Info for Professionals
Who is the low FODMAP diet and FODMAP Friendly logo for?
Your patients should be informed to not assume they need the low FODMAP diet for IBS without speaking to their GP and being investigated for coeliac disease or other conditions. If there is no other condition then the low FODMAP diet may be the most appropriate dietary management. Refer to the research papers supporting the efficacy of the low FODMAP diet below.
- Shepherd SJ, Parker FJ, Muir JG and Gibson, PR Dietary triggers of abdominal symptoms in patients with irritable bowel syndrome- randomised placebo-controlled evidence Clin. Gastroenterol. Hepatol. 2008;6(7):765-771 http://www.sciencedirect.com/science/article/pii/S1542356508001511
- Shepherd SJ and Gibson PR Fructose malabsorption and symptoms of irritable bowel syndrome: guidelines for effective dietary management J. Am. Diet. Assoc.2006;106:1631-1639 http://www.sciencedirect.com/science/article/pii/S0002822306017044
- Halmos, EP, Power VA, Shepherd SJ, et al. A Diet Low in FODMAPs Reduces Symptoms of Irritable Bowel Syndrome Gastroenterology 2014;146(1)67-75 http://www.sciencedirect.com/science/article/pii/S0016508513014078
- Shepherd SJ, MCE Lomer and Gibson PR Short-Chain Carbohydrates and Functional Gastrointestinal Disorders Am. J. Gastroenterol. 2013;108:707-717
- Gibson PR and Shepherd SJ Food Choice as a Key Management Strategy for Functional Gastrointestinal Symptoms Am. J. Gastroenterol. 2012; 107:657–666 http://www.nature.com/ajg/journal/v107/n5/full/ajg201249a.html
- Gibson PR and Shepherd SJ Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach J. Gastroenterol. Hepatol. 2010; 25:252–258 http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1746.2009.06149.x/full
- Ong DK, Mitchell SB, Barrett JS, Shepherd SJ, Irving PI, Biesiekierski JR, Smith S, Gibson PR, Muir JG. Manipulation of dietary short chain carbohydrates alters the pattern of hydrogen and methane gas production and genesis of symptoms in patients with irritable bowel syndrome. J Gastroenterol. Hepatol. 2010 Aug ;25(8):1366-73 http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1746.2010.06370.x/full
- Barrett JS, Muir JG, Gearry RB, Irving PM, Rose R, Rosella O, Haines ML, Shepherd SJ, Gibson PR. Dietary FODMAPs increase delivery of water and fermentable substrates to the proximal colon Aliment. Pharmacol. Therapeutics. 2010;31(8):874-882 http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2010.04237.x/full
- Barrett JS, Irving PM, Gearry R, Shepherd SJ, Gibson PR Comparison of the prevalence of fructose and lactose malabsorption across chronic intestinal disorders Aliment. Pharmacol. Therapeutics 2009;30(2):165-74 http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2009.04018.x/full
- Gearry R, Irving PM, Barrett JS, Nathan D, Shepherd SJ, Gibson PR Reduction of dietary poorly absorbed short-chain carbohydrates (FODMAPs) improves abdominal symptoms in patients with inflammatory bowel disease—a pilot study J. Crohn’s Colitis 2009;3(1):8-14 http://www.sciencedirect.com/science/article/pii/S1873994608001219
- Croagh C, Shepherd SJ, Berryman M, Muir JG, Gibson PR. Pilot study on the effect of reducing dietary FODMAP intake on bowel function in patients without a colon. Inflamm. Bowel Dis. 2007;13(12):1522-8 http://onlinelibrary.wiley.com/doi/10.1002/ibd.20249/full
- Murray K, et al. Differential effects of FODMAPs (fermentable oligo-, di-, mono-saccharides and polyols) on small and large intestinal contents in healthy subjects shown by MRI. The Am J Gastroenterol 2014; 109:110–119. http://www.nature.com/ajg/journal/v109/n1/full/ajg2013386a.html
- Staudacher, H. M., et al. Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with irritable bowel syndrome.” J Human Nutr Diet 2011;24:487-495. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-277X.2011.01162.x/abstract;jsessionid=47F2A977D5615539C1667FEAFA69B217.f03t02?deniedAccessCustomisedMessage=&userIsAuthenticated=false
- Chumpitazi ,BP., et al. Randomised clinical trial: gut microbiome biomarkers are associated with clinical response to a low FODMAPdiet in children with the irritable bowel syndrome. Aliment Pharmacol Ther. 2015 Aug;42(4):418-27
- Mansueto, P., et al. Role of FODMAPs in Patients With Irritable Bowel Syndrome: A Review. Nutr Clin Pract. 2015 Feb 18
- Charlebois A, Rosenfeld G, Bressler B. The Impact of Dietary Interventions on the Symptoms of Inflammatory Bowel Disease: A Systematic Review. Crit Rev Food Sci Nutr. 2015 Jan 8:0.
- Shanti L. Eswaran, William D. Chey, Kenya Jackson, Sivaram G. Pillai, Samuel W. Chey, Theresa Han-Markey. 821 A Low FODMAP Diet Improves Quality of Life, Reduces Activity Impairment, and Improves Sleep Quality in Patients With Irritable Bowel Syndrome and Diarrhea: Results From a U.S. Randomized, Controlled Trial.Gastroenterology, 2016; 150 (4): S172
The low FODMAP diet has been scientifically proven to be effective in:
- People with irritable bowel syndrome
- Patients with inflammatory bowel disease who have ongoing GI symptoms despite IBD being in remission (quiescent disease)
- GI symptomatic patients with IBD (where disease is in remission)
- Patients with coeliac disease who have ongoing GI symptoms despite following a strict gluten free diet
- Ileostomates with high output
- People with non-coeliac gluten intolerance.
How do FODMAP Friendly certified foods fit in the patient’s low FODMAP dietary management?
FODMAP Friendly certified food products are suitable for people on both stages of the low FODMAP diet, as explained below.
All foods with the FODMAP Friendly logo are suitable to consume during the first phase of the low FODMAP diet. The first phase of the low FODMAP diet involves the strict restriction of all foods high in FODMAPs. As FODMAP Friendly certified foods are low in all FODMAPs, they are suitable to consume in this strict first phase.
The strict phase (phase one) should only be implemented for 6-8 weeks in order to establish the role of FODMAPs in triggering symptoms. We do not advocate people to remain on the strict phase of the low FODMAP diet forever. It is anticipated that the patient’s symptoms will improve in this time.
After the 6-8 week initial phase of the low FODMAP diet, health professionals are encouraged to work with their patient to liberalise their diet and establish their own threshold levels by determining the type and amount of FODMAPs that trigger symptoms. Once the patient understands their own FODMAP triggers, they can then follow their liberalised diet for the longer term. The liberalised diet is individualised – each person can have a different FODMAP tolerance. Liberalising the diet can assist in optimising nutritional adequacy as it will prevent unnecessary over-restriction of the diet. FODMAPs are good for bowel health (production of short chain fatty acids) so restricting FODMAPs beyond that which is needed for symptom control is not recommended. Foods with the low FODMAP logo can be consumed during the second phase of the low FODMAP diet, in conjunction with any foods that contain FODMAPs that have been established to be tolerated by the patient after liberalising their diet. Patients can “FODMAP – up” their diet as tolerated. Recipes on this website using foods containing the FODMAP Friendly logo give examples of how this can be achieved.
Where can I learn more?
Dr Sue Shepherd’s book:
- Food Intolerance Management Plan (Aust and NZ) – available from http://shepherdworks.com.au/shop
- The Complete Low FODMAP Diet (US edition of above book) – available from amazon.com