The gastrointestinal tract or gut (including the small and large intestine) has a significant role in maintaining health. The primary function of the gastrointestinal tract is the digestion and absorption of nutrients from food. However, diseases such as inflammatory bowel disease (Crohn's, Ulcerative Colitis), coeliac disease, bowel cancer, and Irritable Bowel Syndrome (IBS) affect the function of the intestine.
IBS or irritable bowel syndrome is a group of symptoms occurring together, including repetitive pain in your abdomen and changes in your bowel movements, which may be constipation, diarrhea, or both. With irritable bowel syndrome, you have these symptoms without any observable signs of disease or damage in your digestive tract. Doctors are not sure what the exact causes of IBS.

Anyway, the treatment of IBS includes:
• Education and counseling about IBS disease.
• Take medicine.
• Proper IBS diet (such as a low FODMAPs diet) with a healthy lifestyle.
• Stress reduction and maintaining calm.

What are FODMAPs?

FODMAPs stands for Fermentable, Oligosaccharides, Disaccharides, Monosaccharides, And Polyols.
FODMAPs are a type of carbohydrate found in different foods. Carbohydrates give us energy, along with protein and fat. Since FODMAPs are not absorbed comfortably by the bowel, they start and worsen the symptoms of IBS. Foods that do not contain carbohydrates, such as meat, poultry, fish, eggs, butter, oils, and hard cheeses, are not a concern.
People with irritable bowel syndrome (IBS) may not tolerate foods with FODMAPS, so restricting these foods from the IBS diet improves the symptoms of the disease. Symptoms of FODMAPs intolerance include abdominal discomfort, gas, distention, fullness, bloating, nausea, and or pain after eating foods containing FODMAPs.

Why should patients with IBS avoid FODMAPs in the IBS diet?

The process of digestion FODMAPs has a lot of effects on the gut. To understand the role of these sugars as triggers for IBS, we should know the process of food digestion and absorption in the body. The small intestine breaks down and absorbs nutrients from foods. The large intestine's role is to absorb water and prepare undigested food to remove from the body (feces). During passage through the large intestine, the large population of bacteria ferments undigested food. It results in the production of gases, including hydrogen and methane.
Because these FODMAPs are small in size and are not absorbed well, they can have an osmotic effect on the gut. The osmotic effect increases the delivery of water through the bowel. It can contribute to diarrhea in some people.
As FODMAPs reach the large intestine, bacteria ferment them and produce gases. This gas production can occur in the small or large intestine and cause wind (flatulence), bloating discomfort, and abdominal discomfort/pain. In addition, the gas production in some individuals may slowly move through the bowel, causing constipation.

How can we start a low FODMAPs diet?

Low FODMAPs diet is a diet that has a low amount of degradable carbohydrates. A low FODMAPs diet is suitable for people who are suffering from irritable bowel syndrome or IBS.
To follow a low FODMAPs diet, seek the advice of an expert nutritionist. The dietitian will ensure that your IBS diet remains balanced and is nutritionally adequate while following the low FODMAP diet. We generally recommend that you try the low FODMAP diet for 2-6 weeks. Then a dietitian reviews you, who will advise which foods (and how much) can be reintroduced into the diet.

Three main steps to reach a Low FODMAP Diet

The low FODMAP diet is not a traditional diet like the ones you may have heard of or tried. Instead, it is a learning process that will help you find out which foods worsen your symptoms.
There are three main steps to follow the low FODMAPs diet include:
Step 1: First of all, look at the list of high FODMAP foods. If you overeat any of them, try cutting them out from your IBS diet.
 Step 2: If reducing high FODMPAs from your diet helps you, that may be all you need to do. If not, try to delete all high FODMAP foods in your diet as much as you can for 6-8 weeks.
• Step 3
: After this period, bring foods back in one at a time. In this way, if your IBS symptoms get worse, you can find out which food caused it.

5 Tips for Starting a Low FODMAP Diet

Limit products with ingredients like fructose, crystalline fructose (not HFCS *), honey, and sorbitol on the label.
Eliminate sugar alcohols from your low FODMAPs diet. These include isomalt, sorbitol, maltitol, lactitol, mannitol, erythritol, xylitol, and lactitol. Unfortunately, we can find these sugar alcohols in some foods such as diet drinks, candy, ice cream, processed goods, etc.
It is better to limit drinks with HFCS less than the recommended serving size – less than 12 oz of soda.
Check your drugs for sorbitol and fructose. They do not always write them on the label, so check with your pharmacist or doctor.
Remember, the amount of fructose found in 2 apples is the same as the amount of fructose in 1 can of soda, but apples have other nutritional value and beneficial for you.

* What is HFCS?

HFCS stands for High Fructose Corn Syrup (HFCS)
There is HFCS in many processed foods. It consists of almost half fructose and half glucose, like regular table sugar (i.e., sucrose). Foods and drinks with HFCS, such as soft drinks, can be ok in your low FODMAPs diet because HFCS may not be a problem for people with FODMAP intolerance if you limit them to 12oz per day and take them with your main meal.
But for some people, even a small amount of processed fruit juice or HFCS causes malabsorption and intestinal discomfort.

FODMPAPs foods

FODMAP fruits

High FODMAP fruits

Moderate FODMAP fruits

Low FODMAP fruits

You can tolerate fresh or fresh frozen fruit better than canned fruit.
Tolerance may depend on the amount you eat at one time.
Limit dried fruit and fruit juices because they are concentrated sources of fruit.

: Don't eat large amounts of any fruit.
You can tolerate fresh or fresh frozen fruit better than canned fruit.
Tolerance may depend on the amount you eat at one time.
Limit dried fruit and fruit juices because they are concentrated sources of fruit.

: Don't eat large amounts of any fruit.
You can tolerate fresh or fresh frozen fruit better than canned fruit.
Tolerance may depend on the amount you eat at one time.
Limit dried fruit and fruit juices because they are concentrated sources of fruit.

: Don't eat large amounts of any fruit.

FODMAP vegetables

High FODMAP vegetables

Moderate FODMAP vegetables

Low FODMAP vegetables

You can tolerate cooked vegetables because cooking causes a loss of free sugars.
Remember tolerance may depend on the amount you eat at one time.
You can tolerate cooked vegetables because cooking causes a loss of free sugars.
Remember tolerance may depend on the amount you eat at one time.
You can tolerate cooked vegetables because cooking causes a loss of free sugars.
Remember tolerance may depend on the amount you eat at one time.

FODMAP dairy

High FODMAP dairy

Moderate FODMAP dairy

Low FODMAP dairy

FODMAP grains

High FODMAP grains

Moderate FODMAP grains

Low FODMAP grains

FODMAP legumes & nuts

High FODMAP legumes & nuts

Moderate FODMAP legumes & nuts

Low FODMAP legumes & nuts

FODMAP beverages

High FODMAP beverages

Low FODMAP beverages

FODMAP sweeteners

High FODMAP sweeteners

Moderate FODMAP sweeteners

Low FODMAP sweeteners

A dietary guide to healthy eating when restricting FODMAPs in your IBS diet

When you reduce the intake of FODMAPs in your IBS diet, achieving adequate nutrient intake is still important. This guide recommends you the number of serves from the five major food groups. It also lists alternatives to help you in choosing suitable foods.

1. yogurt, milk, cheese

Eat at least 2.5 - 4 servings of yogurt, milk, and cheese per day in your low FODMAPs diet. Each serving of these foods include:
• 1tub (200g) regular yogurt or, if you can't absorb lactose, you can use lactose-free yogurt
• 1cup (250mL) regular milk, or if you can't absorb lactose, you can use lactose-free milk
• 40g cheddar cheese
• 1Tbsp cream cheese
• 2Tbsp ricotta/cottage cheese - suitable as lactose content is minimal

2. vegetables

You should eat 5 - 6 serves of vegetables per day in your diet. Each serving of vegetables include:
1cup salad (lettuce, cucumber, capsicum)
1/2 cup cooked vegetables (carrots, zucchini, green beans, squash, pumpkin, parsnip, corn, eggplant)
1/2cup sweet potato

3. Fruit

Eat at least 2 servings of fruits per day; 1 serving of fruits includes:
 2small (150g) mandarins, kiwi fruits
 1medium (150g) orange or banana
 100mL orange juice
 1cup (150g) grapes, strawberries, raspberries, pawpaw, cantaloupe, pineapple, or rhubarb

4. Bread, cereals, rice, pasta, and noodles group

At least 4-6 servings of cereal are needed per day in the IBS diet. Each serving include:
 1/2medium (40g) roll or flatbread (gluten-free)
 1-2slices (60g) of gluten-free bread or spelt bread
 1cup (180g) rice noodles
 1cup (180g) of cooked rice (white or brown)
 1cup (180g) cooked pasta (gluten-free)
 1cup (230g) cooked porridge
1cup (185g) cooked quinoa
 1/4cup (30g) muesli (fruit free, wheat-free)
 1/2cup (15g) rice puffs, 1 cup (50g) flakes of corn (gluten-free)
1-2(12g) crispbreads (corn, rice, or oat-based)

5. meat, fish, poultry

You should eat at least 2-3 servings of these foods in your diet; each serving includes:
80g cooked lean poultry such as chicken or turkey (100g uncooked)
65g cooked meat (about 90-100g raw)
100g fish (about 115 raw)
2slices of roast meat
2large eggs
1/2cup (46g) cooked or canned legumes
30g nuts, seeds, or peanut butter
120g Tempeh
120g tofu

6. oils and fats and extra foods

You should limit your intake of these foods in your diet.
Oils, margarine, biscuits, cakes, pies, chocolate, hot chips, ice cream, alcohol, etc.

: Consumption of Fat, caffeine, and alcohol in excess in your IBS diet can be additional symptom triggers

Low FODMAP diet menu

Low FODMAP Breakfast

Low FODMAP Lunch

Low FODMAP Dinner

Low FODMAP Snacks

How much fiber can we consume in low FODMAP diet?

If you follow a low FODMAP diet, you should monitor the amount and type of fiber you consume with a nutritionist. Despite the many benefits of fiber, highly fermented short-chain, soluble dietary fibers, such as oligosaccharides, produce gas. This gas can cause pain, abdominal discomfort, bloating, abdominal distension in patients with IBS. For better fiber function in the gastrointestinal tract, you must drink a lot of water (at least 4-6 cups per day).

What flavors are allowable in a low FODMAP diet?

Can you believe You can still have foods full of flavor without adding high FODMAP ingredients such as onions? We list some flavors that are all low in FODMAPs and add great flavor to food.
Spring onions (green party only)
Chives Garlic infused oil - either (a) purchase commercially prepared garlic-infused oil or (b) peel and cut garlic into large pieces. Saute in oil for 1-2 minutes to develop flavor in the oil. Discard pieces of garlic and retain the garlic-flavored oil to cook your meal.
Golden syrup
Asafoetida powder - pinch only for onion flavor (from Indian spice market)
Fresh herbs (parsley, coriander, thyme, basil, rosemary)
Lemon juice
Maple syrup
Salt and pepper

Do Medications contain FODMAPs?

The answer is YES. You may think only foods contain FODMAPs, but some personal care items and many liquid medications may have sugar alcohols (mannitol, sorbitol, xylitol, isomalt, maltitol). For example, cough medicines, cough drops, and liquid pain relievers (fluid gel caps) contain sugar alcohols. If you can, choose a tablet or caplet form rather than liquid medication. Talk to your pharmacist to see if any of your medications have sugar alcohols or lactose since they can worsen your symptoms even when you eliminate FODMAPs in your diet.

Finally, what is the best way is to bring food back in your diet?

Researchers are not sure about the best way to bring food back to the diet, but here are three ways.

1- Add low FODMAP foods to your diet, and slowly add foods containing high FODMAPs.
2- Add high FODMAP foods to your diet first.
3- Add your favorite FODMAPs to your diet first.

You can do one of the above ways and see which one is better for you.

FAQ about FODMAP diet

By using the Breath test, we recognize who can't absorb FODMAPs well.
The breath test helps us to identifies individuals who can't absorb lactose, fructose, and sorbitol. This test determines the amount of gas in the breath after swallowing a calculated amount of sugar. If these sugars are poorly absorbed, the intestinal bacteria ferment the sugar to produce gases like hydrogen and methane. These gases are absorbed across the intestine, carried through the bloodstream to the lungs, and exhaled.
So individuals may benefit from the dietary restriction of fructose and or lactose and or sorbitol. Remember that we can only test these sugars. Nevertheless, the dietitian's recommendation is necessary to evaluate the role of the remaining FODMAPs in triggering symptoms.
Breath testing helps with the 'refinement' of your diet. Even if the result of your breath tests are negative, you'd better discuss with a dietitian about restricting the other FODMAPs (fructans, GOS, mannitol) in your diet.
No. It is a normal phenomenon that you can't absorb fructose well, and you should restrict FODMAPs in your diet if you have undesirable gastrointestinal symptoms (IBS).
Nobody can absorb Fructans and GOS, so Fructans and GOS can cause symptoms. They don't test the Malabsorption of polyols (sorbitol, mannitol) routinely, however, so they can worsen your symptoms. Restriction of Fructans, GOS, and polyols can help you improve your symptoms.
We do not limit gluten in a low FODMAPs diet. You should eliminate gluten permanently in your diet Only if you have coeliac disease.
Before limiting the gluten in your diet, you need to make sure you have coeliac disease. If you have coeliac disease and eat something containing gluten, it can cause inflammation of the small intestine.
By choosing gluten-free foods, you also chose low FODMAPs foods, because food containing gluten has a high amount of FODMAPs. for example, wheat, rye, and barley have gluten and are high in FODMAPs. Rice flour, maize or corn flour, potato flour, and quinoa are low in FODMAPs and are gluten-free.
However, read food labels carefully because gluten-free foods may have high FODMAP ingredients added (onion, pear, or honey).
Sucrose is a disaccharide made up of equal parts of glucose and fructose. People with IBS can tolerate a small amount of sucrose well, but they may not endure a large amount of sucrose. We can find sucrose in soft drinks.
When you are following a low FODMAPs diet, occasional intake of FODMAPs may not induce symptoms.
IF you can't tolerate this amount of FODMAP, return to a strict low FODMAP diet, and symptoms should improve within 1-3 days.
No, you should follow full restriction of a low FODMAPs diet for 2-6 weeks, then see a dietitian. The dietitian will help you to return to your usual diet. Dietitians tailor diet for each individual's needs. Many people can return to their usual diet, but they should avoid a few high FODMAPs foods in large amounts.
Some evidence shows that probiotics can improve IBS symptoms, but this may depend on which probiotic mixture we use. We recommend that you try the low FODMAP diet for 2-6 weeks first. If you have not achieved good symptom control, talk with the dietitian about other management strategies.
We suggest limiting rich, spicy, heavily flavored, or sauced foods (curries, soups, or pasta dishes). Choose plain meat, fish with rice, rice noodles, baked potatoes, or fresh salads, steamed vegetables, and dressing on the side.
You can order gluten-free foods with low FODMAPs toppings, such as Korean barbeques.
A low food map diet is not a therapy for everyone with IBS, so we should know other dietary and non-dietary treatments that improve IBS symptoms. These are the gluten-free diet in non-coeliac gluten sensitivity, the low food chemical diet, and gut-directed hypnotherapy.
Let us know if you have any questions or comments.