Low FODMAPs Guideline

CATEGORY:

Clinical Practice

PURPOSE:

To assist MNGI Physicians and NPPAs in the use of the FODMAPs diet in
patients with irritable bowel syndrome.

RESPONSIBLE PARTIES:

All MNGI Physicians, nurse practitioners and physician assistants

GUIDELINE:

Introduction
Symptoms related to functional gastrointestinal symptoms may, at times, improve based upon
what a person eats. Limited data has shown that avoiding certain carbohydrates may improve
symptoms. These carbohydrates, known as FODMAPs include Fermentable:
Oligosaccharides
Disaccharides
Monosaccharides
Polyols
It is believed that the ingestion of FODMAPs increases the delivery of fermentable substrate
and water to the distal small intestine and proximal colon, which may induce luminal distention.
While diets low in FODMAPS have not definitively been shown to be of benefit, it is reasonable
to complete a trial.
The central focus of the FODMAPs diet is to reduce the intake of all poorly absorbed short chain
carbohydrates to be more effective in reducing luminal distension. The global approach to
restricting carbohydrates should optimize symptom control in patients with functional
gastrointestinal disorders, such as irritable bowel syndrome and functional bloating. The
avoidance of short chain carbohydrates may reduce symptoms if the patients underlying bowel
response is exaggerated or abnormal.

Approach to initiating the FODMAPs Diet

1. Identify patients with a diagnosis of a functional gastrointestinal disorder (i.e. irritable bowel
syndrome, functional bloating)
2. Consider completion of fructose and lactose breath tests
Assists in determination of degree of dietary restriction necessary by defining who
can completely absorb fructose and/or lactose
Oligosaccharides and polyols are malabsorbed by everyone
3. Referral to a dietitian for instruction on the FODMAPs diet
A dietitian-delivered diet has been shown to have higher levels of compliance.
The use of written literature alone for the direction of the FODMAPs diet has not
been studied and caution should be used when undertaking that approach.
4. Consider follow up 6-8 weeks after the patient has started the FODMAPs diet

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Low FODMAPs Guideline

Low FODMAP Foods

Fruit
Banana,
blueberry,
boysenberry,
cantaloupe,
cranberry,
grape,
grapefruit,
honeydew
melon, kiwi,
lemon, lime,
mandarin
oranges, orange,
passion fruit,
raspberry,
rhubarb,
strawberry

Vegetables
Alfalfa, bamboo
shoots, bean
shoots, bok
choy, carrot,
celery, endive,
green beans,
potatoes,
pumpkin,
spinach, summer
squash, sweet
potato, tomato,
yam, zucchini

Grain Foods
Gluten free
bread or cereal ,
100% spelt
bread, rice, oats,
polenta,
arrowroot,
millet, psyllium,
quinoa, sorgum,
tapioca

Milk Products
Milk
Lactose-free milk
and yogurt, oat
milk*, rice milk,
soy milk*

Other
Sweeteners
Sugar* (sucrose)
glucose, artificial
sweeteners not
ending in -ol

*Check for additives

Cheese
Hard cheeses,
brie and
camembert
Yogurt
Lactose-free
varieties

Honey
Substitutes
Maple syrup*,
molasses
*small quantities

Ice Cream
Substitutes
Gelato or sorbet

* Eat dried fruit in

small quantities

Butter
Olive oil

High FODMAP Foods

Fruit
Apples, apricots,
blackberries,
canned fruit,
cherries, mango,
nectarines,
peaches, pears,
plums, prunes,
watermelon, large
amounts of dried
fruit or fruit juice

Vegetables
Artichokes,
asparagus, beets,
broccoli, Brussels
sprouts,
cabbage,
cauliflower,
eggplant, fennel,
garlic, green bell
pepper, leek,
mushroom,
onion, snow
peas, sugar snap
peas, sweet corn

Grain Foods
Wheat and rye,
in large amounts
(i.e. bread,
crackers,
cookies, pasta)

Milk Products
Milk from cows,
goats or sheep,
custard, ice
cream and
yogurt, soft
cheeses such as
cottage cheese,
cream cheese
and ricotta

Other
Sweeteners
Fructose, high
fructose corn
syrup, honey,
isomalt, maltitol
mannitol,
sorbitol, xylitol
Legumes
Baked beans,
chickpeas,
kidney beans,
lentils

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Low FODMAPs Guideline

REFERENCES/RELATED DOCUMENTS:
1. MNGI Irritable Bowel Syndrome Guideline
2. Marion, DW. Treatment of irritable bowel syndrome. In: UpToDate, Basow, DS (Ed),
UpToDate, Waltham, MA, 2012.
3. Gibson, PR, Sheperd, SJ.
Evidence-based dietary management of functional
gastrointestinal symptoms: The FODMAP approach. J Gastroenterol Hepatol. 2010;
25(2):252-8
4. Choi YK, Johlin FC, Summers RW, et al. Fructose intolerance: an under-recognized
problem. Am J Gastroenterol. 2003;98(6):1348.
5. Ong DK, et al. Manipulation of dietary short chain carbohydrates alters the pattern of gas
production and genesis of symptoms in irritable bowel syndrome. J Gastroenterol
Hepatol. 2010;25(8): 1366.
6. Sheperd SJ, Parker FC, Muir JG, Gibson PR. Dietary triggers of abdominal symptoms in
patients with irritable bowel syndrome: randomized placebo-controlled evidence. Clin
Gastroenterol Hepatol. 2008;6(7):765.
Person initiating original guideline or revision: _Kadee Watkins, PA-C__________

Original Date of guideline: ___July 2012_________________

Date of Revisions: ______________________________
Date of Review: ________________________________
APPROVAL:

______________________________
Chair, Clinical Practice Committee
Douglas Nelson, MD

_______________________
Date

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