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CATEGORY:
Clinical Practice
PURPOSE:
To assist MNGI Physicians and NPPAs in the use of the FODMAPs diet in
patients with irritable bowel syndrome.
RESPONSIBLE PARTIES:
GUIDELINE:
Introduction
Symptoms related to functional gastrointestinal symptoms may, at times, improve based upon
what a person eats. Limited data has shown that avoiding certain carbohydrates may improve
symptoms. These carbohydrates, known as FODMAPs include Fermentable:
Oligosaccharides
Disaccharides
Monosaccharides
Polyols
It is believed that the ingestion of FODMAPs increases the delivery of fermentable substrate
and water to the distal small intestine and proximal colon, which may induce luminal distention.
While diets low in FODMAPS have not definitively been shown to be of benefit, it is reasonable
to complete a trial.
The central focus of the FODMAPs diet is to reduce the intake of all poorly absorbed short chain
carbohydrates to be more effective in reducing luminal distension. The global approach to
restricting carbohydrates should optimize symptom control in patients with functional
gastrointestinal disorders, such as irritable bowel syndrome and functional bloating. The
avoidance of short chain carbohydrates may reduce symptoms if the patients underlying bowel
response is exaggerated or abnormal.
Vegetables
Alfalfa, bamboo
shoots, bean
shoots, bok
choy, carrot,
celery, endive,
green beans,
potatoes,
pumpkin,
spinach, summer
squash, sweet
potato, tomato,
yam, zucchini
Grain Foods
Gluten free
bread or cereal ,
100% spelt
bread, rice, oats,
polenta,
arrowroot,
millet, psyllium,
quinoa, sorgum,
tapioca
Milk Products
Milk
Lactose-free milk
and yogurt, oat
milk*, rice milk,
soy milk*
Other
Sweeteners
Sugar* (sucrose)
glucose, artificial
sweeteners not
ending in -ol
Cheese
Hard cheeses,
brie and
camembert
Yogurt
Lactose-free
varieties
Honey
Substitutes
Maple syrup*,
molasses
*small quantities
Ice Cream
Substitutes
Gelato or sorbet
Butter
Olive oil
Vegetables
Artichokes,
asparagus, beets,
broccoli, Brussels
sprouts,
cabbage,
cauliflower,
eggplant, fennel,
garlic, green bell
pepper, leek,
mushroom,
onion, snow
peas, sugar snap
peas, sweet corn
Grain Foods
Wheat and rye,
in large amounts
(i.e. bread,
crackers,
cookies, pasta)
Milk Products
Milk from cows,
goats or sheep,
custard, ice
cream and
yogurt, soft
cheeses such as
cottage cheese,
cream cheese
and ricotta
Other
Sweeteners
Fructose, high
fructose corn
syrup, honey,
isomalt, maltitol
mannitol,
sorbitol, xylitol
Legumes
Baked beans,
chickpeas,
kidney beans,
lentils
REFERENCES/RELATED DOCUMENTS:
1. MNGI Irritable Bowel Syndrome Guideline
2. Marion, DW. Treatment of irritable bowel syndrome. In: UpToDate, Basow, DS (Ed),
UpToDate, Waltham, MA, 2012.
3. Gibson, PR, Sheperd, SJ.
Evidence-based dietary management of functional
gastrointestinal symptoms: The FODMAP approach. J Gastroenterol Hepatol. 2010;
25(2):252-8
4. Choi YK, Johlin FC, Summers RW, et al. Fructose intolerance: an under-recognized
problem. Am J Gastroenterol. 2003;98(6):1348.
5. Ong DK, et al. Manipulation of dietary short chain carbohydrates alters the pattern of gas
production and genesis of symptoms in irritable bowel syndrome. J Gastroenterol
Hepatol. 2010;25(8): 1366.
6. Sheperd SJ, Parker FC, Muir JG, Gibson PR. Dietary triggers of abdominal symptoms in
patients with irritable bowel syndrome: randomized placebo-controlled evidence. Clin
Gastroenterol Hepatol. 2008;6(7):765.
Person initiating original guideline or revision: _Kadee Watkins, PA-C__________
______________________________
Chair, Clinical Practice Committee
Douglas Nelson, MD
_______________________
Date