What are FODMAPs?

By Christine Salamida, APRN

FODMAP stands for Fermentable Oligo-, Di-, and Monosaccharides and Polyols. FODMAPS are are types of carbohydrates or sugars found in certain foods that may be difficult to digest for some people. Individuals with irritable bowel syndrome (IBS), slow moving gut, or other bowel disorders may have difficulty digesting FODMAPS and may benefit from diet modification to lower the number of FODMAPs in their diet. Carbohydrates considered to be FODMAPs are:

Oligosaccharides:

  • Two types: Fructans & Galactans
    • Fructans found in wheat, onions, garlic, artichokes, bananas
    • Galactans found in kidney beans, lentils, chick peas, broccoli, and brussel sprouts

Disaccharides:

  • The most common disaccharide is lactose found in products made from cow, sheep, and goat milk
  • Milk, yogurt, soft cheeses, and pudding are all foods that contain lactose

Monosaccharides:

  • Fructose and Glucose are monosaccharides
  • Fructose is found naturally in fruits, vegetables, and honey.
  • Glucose is found in fruits, vegetables, pasta, rice, potatoes, yogurt, and milk.

The ability to absorb fructose varies among individuals. People with IBS and other bowel disorders may have fructose intolerance and may experience symptoms of gas, bloating, abdominal cramping, and diarrhea when they consume foods higher in fructose, such as fruits and fruit juices. Glucose is easier to digest and when fruits and juices contain more glucose and less fructose they may be more easily digested.

High Fructose Corn Syrup (HFCS):

HFCS is found in many processed foods. It is made up of almost half glucose and half fructose and may be tolerated by some patients. Therefore, items with HFCS, such as soft drinks, may be tolerated in limited amounts. Limit to 12 oz per day taken with a meal. Unfortunately, even small amounts of processed fruits juice or HFCS may cause intestinal discomfort and or malabsorption in some patients.

Polyols

  • Sorbitol
  • Mannitol
  • Xylitol
  • Maltitol

Polyols are sugar alcohols that may be found in some stone fruits (such as cherries and nectarines) apples and pears; certain vegetables like mushrooms and cauliflower and artificial sweeteners, xylitol and sorbitol. Sorbitol found in “diet” foods or sugar free candies, chewing gum, soft drinks, and other sugar free products can have a laxative effect and create similar gastrointestinal symptoms as fructose.

General Guidelines for a Low FODMAP Diet:

  • Eliminate products with ingredients that list fructose, crystalline fructose (not HFCS), honey, and sorbitol on the label.
  • Avoid sugar alcohols. These include sorbitol, isomalt, lactitol, maltitol, mannitol, xylitol, erythrytol and lactatol. These are often found in “diet” or diabetic foods.
  • Limit drinks with HFCS. If used, drink less than the recommended serving size of 12 oz and try to drink it with a meal.
  • Check your medications for fructose and sorbitol. They are not always listed on the label, so check with your pharmacist or the manufacturer.
    • Any liquid medications and some personal care items may contain lactose or the sugar alcohols. Examples include: liquid pain relievers (including liquid gel caps), cough medicines, and cough drops. If possible, choose a tablet or caplet form instead of liquid medication. If you have eliminated FODMAPs from your diet and are still having symptoms, talk to your pharmacist to see if any of your medications contain FODMAPs.
  • Keep in mind the amount of fructose found in 2 apples or 2 oz of honey is the same as the amount of fructose in 1 can of soda but have more nutritional benefits.
  • Follow the guidelines below to choose fruits, vegetables and other foods that are friendlier to your intestines.

Fruits:

  • Serving size is ½ cup and limit to 1-2 servings per day.
  • Fresh or frozen fruit may be better tolerated than canned fruit
  • Limit concentrated sources of fruits, such as dried fruit and fruit juices
  • Avoid eating large amounts of any fruit

Intestine Friendly Fruits:

  • Bananas*, blackberries, blueberries, grapefruit, honeydew, kiwi, lemons, limes, mandarin orange, melons, oranges, papaya, passion fruit, pineapple, raspberries, rhubarb, strawberries, and tangelos.

Fruits to Avoid if FODMAP Intolerant:

  • Apples, apple cider, apple juice, applesauce, apricots, cherries, dates, grapes, lychee, mango, peaches, pears, pear juice, plums, prunes, and watermelon

Vegetables:

  • Serving size is ½ cup or 1 cup of leafy green vegetables
  • Limit to 1 ½-3 servings per day
  • Cooked vegetables may be tolerated best as cooking causes a loss of free sugars
  • Keep in mind tolerance may depend on the amount you eat at one time

Intestine Friendly Vegetables:

  • Bamboo shoots, bok choy, carrots, celery, cucumber*, eggplant*, green beans*, green peppers*, leafy greens, parsnip, pumpkin, red bell peppers, spinach, sweet potatoes, tomatoes, and other root vegetables

Vegetables to Avoid if FODMAP Intolerant:

  • Artichokes, asparagus, some beans (baked, chick peas, kidney beans, lentils), beet root, broccoli, brussel sprouts, cabbage, cauliflower, fennel, garlic, sugar snap peas, leeks, soy products, okra, onions, peas, and shallots
    *Indicates possible gas forming foods that may need to be avoided.

References:

Gibson, P. and Shepherd, S. (2010). Evidence-based Dietary Management of Functional Gastrointestinal Symptoms: The FODMAP Approach. The Journal of Gastroenterology and Hepatology, 25(2) 252-258.

King, K. (2016, April 18). What is the Low FODMAP Diet? Retrieved from http://www.eatright.org/resource/health/allergies-and-intolerances/food-intolerances-and-sensitivities/what-is-the-low-fodmap-diet