The good news is, our GP thinks that our 5-year-old daughter does not have food allergies! This is a huge relief! Unfortunately, he thinks that she may have IBS, and has recommended we try a low-FODMAPs diet to manage her symptoms and pinpoint exactly which foods are problematic for her. This is our fourth exclusion diet in 3 years, as a family, so I’m really hoping this one will be the end of it! I spent 2 hours this weekend coming up with a meal plan that was low-FODMAPs whilst also suitable for my 2-year-old’s allergies, and then a further hour doing the online shopping and scouring the ingredients lists of everything I bought. I also had a clear out of the kitchen cupboards and hid all the unsuitable food in a box under the stairs, in the hope that some of it will make a reappearance in a few weeks’ time. Repeat to self: it will all be worth it in the end, it will all be worth it in the end!!!
What are FODMAPs?
FODMAPs are a group of sugars found in food and stands for Fermentable Oligo-saccharides, Di-saccharides, Mono-saccharides and Polyols. These sugars can be fermented by bacteria in the gut to produce gas. The low-FODMAPs diet was developed by Monash University, Australia, and has been found to improve symptoms of Irritable Bowel Syndrome (IBS):
IBS is characterised by chronic and relapsing symptoms; lower abdominal pain and discomfort, bloating, wind, distension and altered bowel habit (ranging from diarrhoea to constipation) but with no abnormal pathology.
I’ve highlighted the last part because it’s really important – if you think you may have IBS or any other gut issues and want to try the low-FODMAPs diet, you absolutely must talk to your doctor or a qualified dietician first. This is because the same symptoms can have a number of different causes, and IBS is a diagnosis of last resort. This means your doctor needs to rule out other possible issues first before starting on a low-FODMAPs diet. It’s really important to get tested for Coeliac disease first, for example, because you need to have eaten gluten regularly for at least 6-8 weeks for the test to work. And from our experience, once you’ve eliminated gluten, it’s very hard to reintroduce it if you are sensitive to it, because it makes you feel very unwell.
Which foods are high in FODMAPs?
High levels of FODMAPs are found in lots of different types of foods. Here are some examples (not an exhaustive list):
- Fruit – including apples, pears, peaches, plums, cherries, mangoes, watermelon and dried fruit
- Vegetables – including onions, garlic, mushrooms, asparagus, leeks, sweetcorn and cauliflower
- Cereals – wheat and rye in large amounts such as pasta, bread, cakes, biscuits and couscous
- Legumes – all types of peas, beans, lentils, kidney beans, chickpeas, soya beans etc
- Lactose – in milk from cows, sheep and goats, and other dairy products such as ice cream, custard and soft unripened cheeses
- Sweeteners – honey, high-fructose corn syrup, sorbitol, mannitol, isomalt, maltitol and xylitol
Which foods are low in FODMAPS?
There are lots of foods that are low in FODMAPs! Serving size is important as well, for example broccoli is ok in small quantities. Here are some examples of low-FODMAPs foods:
- Fruit – including bananas, grapes, strawberries, berries, oranges and pineapples
- Vegetables – red bell peppers, carrots, green beans, olives, tomatoes and courgettes
- Cereals – rice and corn, gluten free breads, pastas and cereals (as long as they don’t contain any other high FODMAPs ingredients!), also some gluten-containing grains such as oats and spelt, plus quinoa, arrowroot, buckwheat, sorghum, millet and tapioca
- Milk and milk substitutes – lactose free milk and milk products, oat milk, rice milk, soy milk (if made from soy protein and not soya beans), hard cheeses including cheddar, some dairy/lactose free ice creams and yogurts
- Sweeteners – sugar, glucose, artificial sweeteners not ending in -ol, maple syrup, golden syrup, molasses and treacle (all in small quantities only)
- Fats and oils – oils, lard, dripping, butter, margerine, mayonnaise (in small quantities as excessive fat can also trigger gut symptoms)
Managing a low-FODMAPs diet
If your health professional has recommended trying a low-FODMAPs diet, I’d definitely suggest downloading the low-FODMAPs app by Monash University (available for iPhone and Android) as you can look up different types of foods to find out if they are high or low in FODMAPs and also which type of FODMAPs they contain. There doesn’t seem to be any rhyme or reason as to why certain foods are high or low FODMAPs so unfortunately it’s a case of checking every individual food. The good news for those of us in the UK is that King’s College London are now working on the low-FODMAPs diet too. If your doctor has never heard of FODMAPs, you can ask to be referred to a FODMAPs trained dietician, of which there is a list here.
You should also minimise your intake of caffeine, alcohol and fat whilst on a low-FODMAPs diet as these can also be irritating to the gut and trigger symptoms if consumed in large amounts in some people.
The good news is you should start to see improvements within a week, and you only need to follow a strict low-FODMAPs diet for 4-8 weeks before you can start trying to reintroduce some of the foods. However this needs to be managed carefully with close monitoring of any symptoms and you should seek advice from a doctor or dietician on how to do this. You may find that you can tolerate small amounts of some high-FODMAPs foods, or even high amounts if only eaten occasionally, or if certain foods remain problematic you will need to exclude them in the long run, for example in the case of lactose intolerance.
We’ve already seen a huge improvement in my daughter’s symptoms by excluding dairy, wheat and peas, beans and pulses, and we’ve identified that sweets are a often trigger for her too. We’re planning to follow the low-FODMAPs diet for 4 weeks then follow up with our GP. After that, we’ll try this plan for reintroducing FODMAPs. Overall we’ll be following a low-FODMAPs diet for at least 14 weeks, so you can expect to see some low-FODMAPs recipes appearing on the blog soon!