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FODMAPs 101

What are FODMAPs?
FODMAP digestive sensitivities

Researchers at Monash University in Australia coined the FODMAP acronym to classify groups of carbohydrates (sugars and fibers) found in foods and beverages, that are similar in length and structure. These, "short-chain" carbohydrates have been shown to be poorly absorbed in individuals living with digestive sensitivities, including Irritable Bowel Syndrome (IBS), and resulting in a common set of gastrointestinal symptoms including abdominal pain, bloating and gas, constipation and/or diarrhea.

 

FODMAP stands for the following:

F – Fermentable – Quickly broken down by bacteria in the gut and produce gas

O – Oligosaccharides (Fructo-and galacto-oligosaccharides) -- Found in select vegetables, legumes, fruits, grains, nuts and teas

D – Disaccharides (Lactose) – Found in select milk and milk products

M – Monosaccharides (Fructose) – Found in select fruits, vegetables and sweeteners

A – And

P – Polyols (Sugar Alcohols) – Found in select fruits, vegetables and artificial sweeteners

 

Additional Learning

Watch this short video: What are FODMAPs? ©2016 The Regents of the University of Michigan. All rights reserved. Used under license by Nestlé.

View and print this overview of The Low FODMAP Diet: At A Glance for easy reference.

 

More technical information…

  • Fructooligosaccharides (FOS, fructans) are a chain of 3–9 fructose molecules with a glucose molecule at the end
  • Galactooligosaccharides (GOS, galactans) are a chain of 3–9 galactose molecules with a fructose molecule at the end
  • Disaccharides, specifically lactose (a natural milk sugar), is made up of 2 sugar molecules (glucose and galactose)
  • Monosaccharides, specifically fructose, is made up of a single sugar molecule where excessive amounts can be difficult to absorb
  • Polyols are known as sugar alcohols including sorbitol, mannitol, xylitol and maltitol
FODMAPS in the Body

For people living with digestive sensitivities, including those with Irritable Bowel Syndrome (IBS), foods high in FODMAPs are not the cause of the problem, rather they can trigger gastrointestinal symptoms causing digestive discomfort and anxiety.

 

Poor Absorption of FODMAPs Leads to Distention, Pain, and Discomfort

Research into FODMAP-containing foods has identified that foods high in FODMAPs have the following common effects for many people with IBS:

 

  1. FODMAPs can be poorly absorbed in the small intestine.
  2. FODMAPs can cause excessive water to be drawn into the intestines.
  3. FODMAPs can become rapidly fermented by bacterial present in the colon, which produces gas.
  4. Water and gas build up creates distention, cramps and diarrhea or constipation.

 

Visual Simulation

Watch this short video to learn more about how foods high in FODMAPs can trigger GI symptoms, and how the Low FODMAP diet works. ©2016 Monash University. Used with Permission. All rights reserved. Used under license by Nestlé.

 

More technical Information…

Why are they poorly absorbed?

  • Fructooligosaccharides (FOS, Fructans) and Galactooligosaccharides (GOS, Galactans) - Humans do not have the enzymes to break these down, so they cannot be absorbed in the small intestine. This leads to rapid fermentation in the large intestine by the microbiota, causing gas formation.
  • Disaccharides – Many IBS sufferers lack the enzyme lactase needed to break lactose down lactose to its monosaccharide constituents (glucose and galactose).
  • Monosaccharides – Fructose is easily absorbed, but it can be malabsorbed in excess of glucose.
  • Polyols – Sugar alcohols are slowly and incompletely absorbed by humans, sometimes even marketed as a laxative or requiring of this possible effect upon consumption.

Are there clinical tests to help identify FODMAP malabsorption?

  • Clinical tests to determine FODMAP malabsorption are not commonly used since the elimination of the foods with resolved symptoms may be adequate to demonstrate intolerance.
  • Some gastroenterologists may use breath hydrogen tests. Following consumption of a test sugar (e.g., fructose, lactose and sorbitol), hydrogen levels in the breath are measured. A significant rise in breath hydrogen indicates fermentation by bacteria (also called the gut microflora or microbiota) in the large intestine.
  • Note fructans and galactans are always malabsorbed and fermented as we do not break them down, so they are not tested.
  • Polyol tolerance is generally tested through dietary elimination and FODMAP re-challenge.
FODMAP Food Lists

Monash University researchers in Australia have developed the most comprehensive database of FODMAP content (types and amounts) in the food supply. It is important to note that the primary foods tested are from Australia. Recently, some US foods have been tested and added. The list is constantly evolving please check the Monash University App for more information.

 

Although each individual’s tolerance to foods is unique, the following lists showcase a sample set of both high and low FODMAP foods, providing a basic education about how foods are categorized on this diet plan.

 EXAMPLES OF HIGH FODMAP FOODS*

 F is for Fermentable, which applies to all of the foods on the list.

 O is for Fructo- and Galacto- Oligosaccharides

 Fructo-Oligosaccharides (FOS)

 Wheat, barley, rye

 Garlic

 Onions

 Dried fruit

 Nectarines

 Persimmon

 Watermelon

 Artichokes

 Inulin (Chicory root extract)  

 Galacto-Oligosaccharides (GOS)

 Split peas

 Red kidney beans

 Black beans

 Baked beans

 Soybeans

 Pistachios

 Cashews

 D is for Disaccharides (Lactose)

 Milk

 Custard

 Ice cream

 Yogurt

 Buttermilk

 Evaporated milk

 Milk powder

 M is for Monosaccharides (Excess Fructose)

 Apples

 Figs

 Boysenberries

 Mango

 Pears

 Watermelon

 Cherries

 Asparagus

 Artichokes

 Sugar snap peas

 High fructose corn syrup

 Honey

 Agave

 Rum

 And

 P is for Polyols (Sugar Alcohols)

 Apples

 Apricots

 Blackberries

 Nectarines

 Peaches

 Pears

 Cauliflower

 Mushrooms

 Snow peas

 Sugar alcohol additives:

 Isomalt, Mannitol, Sorbitol, Maltitol, Xylitol

 

 EXAMPLES OF LOW FODMAP FOODS*

 These are low FODMAP in a single serving.

 F is for Fermentable – These foods create minimal fermentation.

 O is for Fructo- and Galacto- Oligosaccharides (Low FOS and GOS)

 Arugula

 Bok choy

 Bell peppers

 Carrots

 Collard greens

 Common cabbage

 Cucumber

 Eggplant

 Green beans

 Kale

 Lettuce

 Potato

 Corn/Rice/Quinoa, as well as pasta made of these

 Rice, rice cakes

 Potato and Tortilla chips

 Oats

 Polenta

 Corn tortilla

 Macadamia

 Peanuts

 Pecans

 Walnuts

 Chia

 Flax

 Pumpkin

 Sesame

 Sunflower seeds

 D is for Disaccharides (Low or No Lactose)

 Brie, Colby, Cheddar, Swiss cheese

 Goat, Feta, Mozzarella, Parmesan cheese

 Lactose-free cottage cheese

 Lactose-free yogurt

 Lactose free milk

 Almond milk

 Coconut milk (canned)

 Hemp milk

 M is for Monosaccharides (No Excess Fructose)

 Bananas

 Blueberries

 Cantaloupe

 Clementine

 Grapes

 Honeydew melon

 Kiwifruit

 Lemons

 Limes

 Mandarin

 Oranges

 Pineapple

 Raspberries

 Strawberries

 And

 P is for Polyols (Low or No Sugar Alcohols)

 Bananas

 Blueberries

 Cantaloupe

 Clementines

 Grapes

 Honeydew

 Lemons

 Limes

 Oranges

 Pineapple

 Strawberries

 Table sugar

 Glucose

 Maple Syrup

 Sucralose

 Stevia

 

* Note this list is not all-inclusive.

FODMAPs vs. Gluten
gluten free versus FODMAP free

Is Gluten a FODMAP?

No. Gluten is not a FODMAP. Gluten is a protein that people with Celiac disease cannot digest. FODMAPs are short-chain carbohydrates. The two overlap because wheat, rye and barley contain gluten and oligosaccharides (fructans).

While gluten-free products may seem like a good idea on a Low FODMAP Diet, many gluten-free items may contain higher FODMAP ingredients. Read the labels in all food products.

 

More Technical Information:

 

Gluten Intolerance: Celiac Disease and Non-Celiac Gluten Sensitivity

 

Celiac Disease

For the person with Celiac Disease, consumption of gluten results in an easily diagnosable immune reaction with inflammation and damage occurring in the small bowel.

 

Non-Celiac Gluten Sensitivity (NCGS)

A patient that does not have Celiac Disease or food allergies may still have GI symptoms following the consumption of gluten. Although people with NCGS are often put on a gluten-free diet, this does not always effectively eliminate symptoms of gas and bloating. In fact, some people who believe they are gluten-sensitive may in fact be FODMAP-sensitive. A Low FODMAP Diet could be an alternative nutrition solution for these individuals with the goal to help reduce their symptoms associated with digestive discomfort and improve their quality of life.

Sources
  • Barrett, JS, et al. Dietary poorly absorbed, short-chain carbohydrates increase delivery of water and fermentable substrates to the proximal colon. Aliment Pharmacol Ther. 2010;31:874-82.
  • Biesiekierski J, et al. No Effects of Gluten in Patients with Self-Reported Non-Celiac Gluten Sensitivity After Dietary Reduction of Fermentable Poorly Absorbed Short-Chain Carbohydrates. Gastroenterol. 2013;145:320-8.
  • Gibson, PR, Shepherd SJ. Food Choice as a Key Management Strategy for Functional Gastrointenstinal Symptoms. Am J Gastroenterol. 2012;107:657-66.
  • Halmos EP, et al. A Diet Low in FODMAPs Reduces Symptoms of Irritable Bowel Syndrome. Gastroenterol. 2014;146:67-75.
  • Mansueto P, et al. Role of FODMAPs in Patients with Irritable Bowel Syndrome: A Review. NCP. 2015;30(15):665-82.
  • Monash University Low FODMAP Diet for Irritable Bowel Syndrome. Available at http://www.med.monash.edu/cecs/gastro/fodmap/.
  • Monash University. 2016. The Monash University Low FODMAP Diet (Version 1.6) [Mobile Application Software]. Retrieved from https://itunes.apple.com/au/app/monash-university-low-fodmap/id586149216?mt.
  • Mullin GE, et al. Irritable Bowel Syndrome: Contemporary Nutrition Management Strategies. 2014;38:781-99.
  • Rana SV, Malik A. Breath Tests and Irritable Bowel Syndrome. World J Gastroenterol. 2014;20(24):7587–7601.