Managing irritable bowel syndrome: The low-FODMAP diet

Mohannad Dugum; Kathy Barco; Samita Garg

doi:10.3949/ccjm.83a.14159

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TABLE 1

Patterns of malabsorption of FODMAPs

Oligosaccharides
Fructans: no suitable small-intestinal hydrolases—negligible absorption
Galacto-oligosaccharides: no human alpha-galactosidase—minimal absorption

Disaccharides (lactose)
No absorption if lactase is deficient

Fructose
Absorptive capacity limited when in excess of glucose—low in 30% (considered to have fructose malabsorption)

Polyols
Slow passive diffusion and absorption only (< 20%)

FODMAPs = fermentable oligosaccharides, disaccharides, monosaccharides, and polyols

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TABLE 2

Foods with high-FODMAP content, and low-FODMAP alternatives

FODMAP type	High-FODMAP foods	Alternative low-FODMAP foods
Oligosaccharides (fructans/galact-oligosaccharides)	Vegetables: artichokes, asparagus, beets, brussels sprouts, broccoli, cabbage, fennel, garlic, leeks, okra, onions, peas, shallots	Bamboo shoots, bell peppers, bok choy, carrots, celery, chard, chayote, chives, choy sum, corn, eggplant, green beans, lettuce, parsnips, pumpkins, spring onions (green part only), tomatoes; onion and garlic substitutes: garlic-infused oil
	Fruits: watermelon, apple, white peaches, persimmon	Bananas, blueberries, cantaloupes, carambola, durian, grapefruit, grapes, honeydew melon, kiwi, lemons, limes, mandarin, oranges, passion fruit, pawpaw, raspberries, strawberries, tangelos
	Wheat and rye when eaten in large amounts (eg, bread, pasta, couscous, cookies, crackers, biscuits)	Gluten-free and spelt bread and cereal products
	Legumes: chickpeas, lentils, kidney beans, baked beans, soy beans	Canned chickpeas
Disaccharides (lactose)	Milk (cow, goat, sheep), yogurt, soft cheeses, custard, ice cream	Lactose-free milk and yogurt, rice milk, hard cheeses, butter, ice cream substitutes such as gelato and sorbet
Monosaccharides (fructose)	Fruits: apples, Asian pears, pears, clingstone peaches, mango, sugar snap peas, watermelon, canned fruit in natural juice; large total fructose dose: concentrated fruit sources; large servings of fruit, dried fruit, fruit juice	As listed above
	Honey	Maple syrup, golden syrup
	Sweeteners: fructose, high fructose corn syrup	Sweeteners: any except polyols
Polyols	Vegetables: avocados, cauliflower, mushrooms, snow peas, sweet corn	As listed above
	Fruits: apples, apricots, Asian pears, cherries, longon, lychee, nectarines, peaches, pears, plums, prunes, watermelon	As listed above
	Sweeteners: isomalt, maltitol, mannitol, sorbitol, xylitol	Sucrose, glucose