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.

Conclusions

The low FODMAP diet provides an effective approach to the management of patients with functional gut symptoms, with an increasing evidence base. It is a dietitian-delivered diet that achieves a high degree of compliance. It provides relief of global symptoms in the majority of patients with IBS and offers improvement in functional gut symptoms in patients with inflammatory bowel disease. It warrants widespread application.

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Conflicts of interest
SJS has published five cookbooks directed towards issues of celiac disease and low FODMAP diet. The authors have registered the term 'FODMAPs' as a trademark.

Acknowledgments
Studies presented in this review were supported by National Health & Medical Research Council of Australia via a project grant and scholarship for SJS, the Eva and Les Erdi Foundation, Sir Robert Menzies Memorial Research Scholarship in the Allied Health Sciences.

Cite this: Evidence-based Dietary Management of Functional Gastrointestinal Symptoms: The FODMAP Approach - Medscape - Feb 01, 2010.

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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