What Actually Are FODMAPs and who is the Low FODMAP Diet for?
Heard about fructose malabsorption or lactose intolerance?
Seen a FODMAP Friendly food product on the grocery shelves? It’s likely you might know someone who modified their diet for these reasons. Perhaps you even follow or have been advised to follow a Low FODMAP Diet.
So what actually are these things called FODMAPs, what foods are they found in and why do some people go on a low FODMAP diet?
A diet low in FODMAPs (a “Low FODMAP Diet”) is a dietary protocol which has been scientifically proven for the management of uncomfortable digestive symptoms of Irritable Bowel Syndrome (IBS).
FODMAPs are certain types of sugars (short-chain carbohydrates) that can trigger uncomfortable digestive symptomsin people with a sensitive gut. They are found in a wide range of food and drinks such as milk, beans, onion, garlic, apples and wheat. FODMAPs are sometimes added to foods during processing as well.
Without getting too scientific, if we flashback to high school science for a moment (if you remember paying attention back then), you may have learnt about the main nutrients that make up food. One of these is carbohydrates (or carbs). Carbohydrates are made up of smaller sugar molecules joined together to make up a chain.
So, FODMAPs are various short carbohydrate chains. They are known to be poorly absorbed in the part of the digestive tract where most nutrients are absorbed (the small intestine) and instead continue to the large intestine (colon). This is where FODMAPs mostly have their effect, triggering symptoms like bloating, excess gas and pain.
The term FODMAPs stands for Fermentable, Oligosaccharides, Disaccharides, Monosaccharides and Polyols which are the scientific names of these different short-chain carbohydrates. Fermentable refers to the fact that these carbohydrates can be fermented by gut bacteria to produce gases. “Saccharide” is a scientific term for sugar and the prefix of the name indicated the length of these sugars, for example, “di” means two, so a disaccharide is made of two sugars.
What foods are the FODMAPs found in?
Oligosaccharides- Fructans and Galactooligosaccharides: Wheat, rye, barley, onion, garlic, legumes and fruit & vegetables.
Disaccharides- Lactose: Cow’s milk, yoghurt, ice-cream, custard, cream and some soft cheeses.
Monosaccharides- Excess Fructose: Certain fruits and vegetables including mango and asparagus, fruit juice, honey and high-fructose corn syrup.
Polyols- Sorbitol, Mannitol, Maltitol, Xylitol: Certain fruit and vegetables (cauliflower, mushrooms, stone fruit) and some low-calorie sweetened products such as sugar-free gums and mints.
What about pre-packaged foods?
Levels of FODMAPs in food vary depending on the portion size and the way the food is processed. Therefore, it can often be tricky to read food labels to work out if a food is low FODMAP. Many food companies are now registering their products for FODMAP friendly accreditation.
If you see the green FODMAP Friendly logo on any food products, then rest assured that product is suitable for consumption whilst following a low FODMAP diet at the packet serve size.
How do FODMAPs trigger IBS symptoms?
FODMAPs have 2 main features that influence how they trigger digestive symptoms:
1. By attracting water into the intestine. This can create pressure in the gut and can result in loose stools or diarrhoea.
2. They are rapidly fermented in the large intestine by bacteria that reside the gut (ie. the gut microbiome). The fermentation results in the release of gas which can cause the intestinal wall to stretch and expand. In people with a sensitive gut (ie. people with IBS), the stretching and expansion can trigger digestive symptoms including bloating, cramping, abdominal pain and constipation.
The Phases of the Low FODMAP Diet
The Low FODMAP Diet commonly involves three phases: elimination, reintroduction/challenging FODMAPs and maintenance/individualisation.
Phase 1: Elimination
In the elimination phase, all foods with high FODMAP levels are eliminated from the diet. The purpose of this step is to determine whether removing FODMAPs makes a significant difference in gut symptoms. This step usually lasts 2-4 weeks.
Phase 2: Challenge/ Reintroduction
The challenge phase is then commenced if symptom improvement is seen after the completion of the elimination phase. Challenging FODMAPs is a way of identifying which types of FODMAPs are tolerated and which are problematic. This phase is also essential for understanding the amount of FODMAPs you can tolerate, which is known as your individual “threshold”.
Doing these challenges helps to ensure that only problematic foods are limited long term and prevents the need for an over-restrictive diet which can limit a variety of plant-based foods in the diet. Each FODMAP is challenged with a specific test food one at a time and can take several months to complete all challenges.
Phase 3: Individualisation/personalisation
The individualisation/personalisation phase is the next stage once all the FODMAPs have been “challenged” and individual tolerance of each FODMAP has been identified. This looks like a long-term modified FODMAP diet, where well-tolerated high FODMAP foods are reintroduced and included in the diet and only the problematic high FODMAP foods (identified in the challenge phase) are limited.
The aim is to increase the variety in the diet as much as possible while balancing symptoms. Eating a diverse range of food (especially plant-based foods) is associated with positive long-term gut health and improves the social, cultural and mental factors that play a huge part in food enjoyment.
Generally, most people don’t react to all FODMAPs, but rather have one or two main FODMAP triggers. This means that the long-term personalisation phase of the diet provides much more variety than the initial elimination phase.
‘I think I might benefit from low FODMAP, where do I start?’
Before starting on the diet, it’s firstly important to actually make sure it’s IBS and not another gut-related condition. The symptoms of IBS (bloating, pain, constipation, diarrhoea, flatulence) can present identically to other serious gut conditions, mainly – Inflammatory Bowel Diseases (IBD), coeliac disease and even bowel cancer. That’s not to say the IBS itself isn’t serious, as of course, IBS can be very debilitating and greatly impact one’s quality of life. Although, it is very important to rule out these other conditions which can cause structural damage to the gut and other body parts. If you suffer from uncomfortable gastrointestinal symptoms then seeing a doctor is the first step to take to determine a diagnosis.
If you do have IBS, there may be other more simple strategies to implement before going straight to the low FODMAP diet. For instance, adequate hydration, dietary fibre intake, reduction of gut irritants (such as alcohol and caffeine) and incorporating stress-management strategies into your routine are all useful strategies for managing gut symptoms.
This is where seeing an Accredited Practising Dietitian trained in digestive health comes in to play. An expert dietitian can support you to find the best-individualised management approach. If that happens to be the low FODMAP diet, a dietitian will be able to guide you through the 3 phases while ensuring your diet provides all the nutrients you need and, importantly, that it is flavoursome and enjoyable.
Rebecca is an Accredited Practising Dietitian, graduated from Monash University in 2018.
She works predominately in the space of gut health and digestive disorders such as Irritable Bowel Syndrome.
She has expertise in the practical implementation of the Low FODMAP Diet and also has a strong interest in the link between mental health and gastrointestinal health. Rebecca is passionate about supporting people to achieve their health goals and develop healthy relationships with food where they can eat with ease.
How to handle celebrations when your child has allergies- Jackie Nevard
December is a busy time with Christmas parties, family get-togethers, endless food being given out, change in family routines and instead of being enjoyable can feel overwhelming and can often be a high-risk time if not managed well.
In my session I will cover :
How to handle celebrations at childcare, especially Christmas and Easter.
How to manage school celebrations, Christmas parties, sports day, and graduation.
How to make sure your child is included in school functions all year long.
How to manage family celebrations when your family doesn’t get it.
I’ll be sharing our own story of when things went wrong on Christmas Day
Why it’s important to share the load this holiday season
I understand the challenges of bringing up a child with life-threatening allergies and my session offers practical tips and tricks to make celebrations inclusive and enjoyable for everyone, including YOU!
Founded in 2012 Jackie Nevard is the founder and creator behind My Food Allergy Friends. Jackie is the author of the children’s allergy book series featuring Thai & Rabbie. Her son Thai has multiple food allergies, and after realising the need for allergy education
when her son was diagnosed with 7 food allergies, Jackie launched My Food Allergy Friends. She has produced six books in her educational allergy series, a string of educational resources for parents, schools, and childcare centres, and runs the
Food Allergy Smart program in childcare centres and schools as well as her popular allergy awareness sessions in Australia.
Jackie also Co-Founded Allergy Masterclass with Simone Albert providing allergy education for families focusing on practical tips for home life, kindy, and school and addressing the mental health aspect of allergies that are often overlooked. Allergy Masterclass is passionate about educating everyone, so families can work together in providing safe and a fun-filled life for their children. Bringing grandparents, mums, dads, aunts, uncles, and children together to empower them to live an amazing life with allergies.
Living with Coeliac and being an elite athlete - Brooke Stratton
Living with Coeliac and being an elite athlete with Brooke Stratton
Brooke will be sharing an insight into her career thus fur, her diagnosis of coeliac disease touching on some of the struggles she faced prior to diagnosis, the challenges that come with being an elite athlete living and travelling with coeliac disease and how her diagnosis has changed her life for the better.
Brooke is an Olympian, the current Australian record holder in the long jump and a 2018 Commonwealth Games silver medallist.
Brooke was diagnosed with Coeliac Disease in 2013 and has been fortunate enough to be an ambassador for Coeliac Australia for several years.
For people experiencing IBS, eating out can cause stress, anxiety and feelings of embarrassment. These are completely normal. HOWEVER, you shouldn’t have to feel that way! By using some tricks and tips you can eat out without fear and be present and enjoy the company of loved ones.
Knowing ahead of time what’s on the menu is a great strategy to help get rid of some of the anxiety that builds up before eating out. By scanning the menu and taking note what’s in each dish and what’s friendly for your tummy, you can have an idea of what you’re going to order in advance. This helps you to feel comfortable and confident knowing that you’re able to make an informed decision and won’t feel pressured at the moment and make a choice that leads you worrying about the impending explosion in your belly. Stress is also known to trigger these symptoms in some people so anything that can help lower stress is absolutely a win!
2.Know your triggers
Having an awareness of what specific foods trigger your symptoms is a massive advantage when looking at a menu and making a choice. Knowing your triggers means you can avoid these foods completely or ask them to be excluded from a dish where possible. If you’re still in the beginning stage of a low FODMAP diet for the first time and still working out your triggers, it may be harder to make a safe choice but that’s not to say you can’t, it just means you may need to tread more cautiously and your options may be limited. However, if you let the staff know about your dietary requirements, they’ll most likely be able to find something suitable for you.
3.On the side, please
Sauces, dips, curries and other rich dishes are often hiding onion and garlic, two common triggers for IBS sufferers. By asking for them on the side, you are in control of how much you eat, as they may be safe in smaller quantities. Don’t worry about sounding fussy! It’s a completely reasonable request and a valid concern. Nobody wants the uncomfortable, often painful, symptoms that occur after eating these foods if they can avoid it.
4.Pay attention to quantities
As mentioned above, although certain foods/substances may be triggers for you, they may be safe in when consumed in smaller quantities. Alcohol falls into this category – too much alcohol may increase the ‘leakiness’ of the gut in the short term, which affects the normal movement of the gut and can lead to symptoms, particularly for those with sensitive tummies. Some strategies around alcohol are:
Be mindful of how many drinks you’re having and limit yourself to just 1 or 2. I know everyone says it, but you can still have fun with only a couple of drinks, especially if you’re around the right people!
f you’re drinking wine, pour a smaller glass and top it up with soda water. This helps with hydration as well so you’re still getting the taste but not the dehydration, it’s a win-win!
If you’re concerned about alcohol and want to avoid it completely, have a kombucha or mocktail instead, that way you won’t feel like you’re missing out
5.When in doubt, go back to basics
Although it may seem boring, a piece of protein with steamed veggies or a side salad (dressing on the side) is a great, safe option if nothing on the menu seems suitable.
6.Don’t forget your fibre
Try your best to include something on your plate that feeds your gut bugs. Examples include vegetables, fruit, whole grains, legumes, nuts and seeds. These plant-based foods help nourish our guts and keep them happy, healthy and functioning normally. Fibre also helps us to feel full so ordering a side of one of these can help prevent overeating, which can lead to symptom development.
7.Use your support network
Although it may be embarrassing to talk about at first, let those closest to you know about your IBS and how eating out creates those feelings of dread and anxiety. If they decide on a restaurant or café that doesn’t seem to have any suitable options on their menu for you, let them know and they’re more than likely going to be understanding and accommodating to your needs. If you need more support, ask your dietitian! That’s what they’re there for, after all, to support and guide you in your journey to becoming symptom-free.
If there is one take away from this piece, it is that IBS shouldn’t prevent you from enjoying food and the company of your nearest and dearest. Food is so much more than just what to eat, but it is often a foundation of our social behaviours as humans. We use it to celebrate, commiserate, and catch up with both old and new friends. By using some of these simple tips, you can remove some of the fear associated with eating out and instead use that energy to be completely present and at ease in the company you choose to keep.
Chelsea is an online dietitian based in Brisbane, Australia. She specialises in irritable bowel syndrome (IBS) and the low FODMAP diet. She provides professional online video consultations and programs enabling clients from across Australia and around the world to access her specialised services.
Why it is important to be tested and diagnosed with coeliac disease. Georgia Hexter @oftengood
You’re experiencing a lot of symptoms that sound (and feel!) like coeliac disease, and you usually feel your best when you’re avoiding gluten-containing foods, so it must be celiac disease, right?
It is common that people confuse symptoms in response to fructan malabsorption for coeliac disease, and vice versa! Fructans are a carbohydrate structure made up of chains of fructose, that are poorly digested and absorbed by some people, particularly those with IBS. Fructans are found in rye, barley, oats and wheat, and which are also gluten-containing foods.
Symptoms of fructan malabsorption include increased flatulence, bloating, and diarrhea, similar symptoms to that of coeliac disease. It is common for people to cut out gluten, and begin to feel better as the fructan load of their diet has reduced, and therefore come to the conclusion that is must be coeliac disease..
Part of the low FODMAP diet often includes choosing gluten free breads, biscuits and pasta, but it is important that your GP has tested for coeliac disease before your commence a low FODMAP diet in order to ensure we aren’t confusing coeliac disease of IBS.
When testing for coeliac disease your gastroenterologist will be looking for the damage caused to your body when you are eating a gluten including diet. If you have stopped eating gluten containing foods your body may begin to heal, resulting in unreliable, and falsely negative results. This might mean you continue to include small amounts of gluten, or not consider cross contamination, and therefore have improvements in symptoms but still be exposed to gluten, and still be damaging your gastrointestinal tract.
If you have begun a gluten free diet before testing it isn’t the end of the world! It just means that a normal, gluten containing diet much be resumed for at least 6 weeks before your tests. This usually includes a gluten challenge, in which a minimum equivalent of four slices of wheat-based breads should be consumed each day. Speaking to a dietitian to receive support and guidance on your gluten challenge can be really helpful!
A clear diagnosis is important! If it is IBS then cross contamination with gluten containing products, and inclusion of small amounts of wheat-containing products is typically ok. Fructans are part of the FODMAP family, and management of fructan malabsorption often involved a low FODMAP diet and structured reintroduction in order to understand what other foods may trigger symptoms, and how much of each of the FODMAP groups, and the overall FODMAP load you can tolerate.
On the other hand, a strict gluten free diet must be adhered to if coeliac disease is the reason behind the symptoms and discomfort. Either way, the help and support of an accredited practicing dietitian can be incredibly helpful!
Georgia is a Melbourne based private practice dietitian, nutritionist and recipe creator, and the face behind @oftengood on Instagram!
She is passionate about making healthy eating fun, accessible and achievable for all people. Georgia follows an ‘all foods fit’ approach to nutrition, and promotes mindfulness, intuitive eating and joyful movement.
Georgia is committed to empowering and inspiring her clients to improve their health and wellbeing through sustainable nutrition and lifestyle changes. She specialises in Eating Disorders, Disordered Eating, and improving food and body relationships, and follows a non-diet approach.
Georgia also assists clients in managing gut issues including Coeliac disease and IBS, and Chronic Disease Management. Georgia is committed to providing evidence based, collaborative, nurturing and client-centred care, and her skills lie in building client confidence and capacity to take charge of their health.
Low FODMAP: Getting Enough Fermentable Fibre to Support Gut Microbial Balance
Wholefood blends from a naturopath’s kitchen.
refined sugar free
made from mostly organic ingredients
Making it easy to cram as much goodness into your family as possible without making everything from scratch! Starting out in 2012 selling through Qld farmer’s markets, products are now available through many healthy stores Australia wide & online.