All About the Low FODMAP Diet. Written by: Stephanie Clairmont, MHSc, RD

Written by: Stephanie Clairmont, MHSc, RD

All About

the Low

Congratulations! You have successfully downloaded and received the Clairmont

Digestive Clinic E-book “All About the Low FODMAP Diet”. This E-book is full of useful information about the evidence-based Low FODMAP Diet approach that in research and at the Clairmont Digestive Clinic, has improved digestive symptoms in over 75% of

people that have implemented it into their lives. The team and I at the Clairmont Digestive Clinic are excited to share information about this revolutionary diet approach to help you improve your symptoms of Irritable Bowel Syndrome (IBS) and other digestive symptoms to start to feel better.

The Low FODMAP Diet is a relatively new dietary approach in treating Irritable Bowel Syndrome (IBS) being recommended by health practitioners, but there is over 10 years of

research demonstrating the effectiveness of this diet intervention in helping people

decrease digestive distress. Many physicians and gastroenterologists are not yet aware

of this diet, and may not be teaching their clients about the benefits of making these

dietary changes; while other medical doctors are just recently starting to recommend the diet to clients with IBS. At the Clairmont Digestive Clinic, the team and I have been using this approach along with several other strategies and coaching with our

one-on-one clients for three and a half years and have been thrilled with the results that we see in helping people to improve their lives.

So many of our clients have tried various approaches to heal their gut and reduce

digestive symptoms with no results and no improvement. Suffering with gas, bloating, abdominal discomfort, diarrhea, and/or constipation can be life-altering. It affects food

choices, travel, dining out with friends, family get-togethers, the drive to and from work, comfort at work and school, exercise, and more! The list is long. IBS and digestive issues

They can influence your body and mind. These symptoms are uncomfortable, annoying,

and embarrassing.

I know this, because I too was diagnosed with Irritable Bowel Syndrome in 2007. I wasn’t given much advice and just sent on my way to live a life of discomfort and uncertainty in when my system would react. After a few years of studying nutrition and becoming a

dietitian, I realized that there was an evidence-based way to improve my health. When I say

evidence-based, I mean actual research to support changes to my diet that I could make. Not just another theory or recommendation from someone that didn’t know what it was like to deal with IBS and digestive distress.

Many of my clients tell me that they have heard a million and one ways to cope with IBS and

digestive upset. They have tried probiotics, digestive enzymes, fibre supplements, eating

healthy or drinking more water. Some of my clients have tried cutting out foods like gluten or dairy with no results. And for some people, one small change might work... but for most of us, it’s just not enough to heal the gut and reset our digestive system to allow it to work well again.

That’s why I do what I do at the Clairmont Digestive Clinic and on my website

www.stephanieclairmont.com. With weekly articles, recipes, product and restaurant

reviews and videos, the team and I will provide you with advice and expertise on how to live a healthy, happy life with IBS. If you want to learn more about our classes, courses, support groups, and one-to-one services, or just check out all the free resources we have, please visit www.stephanieclairmont.com.

Now let’s learn more about the diet that has helped me and changed so many people’s lives.

Think you Might Have IBS?

Some people have been told that Irritable Bowel Syndrome (IBS) is diagnosed once all other disorders or diseases are ruled out; a diagnosis of exclusion. This is actually not the case. Although it is very important to see your medical doctor to discuss your symptoms

and screen for various disorders and diseases, there are specific digestive symptoms

that are associated with IBS. Many physicians use the Rome II criteria to diagnose IBS, which says that one must experience at least 12 weeks in the previous 12 months of continuous or recurrent abdominal discomfort or pain along with a change in stool (bowel movements).

Many can also experience symptoms that include abdominal bloating, distension,

excessive gas (flatulence), and/or other symptoms. IBS presents differently in different

people and only some or all of the symptoms may be present.

If you are experiencing any of these above mentioned symptoms, seek out the ad-vice of your medical doctor before making any changes to your diet, taking any supplements or doing anything further. It’s important that you be properly screened for various digestive disorders and diseases.

At the Clairmont Digestive Clinic we specialize in Irritable Bowel Syndrome (IBS) and other digestive issues. We have helped hundreds of clients improve their digestive health and reduce uncomfortable and life-altering symptoms such as gas, bloating, distension,

abdominal discomfort or pain, heartburn, reflux, headaches, rumbling/load belly sounds,

diarrhea, constipation or both. To learn more about our classes, courses, support groups, and one-to-one services, visit www.stephanieclairmont.com.

What is FODMAPs?

FODMAPs is an abbreviation that stands for: Fermentable

Oligosaccharides Disaccharides

Monosaccharides and Polyols

These are complex names for groups of poorly digested carbohydrates that are not absorbed well in the digestive tract. Many individuals cannot digest or absorb these molecules, but for those with Irritable Bowel Syndrome (IBS), they can experience a vast amount of symptoms including gas, bloating, distension, abdominal discomfort or pain, diarrhea and/or constipation when these carbohydrates are consumed.

How do FODMAPs Cause Digestive Symptoms?

To understand how FODMAPs cause digestive upset, we need to understand the first

steps of digestion. When you eat food, it moves from your mouth, through the

esophagus, into the stomach and then to the small intestine. At this point, FODMAPs can start to cause trouble.

FODMAPs cause symptoms of IBS in three ways:

1. These molecules are poorly absorbed. They arrive in the small intestine and pass right through to the large intestine (colon) because they cannot be broken down or are slow to

absorb. We differ in our ability to break down FODMAPs, some people break them down

better than others.

2. FODMAPs are small molecules that are consumed in a concentrated dose. When the

body tries to “dilute” these poorly absorbed molecules, extra fluid in the

gastrointestinal tract (small and large intestine) causes diarrhea and movement.

3. FODMAPs provide food for bacteria in the large intestine (colon). If these molecules are not absorbed in the small bowel, the billions of bacteria that live in the colon will quickly break down these molecules as food. This breakdown produces hydrogen, carbon dioxide, and methane, which can contribute to symptoms.

What is the low FODMAP diet?

The low FODMAP diet was developed by a leading dietitian in digestive health, Dr. Sue Shepherd in 1999. She has shown, along with other researchers, that limiting foods that are

high in FODMAPs is an effective treatment for people with symptoms of Irritable Bowel Syndrome (IBS). Over 75% of people with IBS suffering from gas, bloating, discomfort, distension, diarrhea and/or constipation see significant improvement in their symptoms.

There is a small collection of published research that demonstrates the low FODMAP diet

may be beneficial for other types of digestive conditions, but it is not evident yet how effective the treatment is. For links to the most recent research, scroll down to the end

of this E-book.

Where are FODMAPs Found?

FODMAPs are found in many foods. From fruit to milk to vegetables to grains; FODMAPs are very common in most people’s diets.

High FODMAP Foods

Foods to Avoid

Apples, Apricots, Blackberry, Boysenberry , Cherries Figs, fresh, Grapefruit, Lychee, Mango, Nectarine Peach, Pears (except Prickly variety), Persimmon Plum, Tamarillo, Watermelon

Fruit

Apple, Dried, Apricot, Dried, Dates, Dried Figs, Dried, Mango, Dried, Paw paw, Dried Pear, Dried, Pineapple, Dried, Prunes, Raisins

Processed Fruit Vegetables

Bread, Naan or Roti, Bread, Pumpernickel, Bread, Rye (including Dark and Sourdough), Bread, Wheat (including multi-grain, whole-grain), Cous Cous, Wheat Noodles, Wheat Bran, pellets , Pearl barley, Muesli

Grains & Cereals

*Be cautious of prepared dishes that may have added high FODMAP foods, such as onion and/or garlic

Meat, Fish, Eggs & Meat Alternatives

Confectionary, Sugars and Sweetners

Dried fruit bar Artichoke (Jerusalem and Globe), Asparagus, Cauliflower

Garlic, Leek, Leek bulb, Mushrooms, Button, Onion (including shallots, Spanish, spring (bulb), white), Sugar Snap Peas

Baked Beans, Borlotti Beans, Broad Beans, Four Bean Mix, Haricot Beans, Boiled, Red Kidney Beans, Soya Beans, Boiled, Split Peas, Boiled

Legumes & Pulses

Cashews, Pistachio

Nuts & Seeds

Buttermilk, Cream Cheese, Cream, Pure, Regular Fat , Cream, Sour, Cream, Thickened, Custard, Ice Cream, Milk (including homogenized, reduced fat, goats, evaporated, skim, soy beans*, condensed), Yogurt (regular, low fat, flavoured)

Milk Products & Substitutes

Caviar dip, Hummus, Tahini, Tzatziki, Pasta Sauce, Cream-based, Pasta Sauce, Tomato Based, Honey, Mixed Berry Jam

Condiments, Sauces & Spreads

Rum, Wine, Sticky, Apple and Raspberry Cordial (50-100% Real Juice), Orange Cordial (25-50% Real Juice), Juice: Apple, orange blend, tropical blend, Tea (oolong, fennel, chamomile), Herbal Tea (strong), Dandelion Tea (strong), Chai Tea (strong)

Beverages

High FODMAP Foods

Low FODMAP Foods

Foods to Include

Black & Green Olives, pitted , Seaweed/Nori Sun-Dried Tomatoes < 1 tbsp

Processed Vegetables

Avocado <1/8 of a whole, Banana, Blueberries, Carambola Clementine, Dragon Fruit, Durian, Grapes, Kiwi, Lemon Longon <5 (15 g), Mandarin Oranges, Cantaloupe Melon Honeydew Melon, Navel Orange, Passionfruit, Paw Paw Prickly Pear, Pineapple, Pomegranate <1/4 cup seeds (38 g) Rambutans <2, Raspberries, Rhubarb, Starfruit, Strawberry

Fruit

Vegetables

Dried Banana, Coconut Milk, Dried, Shredded Coconut < ¼ cup (18 g), Dried Cranberries <1 tbsp, Currants <1 tbsp

Processed Fruit

Canned Artichoke Hearts < 1/8 cup, Arugula, Alfalfa, Aubergine, Bean Sprouts, Green Beans, Beetroot <2 slices (20 g), Bok Choy, Broccoli Brussel Sprouts, Butternut Squash <1/4 cup diced (30 g), Common Cabbage, Savoy Cabbage < ½ cup (35 g), Carrot, Celeriac, Celery (1/4 medium stalk), Chicory Leaves, Red Chili Pepper, Chives, Choy Sum Sweet Corn < ½ cobb, Courgette, Cucumber, Eggplant, Endive Leaves Fennel Bulb, Fennel Leaves, Ginger root, Kale, Leek Leaves, Butter Lettuce Radicchio Lettuce, Red Coral Lettuce, Rocket Lettuce, Mange tout (<5 pods) Olives, Okra, Spring Onion (Green tops only), Parsnip, Green Peas < ¼ cup (36 g), Snow Peas < 5 pods (17 g), Thawed Peas <1/4 cup, Green Pepper, Red Pepper, Sweet Potato < ½ cup (70 g), Potatoes, Japanese (Kabocha) Pumpkin, Radish, Silverbeet, Spinach, baby, Squash, Butter nut squash <1/4 cup diced, Swiss chard, Tomatoes, Turnip, Water chestnuts Witlof, Zucchini

Beef, Chicken, Eggs, Fish, Kangaroo, Lamb, Pork, Prawns, Salmon, Tuna, Tempeh, Tofu

Meat & Alternatives

Canned Butter Beans < ¼ cup, Chickpeas < ¼ cup, Canned Lentils, Boiled Lentils < ¼ cup, Lima Beans < ¼ cup

Pulses

Milk Alternatives

Gluten-Free Bread , Gluten-Free Multigrain <1 slice, Oat Sourdough Bread <1 slice, Spelt Sourdough Bread, Chia rice, gluten-free bread <1 slice, White or Wholemeal Wheat bread <1 slice, Buckwheat, Buckwheat Kernels <1/8 cup, Cornflakes cereal <1/2 cup, Corn flour, Gluten-free Flour (for baking), Muesli (yeast, fruit, and wheat-free), Oats < ¼ cup dry, Gluten-free Oats, Oat Bran, Gluten-free Pasta, Quinoa Pasta, Wheat Pasta <1/2 cup cooked, Polenta (cornmeal), Quinoa, Quinoa flakes cereal, Rice (all varieties), Rice bran, Rice noodles, Rice puffed cereal < ½ cup, Wheat Bran < ½ tbsp, Amaranth, puffed grain <1/4 cup, Spelt Pasta <1/2 cup, cooked

Grains & Cereals

Low FODMAP Foods

Foods to Include

Cheese, hard (all types – such as cheddar, feta, brie, goat, camembert mozzarella, swiss, colby, Havarti, pecorino), Cheese, soft (such as cottage <4 tbsp, ricotta <2 tbsp) , Cheese, haloumi <2 slices , Almond Milk, Coconut Milk, Lactose-free Cow’s Milk, Soy Milk (made with soy protein)

Lactose-free Yogurt, Whipped Cream <1/2 cup Almonds <10 nuts (12 g), Chia seeds, Hazelnuts <10 nuts

(15 g), Lsa, Macadamia, Peanuts, Pecans, Pine Nuts Pumpkin seeds, Sesame seeds, Sunflower seeds, Walnuts

Low FODMAP Foods

Foods to Include

Basil, Chives, Cilantro/Coriander, Ginger root, Parsley, Rosemary, Tarragon, Thyme, All Spice, Cinnamon, Cumin, Five Spice, Tumeric, Paprika

Herbs & Spices

Barbeque sauce <2 tbsp, Chutney < 1 tbsp, Eggplant dip < 1 tbsp, Fish sauce < 1 tbsp, Marmalade, Mustard < 1 tbsp Oyster sauce < 1 tbsp, Relish < 1 tbsp, Peanut Butter, Pesto sauce < ½ tbsp, Soy sauce < 2 tbsp, Brown & Palm Sugar Sweet and Sour sauce < 2 tbsp, Maple Syrup , Balsamic Vinegar < 1 tbsp, Rice Wine Vinegar < 2 tbsp

Worcestershire sauce < 2 tbsp, Vegemite

Condiments, Sauces & Spreads Snack Food (Read food label for added high FODMAP ingredients)

Beer, Gin, Vodka, Whiskey, Wine (Red, White, Sweet, Sparkling), Cranberry juice, 100% Orange juice < ½ cup

Hot Chocolate <2 tsp, Vegetable blend tomato juice Instant regular & decaffeinated black coffee Espresso , Tea (white, peppermint, green, dandelion) Herbal Tea (weak) <180 ml, Chai Tea (weak) <180 ml Black Tea (strong) < 180 ml

Beverages

Gluten-free Biscuits, Corn-based crackers/biscuits Potato chips, Pretzels, Plain Rice Cakes, Flavoured Rice Cakes <1, Plain Rice-Based Crackers

Low FODMAP Foods

Foods to Include

Confectionary, Sugars and Sweetners

Olive Oil, Peanut Oil, Rice Bran Oil , Sesame Oil Sunflower Oil ,Vegetable Oil

Dark chocolate <5 squares (30g), Milk chocolate <15 g White Chocolate <15 g, Stevia , Brown Sugar, Palm Sugar

How to Follow the low FODMAP Diet

The low FODMAP diet is an exclusion diet developed to be followed along with the support and coaching of a registered dietitian (RD). In research, as well as in our practice at the Clairmont Digestive Clinic, the diet shows an improvement in over 75% of people with IBS when followed for 6 to 8 weeks. All foods that are high in FODMAPs are eliminated, while foods that are low in FODMAPs are included in the diet.

At the Clairmont Digestive Clinic, a registered dietitian and social worker support clients one-to-one to follow the diet, as well as to look for other foods, situations, and patterns that can be contributing to symptoms. For many people with IBS and digestive issues, eating well for digestion and working with a dietitian can help to see great long-term results and reduce or eliminate uncomfortable and embarrassing symptoms.

After following the low FODMAP diet for 6 to 8 weeks, many people see symptom improvement, while others may need to continue to follow the diet for several weeks or

months longer before they see significant improvement. After the exclusion diet phase, foods

may be reintroduced. However, with the complexity of the diet and ingredients in our foods, it is highly recommended to work through this diet, and especially the re-introduction phase with a registered dietitian that has advanced skills in digestive nutrition for best results. At the Clairmont Digestive Clinic, we specialize in Irritable Bowel Syndrome (IBS) and digestive issues. We have helped hundreds of clients to improve their digestive health and reduce uncomfortable and life-altering symptoms such as gas, bloating, distension,

abdominal discomfort or pain, heartburn, reflux, headaches, rumbling/load belly sounds,

diarrhea, constipation or both. To learn more about our classes, courses, support groups, and one-to-one services, visit www.stephanieclairmont.com.

Next Steps

Think you might like to adapt the Low FODMAP Diet to improve your symptoms of IBS and di-gestive distress? Reading this E-book and understanding the principles behind the Low FOD-MAP Diet is a great start. You now have the up-to-date list of low FODFOD-MAP foods to include daily in your diet and the high FODMAP foods to avoid. This exclusion diet should be followed for a period of time before foods are re-introduced.

If you think you may have IBS or that this diet may work for you, the first step is to talk with your doctor. Make sure you don’t make any changes to your diet until you’ve first been

assessed and screened by your medical doctor.

Remember, the Low FODMAP Diet has been designed to follow along with the support of a registered dietitian (RD) who is an expert in nutrition. You’ll want to work with an RD that specializes in the diet and digestive health, like those that are part of the team at the Clairmont Digestive Clinic.

If you would like to follow this diet on your own, ensure you visit www.stephanieclairmont.com for articles, resources, recipes and advice while following this diet.

This article on cooking Low FODMAP

HERE

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Recent Research on FODMAPs

Halmos, E. P., Power, V. A. Et al. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology. 2014 Jan; 146(1):67-75.e5.

doi: 10.1053/j.gastro.2013.09.046.

http://www.ncbi.nlm.nih.gov/pubmed/24076059

De Roest, R.H., Dobbs, B.R., et al. The low FODMAP diet improves gastrointestinal symptoms in patients with irritable bowel syndrome: a prospective study. Int J Clin Pract. 2013 Sep;67(9):895-903. doi: 10.1111/ijcp.12128.

http://www.ncbi.nlm.nih.gov/pubmed/23701141

Staudacher, H. M., Irving, P. M., et al. Mechanisms and efficacy of dietary FODMAP

restriction in IBS. Nat Rev Gastroenterol Hepatol. 2014 Jan 21. doi: 10.1038/nrgastro.2013.259.

http://www.ncbi.nlm.nih.gov/pubmed/24445613

Biesiekierski, J.R., Peters, S.L., et al. No effects of gluten in patients with self-reported non-celiac

gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbo-hydrates. Gastroenterology. 2013 Aug; 145(2):320-8.e1-3. doi: 10.1053/j.gastro.2013.04.051. http://www.ncbi.nlm.nih.gov/pubmed/23648697

Barrett JS, Gibson PR. Fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) and nonallergic food intolerance: FODMAPs or food chemicals? Therap Adv Gastroenterol. 2012 Jul;5(4):261-8. doi: 10.1177/1756283X11436241.