2. INTRODUCING FODMAPS

As we’ve seen, there are five main classes of FODMAPs. These are described in greater detail in this chapter, including the foods that are high in each FODMAP. Foods that contain FODMAPs can be split into three categories:

1. Those with large amounts of FODMAPs (i.e., the amount consumed in a serving of the food is definitely above the cutoff that has been shown to cause symptoms).

2. Those with moderate amounts of FODMAPs (i.e., the amount consumed in a serving of food is elevated, but not excessively so. These foods should be suitable when consumed up to the quantities defined in the following tables).

3. Those that are low in FODMAPs (i.e., they contain FODMAPs at a level that has been proven to be well tolerated by people with IBS).

Note that we don’t look specifically for “FODMAP-free” foods. (Please refer to the table that summarizes high-FODMAP foods to be aware of for easy reference. Acknowledgment to Monash University Central Clinical School, Fodmap Pty Ltd and SSSG International Pty Ltd for the information about FODMAP-tested foods.)

The low-FODMAP diet is used internationally as a treatment for IBS, as it’s the most effective diet for managing IBS symptoms.

FODMAP 1: EXCESS FRUCTOSE

Fructose is sometimes known as the fruit sugar – it is present in every fruit. There’s some good news when it comes to fructose restriction – you don’t have to avoid every food that contains fructose, including fruit! Foods that have a balance of fructose and glucose have been shown to be well absorbed in people with fructose malabsorption, as are foods that contain more glucose than fructose, when eaten one serving at a time. Foods are usually only a problem for people with fructose malabsorption if they contain excess fructose (more fructose than glucose).

One method people use to avoid excess fructose is glucose matching, although this approach doesn’t have strong scientific evidence to support it. Glucose matching involves consuming enough glucose at the same time as the food containing excess fructose in order to bring the glucose and fructose into balance or to create an excess of glucose.

It’s worth noting, however, that balancing fructose with glucose through glucose matching may only be of benefit to people with fructose malabsorption. It won’t assist absorption of lactose, GOS, fructans or polyols. It’s also important to note that it will only be of benefit when consuming foods whose only problematic FODMAP is excess fructose. In other words, if a food contains excess fructose together with a few other problematic FODMAPs, glucose matching will be of limited benefit, as it will not aid the absorption of the other FODMAPs present, so symptoms are still likely. Glucose matching may therefore assist in eating mango and boysenberries, but it won’t work for apples, which also contain sorbitol – the added glucose will balance the fructose, but won’t help at all with the sorbitol.

FOODS CONTAINING LARGE AMOUNTS OF EXCESS FRUCTOSE (PER SERVING)

FRUITS AND FRUIT PRODUCTS	VEGETABLES	OTHER
Apples Asian pears Boysenberries Fruit juice concentrate Fruit juices (apple, pear, mango, tropical) Mangoes Pears Tamarilloes Watermelon	Artichokes – Jerusalem Asparagus Sugar snap peas	Agave High-fructose corn syrup Honey

FOODS CONTAINING MODERATE AMOUNTS OF EXCESS FRUCTOSE (PER SERVING)

FRUITS AND FRUIT PRODUCTS	VEGETABLES	OTHER
Cherries – up to 3 fresh	—	—

FRUCTOSE LOAD

The first key to managing the FODMAP of excess fructose is to choose fruit in which glucose and fructose are in balance or there is more glucose than fructose. It’s also important to note, however, that you should limit the number of these “balanced” fruits you eat at one time. When choosing a “balanced” fruit, eat only the equivalent of one serving of fruit (e.g., one piece of fruit) at a time. This ensures you don’t have an excessive fructose load, which can trigger symptoms even if the fruit is in balance. Some examples of suitable servings of fruit include:

• 1 whole banana or orange
• 2 kiwis or mandarins
• 1 small slice of cantaloupe, honeydew melon or pineapple
• 1 small handful of strawberries, blueberries, raspberries or grapes
• ⅓–½ glass of suitable juice (e.g., orange juice, not apple or pear juice)
• 1 tablespoon dried fruit

This advice doesn’t mean you can only have one piece of fruit per day. On the contrary, you can enjoy many pieces of “balanced” fruit if you wish, as long as you wait two to three hours after eating some “balanced” fruit before you have your next serving.

FODMAP 2: LACTOSE

Lactose is known as the “milk sugar,” as it is present in the milk from any mammal – cow, sheep, goat, buffalo – even human! A common misconception with lactose malabsorption (i.e., lactose intolerance) is that you need to cut out every single trace of lactose from your diet. This is quite wrong – small amounts of lactose-containing foods are often tolerated. In fact, most people with lactose intolerance can tolerate up to 4 grams of lactose per sitting. To put this in perspective, one glass of milk contains 12–16 grams of lactose, so while a whole glass of milk isn’t good, a splash in tea or coffee will be less than 4 grams and will be fine for most lactose-intolerant people.

Also, milk and milk products need not be completely withdrawn from the diet, as not every product made from milk contains lactose (hard cheeses, for example, are virtually lactose-free). Although it may be ideal to choose low-lactose and lactose-free products whenever possible, there’s good news when it comes to your favorite high-lactose foods and drinks. You can purchase the lactase enzyme (the “scissors” that break down lactose so it can be absorbed) in tablet form from pharmacies. Instructions are on the package, but the general rule is the more lactose in the food you’re consuming, the more tablets you need – in other words, it’s dose-related. You need to take the lactase tablets at the same time you consume the lactose-containing food for them to work effectively.

“ I am so grateful for your research and the results. A dietitian recommended I read about the low-FODMAP diet after I presented with what she saw as ‘classic’ signs of illness and intolerance to every category of carbohydrate in the FODMAP acronym. As a child I recall getting stomachaches from wheat, milk, cookies and, horrors, especially legumes. I was once told I’m allergic to legumes but in recent years have not tested as allergic to peanuts although they make me ill with gastrointestinal symptoms. Now I understand! I’ve been on the FODMAP eating plan for about four months and feel like a happy, bon vivant sixty-one-year-old! I’m a licensed clinical social worker, love what I do and think I have more energy than when I was in my forties. ”

FOODS CONTAINING LARGE AMOUNTS OF LACTOSE (PER SERVING)

MILK AND MILK PRODUCTS	OTHER
Milk – cow’s, sheep’s, goat’s (full-fat, low-fat, skim) Custard Dairy desserts Evaporated milk Ice cream Powdered milk Sweetened condensed milk	—

FOODS CONTAINING MODERATE AMOUNTS OF LACTOSE (PER SERVING)

MILK AND MILK PRODUCTS	OTHER
Yogurt – cow’s, sheep’s, goat’s (full-fat, low-fat, skim) – up to ⅓ cup Soft cheeses – cottage, ricotta, quark, cream cheese, mascarpone, crème fraîche – up to 2 tablespoons	Regular milk in tea and coffee – up to ¼ cup Regular milk or powdered milk in baked foods such as cakes – up to 1 large serving of cake Regular milk or powdered milk in chocolate – up to 1½ ounces milk chocolate

FODMAP 3: POLYOLS

Polyols are a group of sugar alcohols. They tend to end in the suffix -ol, but isomalt and polydextrose should also be considered part of the polyol group, as they have a polyol component. Two types of polyols occur naturally in foods: sorbitol and mannitol. These, along with the other polyols (xylitol, maltitol and polyol-related molecules of isomalt and polydextrose), can also be used as food additives. If they are, the package will have a warning statement on the food product: “WARNING: Excess consumption may have a laxative effect.” Besides this effect, these polyols are potent wind-generators and major bloaters! If polyols are used as additives, their name may be listed in the ingredients list.

POLYOL

Isomalt (contains sorbitol and mannitol)

Maltitol

Mannitol

Polydextrose (10% sorbitol)

Sorbitol

Xylitol

Erythritol, although a polyol, is not as potent in triggering symptoms as other polyols and is usually tolerated by many with IBS when consumed in moderate amounts. Assess individual tolerance.

Sorbitol

FOODS CONTAINING LARGE AMOUNTS OF SORBITOL (PER SERVING)

FRUITS AND FRUIT PRODUCTS	VEGETABLES
Apples Apricots (fresh and dried) Asian pears Blackberries Coconut water Nectarines Peaches Pears Plums	—

FOODS CONTAINING MODERATE AMOUNTS OF SORBITOL (PER SERVING)

FRUITS AND FRUIT PRODUCTS	VEGETABLES
Cherries – up to 3 fresh Longan – up to 10 Lychee – up to 5	—

Mannitol

FOODS CONTAINING LARGE AMOUNTS OF MANNITOL (PER SERVING)

FRUITS AND FRUIT PRODUCTS	VEGETABLES
Watermelon	Cauliflower Mushrooms

FOODS CONTAINING MODERATE AMOUNTS OF MANNITOL (PER SERVING)

FRUITS AND FRUIT PRODUCTS	VEGETABLES
—	Butternut squash – up to ½ cup Celery – up to ½ stalk

FODMAP 4: FRUCTANS

Fructans are a FODMAP in everyone – it’s just a matter of how much we need to consume before we experience symptoms. The main food sources of fructans are some vegetables, grains, nuts and fruits, as shown in the table below. You will notice wheat, rye and barley are listed. People with IBS tend to experience symptoms when consuming large servings of wheat, rye and/or barley. Not every wheat-, rye- or barley-based ingredient needs to be avoided, however – only large amounts such as in the foods listed in the table. The good news is that small amounts of wheat are usually well tolerated, such as the amount in soy sauce, for example.

FOODS CONTAINING LARGE AMOUNTS OF FRUCTANS (PER SERVING)

FRUITS AND FRUIT PRODUCTS	VEGETABLES	GRAIN- AND STARCH-BASED FOODS
Custard apples (cherimoya) Nectarines Persimmons Watermelon	Artichokes – globe Artichokes – Jerusalem Garlic Leeks Onions Shallots Spring onions (white part only)	Barley (in large amounts) Rye (in large amounts) Spelt (in large amounts) Wheat (in large amounts) Barley-, rye- and wheat-based bread, pasta, couscous, gnocchi, noodles, croissants, muffins

FOODS CONTAINING LARGE AMOUNTS OF FRUCTANS (PER SERVING), CONT.

NUTS AND SEEDS	OTHER
Cashews Pistachios	Additives: inulin, fructo-oligosaccharides Chickpeas Chicory-based drinks Legumes (e.g., red kidney beans) Lentils (but cooking and draining lowers FODMAP content) Salts – onion, garlic, chicken, vegetable

FOODS CONTAINING MODERATE AMOUNTS OF FRUCTANS (PER SERVING)

FRUITS AND FRUIT PRODUCTS	VEGETABLES	GRAIN- AND STARCH-BASED FOODS
Rambutans – up to 4 fresh Pomegranates – up to ¼ cup seeds	Beets – up to 2 slices	Crackers – up to 3 Plain sweet cookies – up to 3

FOODS CONTAINING MODERATE AMOUNTS OF FRUCTANS (PER SERVING), CONT.

NUTS AND SEEDS	OTHER
Hazelnuts – up to 10 Tahini – up to 1 tablespoon	—

FODMAP 5: GALACTO-OLIGOSACCHARIDES (GOS)

GOS are predominantly found in the legume family, including chickpeas and lentils. These are important foods for vegetarians (especially vegans), as they contain significant amounts of protein.

FOODS CONTAINING LARGE AMOUNTS OF GALACTO-OLIGOSACCHARIDES (PER SERVING)

LEGUMES AND LEGUME PRODUCTS	NUTS
Chickpeas Hummus Legumes – red kidney beans, baked beans, cranberry (borlotti) beans, soybeans, navy beans, butter beans, etc. Lentils (but cooking and draining lower FODMAPs) Refried beans Soy milk (made from whole soybeans)	Cashews Pistachios

FOODS CONTAINING MODERATE AMOUNTS OF GALACTO-OLIGOSACCHARIDES (PER SERVING)

VEGETABLES	NUTS
Beets – up to 2 slices Butternut squash – up to ½ cup Sweet corn – up to ½ cob Peas – up to ¼ cup	Almonds – up to 10 Hazelnuts – up to 10

EXAMPLES OF FOODS HIGH IN FODMAPS (PER SERVING)

FRUIT AND FRUIT PRODUCTS	VEGETABLES	MILK AND MILK PRODUCTS
Apples Apricots (fresh and dried) Asian pears Blackberries Boysenberries Cherries – more than 3 fresh Coconut water Custard apples (cherimoya) Dried fruit – more than 1 tablespoon Fruit juice concentrate Fruit juice – apple, pear, mango, tropical Longans – more than 10 Lychees – more than 5 Mangoes Nectarines Peaches Pears Persimmons Plums Pomegranates – more than ¼ cup seeds Rambutans – more than 4 fresh Tamarilloes Watermelon	Artichokes – globe Artichokes – Jerusalem Asparagus Beets – more than 2 slices Butternut squash – more than ½ cup Cauliflower Celery – more than ½ stalk Garlic Green peas – more than ¼ cup Leeks Mushrooms Onions Shallots Spring onions (white part only) Sugar snap peas Sweet corn – more than ½ cob	Cow’s milk (full-fat, low-fat, skim) Custard Dairy desserts Evaporated milk Goat’s milk (full-fat, low-fat, skim) Ice cream Powdered milk Regular milk in tea and coffee – more than ¼ cup Regular milk or powdered milk in baked foods – more than 1 large serving of cake Regular milk or powdered milk in chocolate – more than 1 ounce milk chocolate Sheep’s milk (full-fat, low-fat, skim) Soft cheeses – cottage, ricotta, quark, cream cheese, mascarpone, crème fraîche – more than 2 tablespoons Soy milk (from whole soybeans) Sweetened condensed milk Yogurt – cow’s, sheep’s, goat’s (full-fat, low-fat, skim) – more than ⅓ cup

 

GRAIN AND STARCH FOODS	OTHERS
Barley (in large amounts) Barley-, rye- and wheat-based commercial bread, bread crumbs, breakfast cereals, muesli, pasta, couscous, gnocchi, noodles, pastries, cakes, cookies, croissants, muffins, spaetzle Flours (in large amounts), including chickpea flour (besan), lentil flour, pea flour, soy flour Plain sweet cookies – more than 3 Rye (in large amounts) Spelt (in large amounts) in bread (except some sourdough varieties), pasta, cereals Wheat (in large amounts), including bulgur, durum, wheat flour, multigrain flour, triticale, wheat germ, wheat bran, semolina Wheat-based crackers, crispbreads – more than 3	Agave Almonds – more than 10 Cashews Chickpeas Chicory-based drinks Chutneys – many varieties Dessert wines – many varieties Fructo-oligosaccharides High-fructose corn syrup Honey Hummus Inulin Legumes – red kidney beans, soybeans, cranberry (borlotti) beans, refried beans, etc. Lentils (note: cooking and draining lower FODMAP content) Onion-containing gravies Pistachios Relishes – many varieties Salts – onion, garlic, vegetable, chicken Sausages – many types (check for onion and dehydrated vegetable powder) Some rums Stock cubes – many varieties Sweeteners – sorbitol, mannitol, xylitol, maltitol, isomalt, polydextrose Tahini – more than 1 tablespoon

EXAMPLES OF FOODS LOW IN FODMAPS (PER SERVING)

FRUIT AND FRUIT PRODUCTS	VEGETABLES	MILK AND MILK PRODUCTS
Avocados Bananas Blueberries Cantaloupe Coconut cream Coconut milk Dragonfruit Durian Grapes Honeydew melon Kiwi Lemons Limes Mandarins Oranges Passion fruit Pawpaw Pineapple Raspberries Rhubarb Star fruit Strawberries Tangelos	Alfalfa Arugula Bamboo shoots Bean sprouts Beans (green) Belgian endive Bell peppers Bok choy Broccoli Carrots Chard Chives Choy sum Cucumber Eggplant Fennel bulb Ginger Kale Kohlrabi Lettuce Olives Parsnips Potatoes Radicchio Radishes Rutabagas Seaweed (nori) Spinach Spring onions (green part only) Squash Sweet potato Tomatoes Turnips Water chestnuts Zucchini	Blue cheese Bocconcini Brie Butter Cheddar Chocolate containing regular milk or powdered milk – a nibble Colby Cream (lactose-free half-and-half is also available) Edam Feta Gloucester cheese Gorgonzola Gouda Gruyère Havarti Lactose-free ice cream Lactose-free yogurt Margarine Mozzarella Neufchâtel Oat milk – most varieties Parmesan Pecorino Raclette Regular milk in tea and coffee – a splash of milk Rice milk – most varieties Soft cheeses – cottage, ricotta, quark, cream cheese, mascarpone, crème fraîche – a spoonful Swiss cheese Taleggio Yogurt – cow’s, sheep’s, goat’s (full-fat, low-fat, skim) – a spoonful or two

 

GRAINS AND STARCHES	OTHERS
Arrowroot Buckwheat Corn Flour – cornmeal, cornstarch, potato flour, rice flour, sago, tapioca, oatmeal Gluten-free cookies, cakes, pastries – many varieties Gluten-free bread and cereal products – many varieties Gluten-free pasta, rice noodles, rice vermicelli, soba noodles (100 percent buckwheat), mung bean (glass) noodles Gluten-free taco shells, corn tortillas Malt Millet, puffed millet Oat bran Oats, rolled oats Polenta Quinoa Rice (white, brown) – ground rice, rice bran, glutinous rice, wild rice Rice cakes Rice- or corn-based fruit-free breakfast cereals, baby rice cereal, porridge Sorghum Some spelt sourdough breads	Alcohol – most Baking powder Baking soda Chia seeds Cocoa Flaxseed (linseed) Garlic-infused olive oil Gelatin Herbs Honey substitutes: maple syrup, golden syrup Jam, marmalade Meat, fish, chicken, eggs, tofu – plain Onion-infused olive oil Peanut butter Poppy seeds Pumpkin seeds (pepitas) Pure cane powdered sugar Salt Sesame seeds Soy sauce Spices Sugar (sucrose), glucose, stevia, any other artificial sweeteners not ending in “-ol” (e.g., aspartame) Sunflower seeds Tamari Tea, coffee Vinegar Water, mineral water, soda water, tonic water Xanthan gum