The application of the low FODMAP diet requires the expert guidance of a dietician trained in the area. A typical approach would involve restricting problematic FODMAPs for 6–8 weeks, or until good symptomatic control is achieved. This is done by:
- substituting high FODMAP foods with lower options, or
- by reducing the total FODMAP load consumed at each meal or across the day.
After this, small amounts of FODMAP-containing foods are re-introduced through challenges as advised by the dietician. The aim of challenging is to gradually increase to levels well-tolerated by the individual while widening the diet as much as possible. Below is a sample menu plan for following the low FODMAP diet.
Sample menu choices guide for a low FODMAP diet (avoid using ingredients listed in the high-FODMAP food list)
|Breakfast||Gluten-free or spelt toast with spread (sucrose sweetened, not with fructose)
Cereal (e.g. oats, Corn Flakes, Rice Krispies)
Tea or coffee (if you have lactose malabsorption, use lactose-free milk)
Serving of suitable fruit, Poached eggs and spinach
|Lunch||Gluten-free or spelt sandwich with fillings (e.g meat, salad, cheese)
Homemade soup with low FODMAP vegetables
Green salad with dressing (olive oil, lemon juice) with tuna, Roast pumpkin, goats cheese & quinoa salad
|Dinner||Meat or fish with low FODMAP vegetables or salad
Baked fish with middle eastern vegetable quinoa
Roast chicken with rosemary-infused vegetables and brown rice
Gluten-free pizza base topped with cherry tomatoes, basil, goats cheese, ham, and pineapple
|Snacks & Sweets||Serving of suitable fruit
Yogurt (if you have lactose malabsorption, use lactose-free yogurt)
Rice cakes with feta
Gluten-free biscuits, Berry crumble
A wide number of health benefits have been attributed to some FODMAPs. Fructans, inulin, and GOS are well-known prebiotics, stimulating the growth of beneficial bacteria in the gut.
For this reason, it is important to note that the “Low FODMAP diet” is not a “No FODMAP diet” and it is not a “lifetime diet.” We recommend that this diet is followed for 6–8 weeks and then your progress is reviewed by a dietician who will help advise which foods (and how much) can be gradually re-introduced into your diet.
Breath hydrogen tests are useful to identify which partly absorbed sugars – fructose, lactose, and the sugar polyols, behave as FODMAPs for the individual. (No breath tests are performed for fructans and GOS [galactooligosaccharides] since they will be malabsorbed in everyone.) For a minority of people (less than 2% of the community) who do not produce breath hydrogen or methane, breath tests do not provide useful information.
The dietician will also ensure that your diet is nutritionally adequate for you. Many people can return to their usual diet with just a few high FODMAP foods that need to be avoided.
For more information, visit http://www.med.monash.edu/cecs/gastro/fodmap/.
Adapted from IFFGD Publication #251 by CK Yao, Jessica Biesiekierski, Sue Shepherd, Peter Gibson, Eastern Health Clinical School, Monash University, Box Hill Hospital, Melbourne, Australia.