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Elimination Diet: FODMAPs

FODMAPs (Fermentable Oligo-Di-Mono saccharides And Polyols) are a group of small chain carbohydrates (sugars and fibers) that are commonly found in everyday foods including certain grains, fruits, nuts, candies and also some medicines. In those people afflicted with intolerance to FODMAPs, the ingestion of FODMAPs contributes to abdominal symptoms such as bloating, abdominal cramps and pain, constipation, diarrhea and flatulence.

 

A FODMAP-free diet may be necessary to either establish or confirm the diagnosis of FODMAP intolerance or to treat the condition and reverse the symptoms associated with ingesting FODMAPs.


Definitions:

 

Food Sensitivity:

A catch-all term for conditions which result in symptoms due to ingestion of a food or nutrient, regardless of the mechanism by which the symptoms occur.

 

Food Intolerance:

Symptoms resulting from the inability to digest/metabolize a food or nutrient – symptoms that are usually limited to the gastrointestinal (GI) tract.

 

Food Hypersensitivity:

An immune/allergic response to a food or nutrient that causes gastrointestinal (GI) symptoms and/or systemic symptoms.

 

 

See:

Food Intolerance & Sensitivity: An Overview

Food Intolerance & Sensitivity: Gluten

Elimination Diet: Gluten

 

See also:

Diet & Diets

Diet & Pain – An Overview

Diet & Fibromyalgia

 

Wellness/Anti-Inflammatory Diets (coming soon):

Mediterranean Diet

Paleo Diet

Okinowan Diet

Elimination Diets

Fasting

 

Diet Supplements:

Supplements – An Overview

Minerals

Vitamins


Key to Links:

Grey text – handout

Red text – another page on this website

Blue text – Journal publication

 

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Elimination Diet – FODMAPs

As a consequence of their resistance to digestion in the proximal small bowel, individuals with intolerance to FODMAPs (Fermentable Oligo-Di-Mono saccharides And Polyols) may have abdominal symptoms such as bloating, abdominal cramps and pain, constipation, diarrhea and flatulence.

 

For those with GI symptoms suggestive of FODMAP intolerance, an elimination diet, whereby FODMAPs are eliminated from the diet for 3-4 weeks, can be both diagnostic and therapeutic. The following two lists of foods, one high in FODMAPs and one low in FODMAPs, are presented as a guide to those wishing to confirm their likelihood of FODMAP intolerance by eliminating FODMAPs from their diet.

 

In some cases, people with established diagnoses may have an underlying FODMAP intolerance that either overlaps with their diagnosis or a FODMAP intolerance is misdiagnosed as a manifestation of their diagnosis. It may be argued, therefore, that even patients with alternative diagnoses for their GI symptoms such as Irritable bowel syndrome (IBS) and Fibromyalgia (FM) should consider a trial FODMAP elimination diet.

 

Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome (IBS) is a relatively common condition with similar GI symptoms that are associated with FODMAP sensitivity.

See: IBS

 

Fibromyalgia (FM)

Fibromyalgia is a condition associated with many symptoms including widespread pain, fatigue and impaired cognition manifest as “brain fog,” forgetfulness or lack of concentration. It is not uncommon for those with FM to also have GI symptoms similar to FODMAP intolerance that may be attributed to the nervous system irregularities associated with FM. Studies have found that many people with FM and GI symptoms respond to a FODMAP elimination diet with improvement or resolution of their GI symptoms.

See: Diet & Fibromyalgia

 

Gluten Sensitivity

Sensitivity to gluten may take the form of Celiac disease (a hypersensitivity to gluten) or Non-Celiac Gluten Sensitivity (NCGS), a collection of poorly understood conditions that do not meet diagnostic criteria for Celiac disease. Gluten sensitivity is associated with many systemic symptoms that include headaches, joint pain, depression and GI symptoms similar to those associated with FODMAP intolerance.

Because of the overlapping presence of both gluten and FODMAPs in wheat, barley and rye,  some cases of non-celiac gluten sensitivity (NCGS) may actually be FODMAP sensitivity. As such, evaluation of a diet eliminating not just these grains but other foods containing FODMAPs may be valuable in establishing an accurate diagnosis of the condition responsible for the GI symptoms.

See: Food Intolerance & Sensitivity: Gluten

 

High FODMAP Foods


Vegetables and Legumes

Avoid entirely if possible:

  1. Garlic – Includes garlic salt, garlic powder
  2. Onions –Includes onion powder, pickled onions

 

  1. Artichoke
  2. Asparagus
  3. Baked beans
  4. Beetroot
  5. Black beans
  6. Black eyed peas
  7. Broad beans
  8. Butter beans
  9. Cassava
  10. Cauliflower
  11. Celery – greater than 5cm of stalk
  12. Cho cho
  13. Choko
  14. Falafel
  15. Fermented cabbage e.g. sauerkraut
  16. Haricot beans
  17. Kidney beans
  18. Lima beans
  19. Leek bulb
  20. Mange Tout
  21. Mixed vegetables
  22. Mung beans
  23. Mushrooms
  24. Peas, sugar snap
  25. Pickled vegetables
  26. Red kidney beans
  27. Savoy Cabbage
  28. Soy beans / soya beans
  29. Split peas
  30. Scallions / spring onions (bulb / white part)
  31. Shallots
  32. Taro

 

Fruit

  1. Apples
  2. Apricots
  3. Avocado
  4. Blackberries
  5. Boysenberry
  6. Cherries
  7. Currants
  8. Custard apple
  9. Dates
  10. Feijoa
  11. Figs
  12. Goji berries
  13. Grapefruit
  14. Guava, unripe
  15. Lychee
  16. Mango
  17. Nectarines
  18. Paw paw, dried
  19. Peaches
  20. Pears
  21. Persimmon
  22. Pineapple, dried
  23. Plums
  24. Pomegranate
  25. Prunes
  26. Raisins
  27. Sultanas
  28. Tamarillo
  29. Tinned fruit in apple / pear juice
  30. Watermelon

 

Meats, Poultry and Meat Substitutes

  1. Chorizo
  2. Sausages
  3. Processed meat – check ingredients

 

Cereals, Grains, Breads, Biscuits, Pasta, Nuts and Cakes

Wheat containing products such as (be sure to check labels):

  1. Biscuits including chocolate chip biscuits
  2. Bread, wheat – over 1 slice
  3. Breadcrumbs
  4. Cakes
  5. Cereal bar, wheat based
  6. Croissants
  7. Crumpets
  8. Egg noodles
  9. Muffins
  10. Pastries
  11. Pasta, wheat over 1/2 cup cooked
  12. Udon noodles
  13. Wheat bran
  14. Wheat cereals
  15. Wheat flour
  16. Wheat noodles
  17. Wheat rolls
  18. Wheatgerm

 

Almond meal

Amaranth flour

Barley including flour

Bran cereals

Bread:

  1. Granary bread
  2. Multigrain bread
  3. Naan
  4. Oatmeal bread
  5. Pumpernickel bread
  6. Roti
  7. Sourdough with kamut

 

Cashews

Cous cous

Einkorn flour

Freekeh

Gnocchi

Granola bar

Muesli cereal

Muesli bar

Pistachios

Rye

Rye crispbread

Semolina

Spelt flour

 

Condiments, Dips, Sweets, Sweeteners and Spreads

Agave

Caviar dip

Fructose

Fruit bar

Gravy, if it contains onion

High fructose corn syrup (HFCS)

Hummus / houmous

Honey

Jam, mixed berries

Jam, strawberry, if contains HFCS

Pesto sauce

Quince paste

Relish / vegetable pickle

Stock cubes

Sugar free sweets containing polyols – usually ending in -ol or isomalt

Sweeteners:

  1. Inulin
  2. Isomalt
  3. Maltitol
  4. Mannitol
  5. Sorbitol
  6. Xylitol
  7. Tahini paste
  8. Tzatziki dip

 

Prebiotic Foods

The follow items may be hiding in yoghurts, snack bars etc:

FOS – fructooligosaccharides

Inulin

Oligofructose

Drinks

Beer – if drinking more than one bottle

Coconut water

Cordial, apple and raspberry with 50-100% real juice

Cordial, orange with 25-50% real juice

Fruit and herbal teas with apple added

Fruit juices in large quantities

Fruit juices made of apple, pear, mango

Orange juice in quantities over 100ml

Rum

Sodas containing High Fructose Corn Syrup (HFCS)

Soy milk made with soy beans – commonly found in USA

Sports drinks

Tea:

  1. Black tea with added soy milk
  2. Chai tea, strong
  3. Dandelion tea, strong
  4. Fennel tea
  5. Chamomile tea
  6. Herbal tea, strong
  7. Oolong tea
  8. Wine – if drinking more than one glass

 

Dairy Foods

Buttermilk

Cheese, cream

Cheese, Halmoumi

Cheese, ricotta

Cream

Custard

Gelato

Ice cream

Kefir

Milk:

  1. Cow milk
  2. Goat milk
  3. Evaporated milk
  4. Sheep’s milk
  5. Sour cream
  6. Yoghurt

 

Cooking ingredients

Carob powder


 

Low FODMAP Foods

(good to eat food)

If quantities are given these are the highest amount allowed

 

Vegetables and Legumes

Alfalfa

Bamboo shoots

Bean sprouts

Bok choy / pak choi

Broccoli – 1/2 cup

Brussel sprouts – 1 serving of 2 sprouts

Butternut squash – 1/4 cup

Cabbage, common and red up to 1 cup

Callaloo

Carrots

Celeriac

Celery – less than 5cm of stalk

Chicory leaves

Chick peas – 1/4 cup

Chilli – if tolerable

Chives

Cho cho

Choy sum

Collard greens

Corn / sweet corn – if tolerable and only in small amounts – 1/2 cob

Courgette

Cucumber

Eggplant / aubergine

Fennel

Green beans

Green pepper / green bell pepper / green capsicum

Ginger

Kale

Karela

Leek leaves

Lentils – in small amounts

Lettuce:

  1. Butter lettuce
  2. Iceberg lettuce
  3. Radicchio lettuce
  4. Red coral lettuce
  5. Rocket lettuce

 

Marrow

Okra

Olives

Parsnip

Peas, snow – 5 pods

Pickled gherkins

Potato

Pumpkin

Pumpkin, canned – 1/4 cup, 2.2 oz

Radish

Red peppers / red bell pepper / red capsicum

Scallions / spring onions (green part)

Seaweed / nori

Silverbeet / chard

Spaghetti squash

Spinach, baby

Squash

Sun-dried tomatoes – 4 pieces

Swede

Swiss chard

Sweet potato – 1/2 cup

Tomato – canned, cherry, common, roma

Turnip

Water chestnuts

Yam

Zucchini

 

Fruit

  1. Ackee
  2. Bananas
  3. Blueberries
  4. Breadfruit
  5. Carambola
  6. Cantaloupe
  7. Cranberry
  8. Clementine
  9. Dragon fruit
  10. Grapes
  11. Guava, ripe
  12. Honeydew and Galia melons
  13. Kiwifruit
  14. Lemon including lemon juice
  15. Lime including lime juice
  16. Mandarin
  17. Orange
  18. Passion fruit
  19. Paw paw
  20. Papaya
  21. Pineapple
  22. Plantain, peeled
  23. Raspberry
  24. Rhubarb
  25. Strawberry
  26. Tamarind
  27. Tangelo

 

Meats, Poultry and Meat Substitutes

Beef

Chicken

Kangaroo

Lamb

Pork

Prosciutto

Quorn, mince

Turkey

Cold cuts / deli meat / cold meats such as ham and turkey breast

 

Fish and Seafood

Canned tuna

Fresh fish e.g.

  1. Cod
  2. Haddock
  3. Plaice
  4. Salmon
  5. Trout
  6. Tuna

 

Seafood (ensuring nothing else is added) e.g.

  1. Crab
  2. Lobster
  3. Mussels
  4. Oysters
  5. Prawns
  6. Shrimp

 

Cereals, Grains, Breads, Biscuits, Pasta, Nuts and Cakes

Wheat free breads

Gluten free breads

Bread:

  1. Corn bread
  2. Oat bread
  3. Rice bread
  4. Spelt sourdough bread
  5. Potato flour bread
  6. Wheat free or gluten free pasta
  7. Bread, wheat – 1 slice
  8. Almonds – max of 15
  9. Biscuit, savoury
  10. Biscuit, shortbread – 1 only
  11. Brazil nuts
  12. Bulgur / bourghal – 1/4 cup cooked, 44g serving
  13. Buckwheat
  14. Buckwheat flour
  15. Buckwheat noodles
  16. Brown rice / whole grain rice
  17. Chestnuts
  18. Chips, plain / potato crisps, plain
  19. Cornflour / maize
  20. Crispbread
  21. Corncakes
  22. Cornflakes – 1/2 cup
  23. Coconut – milk, cream, flesh
  24. Corn tortillas, 3 tortillas
  25. Crackers, plain
  26. Hazelnuts – max of 15
  27. Macadamia nuts
  28. Millet
  29. Mixed nuts
  30. Oatmeal, 1/2 cup
  31. Oats
  32. Oatcakes
  33. Peanuts
  34. Pecans – max of 15
  35. Pine nuts – max of 15
  36. Polenta
  37. Popcorn
  38. Porridge and oat based cereals
  39. Potato flour
  40. Pretzels
  41. Quinoa
  42. Pasta, wheat – up to 1/2 cup cooked

 

Rice:

  1. Basmati rice
  2. Brown rice
  3. Rice noodles
  4. White rice
  5. Rice bran
  6. Rice cakes
  7. Rice crackers
  8. Rice flakes
  9. Rice flour
  10. Rice Krispies

 

Seeds:

  1. Chia seeds
  2. Egusi seeds
  3. Poppy seeds
  4. Pumpkin seeds
  5. Sesame seeds
  6. Sunflower seeds

 

Starch, maize, potato and tapioca

Sorghum

Tortilla chips / corn chips

Walnuts

 

Condiments, Dips, Sweets, Sweeteners and Spreads

Aspartame

Acesulfame K

Barbecue sauce

Capers in vinegar

Capers, salted

Chocolate:

  1. Dark chocolate
  2. Milk chocolate – 3 squares
  3. White chocolate – 3 squares

 

Chutney, 1 tablespoon

Fish sauce

Garlic infused oil

Golden syrup

Glucose

Jam / jelly, strawberry

Ketchup (USA) – 1 sachet

Maple syrup

Marmalade

Marmite

Mayonnaise – ensuring no garlic or onion in ingredients

Miso paste

Mustard

Oyster sauce

Pesto sauce – less than 1 tbsp

Peanut butter

Rice malt syrup

Saccharine

Shrimp paste

Soy sauce

Stevia

Sweet and sour sauce

Sucralose

Sugar – also called sucrose

Tamarind paste

Tomato sauce (outside USA) – 2 sachets, 13g

Vegemite

Vinegars:

  1. Apple cider vinegar, 2 tbsp
  2. Balsamic vinegar, 2 tbsp
  3. Rice wine vinegar

 

Wasabi

Worcestershire sauce

 

Drinks

Alcohol – is an irritant to the gut, limited intake advised:

  1. Beer – limited to one drink
  2. Clear spirits such as Vodka
  3. Gin
  4. Whiskey
  5. Wine – limited to one drink

Coffee:

  1. Espresso coffee, regular or decaffeinated, black
  2. Espresso coffee, regular or decaffeinated, with up to 250ml lactose free milk
  3. Instant coffee, regular or decaffeinated, black
  4. Instant coffee, regular or decaffeinated, with up to 250ml lactose free milk

 

Drinking chocolate powder

Fruit juice, 125ml and safe fruits only

Lemonade – in low quantities

Malted chocolate powder e.g. Milo, Horlicks – 3 tsp

Protein supplement

Soya milk made with soy protein

Sugar free fizzy drinks / soft drinks / soda – such as diet coke, in low quantities as aspartame and acesulfame k can be irritants

‘Sugar’ fizzy drinks / soft drinks / soda that do no contain HFCS such as lemonade, cola. Limit intake due to these drinks being generally unhealthy and can cause gut irritation

Tea:

  1. Black tea, weak e.g. PG Tips
  2. Chai tea, weak
  3. Fruit and herbal tea, weak – ensure no apple added
  4. Green tea
  5. Peppermint tea
  6. White tea

 

Water

 

Dairy Foods and Eggs

Butter

Cheese:

  1. Brie
  2. Camembert
  3. Cheddar
  4. Cottage
  5. Feta
  6. Goat / chevre
  7. Mozzarella
  8. Parmesan
  9. Ricotta – 2 tablespoons
  10. Swiss

 

Dairy free chocolate pudding

Eggs

Margarine

Milk/Dairy:

  1. Almond milk
  2. Hemp milk
  3. Lactose free milk
  4. Oat milk – 30 ml, enough for cereal
  5. Rice milk – upto 200ml per sitting
  6. Sorbet
  7. Soy protein (avoid soya beans)
  8. Swiss cheese
  9. Tempeh
  10. Tofu – drained and firm varieties
  11. Whipped cream
  12. Yoghurt, lactose free
  13. Yoghurt, Greek, in small amounts
  14. Yoghurt, goats

 

Cooking ingredients, Herbs and Spices

Herbs:

Basil, Cilantro, Coriander, Curry leaves, Fenugreek, Gotukala, Lemongrass, Mint, Oregano, Pandan, Parsley, Rampa, Rosemary, Tarragon, Thyme

 

Spices:

All spice, Black pepper, Cardamon, Chilli powder, Cinnamon, Cloves, Cumin, Curry powder, Fennel seeds, Five spice, Goraka, Mustard seeds, Nutmeg, Paprika, Saffron, Star anise, Turmeric

 

Oils:

avocado oil, canola oil, coconut oil, olive oil, peanut oil, rice bran oil, sesame oil, sunflower oil, vegetable oil

 

Asafoetida powder – great onion substitute

Baking powder

Baking soda

Cacao powder

Cocoa powder

Cream, 1/2 cup

Gelatine

Ghee

Icing sugar

Lard

Salt


 

Resources:

  1.  www.wheat-free.org
  2. Celiac Disease – National Institute of Diabetic, Digestive and Kidney Diseases (NIDDK)
  3. What should I avoid eating if I have celiac disease? – NIDDK

 

References:

 

FODMAPs – Fibromyalgia

  1. A low fermentable oligo-di-mono saccharides and polyols (FODMAP) diet reduced pain and improved daily life in fibromyalgia patients. – PubMed – NCBI
  2. A low fermentable oligo-di-mono-saccharides and polyols (FODMAP) diet is a balanced therapy for fibromyalgia with nutritional and symptomatic benefits – PubMed – NCBI
  3. Low FODMAPs diet vs. general dietary advice improves clinical response in patients with diarrhea-predominant irritable bowel syndrome: a randomized… – PubMed – NCBI
  4. Low-FODMAP Diet Improves Irritable Bowel Syndrome Symptoms – A Meta-Analysis – 2017
  5. Polyphenol-Rich Foods Alleviate Pain and Ameliorate Quality of Life in Fibromyalgic Women. – PubMed – NCBI
  6. The Low FODMAP Diet – Many Question Marks for a Catchy Acronym – 2017
  7. Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders

Fibromyalgia (FM) & Diet – FM and Irritable Bowel Syndrome (IBS)

  1. Effect of one year of a gluten-free diet on the clinical evolution of irritable bowel syndrome plus fibromyalgia in patients with associated lymphocytic enteritis – 2014
  2. Gluten-free diet in the management of patients with irritable bowel syndrome, fibromyalgia and lymphocytic enteritis – 2014
  3. The Overlap between Irritable Bowel Syndrome and Non-Celiac Gluten Sensitivity – A Clinical Dilemma – 2015

Fibromyalgia & Diet – Gluten: FM and Celiac Disease

  1. Clinical impact of a gluten-free diet on health-related quality of life in seven fibromyalgia syndrome patients with associated celiac disease

Gluten: Celiac Disease

  1. Update on Celiac Disease – New Standards and New Tests – Algorithm
  2. ACG CLINICAL GUIDELINE – DIAGNOSIS AND MANAGEMENT OF CELIAC DISEASE – 2013
  3. Benefits of a gluten-free diet for asymptomatic patients with serologic markers of celiac disease. – PubMed – NCBI
  4. Coeliac disease -2008-Leeds
  5. Diagnosis and management of adult coeliac disease – guidelines from the British Society of Gastroenterology

Gluten: FM and Celiac Disease

  1. Clinical impact of a gluten-free diet on health-related quality of life in seven fibromyalgia syndrome patients with associated celiac disease

Gluten: Non-Celiac Gluten Sensitivity (NCGS)

  1. Nonceliac gluten sensitivity. – PubMed – NCBI
  2. Non-celiac gluten sensitivity – Time for sifting the grain – 2015
  3. Non-celiac gluten hypersensitivity. – PubMed – NCBI
  4. The Overlap between Irritable Bowel Syndrome and Non-Celiac Gluten Sensitivity – A Clinical Dilemma – 2015
  5. Non-celiac Gluten Sensitivity. Is it in the Gluten or the Grain? – 2013
  6. Fibromyalgia and non-celiac gluten sensitivity – a description with remission of fibromyalgia – 2014
  7. The Effects of a Gluten-free Diet Versus a Hypocaloric Diet Among Patients With Fibromyalgia Experiencing Gluten Sensitivity-like Symptoms: A Pilot… – PubMed – NCBI
  8. Gluten-free diet in the management of patients with irritable bowel syndrome, fibromyalgia and lymphocytic enteritis – 2014
  9. Non-coeliac-gluten-sensitivity – A-new-disease-with-gluten-intolerance-2015

 

Emphasis on Education

 

Accurate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.

 

For medical-legal reasons, access to these links is limited to patients enrolled in an Accurate Clinic medical program.

 

Should you wish more information regarding any of the subjects listed – or not listed –  here, please contact Dr. Ehlenberger. He has literally thousands of published articles to share on hundreds of topics associated with pain management, weight loss, nutrition, addiction recovery and emergency medicine. It would take years for you to read them, as it did him.

 

For more information, please contact Accurate Clinic.

 

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