Allergy diet - FODMAPs low

Aim

To reduce the level of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) in the diet.

Characteristics

Avoids fruits and vegetables high in fructose or with an unfavourable fructose to glucose ratio; limits dairy foods with high levels of lactose, limits fructo- and galacto-oligosaccharides from foods such as wheat and legumes; avoids fruit and artificial sweeteners high in polyols.

Indications

• Irritable bowel syndrome
• functional gut disorders
• small bowel bacterial overgrowth

Nutritional adequacy

Nutritionally adequate.

Precautions

Patients usually experience improvement in symptoms within the first week but if there is no improvement after eight weeks, the diet should be discontinued.

It is not possible to provide a full list of all permitted commercial products; the following are general guidelines only. It is important to check the label of commercial foods to eliminate foods with high levels of fructose:

• high-fructose corn syrup (HFCS), corn syrup solids, fructose and fruit juice concentrate;
• or high levels of polyols: sorbitol (420), mannitol (421), xylitol (967), maltitol (965)
• or isomalt (953).

Paediatrics

Suitable for use in paediatrics when combined with an age-appropriate diet.

Specific menu planning guidelines

	Allowed	Not allowed
Hot main dishes	All others	Dishes cooked with dried fruit, artichokes, asparagus, leeks, onions or mushrooms Dishes prepared with legumes (e.g. chickpeas, lentils, kidney beans) Any dishes containing milk or soft cheese (e.g. ricotta, cottage cheese)
Sauces, gravies	All others sauces made with without milk, e.g. tomato sauce	Sweet and sour sauce, barbecue sauce, plum sauce, Bolognese sauce White sauces made with milk Gravy thickened with wheat flour
Starchy vegetables / pasta / rice	Potatoes Rice prepared without milk	Pasta and couscous
Vegetables	All others (e.g. bamboo shoots, bok choy, carrot, celery, capsicum, choko, corn, eggplant, green beans, sweet potato, tomato, pumpkin)	Artichokes, asparagus, beetroot, brussels sprouts, broccoli, cabbage, cauliflower, fennel, leeks, mushrooms, okra, onions, peas, radicchio, shallots, sugar snap peas
Soups	All other soups made with without milk or wheat flour	Asparagus, cauliflower, leeks, mushrooms, peas, onions Any soups containing noodles
Sandwiches	Sandwiches made with gluten-free bread*	Asparagus, avocado
Salads, dressings	All other ingredients	Artichokes, asparagus, avocado, beetroot, leeks, onions, chicory, radicchio, bean mix Soft cheeses (e.g. cottage cheese, ricotta)
Breads, cereals	Gluten free breads*, rice cakes Corn-, rice- and oat-based breakfast cereals(e.g. rolled oats prepared with water, Corn Flakes®, Rice Bubbles®) – check label for milk ingredients	Wheat and rye breads Wheat- and bran-based breakfast cereals
Spreads	Margarine, butter Vegemite™, peanut butter Jam and marmalade made with sucrose	Honey Jams made with concentrated fruit juice
Hot breakfast choices		Baked beans, mushrooms, canned spaghetti
Fruit	Berry fruits (e.g. strawberries, blueberries, raspberries, cranberries) Citrus fruits (oranges, mandarins, lemons, grapefruit) Other fruits: bananas, grapes, honeydew melons, kiwifruit, pineapples, rhubarb, rockmelons, passionfruit, pawpaw, papaya, tamarillo	Fresh apples, apricots, pears, guavas, mangoes, nashi fruit, peaches, plums, prunes, nectarines, quince, star fruit (carambola), watermelon, lychees, cherries, persimmons Dried apples, apricots, currants, dates, figs, pears, prunes, raisins, sultanas Canned fruit in natural juice
Yoghurt	Soy yoghurt may be used, but milk-based natural yoghurt (without inulin) is usually tolerated in small serves	Fruit yoghurt, or yoghurt with added inulin
Desserts	Jelly, meringues Soy-milk custard or creamy rice Some sorbets – check label Tapioca and sago made without milk (e.g. lemon or orange sago)	Milk-based desserts, eg custards, ice-cream, mousses, cheesecake Cakes, pastry-based and crumble desserts, unless carefully checked Cream, creamy rice
Milk and cheese	Soy milk Lactose-reduced milk (e.g. Zymil®, Liddells®) Matured and semi-matured cheese (e.g. cheddar, brie, camembert)	All cow’s milk (full and low fat) Processed and soft cheeses (e.g. cottage cheese, ricotta)
Beverages	Tea, coffee	Fruit juices, soft drinks, cordial Milk, flavoured milk, Milo®, Aktavite®, Ovaltine®
Biscuits	Gluten-free biscuits without dried fruit	Biscuits made with wheat flour or dried fruit
Miscellaneous	Sugar and glucose Maple syrup, golden syrup, nuts Supplements with low lactose, e.g. Resource® Fruit Beverage	Many nutritional supplements, unless checked for lactose levels

* Note: Although normal wheat bread is strictly restricted on this diet because of the fructan level, the dietitian may allow small amounts of normal bread instead of gluten-free bread.

References

1. Ong DK, Mitchell SB, Barrett JS, Shepherd SJ, Irving PM, Biesiekierski JR et al. Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome. J Gastroenterol Hepatol 2010;25:1366-73
2. Gibson PR, Shepherd SJ. Evidence-based dietary management of functional gastrointestinal symptoms: the FODMAP approach. J Gastroenterol Hepatol 2010;25:252-8.
3. Heizer WD, Southern S, McGovern S. The role of diet in symptoms of irritable bowel syndrome in adults: a narrative review. J Am Diet Assoc 2009;109:1204-14.
4. Shepherd SJ, Parker FC, Muir JG, Gibson PR. Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome: randomized placebo-controlled evidence. Clin Gastroenterol Hepatol 2008;6:765-71.
5. Barrett JS, Gibson PR. Clinical ramifications of malabsorption of fructose and other short-chain carbohydrates. Pract Gastroenterol 2007;31(8):51-65.