Are you looking for relief from your IBS symptoms?
Symptoms of Irritable Bowel Syndrome include abdominal bloating and distension, excess wind (flatulence), abdominal pain, nausea, changes in bowel habits (diarrhea, constipation, or a combination of both), and other gastrointestinal symptoms.
What are the FODMAPs?
FODMAPs are found in the foods we eat. FODMAPs is an acronym for:
- Oligosaccharides (eg. Fructans and Galactans)
- Disaccharides (eg. Lactose)Monosaccharides (eg. excess Fructose)
- Polyols (eg. Sorbitol, Mannitol, Maltitol, Xylitol and Isomalt)
This is a collection of molecules found in food, that can be poorly absorbed by some people. When the molecules are poorly absorbed in the small intestine of the digestive tract, these molecules then continue along their journey along the digestive tract, arriving at the large intestine, where they act as a food source to the bacteria that live there normally. The bacteria then digest/ferment these foods and can cause symptoms of Irritable Bowel Syndrome.
Where are FODMAPs found?
- Excess Fructose: Honey, Apples, Mango, Pear, Watermelon, High Fructose Corn Syrup, Corn Syrup Solids
- Fructans: Artichokes (Globe), Artichokes(Jerusalem), Asparagus, Beetroot, Chicory, Dandelion leaves, Garlic (in large amounts), Leek, Onion (brown, white, Spanish, onion powder), Raddicio lettuce, Spring Onion (white part), Wheat (in large amounts), Rye (in large amounts), Inulin, Fructo-oligosaccharides.
- Lactose: Milk, icecream, custard, dairy desserts, condensed and evaporated milk, milk powder, yoghurt, margarine, soft unripened cheeses (eg. ricotta, cottage, cream, marscarpone).
- Galacto-Oligosaccharides (GOS): Legume beans (eg. baked beans, kidney beans, bortolotti beans), Lentils, Chickpeas
- Polyols: Apples, Apricots, Avocado, Cherries, Longon, Lychee, Nectarines, Pears , Plums, Prunes, Mushrooms, Sorbitol (420), mannitol (421), xylitol (967), maltitol (965) and Isomalt (953).
What is fructose?
Fructose is a monosaccharide, or single sugar. It is found in three main forms in the diet as:
- fructose in fruits, honey and some root vegetables
- part of the disaccharide, or double sugar, sucrose. Sucrose is made up of glucose and fructose.
- Sucrose is also known as table sugar.
- fructans in some vegetables and wheat. Fructans are short chains of fructose. They are also called inulins and fructo-oligosaccharides.
Fructose is the sweetest of all naturally occurring carbohydrates. For this reason it is often added as a sweetening ingredient in prepared foods. Since it is sweeter than table sugar, smaller amounts of fructose are needed to get the same sweetness.
How do I go on the FODMAP diet?
During your elimination trial, it is recommended that you eliminate all FODMAPs either significantly or entirely. Most patients will begin to feel significantly better within a few hours and a few days, but will take up to two weeks to feel fully healthy. A minority of patients have reported that it took up to three months to fully recover. After recovery, you can begin to gradually reintroduce foods using the steps outlined at the end of this article.
Many IBS sufferers with generally mild symptoms will find that a general reduction of fructose intake alone significantly relieves them of their symptoms. Other individuals will find that they must significantly reduce their intake of all FODMAPs to experience relief. You may find over time that eating certain FODMAPs does not bother you.
Finally, it should be noted that fructose – the ubiquitous simple sugar – is often allowed in “safe foods” if the food also contains a glucose-to-fructose ratio greater than one. This is because research shows that ingesting glucose at the same time as fructose (and in the same quantities as fructose) eases fructose absorption.
Is it dangerous to limit fructose intake?
In short: no. While carbohydrates are an essential source of energy, refined sugars are anything but and current research shows that fructose may be best ingested in strict moderation.
Further, some sources report that a modern diet contains upwards of ten times the amount of sugar humans ingested for much of evolution. This may help to explain why fructose malabsorption is found in up to 40% of inhabitants of western countries. You will still be ingesting a significant level of glucose and other carbohydrates. Overall, limiting your fructose intake will likely be beneficial to your health. But when in doubt, listen to your body (and, of course, doctor). It is also not inherently dangerous to limit other FODMAPs, but missing out on whole food groups could easily lead to a diet missing in nutrients and lacking in vitamins.
Which foods contain FODMAPs?
The best way to determine the fructose content of a given food is to use publicly available USDA data.
To save you some time, and to bring your attention to foods which contain non-fructose FODMAPs, the list below names some foods that you will definitely want to avoid at least initially. .
Most fruits which are excluded are excluded due to excessive fructose content, or greater than a 1:1 Fructose:Glucose ratio. Also, some contain Polyols.
- Plums and prunes
- High concentration of fructose from canned fruit, dried fruit or fruit juice
- Ice cream
- Milk (cow, goat, sheep)
- Evaporated milk
- Condensed milk
- Milk powder
- Soft cheese, including cottage cheese and ricotta
- Greek yogurt
- Many legumes contain Galacto-Oligosaccharides (GOS).
- Baked beans
- Kidney beans
- Sweeteners which end in -ol are excluded because they are fermentable polyols.
- High fructose corn syrup
- It should be noted that HFCS actually only contains marginally more fructose than glucose as compared to refined sucrose. It is included in this list only because it was found on another list (better safe than sorry), and because it still has a F:G ratio greater than 1. The accuracy of this entry will be checked soon for validity.
- Corn syrup solids
- See above
- Palm sugar
- Agave nectar
- Vegetables may be on this list for containing fructans.
- Brussel sprouts
- Garlic is possibly okay to consume, but should not be ingested in large quantities.
- Onions have recently been reported to be especially troublesome. It is best to completely avoid them.
- Radiccio lettuce
- Scallions (white parts)
- Sugar snap peas
- Snow peas
So, what’s safe to eat?
It’s best to obtain your calories principally from a source that is indisputably fodmap-friendly (such as rice or meat). In moderation, however, the following foods are safe to eat on a low-FODMAP diet.
- Honeydew melon
- Mandarine oranges
- Artificial sweeteners that do not end in -ol
- Maple syrup
- Sugar (sucrose)
- Hard cheeses
- Brie (exceptional cheese)
- Camembert (exceptional cheese)
- Lactose-free products, such as lactose-free ice cream and yogurt
- Rice milk
- Bok choy
- Green beans
- Scallions (green parts only)
- Reintroducing foods/Moving beyond the elimination phase
Once you are symptom-free, you may attempt to reintroduce foods in order to determine exactly what was causing your symptoms. There are really no established guidelines on how to best do this – it varies from individual to individual. Key concepts, however, follow:
- Write it down! Be scientific. Keep a food diary. Your future self will thank you.
- Only reintroduce one food at a time.
- Wait ~72 hours for symptoms to reappear before moving on to the next food