What is a low FODMAP diet?

1. Elimination
   All FODMAPs need to be restricted in the first stage of the diet. This stage of the low FODMAP diet typically lasts for 4-8 weeks. If symptoms do not improve during the elimination phase, your dietitian will likely recommend that you try a different approach. 
    
2. Reintroduction
   If symptoms have improved on a low FODMAP diet, it is important to start reintroducing some higher FODMAP foods to increase variety in the diet.
   
   This helps to identify which FODMAPs trigger IBS symptoms, and which FODMAPs can be tolerated. Tolerance levels will vary from person to person.
   
   If you experience symptoms after a food challenge, you should avoid this food moving forwarde. It is possible to re-challenge that food again at a later time, likely in a smaller amount.
   
   If you do not have any symptoms after a food challenge, you can assume that the food is well tolerated and include it as part of your diet once the reintroduction phase is completed.
   
   Sometimes including smaller amounts of a problem food as part of a meal rather than on its own can cause less symptoms.
    
3. Personalization
   Once you have established which FODMAPs affect your symptoms, you may personalize your diet to include more of the foods that do not cause symptoms, and avoid foods that trigger them. Individual dietary triggers of IBS symptoms and tolerance to these foods varies among individuals.
   
   If your symptoms return, it could be because you have included too many FODMAPs in one meal. It is also important to remember that sensitivity to FODMAPs may change over time. Therefore, it is worth trying to reintroduce any ‘failed’ FODMAPs again at a later date.
   
   While excluding dietary triggers will help you manage your symptoms, it should be noted that diet is not the only cause of symptoms. Other factors that trigger symptoms include a busy lifestyle, stress, and anxiety, all of which can affect your gut and make you more sensitive to the food you eat.

The idea of the low FODMAP diet is to identify foods that trigger your symptoms and reintroduce those that do not. This will ensure that you have a varied and well-balanced diet.

Before starting on a low FODMAP diet, spend a few days or week familiarizing yourself with the diet and identifying which foods to avoid and include. The low FODMAP diet requires elimination of multiple foods and ingredients. To help manage your new diet effectively, try planning your meals in advance. Make a shopping list and stock up on ingredients to prepare each of your meals and appropriate ready-to-eat snacks for when hunger strikes!

Keep meals balanced – main meals should include carbohydrate, protein, and lots of vegetables.

Prepared meals and sauces often contain high FODMAP ingredients. Cooking from scratch will ensure that you are in control of what foods and ingredients you consume. Save time by ‘batch cooking’ your favorite meals and freezing individual/ family-sized portions for when you have less time to cook.   

High FODMAP sugars and sweeteners may be added to a variety of processed foods. Here is a list of high FODMAP ingredients to look out for when scanning food labels:

• Fructose
• Fructose-glucose syrup
• High fructose corn syrup
• Lactose
• Agave
• Honey
• Isomalt
• Mannitol
• Sorbitol
• Molasses
• Xylitol
• Fruit juice concentrate

In addition, these ingredients represent added fructan ingredients and should also be avoided (may be present in yogurt-based products and/or certain cereals):

• Fructo-oligosaccharides
• Inulin
• Oligofructose

Eating out on a low FODMAP diet can daunting, particularly while dining out. Here are some simple tips to help you enjoy meals eaten away from home:

• Call the restaurant in advance – make sure they are able to cater to special dietary requirements.
• Check out the menu online before booking – most restaurants have a website that shows menus and may also highlight common allergens in various dishes.
• The low FODMAP diet may be a difficult concept to explain to someone who hasn’t experienced it before. When discussing your requirements with servers, you may find it easier to summarize your requirements as ‘wheat, dairy, garlic, and onion free’, as these are high FODMAP ingredients most commonly used in restaurant meals.
• When dining out for the first time, you might feel more comfortable if you book during an ‘off peak’ period to ensure the servers and kitchen staff have more time to respond to your needs.
• Larger Italian restaurant chains may have gluten-free (and therefore wheat-free) pizza and pasta dishes available.
• Thai, Chinese, and Japanese restaurants have a greater selection of rice-based dishes. Select low FODMAP vegetables to go with rice and ask for sauces to be served separately.
• Steak houses are a good option as well. Choose plain meats, salads, and potato-based side dishes. Ask for salad dressings to be served separately.

Enjoy your food and the restaurant experience! Eating out with friends and family should be relaxing and enjoyable. You may find it hard to avoid all sources of FODMAPs while dining out, but if you do your best to minimize your intake of key FODMAP ingredients, you may find that the benefits eating with friends and family outweigh any possible symptoms you experience.

When following a low FODMAP diet, many people find that their fiber intake also goes down. Fiber is essential for maintaining gut health, so it is important to include a variety of higher fiber foods within your low FODMAP diet. Products that contain 10% of the Daily Value for fiber are considered good sources of fiber. Some foods that are high in fiber include:

• High fiber or seeded gluten-free breads
• Oats
• High fiber gluten-free cereals
• High fiber gluten-free pasta
• Brown rice
• Nuts and seeds
• Low FODMAP vegetables
• Low FODMAP fruits
• Potatoes eaten with skin on
• Flaxseeds
• Plain popcorn
• Quinoa
• Buckwheat

If you are avoiding lactose (the sugar found in dairy, which is a known FODMAP ingredient), then your calcium intake may be low. Calcium is essential for maintaining bone health. Aim to eat 2-3 servings of calcium rich foods each day. These include:

• 1 cup of lactose-free milk or calcium-fortified milk alternative (e.g oat, rice, almond, or soy milk)
• 6 oz. of lactose-free or fortified dairy-free yogurt 
• 1-2 oz. of cheddar cheese
• 1 tbsp cottage cheese
• ½ can of sardines
• 1 cup of green, leafy vegetables (e.g kale, watercress,or spinach)

Schär has a range of their foods tested and certified by Monash University as suitable for those following a low FODMAP diet to help manage their IBS symptoms. The product range includes breads, rolls, pizza bases, and crackers, which are available nationwide in many supermarkets. Read more here.