The 2-Step Low-FODMAP Eating Plan

You may be able to work out which FODMAPs are the most likely triggers for your symptoms, especially with the help of an experienced dietitian. This is best done by keeping a seven-day food and symptom diary and looking out for a relationship between the frequency and severity of your symptoms and the foods you ate anytime earlier in the day. Consume and record your usual diet – the food and drink you usually consume when you experience your IBS symptoms. By asking you some specific questions and looking at a completed seven-day food and symptom diary, your dietitian may establish that you seem to tolerate one or more types of FODMAPs. For example, the information that your dietitian gathers may indicate you can tolerate milk. If you can, then lactose may not be a problem for you. It is wise to look at the list of foods high in lactose and be sure that none of these trigger symptoms in you. If you and your dietitian are confident lactose is not your problem, then it may be decided that lactose does not need to be restricted in Step One.

This first step highlights the role FODMAPs play in triggering your symptoms. The goal of this step is for you to attain relief with your IBS symptoms by restricting high-FODMAP foods from your diet. It’s then important to have a review appointment with your dietitian to assess your symptom response and begin Step Two.

“ I’m twenty-two years old. I have suffered from horrible IBS symptoms my entire life, and over my entire life I’ve been through many tests for celiac disease, lactose and fructose intolerance. Up until Christmas Day, nobody had been able to tell me anything or help me manage my symptoms. My cousin showed me your low-FODMAP diet in your book, The Complete Low-FODMAP Diet, and it has been a godsend to me. I want to thank you for your work. I’ve suffered badly from my IBS and now I can live normally and enjoy life more. ”

A SEVEN-DAY FOOD AND SYMPTOM DIARY

STEP TWO: REINTRODUCTION AND LIBERALIZATION

There’s simply no point restricting more foods than you need to in order to feel well. Although Step One is important to determine if FODMAPs are triggers for your symptoms, it’s usually more restrictive than necessary for you to achieve symptom relief. It’s much better to eat a greater variety of foods and feel just as well as when you were eating less variety in Step One. Additionally, FODMAPs are like prebiotics; restricting all FODMAPs may change the amount and type of bacteria in your large intestine. Any FODMAPs you can tolerate are good for other aspects of your bowel health.

Each week, test a new FODMAP. The foods suggested contain only one FODMAP. Consume that food three times in the test week in the amount specified. You don’t need to eat it every day. The purpose is to see if you can handle the food in the suggested quantity, at a “normal” frequency in the diet, without pushing yourself. (Too much of anything can potentially cause symptoms in anyone!)

The Step Two menu plans will help you with reintroducing lactose, sorbitol, mannitol, excess fructose, fructans and GOS (with some fructan tolerance, too, as most foods with GOS in them also have fructans).

FODMAPs and your diet in the long term

Now that you have completed all of the reintroductions for the FODMAP groups you restricted in Step One, you are aware of the types and amounts of FODMAPs that are your symptom triggers.

You can now include other foods containing the FODMAPs that you tolerated in your reintroduction trial into your diet again. See the other foods that contain the FODMAPs you now tolerate, and enjoy them as tolerated. Note that if your symptoms return, it may be due to the accumulation of different FODMAPs (e.g., having an additive effect), as well as large doses of individual FODMAPs. Also be aware that your sensitivity to FODMAPs may change over time, so it is recommended you try reintroducing any failed FODMAP again in the future.

EIGHT-WEEK FODMAP CHALLENGE

* A wide range of foods contain fructans in varying amounts. So the fructan challenge is staggered over three levels, increasing in the amount of fructans at each level from A to C. This is helpful to show that in someone who passes fructan challenges A and B but doesn’t tolerate challenge C, it doesn’t have to mean all fructan-containing foods need to be restricted – foods that are the equivalent of levels A and B should be tolerated.

WHAT IF THE LOW-FODMAP DIET DOESN’T WORK FOR ME?

BEING VEGETARIAN ON A LOW-FODMAP DIET

Eating vegetarian may be a religious, lifestyle or other choice, and people who follow a vegetarian diet can indeed eat flavorful and exciting foods. It’s important to ensure that any vegetarian diet provides all the nutrients required daily for good health. A vegetarian meal is not simply a plate of meat and three vegetables with the meat taken off. Such a meal would be lacking in protein, vitamin B12, and other essential nutrients such as iron and zinc.

In a vegetarian diet, legumes (e.g., chickpeas, various dried beans, lentils, lupins and soybeans) are often major sources of protein. While on the low-FODMAP diet, particularly in the first step, these foods are restricted. Alternative low-FODMAP vegetarian sources of protein are listed below, and may be sufficiently varied for you in the first step. Also see sample vegetarian and vegan low-FODMAP diet menu plans.

Protein-rich vegetarian foods and beverages:

lactose-free milk products (e.g., lactose-free milk and yogurts) and use the lactase enzyme to enjoy lactose-containing milk-based products
lactose-free milk-based products such as hard cheeses)
eggs
nuts and seeds – except for pistachios and cashews, all other nuts can be enjoyed; nibble in small amounts through the day
nut and/or seed spreads – 1 tablespoon
soy milks made from soybean extract or soy protein (not whole soybeans)
tofu, miso and tempeh, all of which are low-FODMAP even though they’re derived from soy
protein-enriched rice, oat or quinoa milks (check ingredients for suitability)
whole grains, e.g., brown rice, buckwheat and quinoa.

In the second step, you can continue to enjoy the high-protein foods listed above and also try to include small amounts of legumes and lentils in your diet (because of their nutritional importance), up to your symptom threshold. Lentils contain fewer FODMAPs than legume beans and chickpeas; a half cup of cooked, drained lentils contains fewer amounts of GOS and fructans compared with other legumes. You might find that you can manage your symptoms by being stricter in cutting out other FODMAP food sources so that you can “fit” these nutritious foods within your threshold.

Vegetarians should also ensure they have adequate intake of iron and zinc. Good vegetarian sources of iron and zinc include eggs, quinoa, brown rice, leafy green vegetables and nuts. Iron from plant sources is called non-heme iron, and is not absorbed as well by the body. Try to have a food containing vitamin C with your non-heme-iron foods to optimize iron absorption. A special note for vegans on a low-FODMAP diet:

It is recommended to consult a registered dietitian if you wish to follow a vegan low-FODMAP diet. Without professional advice, it may be difficult to ensure you have an adequate intake of vitamin B12 and protein, and to maintain your energy levels.
Vegans should consult with their doctors to discuss B12 supplements/injections, as B12 is only present in animal-derived foods (lacto-ovo vegetarians can get vitamin B12 from eggs and dairy products).

LOW-FODMAP DIET MENU PLANS

Day	Breakfast	Lunch	Dinner
Monday	Low-FODMAP wholegrain cereal with lactose-free (LF) milk, or gluten-free or low-FODMAP sourdough bread with butter, margarine, jam, and/or peanut butter	Ham and salad sandwich (gluten-free or low-FODMAP sourdough bread, ham, cheese, tomato, alfalfa, lettuce) 1 serving of fruit	Seasoned Steak with Spicy Tomato Relish 1 serving of french fries Salad made from low-FODMAP vegetables LF ice cream 1 serving of fruit
Tuesday	Smoothie made from LF milk, 3 strawberries, ½ banana, 1 teaspoon chia seeds, vanilla extract, cinnamon and ice cubes Low-FODMAP toast with jam	Roast beef and salad sandwich (gluten-free or low-FODMAP sourdough bread, beef, wholegrain mustard, cheese, tomato, lettuce) 1 serving of fruit	Fettuccine Marinara Salad made from low-FODMAP vegetables Berry Crumble
Wednesday	Low-FODMAP wholegrain cereal with LF milk, or gluten-free or low-FODMAP sourdough bread with butter, margarine, jam, and/or peanut butter	Chicken and Vegetable Soup Gluten-free or low-FODMAP sourdough bread 1 serving of fruit	Pepper Lamb Stir-Fry with Sticky Rice
Thursday	Low-FODMAP wholegrain cereal with LF milk, or gluten-free or low-FODMAP sourdough bread with butter, margarine, jam, and/or peanut butter	Chicken and Quinoa Salad 1 serving of fruit	Tilapia with Lemongrass Chili Noodles Buckwheat noodles LF ice cream
Friday	Smoothie made from LF milk, 3 strawberries, 10 blueberries, 5 raspberries, 1 teaspoon chia seeds, maple syrup and ice cubes Low-FODMAP toast with jam	Egg and salad sandwich (gluten-free or low-FODMAP sourdough bread, boiled egg, tomato, cucumber, lettuce, 1 teaspoon mayonnaise) 1 serving of fruit	Marinated Pork Ribs with Creamy Mash Lemon Soufflé
Saturday	Low-FODMAP wholegrain cereal with LF milk, or gluten-free or low-FODMAP sourdough bread with butter, margarine, jam, and/or peanut butter	Toasted ham and cheese sandwich (gluten-free or low-FODMAP sourdough bread, ham, cheese, tomato) 1 serving of fruit	Chicken Parmigiana Salad made from low-FODMAP vegetables
Sunday	Spanish Omelet Gluten-free or low-FODMAP sourdough bread with butter or margarine	Individual Caesar Salads with Garlic-flavored Croutons 1 serving of LF yogurt 1 serving of fruit	Roast Beef with Fragrant Asian Flavors Roast potato and green vegetables Lime Tart

Notes: The following low-FODMAP menu plans have some gluten-containing suggestions. Please choose only gluten-free foods if you also follow a gluten-free diet. When a meal calls for sandwich bread, use a maximum of two slices in the meal. Also note LF means lactose-free (not low-fat).

Day	Breakfast	Lunch	Dinner
Monday	Low-FODMAP wholegrain cereal with lactose-free (LF) lite milk, or gluten-free or low-FODMAP sourdough bread with butter, margarine, jam, and/or peanut butter	Cheese and salad sandwich (gluten-free or low-FODMAP sourdough bread, cheese, tomato, lettuce) 1 serving of fruit	Quinoa with Bell Pepper, Basil and Lemon LF ice cream 1 serving of fruit
Tuesday	Smoothie made from LF lite milk, 3 strawberries, ½ banana, 1 teaspoon chia seeds, vanilla extract, cinnamon and ice cubes, or gluten-free or low-FODMAP sourdough bread with butter, margarine, jam, and/or peanut butter	Egg and salad sandwich (gluten-free or low-FODMAP sourdough bread, boiled egg, tomato, cheese, lettuce) 1 serving of fruit	Four-Cheese Risotto Salad made from low-FODMAP vegetables Berry Crumble
Wednesday	Low-FODMAP wholegrain cereal with LF lite milk, or gluten-free or low-FODMAP sourdough bread with butter, margarine, jam, and/or peanut butter	Roasted Squash and Ginger Soup Gluten-free or low-FODMAP sourdough bread 1 serving of fruit	Stir-Fried Soba Noodles
Thursday	Low-FODMAP wholegrain cereal with LF lite milk, or gluten-free or low-FODMAP sourdough bread with butter, margarine, jam, and/or peanut butter	Moroccan Roasted Vegetable Salad 1 serving of fruit	Gnocchi with Roasted Bell Pepper Sauce LF ice cream
Friday	Smoothie made from LF lite milk, 3 strawberries, 10 blueberries, 5 raspberries, 1 teaspoon chia seeds, maple syrup and ice cubes Gluten-free or low-FODMAP sourdough bread with butter, margarine, jam, and/or peanut butter	Egg and salad sandwich (gluten-free or low-FODMAP sourdough bread, boiled egg, tomato, cucumber, lettuce, 1 teaspoon mayonnaise) 1 serving of fruit	Goat Cheese and Sweet Potato Frittata Salad made from low-FODMAP vegetables Lemon Soufflé
Saturday	Low-FODMAP wholegrain cereal with LF lite milk, or gluten-free or low-FODMAP sourdough bread with butter, margarine, jam, and/or peanut butter	Toasted tomato and cheese sandwich (gluten-free or low-FODMAP sourdough bread, tomato, cheese) Side salad made from low-FODMAP vegetables 1 serving of fruit	Pasta Puttanesca Salad made from low-FODMAP vegetables
Sunday	Asian Omelet Gluten-free or low-FODMAP sourdough bread with butter or margarine	Roasted Squash, Pecan and Blue Cheese Salad 1 serving of LF yogurt 1 serving of fruit	Tomato, Basil and Mozzarella Arancini Carrot, green vegetables Lime Tart

Day	Breakfast	Lunch	Dinner
Monday	Quinoa cooked in coconut milk served with blueberries and maple syrup	Vegan meat-free slice* and salad sandwich (gluten-free or low-FODMAP sourdough bread vegan slice, tomato, lettuce, alfalfa, 1–2 teaspoon tahini) 1 serving of fruit and small handful of low-FODMAP nuts and/or seeds	Quinoa with Bell Pepper, Basil and Lemon – replace feta with low-FODMAP vegan cheese 1 serving of fruit
Tuesday	Low-FODMAP wholegrain cereal with rice or oat milk, or gluten-free or low-FODMAP sourdough bread with dairy-free spread, jam or peanut butter	Vegan cheese and salad sandwich (gluten-free or low-FODMAP sourdough bread, low-FODMAP vegan cheese, tomato, lettuce, cucumber, carrot) 1 serving of fruit and small handful of low-FODMAP nuts and/or seeds	Pepper Tofu Stir-Fry with Sticky Rice – replace lamb with tofu and remove oyster sauce
Wednesday	Vegan smoothie made from rice or oat milk, ½ avocado, ½ banana, 1 tablespoon pepitas, vanilla extract and ice cubes	Roasted Squash and Ginger Soup Gluten-free or low-FODMAP sourdough bread 1 serving of fruit and small handful of low-FODMAP nuts and/or seeds	Stir-Fried Soba Noodles
Thursday	Gluten-free or low-FODMAP sourdough bread with dairy-free spread, peanut butter and sliced banana Glass of rice or oat milk	Moroccan Roasted Vegetable Salad – served with ½ cup cooked, drained lentils 1 serving of fruit and small handful of low-FODMAP nuts and/or seeds	Wheat-free Pasta with Roasted Bell Pepper Sauce using recipe from Gnocchi dish
Friday	Gluten-free or low-FODMAP sourdough bread with vegan cream cheese and sliced strawberries Glass of rice or oat milk	Vegan meat-free slice* and salad sandwich (gluten-free or low-FODMAP sourdough bread, vegan slice, tomato, cucumber, lettuce, avocado, egg- and dairy-free mayonnaise) 1 serving of fruit and small handful of low-FODMAP nuts and/or seeds	Tofu and Vegetable Skewers – replace beef with tofu
Saturday	Vegan smoothie made from rice or oat milk, 3 strawberries, ½ banana, 1 tablespoon rice protein powder, 1 teaspoon chia seeds, vanilla extract and ice cubes	Schnitzel* and salad sandwich (gluten-free or low-FODMAP sourdough bread, cooked vegan breaded schnitzel, tomato, lettuce) 1 serving of fruit and small handful of low-FODMAP nuts and/or seeds	Pasta Puttanesca Lettuce, cucumber, tomato
Sunday	Vanilla “Porridge” with Strawberry and Rhubarb Compote and Granola – substitute milk with oat or rice milk	Vegetable Soup – replace all chicken with 1 cup cooked, drained lentils and use onion-free vegetable stock 1 serving of fruit and small handful of low-FODMAP nuts and/or seeds	Tofu Fried Rice – replace chicken with tofu, use brown rice instead of white Sweet potato, green vegetables

Day	Breakfast	Lunch	Dinner
Monday	Gluten-free or low-FODMAP sourdough bread with butter, margarine, jam, and/or peanut butter	Ham and salad sandwich (gluten-free or low-FODMAP sourdough bread, ham, cheese, tomato, lettuce) 1 serving of fruit	Beef Bourguignon with Parsnip Croquettes Orange vegetable, green vegetable 1 serving of fruit
Tuesday	Smoothie made from lite milk, 3 strawberries, ½ banana, 1 teaspoon chia seeds, vanilla extract, cinnamon and ice cubes	Beef and salad sandwich (gluten-free or low-FODMAP sourdough bread, beef, cheese, tomato, lettuce) 1 serving of fruit	Saffron Chicken Pasta with Summer Vegetables Basil-Infused Panna Cotta
Wednesday	Gluten-free or low-FODMAP sourdough bread with butter, margarine, jam, and/or peanut butter	Chicken and Vegetable Soup Yogurt 1 serving of fruit	Lasagne Green vegetable, orange vegetable
Thursday	Gluten-free or low-FODMAP sourdough bread with butter, margarine, jam, and/or peanut butter	Moroccan Roasted Vegetable Salad 1 serving of fruit	Thai-Style Salmon with Coconut Rice
Friday	Smoothie made from lite milk, 3 strawberries, 10 blueberries, 5 raspberries, 1 teaspoon chia seeds, maple syrup and ice cubes	Egg and salad sandwich (gluten-free or low-FODMAP sourdough bread, boiled egg, tomato, cucumber, lettuce, 1 teaspoon mayonnaise) 1 serving of fruit	Crispy-Skin Pork Belly with Spiced Squash Low-FODMAP vegetables
Saturday	Gluten-free or low-FODMAP sourdough bread with butter, margarine, jam, and/or peanut butter	Toasted ham and cheese sandwich (gluten-free or low-FODMAP sourdough bread, ham, cheese) Tomato, lettuce, cottage cheese 1 serving of fruit	Chicken Tagine with Creamy Polenta Lemon Coconut Cheesecake
Sunday	Vanilla “Porridge” with Strawberry and Rhubarb Compote and Granola	Roasted Squash, Pecan and Blue Cheese Salad 1 serving of low-fat yogurt 1 serving of fruit	Roast Lamb with Rosemary Potatoes Carrots, green vegetables Salted Caramel Custards

Day	Breakfast	Lunch	Dinner
Monday	Low-FODMAP wholegrain cereal with LF milk, or gluten-free or low-FODMAP sourdough bread with butter or margarine and honey	Ham and salad sandwich (gluten-free or low-FODMAP sourdough bread, ham, cheese, tomato, lettuce) 1 serving of fruit	Pepper Lamb Stir-Fry with Sticky Rice – add sugar snap peas LF ice cream
Tuesday	Smoothie made from LF milk, 1 mango cheek, ½ banana, 1 teaspoon chia seeds, vanilla extract and ice cubes	Beef and salad sandwich (gluten-free or low-FODMAP sourdough bread, beef, cheese, tomato, lettuce) 1 serving of fruit	Saffron Chicken Pasta with Summer Vegetables Berry Crumble
Wednesday	Low-FODMAP wholegrain cereal with LF milk, or gluten-free or low-FODMAP sourdough bread with butter, margarine, or peanut butter	Omelet Wraps 1 serving of fruit	Lasagne Orange vegetable, green vegetable, potato
Thursday	Low-FODMAP wholegrain cereal with LF milk, or gluten-free or low-FODMAP sourdough bread with butter or margarine and honey	Moroccan Roasted Vegetable Salad 1 serving of fruit	Thai-Style Salmon with Coconut Rice
Friday	Smoothie made from LF milk, 3 strawberries, 10 blueberries, 5 raspberries, 1 teaspoon chia seeds, and ice cubes	Egg and salad sandwich (gluten-free or low-FODMAP sourdough bread, boiled egg, tomato, cucumber, lettuce, 1 teaspoon mayonnaise) 1 serving of fruit	Crispy-Skin Pork Belly with Spiced Squash Low-FODMAP vegetables
Saturday	Low-FODMAP wholegrain cereal with LF milk, or gluten-free or low-FODMAP sourdough bread with butter or margarine and honey	Toasted ham and cheese sandwich (gluten-free or low-FODMAP sourdough bread, ham, cheese) Side salad with low-FODMAP vegetables 1 serving of fruit	Chicken Tagine with Creamy Polenta Salted Caramel Custards
Sunday	Buttermilk Pancakes with Blueberry Compote	Chicken and Vegetable Soup 1 serving of LF yogurt 1 serving of fruit	Beef Bourguignon with Parsnip Croquettes Orange vegetable, green vegetable Strawberry and Hazelnut Cake

Day	Breakfast	Lunch	Dinner
Monday	Wheat bread with butter, margarine, jam, and/or peanut butter	Ham and salad sandwich (gluten-free or low-FODMAP sourdough bread, ham, cheese, tomato, lettuce) 1 serving of fruit	Beef Bourguignon with Parsnip Croquettes Orange vegetable, green vegetable 1 serving of fruit
Tuesday	Smoothie made from lactose-free (LF) milk, 3 strawberries, ½ banana, 1 teaspoon chia seeds, vanilla extract, cinnamon and ice cubes	Beef and salad sandwich (gluten-free or low-FODMAP sourdough bread, beef, tomato, cheese, lettuce) 1 serving of fruit	Saffron Chicken Pasta with Summer Vegetables
Wednesday	Low-FODMAP wholegrain cereal with LF milk, or gluten-free or low-FODMAP sourdough bread with butter, margarine, jam, and/or peanut butter	Roasted Squash and Ginger Soup Wheat-based bread 1 serving of fruit	Lasagne Green vegetable, orange vegetable
Thursday	Low-FODMAP wholegrain cereal with LF milk, or gluten-free or low-FODMAP sourdough bread with butter, margarine, jam, and/or peanut butter	Moroccan Roasted Vegetable Salad – using garlic 1 serving of fruit	Thai-Style Salmon with Coconut Rice
Friday	Smoothie made from LF milk, 3 strawberries, 10 blueberries, 5 raspberries, 1 teaspoon chia seeds, maple syrup and ice cubes	Egg and salad sandwich (wheat bread, boiled egg, tomato, cucumber, lettuce, 1 teaspoon mayonnaise) 1 serving of fruit	Crispy-Skin Pork Belly with Spiced Squash Low-FODMAP vegetables
Saturday	Quinoa cooked in coconut milk, served with blueberries and maple syrup	Toasted ham and cheese sandwich (gluten-free or low-FODMAP sourdough bread, ham, cheese) Side salad with low-FODMAP vegetables 1 serving of fruit	Chicken Tagine with Creamy Polenta Dark Chocolate Lava Cakes
Sunday	Corn Fritters with Herbed Ricotta, Avocado and Tomatoes – use wheat flour	Roasted Squash, Pecan and Blue Cheese Salad LF yogurt 1 serving of fruit	Roast Lamb with Rosemary Potatoes Carrots, green vegetables Passion Fruit Brûlée

3. A 2-STEP PLAN FOR THE LOW-FODMAP WAY OF EATING

STEP ONE: THE STRICT PHASE

SUMMARY OF STEP ONE

Identifying which FODMAPs cause your IBS symptoms

A SEVEN-DAY FOOD AND SYMPTOM DIARY

STEP TWO: REINTRODUCTION AND LIBERALIZATION

SUMMARY OF STEP TWO

How to do a FODMAP challenge

FODMAPs and your diet in the long term

EIGHT-WEEK FODMAP CHALLENGE

WHAT IF THE LOW-FODMAP DIET DOESN’T WORK FOR ME?

LOW-FODMAP DIET MENU PLANS

STEP ONE LOW-FODMAP MENU PLAN: ADULT

STEP ONE LOW-FODMAP MENU PLAN: KIDS

STEP ONE LOW-FODMAP MENU PLAN: LACTO-OVO VEGETARIAN ADULT

STEP ONE LOW-FODMAP MENU PLAN: VEGAN ADULT

STEP TWO LOW-FODMAP MENU PLAN WITH LACTOSE: ADULT

STEP TWO LOW-FODMAP MENU PLAN WITH MANNITOL: ADULT

STEP TWO LOW-FODMAP MENU PLAN WITH SORBITOL: ADULT

STEP TWO LOW-FODMAP MENU PLAN WITH EXCESS FRUCTOSE: ADULT

STEP TWO LOW-FODMAP MENU PLAN WITH FRUCTANS: ADULT

STEP TWO LOW-FODMAP MENU PLAN WITH GOS (AND SOME FRUCTAN TOLERANCE): ADULT