I get it - the low FODMAP diet can seem daunting at first. I see it all the time when I first share the protocol with clients. The elimination list seems random and long and the first thought is always, "what CAN I eat??" While I always provide clients with a list of foods that are suitable to consume when discussing necessary foods to eliminate (often temporary), as well as additional resources, such as shopping lists and recipes, I find that many people can still feel overwhelmed when trying to come up with their own meal and snack ideas, or follow traditional recipes. I thought it might be helpful to develop a brief guide that can help to alleviate some of the stress that can come along with starting this plan. Also, remember that meeting with a dietitian who has knowledge and experience with the low FODMAP diet can help to increase compliance, provide support and resources and, ultimately, make the process a bit easier!
For those of you who may be unfamiliar with a low FODMAP diet and are scratching your head, saying "low FOD-what??", this is not a diet for weight management. Instead, it is a diet used for the symptom management of irritable bowel syndrome (IBS). FODMAP is an acronym and it stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. The low FODMAP diet consists of 3 phases - the elimination phase, the reintroduction phase and the maintenance or personalization phase. The general philosophy behind the diet is that some individuals with IBS are sensitive to FODMAPs, which are certain carbohydrates that are highly fermentable by our gut bacteria. This is not to say that all carbohydrates are likely to bother individuals with IBS. Instead, certain carbohydrates are more fermentable than others and may worsen symptoms related to IBS, such as bloating, gassiness and altered bowel habit. It is important to note that many of these foods are likely to cause some bloating or gassiness within an individual that does not have IBS and that occasional symptoms such as these can be perfectly normal. However, for some people with IBS, these symptoms can be debilitating and interfere with daily life. It is very important to meet with a physician, such as a gastroenterologist, to discuss your symptoms and undergo proper screening and testing in order to determine whether IBS is, in fact, the diagnosis, as many symptoms of IBS are similar to that of other gastrointestinal conditions. Once you have met with your physician and received a diagnosis of IBS, it is then recommended to meet with a registered dietitian to help guide you through the nutritional management of this condition. As a dietitian with a focus on digestive health and improving food relationships, I help to guide clients through the nutritional management of many digestive conditions, such as IBS, in the least restrictive way possible. Below, I've shared some general tips to show you how simple it can be to replace high FODMAP foods with low FODMAP alternatives!
Not only are apples a convenient, portable, on-the-go fruit option since they don't require refrigeration and last for a relatively long time, they also tend to be prominent in many recipes for baked goods. Specifically, applesauce is common in many cakes, brownies and other desserts. Also, apples can sometimes be used to add a sweet taste to soups and other recipes. However, apples are a high FODMAP food are unlikely to be tolerated by many people with IBS who are sensitive to FODMAPs.
A banana is a simple low FODMAP swap for an apple as a simple, portable snack option, since bananas also don't require refrigeration, have a peel that keeps them protected and taste equally as amazing with nut or seed butter, such as peanut butter, almond butter or sunflower seed butter (also low FODMAP)! Additionally, mashing bananas for a recipe yields a similar consistency and sweetness when compared to applesauce, so swapping applesauce for mashed bananas in recipes can help to keep your FODMAP content in check.
When it comes to soup, a banana may not work as well as an apple, however, opting for another low FODMAP sweetener (such as maple syrup or sugar) or omitting the sugar source completely can also help to transform the recipe to one that is suitable for a low FODMAP diet. I often see apple in fall-inspired pureed soups, such as butternut squash or pumpkin soup, and these soups will naturally taste sweet due to the squash itself and likely do not require additional sweetener.
Remember, unripe bananas are low FODMAP (think: green at the tip). While ripe bananas are sweeter (and will make for sweeter recipes when baking), I have used unripe bananas in recipes and they work very well. Alternatively, using a small amount of ripe banana is likely to be well tolerated by many people.
Honey is a popular sweetener, however, it is also high in FODMAPs. Maple syrup is a great low FODMAP alternative, as it provides a similar consistency and sweet taste. Maple syrup works well as an oatmeal topping, mixed into tea, and as a baking ingredient and can essentially replace honey in a 1:1 ratio. Additionally, maple syrup is a great option for athletes who suffer from IBS symptoms, as it can be used as a low FODMAP fueling source (especially a great option for endurance athletes, such as marathon runners, as an alternative to energy gels or homemade honey-based electrolyte drinks).
One of my favorite low FODMAP breakfast ideas is plain oats made with water or lactose-free milk topped with blueberries, strawberries, walnuts and a drizzle of maple syrup!
Remember to use a pure maple syrup, as a blend that contains agave, honey or other high-FODMAP ingredients may trigger symptoms.
Onion and Garlic
Onion and garlic are often the foods that cause the many spirits to dwindle as I review the low FODMAP plan - especially once I explain that the low FODMAP diet elimination phase requires the elimination of onion and garlic powder, as well, and discuss many common foods that often contain these seasonings. However, there are a few alternatives that truly make this temporary elimination more bearable.
The green component of scallions and leeks can help to provide an onion-flavor to dishes, without the excessive FODMAPs. This is because these foods are actually high FODMAP due to the bulb (the white component). So, if you only use the green part of these plants, your dishes will be limited in FODMAPs, without being limited in onion flavor! Similarly, garlic scapes (the green stalks of the garlic) are thought to be low FODMAP, too, and can provide additional low FODMAP flavor. Although garlic scapes have not been tested by Monash University, many people are able to tolerate these well.
If you love the intense flavor of garlic and onion, you can also infuse oil with these foods by sautéing onion and garlic in oil, removing the onion and garlic and straining (and reserving) the infused oil, so that you can use it while cooking. Alternatively, you can also purchase garlic-infused oil. This is because the fructans (the FODMAP source) found in garlic and onion are not fat-soluble, meaning they will not leach into the oil. So, you can get the flavor without the FODMAPs!
Asafoetida powder is another low FODMAP option, as this seasoning can replace onion powder and garlic powder in recipes. While it is not always found in standard grocery stores, you can actually purchase asafoetida powder online (you can click here to purchase it through Amazon).
Lastly, while some traditional recipes may contain onion and garlic, it is often possible to provide a dish with a ton of flavor without the onion and garlic (i.e. using different spices). Although this may change the overall flavor, this doesn't mean the flavor will be bad! For example, it is definitely possible (and easy) to make a quick, homemade tomato sauce without onion and garlic and instead, use fresh tomatoes and basil for flavor.
Milk, Ice Cream and Other Lactose-Containing Foods
Lactose is the sugar naturally found in milk. Since foods that contain lactose (such as many dairy products) are high FODMAP, many people feel restricted and worry that they will not be able to tolerate foods such as milk, ice cream, yogurt and cheese. However, just because the low FODMAP elimination phase is lactose-free, this does not mean that all dairy needs to be avoided.
A simple swap for milk is lactose-free milk. Lactose-free milk is just like traditional cow's milk, however, it does not contain the milk sugar, lactose, and therefore is suitable for those with lactose intolerance, as well as those following a Low FODMAP protocol. It is important to note that this is different than a cow's milk allergy, in which the offending component is a protein, not a sugar. There are many types of lactose free items available, including lactose-free milk, lactose-free ice cream and even lactose-free varieties of many types of cheese, such as cottage cheese and cream cheese. You could, of course, consume low FODMAP dairy-free alternatives, such as unsweetened almond milk and products, if you prefer. It's just important to know that if you want to continue consuming dairy, you certainly can! The low FODMAP diet is lactose-free, not dairy-free. One important note, however, is to be cautious if consuming a flavored yogurt, as there may be additional FODMAPs present. Therefore, I often recommend plain, lactose-free yogurt (for example, Green Valley Organic brand) topped with low FODMAP toppings (such as blueberries, almonds, and/or maple syrup).
Additionally, some cheeses may not specifically be labeled "lactose-free", however, they may be naturally low in lactose and are likely to be well tolerated by those with lactose intolerance, as well as those following a low FODMAP elimination diet. For example, hard, aged cheese, such as cheddar or parmesan, are often well tolerated.
I hope you've found this post to be helpful as you navigate the low FODMAP plan. Remember, it is so important to eventually reintroduce foods and asses your tolerance to these foods, as many of the foods that are eliminated during the the low FODMAP elimination phase are beneficial to gut health and everyone's tolerance is likely to be different. Also, due to this fact, this plan is temporary and ultimately can be modified so that you can enjoy the foods you tolerate in the amounts in which you tolerate them, ultimately lowering the restrictive nature of the diet. So, if you're feeling overwhelmed with this plan, make sure to work with a registered dietitian who is knowledgeable regarding the low FODMAP diet and keep in mind that the elimination phase is meant to be short-term!
*This list includes low FODMAP options suitable for the elimination phase of the low FODMAP diet, as tested at the time of this post. Research regarding FODMAPs continues to be ongoing and updates may be revealed at a later time that deem foods high FODMAP after further research. Additionally, processing and serving size often play a role in FODMAP presence within the diet. It is best to work with a registered dietitian when following a low FODMAP protocol in order to ensure that you are receiving up-to-date recommendations, as well as personalized advice regarding navigation of the diet. This post is not meant to diagnose or treat any medical condition. This is provided as an educational resource to provide general advice and does not replace the role of a physician and a healthcare team.
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