPs that are partly absorbed coeliac disease and bowel cancer) and also some
(fructose, lactose, polyols) gynaecological conditions.
• Those FODMAPs that are not absorbed in anyone
(fructans and GOS)

TABLE 1: REDUCE FOODS HIGH IN FODMAPs

EXCESS FRUCTOSE FRUCTANS LACTOSE GOS POLYOLS

Apples Custard apples Custard Chickpeas Apples

Boysenberry Nectarines Condensed milk Legume beans Apricots
Figs White peaches Dairy desserts (e.g. baked beans, Blackberries
Mango Persimmon Evaporated milk kidney beans, Longon
Pear Tamarillo Ice cream borlotti beans) Lychee
Tamarillo Watermelon Milk Lentils Nashi pears
Watermelon Artichoke Milk powder Pistachio nuts Nectarines
Asparagus Chicory Unripened cheeses Cashews Peaches
Artichokes Garlic (and powder) (e.g. ricotta, cottage, Pears
Sugar snap peas Leek cream, mascarpone) Plums
Fruit juices Onion (and powder) Yoghurt Cauliflower
Dried fruit Spring onion (white Mushrooms
High-fructose corn part) Snow peas
syrup Barley Isomalt (953)
Honey Rye Maltitol (965)
Wheat Mannitol (421)
Sorbitol (420)
Xylitol (967)
Testing for poor absorption • Select low lactose dairy foods such as ripened
cheeses including parmesan and swiss, and
Hydrogen/methane breath-testing can be used to lactose-free yoghurt and lactose-free kefir milk
assess if a person absorbs fructose, lactose and
• Select a variety of meats, fish and poultry, and oils
sorbitol effectively. It may also be helpful in tailoring
the Low FODMAP Diet. • Choose nuts and seeds low in FODMAPs such
as walnuts, almonds, peanuts, pecans, pine nuts,
Breath tests are not essential. A FODMAP restricted macadamia nuts and sesame seeds.
diet can be implemented by your dietitian, who can
then take you through challenges to determine which What are some of the barriers to
of the FODMAP carbohydrates you need to avoid for
following a Low FODMAP Diet?
symptom relief. They will also help you determine your
degree of absorption, allowing you to consume small The Low FODMAP Diet is somewhat restrictive
amounts of high FODMAP foods without symptoms.. but can provide adequate nutrients with careful
planning. Your dietitian can ensure that restricted
How do I follow the Low FODMAP Diet? foods are replaced with suitable alternatives. Your
dietitian can also advise on the need and suitability of
It is essential to develop a strategy and plan ahead. vitamin and mineral supplements.
Work with your dietitian to develop easy and tasty
For people suffering from lactose intolerance, meeting
meal plans. Ask for a low FODMAP shopping guide.
calcium and vitamin D requirements used to be
Maintaining a low FODMAP pantry is key to sustaining
difficult. With the availability of lactose free dairy
a Low FODMAP Diet.
products, it is much easier to consume adequate
When reducing FODMAPs in the diet it is still important calcium by choosing sufficient lactose-free milk; low
to balance good nutrition with symptom control and lactose cheeses such as swiss, cheddar, feta and
eat from the five food groups: mozzarella; enriched rice milk; spinach; and canned
salmon.
Food Group per / day
Your doctor and dietitian will advise whether a low
Vegetables 5-7 servings FODMAP diet is recommended for you if you have
other conditions.
Bread, cereals, rice, 4 servings If you do not choose suitable alternative low FODMAP
pasta, noodles foods, fibre intake can decrease when you follow the
Low FODMAP Diet. See Table 2 for good low FODMAP
Fruit 2 servings
fibre sources.
Meat, fish, poultry 1-2 servings
TABLE 2: FIBRE WITHOUT FODMAPs
Dairy 2-3 servings
Food Portion size Fibre content
(grams)

Oatmeal 1/2 cup – dry 4.1

Oat Bran 1/2 cup – dry 7.2
Rice Bran 1/4 cup – dry 6.2
Strawberries 1 cup – halves 3
Blueberries 1 cup 3.6
Orange 1 medium 3.1
Spinach 1/2 cup – cooked 2.2

One of the most important things to remember when

you follow a low FODMAP diet is that FODMAPs are
Low FODMAP food tips natural prebiotics, i.e. they encourage the growth of
• Choose colourful fruits low in FODMAPs such good bacteria in the gastrointestinal tract. Studies
as strawberries, bananas, blueberries, grapes, have shown that ingestion of fructans and GOS can
rockmelon, pineapple, oranges and kiwifruit encourage the growth of good bacteria such as
bifidobacteria. The long term consequences of a low
• Select vegetables such as spinach, carrots,
FODMAP diet needs to be considered.
capsicum, eggplant, bok choy, tomatoes,
zucchini and potatoes
• Purchase wheat and rye free, all-purpose flour
blends that are free of soy
This is why the diet is only administered strictly during • Risotto with chicken, cherry tomatoes, capsicum,
the initial 2-6 week period, until symptoms settle. zucchini (use homemade stock)
Reintroduction of small amounts of FODMAPs is Safe snacks
essential and can be guided by your dietitian • Two rice cakes spread with peanut butter
• Banana, kiwifruit
Is this a lifetime diet? • Lactose-free yoghurt with blueberries
No. This diet is usually recommended for 2-6 weeks at • Walnuts
a time. Progress should be assessed by an accredited • Lactose free milk
dietitian. They will help advise which foods can be
gradually re-introduced into your specific diet. Additional Information
• Monash University, Central Clinical School, Department of
Many people can liberalise the diet and may only need to Gastroenterology
www.med.monash.edu.au/cecs/gastro
avoid large amounts of a few high FODMAP foods. • Monash University Low FODMAP Diet app available from iTunes store

Low FODMAP Diet sample meal plan

Breakfast
Take home points
• FODMAPs are sugars commonly found in everyday foods.
• Gluten-free or spelt toast with Vegemite®
• Dietary restriction of FODMAPs may improve IBS
• Cereal (oats, porridge, cornflakes)* symptom control.
• Homemade low FODMAP muesli • Speak with your health care professional to ensure other
gastrointestinal conditions have been investigated prior
• Poached egg and spinach to changing your diet.
• Lactose free yoghurt and serve of suitable fruit • Work with a dietitian to develop a personal eating,
shopping and dining-out plan.
(e.g. banana)
• This diet is usually recommended for 2-6 weeks. Once
• Tea or coffee (use lactose-free milk if you symptoms settle foods may be gradually re-introduced.
have lactose malabsorption).
• A strict low FODMAP diet should NOT be followed long
* Add oat or rice bran for extra dietary fibre. term.

Lunch
• Gluten-free or spelt sandwich with fillings (ham/
tuna/cheese/egg and salad) Digestive Health Foundation
• Sushi or rice paper rolls with suitable fillings
This information leaflet has been designed by the Digestive Health
• Frittata
Foundation (DHF) as an aid to people who have been recommended
• Homemade soup with low FODMAP vegetables a Low FODMAP Diet or for those who wish to know more about
• Fresh salads with tuna, pine nuts, lemon juice or this topic. This is not meant to replace personal advice from your
olive oil medical practitioner.

• Gluten-free pizza with low FODMAP vegetables The DHF is an educational body committed to promoting better
• 1/2 cup blueberries and lactose-free vanilla yogurt health for all Australians by promoting education and community
health programs related to the digestive system.
Dinner
• Grilled chicken, salmon, steak with salad and The DHF is the educational arm of the Gastroenterological Society
potatoes of Australia (GESA), the professional body representing the specialty
• Lamb shanks with mashed sweet potato, carrots of gastrointestinal and liver disease. Members of the Society are drawn
from physicians, surgeons, scientists and other medical specialties with
and green beans
an interest in gastrointestinal (GI) disorders. GI disorders are the most
• Tofu stir fry with rice noodles, capsicum, carrot, common health-related problems affecting the community.
bok choy, ginger, chilli, soy sauce
• Baked potato with skin (butter optional), hard Research and education into gastrointestinal disease are essential
cheese, lean bacon, chives, grated carrot to contain the effects of these disorders on all Australians.

• Gluten free pasta with sauce (no garlic or onion) Further information on a wide variety of gastrointestinal conditions
is available on our website – www.gesa.org.au

Digestive Health Foundation

c/- GESA ®Copyright: Digestive Health Foundation June 2013
PO Box 508, Mulgrave VIC 3170, Australia This leaflet is promoted as a public service by the Digestive Health Foundation.
Telephone: 1300 766 176 Facsimile: (03) 9802 8533 It cannot be comprehensive and is intended as a guide only. The information
www.gesa.org.au given here is current at the time of printing but may change in the future.
 Published by/ D.T Mahmoud sultan

For more books and articles join to the channel in Telegram

https://t.me/Mss01098772552

WhatsApp: 00201098772552