3/18/2015

Objectives:

The role of FODMAP diet

in IBS

1) Understand low FODMAP diet

2) Learn the relationship between FODMAP and IBS
3) Review sample menus of low FODMAP diet
4) Few other dietary and non dietary interventions for IBS

By: Jigna Mehta, Registered Dietitian and Nutritionist

What is the FODMAP Diet?

History of FODMAP

FODMAP is an acronym that stands for Fermented Oligo-DiMono-saccharides, And Polyols.

Originated in Australia at Monash University in Melbourne

in 2001

These different carbohydrates were grouped together

based on the length of their carbohydrate chains,
resulting in the FODMAP term.

Addresses the total amount of fermentable sugars in diet

rather than looking at each sugar individually

The FODMAP Diet

Certain carbohydrates called Fermentable Oligo-Di-Monosaccharides, and Polyols are poorly digested in the small
intestine and are rapidly fermented by bacteria leading
to the symptoms associated with IBS
Degree of FODMAP maldigestion will vary among
individuals

The FODMAP Diet

Fermentable

The process through which gut bacteria degrade undigested

carbohydrate to produce gases (hydrogen, methane and carbon
dioxide)

Oligo-saccharides
(unable to be digested)

Fructo-oligosaccharides (FOS) found in wheat, rye, onions and

garlic
Galacto-oligosaccharides (GOS) found in legumes

Disaccharides
(lack of lactase- GI
discomfort)

Lactose found in; milk, soft cheese, yogurt

Mono-saccharides
(excessive amount leads to
malabsorption)

Free-fructose (in excess of glucose) found in honey, apples, high

fructose corn syrups

Polyols
(slow intestinal absorption)

Sugar Polyols (ex. sorbitol, mannitol) found in some fruit and

vegetables and used as artificial sweeteners

3/18/2015

High FODMAP Foods

FODMAP

Funny
Promising
ExcessName
Fructose
LactoseRelief

High
FODMAP

Fruits: apples,
pears, mango, sugar
snap peas,
watermelon, canned
fruit in natural juice,
coconut milk

Milk: cow, goat, and

sheep, ice cream
Yogurt
Cheeses: soft and
fresh (Ricotta or
cottage cheese)

Sweeteners: honey,
agave, fructose, high
fructose corn syrup
Large total fructose
dose: concentrated
fruit sources, large
servings of fruit,
dried fruit, fruit
juice

Low FODMAP Foods

Oligosaccharides

Polyols

FODMAP

Vegetables: artichokes,
asparagus, Brussels
sprout, broccoli,
cabbage, fennel, garlic,
leeks, okra, onions,
peas, shallots, beetroot

Fruits: apples,
apricots,
blackberries,
cherries, lychee,
nectarine, pears,
peaches, plums,
prunes, watermelon,
longon

Low
FODMAP

Cereals: wheat and rye

in large amounts
Legumes: chickpeas,
lentils, red kidney
beans, baked beans
Fruits: watermelon,
custard apple, white
peaches, rambutan,
persimmon

Alcohol: sherry and

port wine

Sample Menu

DAY 1

Funny Name Promising Relief

Vegetables:
avocado,
cauliflower,
mushrooms, snow
peas

Excess Fructose

Lactose

Oligosaccharides

Polyols

Fruit: banana,
blueberry, durian,
grape, grapefruit,
honeydew, kiwi,
lemon, lime,
mandarin, orange,
passion fruit,
raspberry,
strawberry, tangelo

Milk: lactose-free,
rice milk

Vegetables: bamboo
shoots, bok choy, carrot,
celery, capsicum, corn,
eggplant, green beans,
lettuce, chives, parsnip,
pumpkin, spring onion,
tomato

Fruits: banana,
blueberry, durian,
grapefruit, grape,
honeydew, kiwi
lemon, lime,
mandarin, orange,
passion fruit,
raspberry

Honey substitutes:
maple syrup, golden
syrup

Cheese: Hard cheeses

including brie,
camembert
Yogurt: lactose-free
Ice cream substitutes:
gelato, sorbet
Butter

Onion/garlic
substitutes: garlicinfused oil
Cereals: gluten-free and
spelt bread/cereal
products

Sweeteners: sugar,
glucose, some
artificial sweeteners
other than polyols

Sweeteners:
sorbitol, mannitol,
xylitol, maltitol,
isomalt, and others
ending in -ol

Sample Menu (lacto-ovo Vegetarian)

DAY 2

Breakfast:

Breakfast:

1 scrambled egg, cooked with cup each green peppers and spinach,

Corn flakes with Enriched rice milk, Banana, and 1 Tbsp. sliced almonds

chopped with cup shredded potatoes cooked in 2 tsp. olive oil

Lunch:

Lunch:

Vegetable sandwich with 2 slices of gluten free bread, a slice of cheese and a

4 oz grilled Chicken Breast, 1 cup spinach, and cup brown rice

cup of mixed vegetables with a side of 1 cup of blueberries

Dinner:

Dinner:

4 oz. Ground Turkey, 1 cup gluten free pasta, and cup grilled zucchini

Black bean burger with cup black beans, cup gluten free bread crumbs,
1 Tbsp favorite seasonings, with romaine lettuce, 2 slices of tomatoes, and
cup baked sweet potato fries

Sample Menu (Vegan)

DAY 3
Breakfast:
2 gluten-free English muffins with 1 tsp. of almond butter, 1 cup rice milk,
with 1 cup honeydew melon

Challenges

Adherence

Lifestyle change (eating out)

Misinformation and/or misunderstandings

Lunch:

Leading to:

2 cups of stir-fried vegetables (bamboo shoots, bokchoi, carrots, baby corn,

Nutritional deficiencies and/or imbalance of nutrients

Complexity with other comorbidities

baby spinach, and spring onion) with tofu and 1 medium orange
Dinner:
1 cup cooked quinoa sauted with cup mixed vegetables, cup pinto
beans, and cup grapes

3/18/2015

Management of FODMAP Diet

FODMAP Resources
Books

To ensure IBS symptoms are well-controlled, a trial of the

low FODMAP diet is warranted for the first 6-8 weeks

May need to take general multivitamins to avoid

micronutrient deficiency for up to 8 weeks

After 6-8 weeks, add foods from one FODMAP group in

small amounts, and observe for symptoms

Continue through all FODMAP groups

IBS Free at Last! A revolutionary, New step-by step method for those who have tried
everything. Control IBS symptoms by limiting FODMAPS Carbohydrates in your Diet.
Pasty Catsos, MS, RD, LD
Low FODMAP Diet shopping Guide - Dr. Sue Shepherd

Websites:
Monash University Low FODMAP Diet
http://med.monash.edu.au/cecs/gastr/fodmap/
Founders of the FODMAP Diet
Shepherd Works Low FODMAP Diet
http://shepherdworks.com.au/disease-information/low-fodmap-diet

Other: iphone App

Theres an App for That!

Case Study Presentation

Lunch/Dinner

IBS. NEJM 2008

Developed by creators of FODMAP diet

A 28 year old woman presents with a 7-month history of recurrent,

crampy pain in the left lower abdominal quadrant, bloating with
abdominal distention, and frequent, loose stools. She reports having
had similar but milder symptoms since childhood. She spends long
times in the bathroom because she is worried about uncontrollable
discomfort and fecal soiling. She feels anxious and fatigued and is
frustrated that her previous physician did not seem to take her
distress seriously. Physician examination is unremarkable for
tenderness over the left lower quadrant.

How should her case be evaluated and treated?

Other therapeutic options besides

FODMAP for IBS

Alternative Herbs/supplements

Probiotics are good bacteria that normally live in your

intestines
Some studies have found that probiotics may relieve
symptoms of IBS, however, more research is needed
Good sources of probiotics are yogurt and dietary
supplements such as:

Peppermint Oil

0.2 ml 2-3 times per day

May decrease abdominal spasms and have a relaxing

effect on GI tract

Ginger

Align

500 mg 3 times per day

Culturelle

May also decrease abdominal spasms and also has mild

anti-inflammatory actions

Phillips

Colon Health
Florastor

3/18/2015

Overall Dietary Recommendations

Eat on regular schedule dont skip meals

With diarrhea, it may be better to eat small, frequent meals

If constipated, eat larger amounts of high fiber foods may help

move food through intestines

Keep hydrated

Try to drink plenty of fluids daily (caution with cardiac and renal
conditions)

Drink 1 oz of water for every 2 lbs of body weight

Note: Alcohol and caffeinated beverages can act as stimuli to GI

tract causing symptoms to worsen

Stress management and regular physical activities

THANK YOU
Questions ???????