Fact sheetDiet specifications

Published on 1 Nov 2011


Allergy diet - FODMAPs low

This document is part of the ACI Diet Specifications for Adult Inpatients. It is not to be used for patient education.

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

YoghurtSoy yoghurt may be used, but milk-based natural yoghurt (without inulin) is usually tolerated in small servesFruit 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)

BeveragesTea, coffee

Fruit juices, soft drinks, cordial

Milk, flavoured milk, Milo®, Aktavite®, Ovaltine®

BiscuitsGluten-free biscuits without dried fruitBiscuits 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.
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