The Low FODMAP Diet Plan with a Registered Dietitian

​​Can a low FODMAP diet plan help resolve IBS symptoms?

If you are suffering from symptoms like bloating or diarrhea, chances are your doctor may have recommended that you try the low FODMAP diet. And you may be thinking  “what even is a FODMAP?” or “do I need to be on this diet forever?” or “what am I going to cook for myself and my family?” or “is going on the low FODMAP diet even going to help my symptoms?” Not to worry! We are going to go through what the low FODMAP diet entails, and some helpful tips and resources to make this low FODMAP elimination diet process easier.

What is the low FODMAP diet plan?

The low FODMAP diet has quickly become the most common dietary intervention for Irritable Bowel Syndrome (IBS). For good reason, since about 70% of IBS patients report reduced symptoms once they started the diet plan. Despite its usefulness, there can be a large amount of confusion on what you can eat, length of time this all takes, and more. For now, just know, this dietary change is temporary!!

What are FODMAPs?

FODMAP is an acronym for Fermentable Oligo-, Di-, and Monosaccharides And Polyols. These are long names for carbohydrates (sugars) that travel through the gut partially undigested and then ferment in the colon. This fermentation causes unwanted digestive symptoms in IBS individuals such as diarrhea, constipation, gas, and bloating. 

Where are FODMAPs found?

FODMAPs are found in a wide range of foods such as fruits, vegetables, grains, dairy products, legumes, nuts, and certain sweeteners. Who decides this you may be wondering? The answer is that a laboratory at Monash University measures the FODMAP content of foods and tells us how much of each food is safe! 

Let’s look at some specific food examples.  There are 4 primary FODMAP groups that fall under those long carbohydrate names. (Please remember this list below is abbreviated. For more detailed information, make an appointment with a registered dietitian.)

• Oligosaccharides
  • Fructans— commonly found in many foods, including wheat, rye, barley, garlic, onion
  • GOS— found in legumes and some nuts
• Disaccharides
  • Lactose- carbohydrates found mainly in dairy products like milk, soft cheese, yogurt, ice cream
• Monosaccharides
  • Fructose— found in many fruits and vegetables, table sugar and most added sugar. Found in high quantities in honey, apples, mango
• Polyols
  • Sorbitol—Sugar alcohol used in artificial sweeteners but also found in apples, pears, avocado
  • Mannitol— Sugar alcohol used in artificial sweeteners but also found in cauliflower, mushrooms, celery

Now that we have examples of foods that contain FODMAPs, let’s walk through how this all comes together to improve your quality of life and reduce those unwanted digestive symptoms.

Getting Started with Low FODMAP

The Low FODMAP Diet Phases

The Low FODMAP diet plan is completed in phases: the elimination phase, challenge phase, and modified diet phase. Your dietitian is an integral part of this process, so be sure to consult someone rather than starting on your own! It can be confusing.

Phase 1: FODMAP Elimination Phase

The FODMAP elimination phase is the first, and some think the hardest phase since high FODMAP foods will be replaced with lower FODMAP foods. The first phase lasts 2-8 weeks until symptoms are controlled! The goal is to have a minimally restrictive diet that can aid in controlling symptoms.  The phase should not be continued long term for many reasons. That’s where phase 2 of the approach comes in!

Phase 2: FODMAP Challenge Phase

The challenge phase, as the name implies, is when we begin to trial each FODMAP group one by one to determine personal tolerance. The base low FODMAP diet will be maintained during this process until you finish all challenges.  Some dietitians will have different approaches to this, but I typically use a 3-day challenge followed by a 3-day washout (back to the low FODMAP diet). Then onto the next group! You and your dietitian will decide which group, how much, and when to do each challenge. If all goes well, this phase can take around 8 weeks.

Phase 3: Modified low FODMAP Phase

Once we complete all of the individual and combination food challenges, we will now incorporate the tolerable groups into your diet, while avoiding the group(s) that caused symptoms! This is your long term, individualized approach.  The good news is that FODMAP tolerance can change over time so if a particular group didn’t go well, try it again in a couple of months to see if anything has changed.

I’m feeling better after Phase 1, do I have to add high FODMAP foods back in?

It might be tempting to stay in the FODMAP elimination phase long term, especially if you noticed significant symptom relief and don’t want to risk experiencing GI symptoms again.  But eliminating large groups of food for extended periods of time opens you up to potential nutritional deficiencies, like calcium and magnesium. There is also a possibility that the long-term restriction can affect the healthy bacteria in your gut, which can make your digestive issues worse. 

Resources for following a Low FODMAP diet plan

Online Resources

Monash University in Australia have created a handy app that helps you know if a food item is okay to have. Some products are also labeled as FODMAP friendly, which can make finding options easier. We also love the Spoonful App, which lets you scan products in the store to see if they are low FODMAP friendly.

Food Lists

Our team of registered dietitians who specialize in gut health, IBS management and the low FODMAP diet have put together food lists that you can use while grocery shopping and meal planning.

• Low FODMAP Bread
• Low FODMAP Cheese
• Low FODMAP Ice Cream
• Low FODMAP Dairy
• Low FODMAP Chips
• Low FODMAP Granola
• Low FODMAP Protein Bars
• Low FODMAP Yogurt
• Low FODMAP Pasta Sauce
• Low FODMAP Crackers
• Low FODMAP Protein Powder 
• Low FODMAP Salad Dressing

Low FODMAP Recipes

Our team has assembled a recipe database plus several lists of recipes to give you inspiration while following the low FODMAP diet.

• Low FODMAP Breakfast
• Low FODMAP Lunch
• Low FODMAP Dinner
• Low FODMAP Snacks
• Low FODMAP Desserts
• Low FODMAP Thanksgiving Recipes

Eating Out on a Low FODMAP Diet

When you are on the go, there are options available for eating out at a restaurant while following the low FODMAP diet. Keep in mind that many meals and ingredients will be based on individual tolerance and whether or not you are doing the low FODMAP elimination phase or the modified version.

Challenges when eating out on a Low FODMAP diet

Eating out while following low FODMAP dietary restrictions can be difficult, but not impossible. Here are some things to keep in mind when you are eating at a restaurant:

• Meals can contain hidden FODMAPS such as honey, wheat, garlic and onion. 
• Gluten free options can be hard to come by (wheat is eliminated on a low FODMAP diet)
• Not all restaurants and food facilities offer their ingredient list, making it tough to check if a food is safe or not

Tolerance is really dependent on the individual, each person is going to tolerate different foods depending on their body and what phase of the FODMAP diet you are in.

Tips for eating out on a Low FODMAP diet

• Check the ingredient list online so you can be prepared! Almost all chain restaurants have this available online. 
• Look for garlic/onion, high fructose corn syrup, milk, and wheat in the ingredient lists. These are the most common offenders. Don’t forget to check the condiments!
• Foods are listed on the ingredient label based on how much of that item is present in the recipe or food item. The ingredients used in the greatest amount go first, followed by those in smaller amounts. If the FODMAP-containing food is after the 5th ingredient on the ingredient list, you may be able to tolerate the meal because of the small portion of the higher FODMAP food. 
• Proceed with caution if you see “natural flavors”.
• If possible, keep a low FODMAP salad dressing in your car or ask restaurants for olive oil and lemon, if they have it.
• If gluten free bread isn’t available, you will have to avoid the wheat-containing bread. 
• For beverages, stick with water or iced tea.
• When ordering, avoid condiments, and onions/pickles unless otherwise stated. If you want to add a condiment, 1 sachet of ketchup with high fructose corn syrup (13 grams) and 1 sachet of mustard should be tolerated.

To help make it easier, we have put together some options for following low FODMAP while eating out at fast food restaurants the next time you find yourself out and about.

Managing Social Situations

Navigating social events when on the low FODMAP diet is difficult to say the least. Trying to explain the ins and outs of the low FODMAP diet can also be frustrating! With that said, IBS is extremely common and elimination diets therefore have become more common. Advocate for yourself when with family or friends! Try to explain the basics but emphasize that this is short term and it is going to improve your GI symptoms. No one can argue with that! 

Social gatherings can be navigated on the low FODMAP diet with just a few tips/options:

• You can either offer to bring a dish to a gathering that you know is safe to eat, or eat before. 
• If you plan to eat before, you can pack a snack or two in your bag so you have something to munch on. For example, pack a granola bar, or gluten-free crackers.
• If the gathering is out at a restaurant, you can glance at the menu before to see if they carry something basic like a salad with chicken or even gluten-free grains (which has become more common).

If you find yourself in a pinch and on the verge of being hangry, use your best judgement with what you have available. There are FODMAP digesting enzymes* on the market that can make eating out much less stressful.

Tips for Success

Keep a food diary

Keep a food and symptom diary while experimenting with a lower FODMAPs food plan, as this can help you determine how well it is working for you. There is also the possibility that foods other than high FODMAPs may cause an adverse food reaction. Thus, it is important that you self-monitor and avoid any item that you determine causes distress.

Label Reading

Read all packaged food, supplement and medication labels to avoid high FODMAPs ingredients such as agave, high fructose corn syrup, polyols, inulin, and chicory.

Stress Management

There has been a documented link between stress and digestive symptoms. A clinical trial in 2023 followed participants who participated in an 8 week online yoga program that could assist in reducing their IBS symptoms. At the end of the 8 weeks, most participants found the yoga program to be effective in managing their IBS symptoms, as well as improving their mental health and providing other physical health benefits. Alternate nostril breathing (ANB) was found particularly effective for reducing symptoms.

Total Load

Reduce the total load of FODMAPs in your diet for at least two weeks. You may find your symptoms improve within the first week; however, some individuals need more time with a FODMAPs-friendly eating plan to notice a reduction in symptoms, so stick with it!

Top FODMAPs

Some FODMAPs may be more problematic than others. If following all of the low FODMAP guidelines feels overwhelming, you can start by eliminating the following top FODMAPs to see if that reduction makes a difference in your symptoms. These include:

• Grains: wheat, rye, barley
• Fruit: apples and pears
• Vegetables: onions and garlic
• Dairy: milk and milk products 
• Sweeteners: Agave, high fructose corn syrup, honey, all polyols/sugar alcohols

GI Maintenance

There are a number of factors beyond FODMAPs that influence healing and regeneration of the GI tract. If you have followed the low FODMAP diet plan for at least 2 weeks and have not found any symptom relief, a more extensive nutritionist guided holistic GI restoration program may be indicated.

Transitioning

Consider a gradual reintroduction of small amounts of FODMAPs including some of the fruits and vegetables, and beans and lentils that were initially restricted. Go slowly and take note of any specific foods or food combinations that may not be well tolerated.

Low FODMAPs are an evolving science

It is important to note that FODMAP research continues to evolve. Monash University is continually making adjustments to their recommendations on which foods are considered safe on the low FODMAP diet and new information comes out regularly!