Evidence-based Dietary Management of Functional Gastrointestinal Symptoms: The FODMAP Approach

Peter R Gibson; Susan J Shepherd

J Gastroenterol Hepatol. 2010;25(2):252-258.

More Than Just FGID

There is considerable evidence to point to a strong association of functional gut disorders with inflammatory bowel disease; FGID appears to be about two- to threefold more common in than in the general community.^[43,44] Functional gut symptoms in patients with quiescent inflammatory bowel disease appear to respond just as well to the low FODMAP diet.^[45] Other applications include patients with troublesome frequency of bowel actions in the presence of an ileal pouch. In a pilot study, the frequency of pouch emptying was reduced when the low FODMAP diet was instituted, particularly in those who had a high dietary intake of FODMAPs, although there was little evidence of any benefit in those with pouchitis.^[46] Likewise, high ileostomy output might respond to reducing dietary FODMAP intake, although the study was not performed in patients who considered their ileostomy output troublesome.^[7]

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Table 1. Food sources of FODMAPs (where FODMAPs are problematic based on standard serving size) and suitable alternatives
FODMAP	Excess fructose	Lactose	Oligosaccharides (fructans and/or galactans)	Polyols
Problem high FODMAP food source	Fruits: apples, pears, nashi pears, clingstone peaches, mango, sugar snap peas, watermelon, tinned fruit in natural juice Honey Sweeteners: fructose, high fructose corn syrup Large total fructose dose: concentrated fruit sources; large serves of fruit, dried fruit, fruit juice	Milk: cow, goat and sheep (regular & low-fat), Ice cream Yoghurt (regular & low-fat) Cheeses: soft & fresh (e.g. ricotta, cottage)	Vegetables: artichokes, asparagus, beetroot, Brussels sprout, broccoli, cabbage, fennel, garlic, leeks, okra, onions, peas, shallots. Cereals: wheat & rye when eaten in large amounts (e.g. bread, pasta, couscous, crackers, biscuits) Legumes: chickpeas, lentils, red kidney beans, baked beans Fruits: watermelon, custard apple, white peaches, rambutan, persimmon	Fruits: apples, apricots, cherries, longon, lychee, nashi pears, nectarine, pears, peaches, plums, prunes, watermelon Vegetables: avocado, cauliflower, mushrooms, snow peas Sweeteners: sorbitol(420), mannitol(421), xylitol(967), maltitol (965), isomalt (953) & others ending in '-ol'
Suitable alternative low-FODMAP food source	Fruit: banana, blueberry, carambola, durian, grapefruit, grape, honeydew melon, kiwifruit, lemon, lime, mandarin, orange, passionfruit, paw paw, raspberry, rockmelon, strawberry, tangelo. Honey substitutes: maple syrup, golden syrup Sweeteners: any except polyols	Milk: lactose-free, rice milk Cheese:'hard' cheeses including brie, camembert Yoghurt: lactose-free Ice cream substitutes: gelati, sorbet Butter	Vegetables: bamboo shoots, bok choy, carrot, celery, capsicum, choko, choy sum, corn, eggplant, green beans, lettuce, chives, parsnip, pumpkin, silverbeet, spring onion (green only), tomato Onion/garlic substitutes: garlic-infused oil Cereals: gluten-free & spelt bread/cereal products	Fruits: banana, blueberry, carambola, durian, grapefruit, grape, honeydew melon, kiwifruit, lemon, lime, mandarin, orange, passionfruit, paw paw, raspberry, rockmelon Sweeteners: sugar (sucrose), glucose, other artificial sweeteners not ending in 'ol'

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