Attention A T users. To access the menus on this page please perform the following steps. 1. Please switch auto forms mode to off. 2. Hit enter to expand a main menu option (Health, Benefits, etc). 3. To enter and activate the submenu links, hit the down arrow. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links.

Whole Health For Life

Menu
Menu

Quick Links

Veterans Crisis Line Badge
My healthevet badge
EBenefits Badge
 

Eating to Reduce Irritable Bowel Symptoms: The FODMaP Diet

WHOLE HEALTH: INFORMATION FOR VETERANS

Components of Health and Well-Being image

Eating to Reduce Irritable Bowel Symptoms: The FODMaP Diet

Whole Health is an approach to health care that empowers and enables YOU to take charge of your health and well-being and live your life to the fullest. Whole Health starts with YOU. It is fueled by the power of knowing yourself and what will really work for you in your life. Only you have these insights, this knowledge.

This information was gathered to help you as you make choices to support your health. As you learn more, you will have even more power to take care of yourself. This information has also been formatted for printing for your convenience. Best wishes!

What is the FODMaP diet?

The FODMaP diet is a guide to help decrease symptoms of irritable bowel syndrome (IBS). The word “FODMaP” is made up of the first letters of the scientific names of certain types of carbohydrates that are found in foods (see below). We often talk about carbohydrates as a single group. There are actually different types of carbohydrates in different foods. These different types of carbohydrates can have different effects on our digestive systems (the stomach, intestines, and other parts of the body that work together to digest food). If you have IBS, then you probably already know that eating certain foods can cause more symptoms. These can be bloating, gassiness, diarrhea, or constipation. Research studies show that the FODMaP diet is a tool that can help decrease these symptoms.1-3

How does the FODMaP diet work?

The diet works by cutting down or totally cutting out carbohydrates that might cause more symptoms. Carbohydrates that don’t get absorbed well pass to the end of the intestine (the colon). Decreasing these carbohydrates helps IBS symptoms in two ways:1

  • There are trillions of bacteria living in our intestines. They are important for many things, including digestion and helping us get the nutrients we need from our food. (For more information, see the Whole Health handout “How a Healthy Gut Makes for a Healthier You.”) Some bacteria use the process of fermentation. This is the same process that brewers use to make beer. As you can imagine, this creates gas. Some people have no problem when gas is produced in the intestines. People with IBS can be more sensitive to the gas, and it causes bloating. Bacteria use the carbohydrates that pass into the colon for fermentation. By decreasing the amount of carbohydrates that the bacteria can use, the FODMaP diet helps decrease the amount of gas and bloating.

  • When more carbohydrates pass through into the colon, they pull more water into the stool. People with diarrhea have too much water in the stool. The FODMaP diet decreases this extra water that’s pulled into the colon. This decreases diarrhea.

What does FODMaP stand for?

FODMaP stands for the following:

F = Fermentable carbohydrates.
These are carbohydrates that the bacteria in our intestines use for fermentation, which makes gas.

O = Oligosaccharides.
This group of carbohydrates contains fructans and galactans. These are in certain types of grains such as wheat and rye, certain vegetables such as onions, garlic, and cabbage, some fruits, and legumes such as beans.

D = Disaccharides.
Lactose, found in milk products, is the main source of this.

M = Monosaccharides.
This includes fructose, found in foods that have high fructose corn syrup, as well as honey and certain fruits.

a = and

P = Polyols.
Sweeteners whose name ends in “ol” are in this category, like sorbitol and xylitol. These are often artificial sweeteners and found in candy or chewing gum.

How should I use the FODMaP diet?  

First, it is important to know that the FODMaP foods do not cause IBS. They only may be part of what increases the symptoms for people with IBS. So, the main goal with using the FODMaP diet is to manage and decrease symptoms, not to cure IBS.

Clinicians may recommend using the FODMaP diet in a variety of ways.4 We recommend a “stepwise” approach, as described below.

Take a look at the list of foods above and the table on the following page. A lot of the FODMaP foods are vegetables, fruits, and beans. These are some of the most nutritious foods we can eat. They are important for good health. In addition, many of the FODMaP foods are actually good prebiotics, or food for the “healthy bacteria” in the gut. (This is described in the Whole Health handout “How a Healthy Gut Makes for a Healthier You.”) In fact, there is research being done to figure out exactly how the FODMaP diet affects the bacteria that live in our gut.5-7

Therefore, we recommend a “Stepwise FODMaP” diet. The goal of this approach is to still eat as many fruits and vegetables as possible while decreasing your IBS symptoms. Follow these steps:

  1. Start by avoiding dairy, wheat, rye, high-fructose corn syrup, honey, and polyol sugars (artificial sweeteners). These are in the top row of the chart below.
  2. If this doesn’t work, then continue on down the chart by avoiding foods in the other rows.
  3. In doing the “Stepwise” FODMaP diet, you may find yourself needing to cut out more foods to start with in order to control symptoms. If you do this, don’t worry! Sometimes this is necessary at the start.
  4. After doing the FODMaP diet for about 4-6 weeks, you can try adding back foods, one at a time. Keep track in a diary or calendar the date you add back foods and what your symptoms are like. If your symptoms are still OK, then go ahead and eat that food again regularly.

Use the following chart to guide you:

Consider starting with the first row (stepwise FODMaP) and progress to full FODMaP if needed.

Table of FODMaP Foods to Avoid 

Consider starting with the first row (stepwise FODMaP) and progress to full FODMaP if needed.

 Table of FODMaP foods to consume

What are probiotics and how can they be used along with the FODMaP diet?

We have both helpful and harmful bacteria in our guts. Probiotics are products that contain live bacteria or yeast. They can help create a better balance between the helpful and harmful bacteria in the gut. So far, research studies suggest that taking probiotics can be a helpful treatment for IBS.8 As we mentioned, some of the FODMaP foods are actually good “food” for healthy types of bacteria in our gut. Research studies are showing that the FODMaP diet does change which bacteria live in our gut.5,6 Taking a probiotic that supports healthy bacteria while also using the FODMaP diet might be helpful in treating IBS. This has been suggested by scientists but hasn’t been directly researched yet.7

Consider using one of the following strains (types) of probiotics for IBS. When using a probiotic for IBS, take it for at least two months in order to see the full effect of the treatment. It is reasonable to try a different strain or to try combining more than one strain if the first one you try does not help.8,9 Consumerlab.com reviews manufacturers and their products. It is one place you can look to find a reliable brand of probiotic.

Table of Proboitics

For you to consider:

As a baseline, start a log of your IBS symptoms, the date you had the symptoms, and what you ate that day. Notice if you see any patterns.

  • What do you think about the FODMaP Diet? Is this something you would like to try using? When will you start?
  • Do you want to try a probiotic? Which brand will you try?
  • If you have any concerns about starting this diet or taking probiotics, contact your health care provider or a registered dietitian nutritionist to help guide you.

The information in this handout is general. Please work with your registered dietitian nutritionist and/or health care team to use the information in the best way possible to promote your health and happiness.

For more information:

Veterans Health Administration

Variety of Whole Health handouts on healthy eating
https://www.va.gov/patientcenteredcare/veteran-handouts/index.asp


This handout was written by Jonathan Takahashi MD, MPH, Academic Integrative Health Fellow, Integrative Health Program, University of Wisconsin Department of Family Medicine and Community Health. It is based in part on the VA Whole Health document for clinicians, “The FODMaP Diet Clinical Tool,” written by David Rakel MD.

References

  1. Gibson PR, Shepherd SJ. Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. J Gastroenterol Hepatol. 2010;25(2):252-258. doi: 10.1111/j.1440-1746.2009.06149.x.
  2. Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology. 2014;146(1):67-75.e65. doi: 10.1001/jama.2013.280490 and 10.1053/j.gastro.2013.09.046.
  3. Böhn L, Störsrud S, Liljebo T, et al. Diet low in FODMAPs reduces symptoms of irritable bowel syndrome as well as traditional dietary advice: a randomized controlled trial. Gastroenterology. 2015;149(6):1399-1407.e1392. doi: 10.1053/j.gastro.2015.07.054.
  4. Wolfram T, Catsos P. Why the Low-FODMAP Diet Is a Growing Dietitian-Led Treatment for People with IBS. Food & Nutrition. Vol September/October 2016:17-19.
  5. Halmos EP, Christophersen CT, Bird AR, Shepherd SJ, Gibson PR, Muir JG. Diets that differ in their FODMAP content alter the colonic luminal microenvironment. Gut. 2015;64(1):93-100. doi: 10.1136/gutjnl-2014-307264.
  6. Halmos EP, Christophersen CT, Bird AR, Shepherd SJ, Muir JG, Gibson PR. Consistent Prebiotic Effect on Gut Microbiota With Altered FODMAP Intake in Patients with Crohn's Disease: A Randomised, Controlled Cross-Over Trial of Well-Defined Diets. Clin Transl Gastroenterol. 2016;7:e164. doi: 10.1038/ctg.2016.22.
  7. Staudacher HM, Whelan K. Altered gastrointestinal microbiota in irritable bowel syndrome and its modification by diet: Probiotics, prebiotics and the low FODMAP diet. Proc Nutr Soc. 2016;75(3):306-318. doi: 10.1017/S0029665116000021.
  8. Ford AC, Quigley EM, Lacy BE, et al. Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: Systematic review and meta-analysis. Am J Gastroenterol. 2014;109(10):1547-1561; quiz 1546, 1562. doi: 10.1038/ajg.2014.202.
  9. Rutten JM, Korterink JJ, Venmans LM, Benninga MA, Tabbers MM. Nonpharmacologic treatment of functional abdominal pain disorders: A systematic review. Pediatrics. 2015;135(3):522-535. doi: 10.1542/peds.2014-2123.


 >>>  BACK TO WHOLE HEALTH FOR VETERANS INDEX <<<