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FODMAPs diet

WebMD Feature
Medically Reviewed by Dr Rob Hicks

What is FODMAPs?

FODMAPs stands for Fermentable, Oligo-, Di-, Mono-saccharides and PolyolS.

They comprise fructose, lactose, fructo- and galacto-oligosaccharides (fructans and galactans), and polyols (such as sorbitol, mannitol, xylitol and maltitol) that are poorly absorbed in the small intestine.

This diet approach is sometimes used to treat gut symptoms such as bloating, wind, abdominal pain and an altered bowel habit such as diarrhoea and constipation associated with irritable bowel syndrome (IBS).

The low FODMAP diet was developed at Monash University in Melbourne, Australia. It has been adapted for the UK by researchers at King’s College London and implemented at Guy’s and St Thomas’ NHS Trust in London.

What is the FODMAPs approach?

The five FODMAP carbohydrates can trigger changes in fluid content and bacterial fermentation in the colon, leading to gut symptoms in susceptible individuals.

Patients therefore follow a low FODMAP diet which aims to eliminate the fermentable carbohydrates including Oligo-, Di-, Mono-saccharides and Polyols.

These carbohydrates are eliminated from the patient’s diet for a trial period with the aim of re-introducing each FODMAP carbohydrate gradually to observe symptoms.

What foods are sources of high FODMAP?

These are just a few examples of foods high in FODMAP:

Fructose: Apples, pears, peaches, mango, sugar-snap peas, watermelon, tinned fruit in natural juice.

Lactose: Milk, ice cream, yoghurt and cheeses.

Oligosaccharides (fructans and/or galactans): Vegetables including Brussels sprouts, cabbage, onions; cereals, legumes and some fruits.

Polyols: Fruits including apples, cherries and plums; vegetables such as avocado, cauliflower and mushrooms; artificial sweeteners, usually ending in ‘-ol’, such as sorbitol. Some manufactured foods, such as low sugar foods may contain polyols. Check the ingredients list.

Does the FODMAP diet work?

According to researchers at King’s College London, the low FODMAP diet is effective for about 70% of people with IBS who try it. They report no evidence that it works for non-gut symptoms that are sometimes associated with IBS, such as headaches and skin or joint problems.

A 2009 study by Monash University researchers concluded that the low FODMAP diet provides an effective approach to the management of patients with functional gut symptoms and that there was sufficient evidence available to recommend its widespread application.

"The Low FODMAP diet is based on sound scientific evidence and offers a good diet solution for IBS sufferers," according to Sasha Watkins, a registered dietitian. "Ideally FODMAP foods should be removed from the diet for a period of eight weeks - which seems like a long time, but many people report improvements in their symptoms after as little as two weeks."

She continues: "A key strength of the diet is that it is individually tailored to each patient as no two IBS sufferers are the same. When foods are reintroduced, quantities are slowly increased to pin-point individual levels of tolerance. Complete elimination of FODMAP foods is important to get good results. Eating out or going on holidays can pose a challenge but the occasional slip up can help provide proof that that the diet is working."

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