Low FODMAP Diet

for Irritable Bowel Syndrome

1
 This booklet provides a short
introduction to irritable bowel
syndrome (IBS) before taking a
more detailed look at a specialist
dietary treatment available to help
manage this condition.
It is designed to follow on from
the ‘Healthy Eating and Lifestyle
Advice for IBS’ booklet. The dietary
treatment covered in this booklet
should only be considered if
general dietary advice for IBS has
not resulted in an improvement in
your symptoms. It is important to
seek the advice of a healthcare
professional before starting a
restrictive diet to ensure that it is
appropriate for your needs.

2
Contents
What is IBS? P. 4
How is IBS diagnosed? P. 5
How is IBS treated? P. 5
What are FODMAPs? P. 6
What happens during digestion? P. 7
Why might FODMAPs affect my gut symptoms? P. 8
What is a low FODMAP diet? P. 9
Starting out on a low FODMAP diet P. 16
Food Challenges in the Reintroduction Phase P. 22
Other dietary treatments for IBS P. 30
Support & Advice P. 31
Notes P. 32
3
 What is IBS?

IBS is a medical term used to

describe a collection of gut
symptoms not explained by any
other disease. Symptoms may
include diarrhea, constipation,
bloating, abdominal pain, cramping
and gas/flatulence. These can vary
from person to person and also in
the same person at different times,
often in response to changes in
diet, lifestyle or stress levels.

IBS is one of the most common

gut-related reasons for people
to visit their doctor. It is thought
to affect up to 15% of the US
population and usually develops
in early adulthood and persists
on and off throughout life. IBS
can have a significant impact on
the quality of life of those with the
condition.

While the cause of IBS is not fully

understood, studies have shown
that the gut of people with IBS
tends to be more sensitive and
reactive.
A hectic lifestyle, anxiety and stress
can all affect the gut, which may
increase symptoms.

4
How is IBS
diagnosed?
There is no test to diagnose IBS.
Symptoms can be very similar
to other gastrointestinal (gut)
conditions. Before a diagnosis of
IBS is confirmed, it is important
that other serious gastrointestinal
conditions, such as celiac disease,
inflammatory bowel disease, as well
as other bowel and gynecological
conditions, are first ruled out.
Your doctor should perform a
simple blood test to screen for
some of these conditions. Following
a full assessment, your doctor may
refer you to a gastroenterologist (a
specialist in bowel disorders) at your
local hospital for further investigations
or advice, particularly in the presence
of red-flag symptoms.
Red Flag Symptoms
•C
 hange in bowel movements to
looser and/or more frequent stools
persisting for more than six weeks
in a person 60 years of age or older
• Passing blood in stool
• Unintentional and unexplained
weight loss
• Family history of bowel or ovarian
cancer
How is IBS
treated?
There is no single effective
treatment for IBS. Many people
with IBS report symptoms worsen
after eating. Dietary changes
can significantly improve IBS
symptoms. If a dietary cause
is suspected, then you may be
given some general dietary and
lifestyle advice from your doctor
or nurse practitioner as a first step
(see ‘Healthy Eating and Lifestyle
Advice for IBS’ booklet). However,
in approximately 50% of people
with IBS, this does not result in a
satisfactory improvement of their
symptoms.
If this approach does not result in
improvement of symptoms, then
other dietary treatment options
can be explored. It may be
suggested that you try a diet that
is low in short-chain fermentable
carbohydrates (also known as
the ‘low FODMAP diet’) which may
improve symptoms of IBS. This is a
complex diet and should only be
followed under the guidance of a
low FODMAP-trained dietitian.
5
 What are
Recent research has shown that certain
dietary carbohydrates may contribute to
IBS symptoms. These carbohydrates are
called Fermentable, Oligosaccharides,
Di-saccharides, Mono-saccharides And
Polyols or ‘FODMAPs’.
FODMAPs include:
Fructans and
galacto-oligosaccharides (GOS)
are poorly absorbed in all people
as the body is unable to break
them down in the small bowel.
Dietary restriction of fructans and
GOS is helpful in most people with
IBS. Examples include wheat,
barley, rye, onion, leek, white part
of spring onion, garlic, shallots,
artichokes, beetroot, fennel,
peas, chicory, pistachio, cashews,
legumes, lentils & chickpeas
Lactose
may be poorly absorbed by
some people and does not
need to be restricted in every-
one with IBS- like symptoms.
Seek advice from a dietitian.
Examples include milk,
custard, ice-cream and yogurt
6
?
FODMAPs are found in a range of
different foods including some that are
considered healthy. Common sources
of FODMAPs include wheat, rye, pulses,
various fruit and vegetables, milk,
yogurts, honey, and sugar-free mints.
Polyols
are sugar alcohols and are
poorly absorbed in many people,
triggering IBS-like symptoms.
Examples include various fruit
and vegetables and sugar free
mints/gum
Fructose
may be poorly absorbed
by some people and does
not need to be restricted in
everyone with IBS-like symptoms.
Seek advice from a dietitian.
Examples include honey and
various fruits/vegetables
What happens during digestion?
FODMAPs have a wide range of effects in the gut. It is necessary to understand
the process of food digestion and absorption of nutrients to understand why these
carbohydrates can trigger IBS symptoms in some people.
During healthy digestion, food travels through the digestive system and mixes with
digestive juices that help break it down. The nutrients from the food are then absorbed
by the body and waste products are removed.

1. Food is chewed in the mouth

and mixes with saliva

2. Food is SWALLOWED
and passes down the
esophagus

3. Food enters the stomach

and mixes with digestive juices
that help BREAK it down

4. The contents of the stomach

move into the small INTESTINE
where nutrients are ABSORBED
into the blood

5. Undigested food passes into the large

bowel. here water is ABSORBED and the
undigested food is prepared for removal
from the body (as stool). As the food
passes through the large INTESTINE it is
fermented by the billions of bacteria
that are found there. This results in
the production of gas.

6. The stool leaves the body

via the rectum and anus.

7
 Why might FODMAPs affect my gut symptoms?

Some FODMAPs are not fully broken down and absorbed in the gut. When
FODMAPs reach the small intestine, they remain there and attract water into it
(a process known as ‘osmosis’). This results in an increased passage of water
through the gut and can contribute to diarrhea in some individuals.

Large intestine

small intestine

FODMAPS bacteria

As FODMAPs reach the large intestine, they are fermented by bacteria, which
results in gas production. This can lead to gas (flatulence), bloating, discomfort
and abdominal pain.
In someone with IBS the gut may be more sensitive to the gas produced or the
amount of gas produced may be greater than in a person who doesn’t have IBS.

Large intestine

small intestine bacteria

GAS
GAS
FODMAPS GAS
GAS
GAS
GAS

bloating, pain and DIARRHEA

8
What is a low FODMAP diet?
A low FODMAP diet consists of three different stages and it is important
that you complete each one.

Stage 1 Restriction Phase

This is a 4–6 week period in which all high
FODMAP foods are removed from the diet
to identify if symptoms improve. Clinical
experience shows that people who follow
the diet more strictly experience better
symptom improvement.

Stage 2 Reintroduction Phase

This is a step-wise process during
which individual high FODMAP foods are
reintroduced into the diet. The purpose of
this is for you to identify 1) which FODMAPs
trigger and worsen your IBS symptoms and
2) which FODMAPs can be tolerated and to
what level (i.e. your FODMAP threshold level
before IBS symptoms appear)

Stage 3 Personalization Phase

Once the reintroduction phase has been
completed, a tailored approach can be
adopted which restricts FODMAPs that
worsen your symptoms and incorporates
FODMAPs that are tolerated into the diet.

A low FODMAP diet should be information packets such as the

implemented with guidance from a
registered dietitian to ensure the diet
is followed correctly and is healthy,
well-balanced, and varied.
There are a variety of resources
to support you in following a low
FODMAP diet. These include
traffic light lists (see pages 10–13) and
apps specifically designed for those
following a low FODMAP diet, such as
the Monash University FODMAP app.
Refer to the Monash app for serving
size information.
9
 Stage 1:
Restriction Phase
FODMAPs are found in a range of different foods including some that are
considered to be healthy.

Cereals & cereal products

Low in FODMAPs

Rice, rice bran, potato, oats, oat bran, buckwheat, millet, polenta,
Grains Buc
quinoa, gluten-free cous cous

Wheat-free or gluten-free bread & rolls (Schär), pizza bases,

Bread ciabatta (Schär), pita bread, naan bread, 100% sourdough spelt Oat
bread*

Wheat-free or gluten-free flour, cornflour, maize flour, millet flour,

polenta flour, rice flour, sorghum flour, teff flour, raising agents e.g.
Flour & Baking bicarbonate of soda, baking powder, tapioca flour, buckwheat
flour, quinoa flour, pounded yam flour, potato starch, tapioca
starch
Wheat-free or gluten-free pasta, buckwheat pasta, quinoa pasta.
Pasta/Noodles Rice noodles, buckwheat noodles, kelp noodles, chickpea pasta,
wonton wrapper
Breakfast Porridge and oat-based cereals, gluten-free cornflakes, rice Cor
Cereals krispies*, buckwheat flakes, rolled oats puff
Savoury biscuits/
Rice crackers, corn cakes, oat cakes*.
crackers
Sweet biscuits & Some Florentines, macaroons, oat-based biscuits, flapjacks.
cakes Flourless cakes, meringues*

Pastry/ Wheat-free or gluten-free varieties & mixes.

Breadcrumbs Polenta, oats, cornflake crumbs, gluten-free breadcrumbs

Please note that in large servings some low FODMAP foods in the ‘green section’ can contain moderate amounts
of FODMAPs and therefore intake should be limited. e.g. eggplant is in the green section. A serving size of 75g is
well tolerated but a larger serving size 182g contains moderate amounts of the polyol sorbitol and therefore intake
should be limited. Please note you can have multiple serving of the foods in the green section but foods in the
yellow section must be limited to one serving per meal.

10
 Your Low FODMAP diet guide
Please note, this is not an exhaustive list. Refer to the Monash
app for a complete list of foods.

Moderate in FODMAPs High in FODMAPs

Wheat, bulgur wheat, couscous, semolina,
ta,
Buckwheat kernels rye, barley, amaranth, freekah, pumpernickel,
bourghal
All wheat bread & rolls, pita bread, ciabatta,
focaccia, panini, naan bread, chapatti,
lt Oat sourdough (26g)
crossiants, pastries, muffins, brioche, garlic
bread, pizza
ur,
All wheat flour, rye flour, barley flour, spelt
e.g.
flour, soya flour, almond flour, coconut flour,
chestnut flour, amaranth flour, kamut flour,
einkorn flour, emmer flour

ta. All fresh & dried wheat pasta, spelt pasta,

sta, gnocchi. Egg noodles, hokkein, udon, ramen,
pot noodles
Cornflakes 15g, quick dry oats 23g, Wheat or bran-based cereals, wheat bran,
puffed rice 15g wheat germ, spelt flakes, muesli
Water biscuits, crispbreads, wheat crackers,
cream crackers, spelt crackers

All biscuits and cakes made with wheat flour

All pastry & pastry goods made with wheat

flour. Crumbed fish & poultry, fish in batter,
tempura batter, scotch eggs

*Check for other FODMAP ingredients. Suitability †Seek advice from your dietitian if you need to avoid
may vary between brands/flavors. or limit lactose.

11
 Fruit & Vegetables
Low in FODMAPs
Ban
boy
che
fres
mel
Banana (unripe), breadfruit, canteloupe melon, clementine, rasp
cranberries, cumquats, grapes, kiwi fruit, lemon, lime, mandarin, 150g
Fruit
orange, papaya, passion fruit, paw paw, pineapple, rhubarb, Drie
strawberries, tamarind coc
curr
25g
juic
pine
27g
Artic
bee
bee
Alfalfa, eggplant, bamboo shoot, beansprouts, cabbage (red, 45g
white), canned mushrooms, carrot, celeriac, chard/swiss chard, 2 sp
chicory leaves, chilli, chives, cho cho, choy sum, cucumber, cas
edamame (frozen soya beans), endive, fennel leaves, galangal, 65g
Vegetables ginger, green beans, kale, kohlrabi, lettuce, olives, okra, oyster pep
mushrooms, pak choy, parsnip, pattypan, red pepper, pickled 5 po
onions, plantain, potato, pumpkin, radish, rocket, seaweed, pea
spinach, spring onion (green part), squash, swede, taro, tomato, spro
turnip, water chestnuts, yam piec
swe
100g
juic

Please note that in large servings some low FODMAP foods in the ‘green section’ can contain moderate amounts
of FODMAPs and therefore intake should be limited. e.g. eggplant is in the green section. A serving size of 75g is
well tolerated but a larger serving size 182g contains moderate amounts of the polyol sorbitol and therefore intake
should be limited. Please note you can have multiple serving of the foods in the green section but foods in the
yellow section must be limited to one serving per meal.

12
 Moderate in FODMAPs High in FODMAPs
Banana (ripe) <56g, blueberry 40g,
boysenberry 12g, canteloupe melon 90g,
cherries 20g, clementine 86g, coconut,
fresh 64g, grapefruit 80g, mango 40g,
melon, honeydew 90g, nectarine 18g, Apple, apricot, blackberries, dates, figs, goji
raspberry 60g, starfruit 94g, strawberry berries, nectarine, peach, pear, persimmon,
150g plum, prune, sultanas, watermelon, tinned
Dried fruits: dried banana 10 chips, fruit in apple or pear juice. Fruit juice e.g.
coconut 18g tbsp, cranberries 1 tbsp, apple, guava, mango, peach, pear, tropical
currants 16g, papaya 5g, pineapple (1 piece)
25g, raisins 18g, sultanas 7g (2 tsp) Fruit
juice: cranberry juice 200ml, orange 100ml,
pineapple 100ml. Tinned guava (1 slice)
27g
Artichoke hearts 28g*, avocado < ¼,
beetroot < 2 slices, beetroot canned 60g,
beetroot pickled 75g, broccoli stalks
45g, broccoli heads 75g, brussel sprouts
2 sprouts/38g, butternut squash < 45g, Asparagus, beetroot (fresh), broccoli stalks,
cassava < 100g, celery 10g, courgette chicory root, chipotle chilli, fennel bulb,
65g, fennel 48g, fennel leaves 15g, green garlic, globe artichoke, jerusalem artichole,
pepper 52g, leek leaves 54g, mange tout < karela, leek, mushrooms (button, shiitake,
5 pods, marrow 65g, portobello), onion (red, white,shallots,
peas < 15g, savoy cabbage < 40g, spring onion- white part), sugar snap peas
sprouts 76g (5), sundried tomatoes 16g (4
pieces), sweetcorn <38g or 1/2 cob, baby
sweetcorn (canned) 80g, sweet potato
100g, tenderstem broccoli 45g, tomato
juice 200ml

*Check for other FODMAP ingredients. Suitability †Seek advice from your dietitian if you need to avoid
may vary between brands/flavors. or limit lactose.

13
 Dairy & Other Protein Sources
Low in FODMAPs
50m
Lactose-free milk, nut milk (almond / hazelnut /macadamia), hemp skim
Milk
milk, quinoa milk milk
<60
2 tb
Lactose-free yogurt, soy yogurt*, coconut yogurt, cheese 40g,
sna
Yogurts/Cheese cheddar, feta, mozzarella, brie, camembert, blue, edam, goat‘s,
low-
pecorino, swiss cheese. Soft and hard cheeses are low lactose.
qua
2 tb
Soy custard (limit to 125g), soy-based ice creams.
Desserts crea
Dark chocolate*
or w
Other protein
Plain meat, fish, eggs.
sources
Brazil nuts, chestnuts, macadaemia nuts, peanuts, pecan nuts, Alm
Nuts & Seeds
pine nuts. linse

Chic
Pulses & Legumes
46g

Vegetarian
Quorn mince, tempeh, tofu firm & drained
Substitutes*

Protein supplement, pea protein. Alcohol: beer, gin, vodka,

whiskey, wine. Artificial sweeteners: Aspartame, acesulfame K,
Miscellaneous saccharin, sucralose, silver spoon, Splenda, Hermesetas, Stevia. Gol
Sugar/preserves: glucose, sucrose, sugar, dextrose, maple syrup,
treacle, jam, marmalade.

Please note that in large servings some low FODMAP foods in the ‘green section’ can contain moderate amounts of
FODMAPs and therefore intake should be limited. e.g. eggplant is in the green section. A serving size of 75g is well
tolerated but a larger serving size 182g contains moderate amounts of the polyol sorbitol and therefore intake should be
limited. Please note you can have multiple serving of the foods in the green section but foods in the yellow section must
be limited to one serving per meal.

14
 Moderate in FODMAPs High in FODMAPs
50ml max whole, semi-skimmed or
mp skimmed milk, coconut milk <125ml, oat Buttermilk, condensed milk, evaporated
milk <30ml, rice milk <200ml, soya milk milk, kefir
<60ml
2 tbsp maximum as part of a meal or
Cottage cheese, processed cheese,
snack*+: yogurt, cream cheese, ricotta,
reduced-fat cheddar, ricotta, Fromage Frais,
low-fat soft cheese, cottage cheese,
low-fat drinking yogurt
quark, 2 slices halloumi
2 tbsp maximum of normal custard/ice-
cream*†. 30gr/~5 square maximum of milk Ice-cream and custard*
or white chocolate*

Almonds <10 nuts, hazelnuts < 10,

Cashew nuts, pistachios
linseeds 12g, caraway seeds 10g
Beans & pulses e.g. broad beans, soy
Chickpeas canned 42g, lentils, canned
beans, butter beans, baked beans, kidney
46g
beans
Quorn mince containing onion, soy protein,
textured (TVP), tofu, silken
Drinks: Kombuncha tea, Camp coffee,
Tea: Chai, chamomile, dandelion, fennel,
oolong. Alcohol: rum, dessert wine.
. Golden syrup
Artificial sweeteners: Sorbitol, mannitol,
p,
xylitol, isomalt. Sugar/preserves: jams &
marmalades containing fructose

*Check for other FODMAP ingredients. Suitability †Seek advice from your dietitian if you need to avoid
may vary between brands/flavors. or limit lactose.

15

Starting out on a low
FODMAP diet
Plan ahead
Before starting on a low FODMAP diet,
spend a few days familiarizing yourself
with the diet, identifying which foods to
avoid and which can be included. The
low FODMAP diet requires avoidance of
multiple foods and ingredients.
To help manage your new diet
effectively, try planning your meals a
week in advance. Make a shopping list
and ensure you have all the foods and
ingredients needed to prepare each of
your meals, plus suitable ready-to-eat
snacks for when your hunger strikes!
Keep meals balanced –
main meals should include
carbohydrate, protein, fat and
vegetables.
Snack ideas:
• A low FODMAP fruit
• Carrot/ cucumber sticks
• Olives
• Handful of nuts (avoid cashews
and pistachios; limit almonds and
hazelnuts to less than 10)
• Lactose-free yogurt (avoid high
FODMAP fruit flavours)
• Piece of gluten-free toast with
peanut butter
• Gluten free crispbreads/ crackers
with cottage/ cream cheese (max 2
tbsp per sitting)
• Gluten-free bread sticks
• Plain popcorn
16
Ready meals and ready-prepared
sauces often contain high
FODMAP ingredients. Cooking
from scratch will ensure 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.
Read food labels carefully
High FODMAP sugars and
sweeteners may be added to a
variety of processed foods. Here’s
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
INGREDIENTS
Wholegrain Oats (78%), Sugar,
cranberry-flavored fruit pieces
(8.7%)(Sugar, humectant (Glycerol),
Fruit pieces (Cranberry 0.7%),
Apple), Invert sugar, Syrup, Oat
fibre, Vegetable oil, Glucose Syrup,
Rice starch, Gelling agent (Pectin),
Acidity Regulator (Citric acid),
Natural flavouring, Fruit juice
concentrates (Blueberry,
Blackcurrant), Concentrated carrot
juice, Prebiotic Oligofructose Syrup,
Salt, Natural flavouring, Niacin,
Iron, Thiamin (B1), Riboflavin.
Allergen Information:
Contains oats
In addition, these ingredients
represent added fructan
ingredients and should also
be avoided (may be present in
yogurt-based products and/or
certain cereals):

• Prebiotics
• Fructo-oligosaccharides
• Inulin
• Oligofructose

Flavor without FODMAPs

Garlic and onion are used to
enhance flavor in numerous
recipes. Unfortunately, both must
be avoided when following a low
FODMAP diet. In place of garlic
and onion, experiment with the
following ingredients to make
your favorite recipes super tasty:

• Fresh/ dried herbs and spices (be

cautious with ‘spice mixes’, these may
contain garlic/ onion powder)
• Asofetida spice – this Indian spice
provides an onion-like flavor
• Garlic-infused oil (FODMAPs are not
fat soluble, therefore garlic adds
flavor without FODMAPs in this widely
available condiment)
• Chopped chives
• Spring onion (green part only)
• Chopped/ grated ginger
• Chilli- limit if chilli aggravates your IBS
symptoms
• Lemon/ lime juice
• Soy sauce (the small amount of wheat
included in soy sauce is acceptable
while following a low FODMAP diet)
• Worcestershire sauce
• Vinegar
17
 Eat out with confidence
Eating out while following a low FODMAP diet can be a daunting idea.
Some simple steps will give you the confidence to still enjoy meals while
eating away from home:
• Call your chosen restaurant in
advance – make sure they are
able to cater for special dietary
requirements.
• Check out the menu online before
booking – most restaurants have
a website which features 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 waiting staff, you
may find it easier to summarize your
requirements as ‘wheat, dairy, garlic
and onion free’, these are the high
FODMAP ingredients most likely to
be encountered in a main meal.
• When dining out for the first time, you
might feel more comfortable if you
book during an ‘off peak’ period to
ensure the waiting and kitchen staff
have more time to respond to your
needs.
18
• Larger Italian restaurant chains are
likely to produce gluten-free (and
therefore wheat-free) pizza and pasta
dishes
• Thai, Chinese and Japanese
restaurants have a greater choice
of rice-based cuisine. Select low
FODMAP vegetables and ask for
sauces to be served separately.
• Steakhouses are a good option,
offering plainer 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 but
if you do your best to minimize your
intake of key FODMAP ingredients
you should find that the benefits
of taking part in this important
social event outweigh any possible
symptoms you experience.
Eat a diet rich in fiber
When following a low FODMAP
diet, many people find that their
fiber intake also reduces. Fiber
is essential for maintaining gut
health so it’s important to include
a variety of higher-fiber foods
within your low FODMAP diet.
Products that contain at least 10%
of your daily needs (about 2.5g
fiber per serving) are considered
good sources of fiber:
• High fiber/ seeded gluten-free
breads
• Porridge oats
• High fiber gluten-free cereals
• High fiber gluten-free pasta
• Brown rice
• Nuts and seeds (avoid cashews
and pistachios; limit almonds and
hazelnuts to less than 10)
• Low-FODMAP vegetables
• Low-FODMAP fruits
• Potatoes eaten with the skin
• Flaxseeds
• Plain popcorn
• Quinoa
• Buckwheat
Boost your calcium intake
If you are avoiding lactose (the
sugar found in milk and a known
FODMAP ingredient) then your
calcium intake may be low.
Calcium is essential to maintain
good bone health. Aim to eat 2–3
portions of calcium-rich foods
each day. Example portions of
calcium-rich foods include:
• 200ml lactose-free milk/ 200ml
calcium-enriched milk alterna-
tives (e.g oat, rice, almond, hazel-
nut milk or soy milk – max 60ml
per sitting for soy milks)
• 1 pot of lactose-free or soy or
nut-based yogurt (limit to 125ml/
sitting)
• 30g/ match-box sized piece of
cheddar cheese
• 1 tbsp cottage cheese
• ½ can of sardines
• 80g of green, leafy veg e.g kale,
watercress or spinach
19
 Plant-based eating &
a low FODMAP diet
It is possible for vegetarians with
IBS to follow a low FODMAP diet.
However, some staple protein
foods are classed as high
FODMAP, for example pulses and
legumes. It is therefore important
to ensure you aren’t missing out
on key nutrients in your diet- the
following tips will help:
20
• Use alternative protein foods
such as tofu, quorn*, eggs, nuts
and seeds more regularly in your
diet
• If you are unable to avoid pulses
and legumes completely, it is
best to opt for canned legumes
as these have lower FODMAP
levels than legumes that have
been soaked and boiled. Try a
small serving initially, for example,
2 tbsp (44g) canned chickpeas,
2 tbsp (44g) canned lentils, 1 tbsp
(23g) boiled or green lentils and
ensure the rest of your diet is
strictly low FODMAP.
• Small amounts of soy milk (<60ml)
may be suitable to include and
can be an easy way of adding
some calcium into your diet.
It is important to check if the
soy milk is made from ‘whole
soybeans’ (which tend to be
high in FODMAPs) or from ‘soy
protein’ (which tends to be lower
in FODMAPs)- this information can
be found in the ingredients list.
*Some Quorn products contain high
FODMAP ingredients e.g. onion, garlic.
It is therefore important you read the
ingredients list carefully.
Stage 2:
Reintroduction Phase
If your symptoms have improved on a low FODMAP diet it is important
to start to reintroduce some high-FODMAP foods to increase variety in
your diet and ensure you are consuming enough essential nutrients.

Challenging foods
Tolerance levels for the various For foods containing polyols, there
FODMAPs will vary from person is only a need to test one food
to person. If you experience containing sorbitol and one food
symptoms after a food challenge containing mannitol.
then avoid that food completely. It
is possible to rechallenge with that Sometimes including a problem
food again, in a smaller amount, food as part of a meal rather
at a later time. than on its own can cause less
If you do not get symptoms after symptoms.
a food challenge, you can assume
that the FODMAP is well tolerated
and include it as part of your diet
following the reintroduction phase.

For foods containing fructans

Challenge each food individually to
test your tolerance. This is because
the way the gut handles fructans
varies from one food to another.

For foods containing fructose,

lactose or GOS
Test only one food in each group.
If you get symptoms then you are
likely to get symptoms with all foods
in that group.

21
 Food Challenges in the reintroduction phase

Recording challenges
The following tips will help make sure your challenge results are clear.

Challenge Tips

• Keep to a strict low FODMAP diet until you have

finished all of the challenges

• Remove the food you have challenged with before

starting the next one, even if it has not caused
symptoms

• Wait until you are symptom free for at least 3 days

before you challenge with a new food

• Challenge with the same food each day

• Eat the recommended quantity of the test food

• Avoid eating out during the 3 challenge days

as it is more difficult to make sure your diet is low
in other FODMAPs

• Keep your daily caffeine and alcohol intake as

regular as possible

• Keep a food and symptom diary

22
 How to do a FODMAP challenge
Ensure you are symptom free for at least three days before starting a challenge

DAY 1
Eat the challenge food

symptoms
STOP no symptoms

DAY 2
Double challenge portion from Day 1

symptoms
STOP no symptoms

DAY 3
Triple challenge portion from Day 1

symptoms
STOP
Commence next
wait for 3 days without symptoms challenge
23
 It is useful to keep a record of your food challenges and any symptoms
experienced. It is recommended that the same food is used for each day
of the challenge. A list of foods to challenge with can be found on page 31.

Fructan challenges
It is recommended that foods containing fructans be challenged
separately to test the level of tolerance. This is because the way the gut
handles fructans varies from food to food.

Wheat: Bread
Day Quantity Symptoms
1 1 slice
2 2 slices
3 3 slices

Wheat: Wheat Flake Cereal

Day Quantity Symptoms
1 about ½ cup

2 about 1 cup

3 about 1.5 cups

Wheat: Pasta
Day Quantity Symptoms
1 5 tbsp

2 10 tbsp

3 15 tbsp

Onion
Day Quantity Symptoms
1 1 tbsp

2 2 tbsp

3 3 tbsp

24
Garlic
Day Quantity Symptoms
1 ¼ clove

2 ½ clove

3 ¾ clove

Leek
Day Quantity Symptoms
1 ½ leek

2 1 leek

3 1 ½ leeks

Other foods containing fructans to challenge with:

FODMAP Food
Beetroot
Brussel Sprouts
Chai Tea
Chamomile Tea
Dandelion Tea
Dates
Fructans Fennel Tea
(Test individually)
Fig (Dried)
Garlic (1/4 clove, raw or
cooked)
Globe artichoke
Grapefruit
Leek (1/2 leek)
Onion (1 tbsp, raw or cooked)
Okra
Pomegranate
Savoy cabbage
Spelt pasta

25
 Galacto-oligosaccharides (GOS) Challenges:
Challenge with one food that contains only GOS e.g. beans & pulses (2
tbsp), peas or cassava. If you experience symptoms then you are likely to
with other foods high in GOS.

Day Quantity Symptoms

Sorbitol Challenges:
Challenge with one food that contains only sorbitol. Examples include
avocado (1/4), blackberry, broccoli (3 tbsp), coconut, lychee. If you experience
symptoms then it is likely you will with other foods high in sorbitol.

Day Quantity Symptoms

Mannitol Challenges:
Challenge with one food that contains only mannitol. Examples include
cauliflower (2 tbsp), celery (1 stick), sweet potato (3 tbsp). If you experience
symptoms then it is likely you will also react to other foods high in mannitol.

Day Quantity Symptoms

26
Fructose Challenges:
Challenge with one food that contains only fructose. Examples include
artichoke hearts, figs (fresh), mango (1/2), sugar snap peas, honey (1 tsp),
agave nectar/fruit juice (about 1/4 cup). If you experience symptoms then it is
likely you will also react to other foods high in fructose.

Day Quantity Symptoms

Lactose Challenges:
Challenge with either 4 oz. milk or 4 oz. yogurt. Other milk-containing foods
such as ice-cream and custard do not need to be challenged
separately.

Day Quantity Symptoms

27
 Foods containing more than one FODMAP
Some foods contain more than one FODMAP but may be tolerated
in small quantities. Examples of these foods are included in the
table below and should be challenged individually.

Portion guide for challenging fruit and vegetables:

Day 1: 40g (about 1/4 cup)
Day 2: 80g (about 1/2 cup)
Day 3: 120g (about 3/4 cup)

*These serving sizes are estimations, and the weight of the actual food may vary.
For accuracy, weigh each portion of food on a kitchen scale.

For other foods it is recommended to start with half a normal

portion on day one, then double on day two and triple the portion
on day three.

28
 Test Contains more
Results
Individually than 1 FODMAP
Apple Sorbitol, fructose

Apricot Fructans, sorbitol

Asparagus Fructans, fructose

Barley Fructans, GOS

Butternut squash Mannitol, GOS

Cashew nuts/ Fructans, GOS

Pistachio nuts
Cherry Sorbitol, fructose

Fennel bulb Fructans, mannitol

Jerusalem Fructans, fructose

Artichoke
Snow peas Fructans, mannitol

Mushroom Fructans, mannitol

Nectarine Fructans, sorbitol

Pistachio Fructans, GOS

Peach Fructans, sorbitol

Pear Sorbitol, mannitol

Plum or prune Fructans, sorbitol

Amarath/barley/ Fructans, GOS

frekeh
Rye Fructans, fructose,
GOS
Sugar-free gum Sorbitol, mannitol

Raisins Fructans, fructose

Sweetcorn Sorbitol, GOS

Watermelon Fructans, mannitol,

fructose

29
 Stage 3:
Personalization Phase
Once you have completed the
reintroduction phase of the diet, it
is important to follow as normal of
a diet as possible while avoiding
foods that trigger your symptoms
(which you have identified during
the reintroduction phase). Try to
vary your diet as much as possible
including a variety of fruit and
vegetables.
If symptoms return, it may be due
to an accumulation of different
FODMAPs. It is also important
to remember that sensitivity to
FODMAPs may change over time;
and therefore, it is worth trying to
reintroduce any ‘failed’ FODMAPs
at a later date.
While excluding dietary triggers
will help you self-manage your
symptoms, it should be noted
that diet is not the only cause of
symptoms. Other factors such as
a busy lifestyle, stress, and anxiety
can often affect your gut which can
make you more sensitive to the
food you eat.
If you are concerned about the
number of foods that you have or
haven’t been able to reintroduce
to your diet without symptoms
reappearing, contact your dietitian
30
for further advice. A dietitian will be
able to provide you with specific
advice and suggestions on how to
make sure a restricted diet is
well-balanced and healthy.
Other dietary
treatments for IBS
It is important to give yourself
time to adjust to any dietary
changes you make. If your
symptoms continue to persist or
worsen despite these changes
seek advice from a dietitian
with expertise in the dietary
management of IBS.
If you think specific foods such
as wheat or dairy-containing
foods trigger your symptoms,
your dietitian can support you in
identifying and removing possible
‘trigger’ foods. It is important to
receive expert advice before
removing whole food groups from
your diet. This will ensure that you
are still getting all the right nutrients
needed for good health. Keeping a
food and symptom diary may help
you to identify links between what
you are eating and your symptoms.
A dietitian might use this to help
provide appropriate dietary advice.
Support & Advice
Schär
is a gluten-free food manufacturer
that is committed to supporting
those with special dietary needs.
With decades of experience and a
team of expert food technologists
and health professionals, the Schär
range offers a wide selection of
tasty and high-quality ambient,
chilled and frozen products and is
available in leading retailers.
Schär also provides a range of
staple low-FODMAP certified
products and resources including
practical tips, information &
low-FODMAP recipes to support
those following a low FODMAP
diet. Further information on Schär
certified products, resources and a
low FODMAP diet can be found on
the website.

us.medaffairs@drschar.com
www.schar.com

31
 Notes:

32
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 Leaflet produced with
the editorial support of Mairi Huntly (RD).
36 Adapted for the US in January 2020