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Incorporating FODMAP Dietary Restrictions: Help or Hype?

  • Gastroenterology and Nutrition (SA McClave, Section Editor)
  • Published:
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Abstract

Irritable bowel syndrome (IBS) is defined by abdominal pain and alterations in stool patterns. It is a common disease with a heavy burden on patients and providers. Pharmaceutical and psychiatric therapies have low success rates. A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) has been suggested to treat symptoms of IBS by reducing consumption of poorly absorbed and indigestible carbohydrates. This decreases the amount of water in the bowel lumen and the amount of fermentable sugar available for colonic bacteria. Several recent randomized trials in patients treated for IBS with low-FODMAP diets have demonstrated improvements in IBS symptoms and stool characteristics. However, studies to date have had limitations, and the long-term efficacy and health impact of low-FODMAP diets is not known. Ongoing research will help address the benefits of low-FODMAP diets for IBS and other diseases.

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Acknowledgments

This research was funded in part by T32 DK07634 (WAW) from the National Institutes of Health. All authors have received research (LNK, CIJ) or educational (WAW) support from Nestlé Corporation.

Compliance with Ethics Guidelines

ᅟ

Conflict of Interest

W. Asher Wolf received support from Nestlé, during and before the drafting of this article, to cover the cost of attendance at educational events and an academic conference.

Laszlo N. Kiraly has received compensation from the Nestlé Nutrition Institute for service as a faculty consultant for an educational fellowship, compensation from Metagenics for service on an advisory board, and compensation from Excited States LLC for service on a data and safety monitoring board.

Carol Ireton-Jones has received compensation from Nestlé for service as a consultant but did not collaborate with Dr. Wolf in any capacity related to Nestlé during the writing of this article.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, The University of North Carolina, Chapel Hill, NC, 27599-7080, USA

    W. Asher Wolf

  2. Division of Trauma, Critical Care & Acute Care Surgery, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road—L611, Portland, OR, 97239, USA

    Laszlo N. Kiraly

  3. 1730 Countryside Dr, Carrollton, TX, 75007, USA

    Carol Ireton-Jones

Authors
  1. W. Asher Wolf
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  2. Laszlo N. Kiraly
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  3. Carol Ireton-Jones
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Corresponding author

Correspondence to W. Asher Wolf.

Additional information

This article is part of the Topical Collection on Gastroenterology and Nutrition

Appendix

Appendix

FODMAP Basics

A FODMAP elimination diet is learning diet, not a permanent diet prescription. The object is to discover how changing certain sugars and fibers in your diet can help you manage your symptoms of gas, bloating, abdominal pain, diarrhea and/or constipation; the eventual goal is the most nutritious and varied diet you can tolerate. It may be right for you if you have irritable bowel syndrome (IBS) or a related condition and standard IBS therapy did not help.

The low-FODMAP diet can be tricky, since many kitchen staples and common food ingredients are off limits at first. It must be carefully planned to meet your nutrition needs. A registered dietitian nutritionist can help. This is especially important if you have other nutrition-related medical conditions.

Common high-FODMAP foods or ingredients

Popular low-FODMAP alternatives

Regular milk, yogurt, or ice cream

Lactose-free versions of cow’s milk products, sorbet

Cottage or ricotta cheese

Hard or aged cheeses; lactose-free cottage cheese

Dried fruit, fruit juice, trail mix, fruit bars

Small portions of fresh or frozen fruit

Apples, pears, stone fruits (cherries, peaches, prunes, apricots, avocados, mango), watermelon, blackberries

Strawberries, blueberries, cranberries, grapes, pineapple, cantaloupe, honeydew, kiwi, ripe bananas, oranges, lemons, limes

Cauliflower, brussels sprouts, mushrooms, sweet corn, tomato paste, artichokes, asparagus, celery, beets

Spinach, kale, lettuce, fresh tomatoes, cucumber, carrots, zucchini, bell peppers, white potatoes. Small portions of green beans, peas, sweet potato, broccoli

Wheat, barley or rye; breads, cereals, pastas or baked goods made of wheat, barley or rye; high-fiber bars or cereals

Rice, cornmeal, spelt or quinoa; breads, cereals, pastas or baked goods made of rice, cornmeal, millet, potatoes or quinoa; small portions of oats or buckwheat

Sugar-free candy or gum sweetened with sorbitol, mannitol, maltitol, xylitol; milk chocolate

Small portions of sugar-sweetened candy, gum, or dark chocolate

Canned, baked or refried beans (most varieties), edamame, hummus, soy milk

Firm tofu, tempeh, canned, drained chickpeas, or lentils

Pistachios, cashews

Small portions of other nuts, nut butters, or seeds

Garlic, onions, ketchup, commercial salad dressings

Garlic-infused oil, chives, scallion greens, leafy herbs, sweet spices, ginger, vinegars, mustards, lemon or lime juice

Beverages, syrups, or condiments sweetened with high-fructose corn syrup (regular soda, bottled ice tea), honey, agave

Foods or beverages sweetened with granulated sugar, evaporated cane juice, brown sugar, 100 % pure maple syrup, brown rice syrup, stevia

Rum, fortified wines

Small portions of beer, wine, gin, vodka, whiskey. Alcohol is a gut irritant, so consume in moderation

Instant coffee, lattés, chamomile or fennel tea

Espresso, filtered coffee, green or peppermint tea. Caffeine is a gut irritant so consume in moderation

FODMAP stands for fermentable oligo-, di-, and monosaccharides and polyols. FODMAPs are a group of poorly absorbed, fermentable carbohydrates that act together to produce gastrointestinal symptoms.

© 2015 Patsy Catsos, MS, RDN, LD, adapted from IBS—Free at Last! (Pond Cove Press). May be reproduced for patient education only. Reprinted with permission of Patsy Catsos, MS, RDN, LD.

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Wolf, W.A., Kiraly, L.N. & Ireton-Jones, C. Incorporating FODMAP Dietary Restrictions: Help or Hype?. Curr Nutr Rep 4, 214–219 (2015). https://doi.org/10.1007/s13668-015-0131-9

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