Low FODMAP Diet for IBS

A low FODMAP dietary plan can help ease IBS symptoms.

• FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols, which are short-chain carbohydrates and sugar alcohols that are poorly absorbed by the body, resulting in abdominal pain and bloating.
• FODMAPs occur in some foods naturally or as additives.
• If you eat a lot of these foods you may have symptoms and signs like:
  • Gas
  • Pain
  • Bloating
  • Abdominal distention
  • Abdominal pain
  • Diarrhea
• A list of examples of certain foods and drinks to avoid on a low FODMAP diet are some vegetables and fruits, beans, lentils, wheat, dairy products with lactose, high fructose corn syrup, and artificial sweeteners.
• A list of examples of foods and drinks to eat on a diet are certain vegetables and fruits, lactose-free dairy, hard cheeses, meat, fish, chicken, eggs, soy, rice, oats, quinoa, non-dairy milk, and small servings of nuts and seeds.
• This diet cuts out many common foods that may contain high FODMAP foods. They are eliminated or severely limited for 3-8 weeks, then gradually reintroduced into a low-FODMAP diet to see if they cause symptoms (elimination diet). It is not meant to be a permanent solution because it is very restrictive, but it may work well enough to be a treatment for people with gastrointestinal (GI) problems.
• This type of dietary meal plan often is used to help with digestive symptoms from many different conditions, including, irritable bowel syndrome (IBS), small intestinal bacterial overgrowth (SIBO), and other functional GI disorders.

FODMAPs are short-chain carbohydrates and sugar alcohols that are poorly digested by the body. They ferment in the large intestine (bowel) during digestion, drawing in water and producing carbon dioxide, hydrogen, and methane gas that causes the intestine to expand. This causes GI symptoms such as bloating and pain that are common in disorders like IBS.

FODMAPs are in some foods naturally or as additives. They include fructose (in fruits and vegetables), fructans (like fructose, found in some vegetables and grains), lactose (dairy), Galatians (legumes), and polyols (artificial sweeteners).

These foods are not necessarily unhealthy products. Some of them contain fructans, inulin, and galactooligosaccharides (GOS), which are healthy prebiotics that helps stimulate the growth of beneficial gut bacteria. Many of them are otherwise good for you, but in certain people, eating or drinking them causes gastrointestinal symptoms.

A low FODMAP diet cuts out many common products that contain certain foods. The principle behind the diet is to give the gut a chance to heal, especially if you have GI problems like IBS. People with GI disorders may use this diet as part of their treatment.

This diet may be difficult to follow, and it is advisable to contact your health care professional or a dietitian to make sure that you are on the right track and getting enough dietary nutrients that you can consume.

• Low FODMAP diets are often used to help with digestive problems from many different conditions, including IBS.
• These foods cause irritable bowel syndrome, but they also may aggravate IBS symptoms. A low FODMAP diet often is recommended for IBS treatment.
• Small intestinal bacterial overgrowth (SIBO)
• Functional GI disorders other than IBS

Experts believe that a meal plan that includes low FODMAPs also may help ease symptoms from other health conditions, such as:

• Autoimmune diseases:
  • Rheumatoid arthritis
  • Multiple sclerosis
  • Eczema
• Fibromyalgia
• Migraines triggered by eating certain products

After your doctor makes the diagnosis of your bowel disease or syndrome, (for example, IBS, IBD, or microscopic colitis), he or she may suggest a low FODMAP diet.

FODMAPs are not absorbed well in the small intestine. They increase the amount of fluid in the large intestine (bowel) and they produce more gas.

Symptoms and signs that suggest you may be eating products high in these short-chain carbohydrates are:

• Gas
• Pain
• Bloating
• Abdominal distention
• Abdominal pain
• Diarrhea (similar to IBS symptoms)
• A feeling of fullness after eating or drinking only a small amount of food or liquid

A diet low in FODMAPs may help relieve these problems, particularly in people with IBS.

A list of common low FODMAP foods that are good to eat on a low FODMAP diet include:

• Vegetables
  • Alfalfa sprouts
  • Bean sprouts
  • Bell pepper
  • Carrot
  • Green beans
  • Bok choy
  • Cucumber
  • Lettuce
  • Tomato
  • Zucchini
  • Bamboo shoots
  • Eggplant
  • Ginger
  • Chives
  • Olives
  • Parsnips
  • Potatoes
  • Turnips
• Fresh fruits
  • Oranges
  • Grapes
  • Honeydew melon
  • Cantaloupe
  • Banana
  • Blueberries
  • Grapefruit
  • Kiwi
  • Lemon
  • Lime
  • Oranges
  • Strawberries
• Dairy that is lactose-free, and hard cheeses, or ripened/matured cheeses including (If you are not lactose intolerant, you may not need to avoid dairy with lactose.)
  • Brie
  • Camembert
  • Feta cheese
• Beef, pork, chicken, fish, eggs
• Avoid breadcrumbs, marinades, and sauces/gravies that may be high in FODMAPs.
• Soy products including tofu, tempeh
• Grains
  • Rice
  • Rice bran
  • Oats
  • Oat bran
  • Quinoa
  • Corn flour
  • Sourdough spelled bread
  • Gluten-free bread and pasta
• Gluten is not a FODMAP, but many gluten-free products tend to be low in FODMAPs.
• Non-dairy milk
  • Almond milk
  • Rice milk
  • Coconut milk
• Drinks
  • Tea and coffee (use non-dairy milk or creamers)
  • Fruit juice not from concentrate
  • Water
• Nuts and seeds
  • Almonds
  • Macadamia
  • Peanuts
  • Pine nuts
  • Walnuts (fewer than 10-15/serving for nuts)
  • Pumpkin seeds

In some cases, portion sizes make a difference as to whether a product has enough high FODMAPs to cause symptoms. For example, a serving of almonds is a good choice that is in these short-chained carbohydrates but eats more, and you could have too many.

Many foods considered high in FODMAPs are healthy foods otherwise, but they can cause symptoms in some people with a sensitive gut; particularly people with IBS or other bowel diseases and disorders like SIBO.

Print both of these lists of foods and drinks for easy reference.

A list of common foods that you should avoid (especially if you have IBS) include:

• Some vegetables
  • Onions
  • Garlic
  • Cabbage
  • Broccoli
  • Cauliflower
  • Snow peas
  • Asparagus
  • Artichokes
  • Leeks
  • Beetroot
  • Celery
  • Sweet corn
  • Brussels sprouts
  • Mushrooms
• Fruits, particularly "stone" fruits like:
  • Peaches
  • Apricots
  • Nectarines
  • Plums
  • Prunes
  • Mangoes
  • Apples
  • Pears
  • Watermelon
  • Cherries
  • Blackberries
• Dried fruits and fruit juice concentrate
• Beans and lentils
• Wheat and rye
  • Bread
  • Cereals
  • Pasta
  • Crackers
  • Pizza
• Dairy products that contain lactose
  • Milk
  • Soft cheese
  • Yogurt
  • Ice cream
  • Custard
  • Pudding
  • Cottage cheese
• Nuts, including cashews and pistachios
• Sweeteners and artificial sweeteners
  • High fructose corn syrup
  • Honey
  • Agave nectar
  • Sorbitol
  • Xylitol
  • Maltitol
  • Mannitol
  • Isomalt (commonly found in sugar-free gum and mints, and even cough syrups)
• Drinks
  • Alcohol
  • Sports drinks
  • Coconut water

• This diet consists of severely restricting or eliminating those particular foods and drinks, but only for a short period of time because it may not meet all the nutritional dietary requirements you need. It can be very restrictive and it is not recommended as a permanent diet.
• This meal plan may not provide any benefits for healthy people, and because it restricts many healthy foods it should only be tried if medically necessary and prescribed by your doctor or other health care professional.
• For 3-8 weeks, foods and drinks that contain FODMAPs are limited or avoided. After that, individual foods can be introduced back into the diet, one at a time, to see whether that particular food or drink causes symptoms. If it does, you know you need to avoid that type of product. If no symptoms occur after consuming a particular food or drink for a week, it may be considered safe to continue to eat.

Stress management: Various strategies to manage stress may help ease the symptoms. These include yoga and meditation.

Medical Author: Shaziya Allarakha, MD; Medical Reviewer: Pallavi Suyog Uttekar, MD

Irritable bowel syndrome or IBS refers to a medical condition that affects the bowel. IBS is associated with a group of symptoms that include repeated episodes of pain or cramps in the abdomen, bloating, and changes in bowel movements, which may be diarrhea, constipation, or both. The classical feature of IBS is that these symptoms occur without any visible signs of damage or disease in the gut. Although the condition causes significant discomfort, it does not damage the bowel (intestines). IBS is a type of functional gastrointestinal (GI) disorder, which means there are no structural problems in the bowel. It occurs due to disturbances in the interaction between the bowel and the brain. This disordered gut-brain interaction can make the bowel more sensitive leading to the various symptoms of IBS, such as abdominal cramps, diarrhea, and constipation.

IBS is a common medical condition that affects about 12% of people in the United States. It is about twice as common in women than in men and is most often reported in people younger than 45 years of age. The exact cause of IBS is not known. The condition does not have any specific test for it. Tests may be done to exclude other conditions, such as Crohn’s disease, ulcerative colitis, and certain cancers. Most cases of IBS are effectively managed with diet, stress management, probiotics, and symptomatic medicine.

How can I treat IBS naturally?

There is no cure for IBS. You must consult your doctor to get proper management for the condition and know what lifestyle changes will work best for you. The management of IBS involves several lifestyle changes that include:

Proper diet:

A low FODMAP diet is a special type of diet that may help manage IBS. In this diet, certain foods that contain difficult to digest carbohydrates (FODMAPs) are avoided or reduced.

Some of the foods containing FODMAPs are:

• Certain fruits and their juices including apples, mango, apricots, blackberries, cherries, nectarines, pears, plums, and watermelon
• Vegetables, such as beans, cabbage, cauliflower, artichokes, asparagus, garlic and garlic salts, lentils, mushrooms, onions, and sugar snap or snow peas
• Dairy products, such as milk, soft cheeses, yogurt, custard, and ice cream
• Wheat and rye products
• Honey
• Foods containing high-fructose corn syrup
• Food products including candy and gum with sweeteners (sugar alcohols) including Sorbitol, Mannitol, Xylitol, and Maltitol

Depending upon your predominant symptoms, you may need to avoid certain foods.

Foods triggering constipation in people with IBS:

• Food products, such as cereals and bread, made with refined (not whole) grains
• Processed foods, such as chips and cookies
• Carbonated drinks
• Caffeine
• Alcohol
• A high protein diets
• Dairy products, particularly cheese

Foods triggering diarrhea in people with IBS:

• Fried and fatty foods
• A diet with too much fiber especially the insoluble fiber present in the skin of fruits and vegetables
• Chocolate
• Caffeine
• Alcohol
• Fructose (a type of sugar)
• Sorbitol (a type of sugar alcohol used as a sweetener)
• Carbonated drinks
• Large or heavy meals
• Dairy products
• Foods containing gluten (a protein found in wheat, barley, and rye) such as most cereal, grains, pasta, and many processed foods

Stress management:

Various strategies to manage stress may help ease the symptoms. These include:

• Yoga
• Meditation
• Psychotherapy
• Hypnosis
• Acupuncture

Fiber:

Only soluble fiber is found to help in IBS. Excess insoluble fiber may cause cramping and bloating.

Gluten:

A few people have gastric trouble after eating gluten, a protein found in wheat, rye, and even oats. You may give the gluten-free diet a try.

Medications:

Your doctor may prescribe certain medications to manage your symptoms. They include:

• Fiber supplements and laxatives to ease constipation
• Loperamide to control diarrhea
• Probiotics (live microorganisms for health benefits)

Herbal remedies:

Although not scientifically backed with evidence, several herbal remedies, such as St. John's wort, flaxseed oil, fish oil, aloe vera juice, and chamomile tea, are being used to manage IBS. You must consult your doctor before trying any of these.

Pain and cramps are the main symptoms

Medical Author: Shaziya Allarakha, MD; Medical Reviewer: Pallavi Suyog Uttekar, MD

The most common symptoms of irritable bowel syndrome or IBS are:

• Pain or cramps in the abdomen often related to the bowel movements
• Changes in the bowel movements which may be diarrhea, constipation, or both occurring alternately depending upon the type of IBS a person has

Other symptoms of inflammatory bowel syndrome include:

• Bloating or distention (a feeling of fullness or swelling in the abdomen)
• Feeling that you have not finished a bowel movement
• Whitish, sticky discharge (mucus) in the stool
• Symptoms of indigestion such as nausea, heartburn, and gas

IBS symptoms often get worse in women during their menstrual periods. Although IBS causes considerable discomfort, it does not lead to other health problems or damage to the gut.

What is IBS?

IBS or irritable bowel syndrome is a medical condition affecting the large bowel.  It is a type of functional bowel or gastrointestinal (GI) disorder. This means that although it causes disturbing symptoms, it does not cause any structural damage to the bowel. Functional GI disorders are caused by problems with how the brain and gut work together (brain-gut interaction). Thus, a faulty brain-gut interaction in some people with IBS may cause the food to move too slowly or too quickly through the gut. This causes changes in bowel movements. IBS refers to a group of symptoms occurring together, including repeated pain in the abdomen, cramping, bloating, and changes in the bowel movements, which may be diarrhea, constipation, or both. The typical feature of IBS is that these symptoms occur without any visible signs of damage or disease in the gut. IBS can cause a huge amount of discomfort, however, it does not damage the intestines.

IBS is a long-term or chronic disorder. The symptoms of IBS may come and go. It is a common condition affecting about twice as many women as men. IBS is most often reported in people younger than 45 years of age. The exact cause of IBS is not known. The condition does not have any specific test for diagnosing it. Tests may be done to exclude other conditions such as Crohn’s disease, ulcerative colitis, and certain cancers. Most cases of IBS are effectively managed with diet, stress management, probiotics, and medicine.

What are the different types of IBS?

Based on different patterns of changes in the bowel movements or the presence of abnormal bowel movements, IBS is of three types. Certain diets or medications may work for one type of IBS but not for the other or may make other types worse. People with IBS often have normal bowel movements on some days and abnormal bowel movements on other days. 

The three types of IBS are:

IBS with constipation (IBS-C): It is also called constipation-predominant IBS. It presents with the following symptoms on days when the person has at least one abnormal bowel movement:

• more than a quarter of the stools are hard or lumpy
• less than a quarter of the stools are loose or watery

IBS with diarrhea (IBS-D): It is also known as diarrhea-predominant IBS. In IBS-D, on days when the person has at least one abnormal bowel movement:

• more than a quarter of the stools are loose or watery and
• less than a quarter of the stools are hard or lumpy

IBS with mixed bowel habits (IBS-M): It is also called alternating type IBS or IBS-A. In this type of IBS, on days when there is at least one abnormal bowel movement:

• more than a quarter of the stools are hard or lumpy and
• more than a quarter of the stools are loose or watery

More information, recipes, resources, and lists of products to eat, and avoid, on this type of diet for IBS (irritable bowel syndrome) or other bowel diseases:

• Low FODMAP Diet for IBS: Monash University (http://www.med.monash.edu/cecs/gastro/fodmap/). Monash University also offers a FODMAP diet app and a recipe booklet for a fee.
• Stanford Low FODMAP Diet (http://fodmapliving.com/wp-content/uploads/2013/02/Stanford-University-Low-FODMAP-Diet-Handout.pdf), which also contains links to apps, support groups, and recipe suggestions.
• Low FODMAP Recipes (http://cooklowfodmap.com/)
• Low FODMAP Recipes for Vegans and Vegetarians (http://www.stephanieclairmont.com/meat-free-meals-low-fodmap-way/)