Cynthia Knipe, RDN, LD

Nutrition Counseling, Consulting

and
Worksite Wellness

The FODMAP Diet

Jaclyn A. Schermer , B.Sc. (Nutrition)
University of Minnesota, Keene State College Dietetic Intern

Edited By: Cynthia A. Knipe, RDN, LD

Introduction:
FODMAPs are fermentable starches, oligosaccharides disaccharides
monosaccharides and polyols, found in food1-10. Research suggests that a subset
population, with functional gastrointestinal disorders like irritable bowel syndrome, may
have difficulty with foods that have high amounts of specific FODMAP-containing
carbohydrates. Symptoms may include but are not limited to bloating, constipation,
distention, diarrhea, abdominal pain, and excess flatulence1-9. In 2001, Dr. Sue
Shepherd, a Registered Dietitian Nutritionist, joined a team of researchers at Monash
University in Melbourne, Australia to identify foods containing specific fermentable
carbohydrates. They developed a trial elimination diet with the purpose of decreasing
functional gastrointestinal symptoms. The results of their work support the theory that
consumption of FODMAPs may contribute to the symptoms experienced by some
patients with diagnosed gut motility disorders2. Limitations to the FODMAP diet include
determining cut-off levels to indicate if the food is low or high FODMAP7, decreasing
foods that contain gut supportive prebiotics, and restricting high fibrous foods. High
FODMAP foods include those with prebiotics that support bowel health. Elimination of
prebiotics could affect the gut flora8, 15. Following, the diet limits wheat, rye, fruits and
vegetables (including legumes) which could cause a decrease in fiber consumption.
Having a decrease in fibrous foods can lead to constipation8.

1
WWW.WHATNOURISHESYOU-NH.COM
603-738-5791
 Cynthia Knipe, RDN, LD
Nutrition Counseling, Consulting
and
Worksite Wellness

History:
In 1999, Dr. Sue Shepherd found that fructose malabsorption may contribute to
symptoms associated with gut motility disorders. She and her team created a diet to
monitor fructose malabsorption which she used in her own private practice, as a way to
help those who experienced undesirable outcomes when they consumed foods that
contained fructose12. After success with the fructose malabsorption diet, Shepherd
wanted to research effects that other fermentable starches may contribute to those
whose symptoms were not resolved with the elimination of fructose. In 2001
gastroenterologist Dr. Peter Gibson, Dr. Shepherd, and their team in the Department of
Gastroenterology at Monash University in Melbourne, Australia transitioned to finding
those components of carbohydrates that along with fructose can cause poor absorption
and discomfort among a subset of the population that experience symptoms related to
gut motility, specifically patients with Crohns disease. The trend resulted in the
acronym FODMAP2. Gibson and Shepherd published their research in 2005 outlining
the hypothesis that excessive delivery of highly fermentable but poorly absorbed short-
chain carbohydrates and polyols to the distal small intestine and colonic lumen may
contribute to susceptibility to Crohns disease. A 2008 small pilot study indicated that
IBD patients with concurrent functional gut symptoms perceived a decrease in
abdominal symptoms while following a low FODMAP diet3. Recommendation was made
for a controlled dietary intervention trial for patients with functional gut symptoms. By
2009, Shepherd had enough evidence to suggest that the low FODMAP diet approach
was sufficient for widespread application for those with Irritable Bowel Syndrome, with a
continuation of research needed to support the diet for Inflammatory Bowel Disease
patients with coexistent functional gut symptoms3, 7.

2
WWW.WHATNOURISHESYOU-NH.COM
603-738-5791
 Cynthia Knipe, RDN, LD
Nutrition Counseling, Consulting
and
Worksite Wellness

Mechanism for FODMAP Intervention:

Patients with functional gastrointestinal disorders (FGID) may experience
osmotic effects, increased hydrogen breath due to rapid fermentation, altered
microflora, small intestinal bacterial overgrowth, visceral hypersensitivity and increased
symptoms when they consume diets that are high in FODMAP-containing food1, 8, 11.
Luminal distention is common and may induce pain in the abdomen, create visible
extension, sensation of bloating and change in motility. Liquid, solids, and gas can
cause this intestinal lumen distention. Solid distention can create alteration in the large
intestine by creating expansion or contraction of bacterial mass. Liquid can lead to
osmotic alterations, causing a decrease in absorption in the epithelium. Gas will be
caused due to rapid bacterial fermentation7. Foods that are high in FODMAPs create a
food that is eaten quickly by the bacteria and can lead to bacterial overgrowth and
increase epithelial permeability1.
Fructose is absorbed in the small intestine by facilitated transport using GLUT2
with glucose and GLUT5 with facilitated transport. When there is plenty of glucose
present during the absorption of fructose, it is less likely to have malabsorption occur
because of the GLUT2 transporter. In the presence of a GLUT5 impairment or if
fermentation of fructose occurs prior to absorption, this can cause malabsorption9. This
process of fructose absorption has decreased cell function for some individuals, causing
more susceptibility to malabsorption8. The slow low capacity transporter mechanisms
are unable to actively get across the epithelium9.
Malabsorption of lactose occurs when there isnt enough production of the
lactase enzyme, which is used to break down the disaccharide into two
monosaccharides (glucose and galactose). This break down occurs in the brush border
of the small intestine. Individuals may have varying levels of lactasia, and the more
hypolactasia they are, determines the response of malabsorption of patients. When
malabsorbed, the bowel may experience more luminal distention and osmotic effect 9.
The malabsorption of fructans and galactans are proved to be malabsorbed in
everyone, including healthy individuals8. People that are healthy lack hydrolases that

3
WWW.WHATNOURISHESYOU-NH.COM
603-738-5791
 Cynthia Knipe, RDN, LD
Nutrition Counseling, Consulting
and
Worksite Wellness

can split fructan and galactans which cause malabsorption in almost all people. The
length of the oligosaccharide impact the malabsorption, anything with a polymerization
of less than 10 may have greater effect when malabsorbed9.
Polyols create osmotic symptoms. This is because polyol molecules are often too large
for simple diffusion across the epithelium. The smaller the polyol molecule the easier it
can get across the epithelium, creating less complication9.
The Monash University Low-FODMAP Diet was created to minimize the
consumption of foods that cause these liquid, solid, and gas distention, relieving
functional GI symptoms7. FODMAPs ferment rapidly and the rate is determined by the
length of the carbohydrate chain. Poor absorption occurs by virtue of slow, low-capacity
transport mechanisms across the epithelium(fructose), reduced activity of brush border
hydrolases(lactose), lack of hydrolases (fructose and galactans),or molecules being too
large for simple diffusion (polyols).7

4
WWW.WHATNOURISHESYOU-NH.COM
603-738-5791
 Cynthia Knipe, RDN, LD
Nutrition Counseling, Consulting
and
Worksite Wellness

What are FODMAPs:

FODMAPs are types of carbohydrates that ferment in the gut. Fermentation can
be challenging for some people that lack hydrolase enzymes and may have decreased
transport mechanisms to cross the epithelium, which are essential during the process of
food breakdown7. Lack of
proper function may cause Table. 1 FODMAPs by category, common food sources

food to reside in the gut for an

Carbohydrate High FODMAP Common food
extensive amount of time. Components specific categories in
When the gut holds onto these this
Common Mono- Fructose fruit,
undigested carbohydrates,
saccharide sweeteners,
fermentation allows gas to get and sugar
alcohols
trapped and foods become
Common Di- Lactose Dairy products
malabsorbed2 Rapid bacterial saccharides (glucose +
galactose)
overgrowth allows stress of the
Common Oligo- Galactan Vegetables,
gut lining and may allow for the saccharide (chain of beans and soy
gut to become more galactose products
molecules)
permeable which allows for
key nutrients to leak out before Fructan vegetables,
(chain of grains, added
being absorbed.2 glucose + 2 fiber
There are many types fructose)
of saccharides however there Polyols Sugar alcohols Candy, gums,
are some are more specific to fruit spread,
apples, pears,
FODMAPs then others. These sugar-free
saccharides are most specific products
to the fermentable carbohydrates lactose, fructose, fructans/galactans, and
sorbitol/mannitol. Galactans are a large molecule composed of galactose, in repetition.
Unlike the saccharides, polyols are sugar alcohols.

5
WWW.WHATNOURISHESYOU-NH.COM
603-738-5791
 Cynthia Knipe, RDN, LD
Nutrition Counseling, Consulting
and
Worksite Wellness

The Monash University Low-FODMAP Diet protocol involves three phases:

Phase One: Time-limited elimination phase where identified high FODMAP foods are
restricted and increase consumption of low FODMAP containing foods.
The elimination phase may last two to six weeks.13 In the Australian
studies, greatest symptom improvement occurred within 7 days.14 The
length of the elimination phase is variable, under supervision, to allow the
gut to rest in patients with more inflammation or long-term symptoms.

However, it should be noted that if symptoms are not noticeably resolved

by week three it is probable that that other treatments may be beneficial.

Not to be overlooked is the risk of unwanted weight loss and malnutrition if

calorie and nutrient intake is not supervised. 6,15

Phase Two: Controlled challenge phase

Time-consuming - challenge one FODMAP group at a time with a
recommendation of 3 days between challenges
Should be deliberate and well-planned
Risk of unwanted weight loss and malnutrition in those individuals who are
hesitant to re-introduce food that may stimulate symptoms

Phase Three: Most liberal and varied diet the individual can tolerate

FODMAPs-containing carbohydrate are identified by five main categories (Table 1.):

fructose, fructans, lactose, polyols, and galactooligosaccharides (GOS). Fructose is a
monosaccharide and when consumed in excess requires a facilitated transporter. This
allows for only some excess to be absorbed and may cause fructose malabsorption.
Fructans require beta1-2 bonds to be broken, then brought to the large bowel for
6
WWW.WHATNOURISHESYOU-NH.COM
603-738-5791
 Cynthia Knipe, RDN, LD
Nutrition Counseling, Consulting
and
Worksite Wellness

fermentation. Lactose is a disaccharide that needs adequate activity of the lactase

enzyme in the small intestine for proper breakdown. Polyols are sugar alcohols that are
poorly absorbed in the small intestine and are fermented. Then lastly, GOS need alpha-
galactosidase to hydrolyze linkages to make simple sugars. Naturally these enzymes
are limited and therefore ferment quickly and produce excess gas1.

Table 2. Common foods that contain high FODMAPs, categorized by the five FODMAP
specific groups2,4,12,13
FODMAP group Common High FODMAPs ( foods to avoid)

Excess Fructose Apple, watermelon, pear, mango, dried fruit, boysenberry, fig,
fruit juice, high fructose corn syrup, fructose, honey, corn syrup,
asparagus, artichoke, sugar snap peas
Fructans Beets, asparagus, garlic, leek, shallots, onions, artichoke,
Brussel sprouts, cabbage, eggplant, okra, fennel, wheat(bread,
pasta, biscuits, cracker, tortilla, gravy, etc.), rye, watermelon,
apples, peaches, nectarines, persimmon, chicory, onion
powder, barley
Lactose Milk, ice cream, yogurt, cottage cheese, sour cream, custard,
soft cheeses, evaporated milk, ripened cheeses
Galactans (GOS) Chickpeas, lentils, kidney beans, baked beans, legume beans,
pistachio nuts, cashews
Polyols Apple, apricot, avocado, cauliflower, green pepper, sorbitol,
mannitol, xylitol, malitol, isomalt, mushrooms, cherry,
watermelon, peach, pear, nectarines, snow peas, plums,
blackberries, lychee
Bold= in more than one area
Note: appendix 1 has an extensive FODMAP list categorized by food groups.

7
WWW.WHATNOURISHESYOU-NH.COM
603-738-5791
 Cynthia Knipe, RDN, LD
Nutrition Counseling, Consulting
and
Worksite Wellness

Evidence Supporting FODMAP

A team of scientists at the GI Diseases Research Unit at Kingston General
Hospital in Kingston, Ontario, Canada, performed a controlled, single-blind study. 40
participants with all subtypes of IBS were included and randomly assigned to either a
low or high FODMAP diet for 3 weeks. Symptoms were assessed using the IBS
symptom severity scoring. The metabolome was evaluated using the lactulose breath
test and metabolic profiling in urine using mass spectrometry. Stool microbiota
composition was also analyzed. IBS-SSS decreased with the low FODMAP diet but
was unchanged with the high FODMAP group. Histamine was reduced eightfold in the
low FODMAP group. The high FODMAP diet decreased the relative abundance of
bacteria involved in gas consumption5. IBS symptoms are associated with FODMAPs
and associated with alterations in the metabolome, histamine, microbiota, and
symptoms.5
A Swedish study conducted from 2013-2104, with 67 participants who met Rome
III criteria for IBS, assigned participants to either a diet low in FODMAPs or a
traditionally recommended diet for patients with IBS. The duration was 4 weeks.
Symptom severity was measured using the IBS-SSS. Symptom severity was reduced
in both groups with participants in the low FODMAPs group without any clear
differences between the two strategies. Food diaries indicated good adherence among
both groups to the diet assigned. An unexpected outcome among both groups was low-
calorie intake. Participants focused on following the limitations on specific food
constituents and underestimated their actual food intake. The authors of the study
concluded that both dietary approaches, or a combination, can contribute to a reduction
in symptoms but that monitoring of energy (calories) and nutrient intake is important. 6
A 2012 New Zealand prospective study followed 90 patients with a mean follow-up
of 15.7 months. Participants were first given a hydrogen/methane breath test to
evaluate appropriateness to participate; followed by dietary advise for following the low
FODMAP diet. 75.6% had fructose malabsorption; 37.8% had lactose malabsorption,
and 13.3% of participants had small intestinal bacterial overgrowth. Participants were

8
WWW.WHATNOURISHESYOU-NH.COM
603-738-5791
 Cynthia Knipe, RDN, LD
Nutrition Counseling, Consulting
and
Worksite Wellness

assessed for dietary adherence and satisfaction with symptom improvement. 75.6%
were adherent to the diet, and 72.1% reported satisfaction with symptom improvement.
The researchers suggested that breath testing and dietary guidance may be a good
basis for adherence to the diet.10

Limitations and Areas that need more research:

The number of studies is limited, and participant sample sizes are small.
Indications are that both the Monash University low-FODMAP diet plan and the
traditional IBS diet may be effective in reducing gut motility-related symptoms in a
percentage of IBS patients. Concerns related to inadequate energy intake and potential
for malnutrition with both approaches support recommendations for oversight from a
Registered Dietian.6
More evidence is needed to determine the cut-off levels needed to indicate if the
food are low or high FODMAP. Across the resources some areas show
differentiation among what is considered high or low7. Cut off levels are not easily
coined, as they are not considered by the total of a patients individual FODMAP
consumption or ranging thresholds of individuals.
The diet restricts prebiotic-containing food. Prebiotics support bowel health by
assisting the gut flora7,8 Foods that contain fructans, galactans, and inulin contain
prebiotics which help increase growth of bifidobacteria as well as reduce Escherichia
coli, Bacteroides spp, and Clostridium spp8. Removing prebiotics from ones diet may
allow for an increase of pro-inflammatory bacteria and increase osmotic load3.
Fiber consumption may be decreased, contributing to some symptoms in patients
with IBS-C.8
Areas that are still under of further exploration include but are not limited to
polyols, non-celiac gluten intolerance, and the effect of the FODMAP diet in patients
with IBD.7,11 Polyols are considered on the FODMAP elimination diet, but are
underexplored. These are absorbed by passive diffusion instead of active transport into
the small intestine. The rate that they are absorbed is impacted by the polyol size, the
pore size on the epithelium, and the impact of disease on pore size. The management
9
WWW.WHATNOURISHESYOU-NH.COM
603-738-5791
 Cynthia Knipe, RDN, LD
Nutrition Counseling, Consulting
and
Worksite Wellness

of Celiac disease is well known for its use of the gluten restriction diet. However,
nonceliac gluten restriction is being investigated for patients with IBS, ADHD, chronic
fatigue, and many other conditions.11

Is a dietitian a key for success?

It is not uncommon for patients with IBS symptoms to resort to unverified internet
sources, increasing the risks for inadequate energy and nutrient intake as well as
unwanted weight loss. Dietitians play a role in the FODMAP elimination diet, reducing
the risk of nutrient deficiencies. Dietitians can educate on balancing intake during the
FODMAP Elimination Phase while tailoring the diet to what is manageable and realistic
for the individual patient.
For those who achieve long-sought relief from symptoms It can be tempting to
continue with the highly restrictive diet. Dietitians provide important support during the
Challenge Phase, helping patients plan and progress to the most liberal and varied diet
the individual can tolerate.

Conclusion
The FODMAP elimination diet is a treatment option that may be appropriate for
patients who experience gut motility related symptoms. By eliminating fermentable
olgio-, di-, mono- saccharides, and polyols in the diet patients are likely to see
improvement in bloating, constipation, distention, diarrhea, abdominal pain, and excess
flatulence1-9 . The diet is not a diet for otherwise healthy people7. Limitations to the
FODMAP diet include determining cut-off levels to indicate if the food is low or high
FODMAP7, decreasing foods that contain gut supportive prebiotics7, and restricting high
fibrous foods.

10
WWW.WHATNOURISHESYOU-NH.COM
603-738-5791
 Cynthia Knipe, RDN, LD
Nutrition Counseling, Consulting
and
Worksite Wellness

References
1
Gibson PR, Shepherd SJ. Personal view: food for thought - Western lifestyle and susceptibility
to Crohn's disease. The FODMAP hypothesis. Alimentary pharmacology and
therapeutics aliment pharmacol ther. 2005;21(12):1399-1409. doi:10.1111/j.1365-
2036.2005.02506.x.
2
The Fodmap Solution: A Low Fodmap Diet Plan and Cookbook to Manage IBS and Improve
Digestion. Berkeley, CA: Shasta Press; 2014:1-28.
3
Gearry RB, Irving PM, Barrett JS, Nathan DM, Shepherd SJ, Gibson PR. Reduction of dietary
poorly absorbed short-chain carbohydrates (FODMAPs) improves abdominal symptoms
in patients with inflammatory bowel diseasea pilot study. Journal of Crohn's and
Colitis. 2009;3(1):8-14. doi:10.1016/j.crohns.2008.09.004.
4
Catsos P. Ibs: Free at last! Change your carbs, Change your life with the fodmap
elimination diet. 2nd ed. Portland, ME: Pond Cove Press; 2008.
5
Mcintosh K, Reed DE, Schneider T, et al. FODMAPs alter symptoms and the metabolome of
patients with IBS: a randomised controlled trial. Gut. March 2016. doi:10.1136/gutjnl-
2015-311339.
6
Bhn L, Strsrud S, Liljebo T, et al. Diet Low in FODMAPs Reduces Symptoms of Irritable
Bowel Syndrome as Well as Traditional Dietary Advice: A Randomized Controlled Trial.
Gastroenterology. 2015;149(6). doi:10.1053/j.gastro.2015.07.054.
7
Gibson PR, Shepherd SJ. Evidence-based dietary management of functional gastrointestinal
symptoms: The FODMAP approach. Journal of Gastroenterology and Hepatology.
2010;25(2):252-258. doi:10.1111/j.1440-1746.2009.06149.x.
8
Barrett JS. Extending Our Knowledge of Fermentable, Short-Chain Carbohydrates for
Managing Gastrointestinal Symptoms. Nutrition in Clinical Practice. 2013;28(3):300-
306. doi:10.1177/0884533613485790.
9
Barrett JS, Gibson PR. Clinical ramifications of malabsorption of fructose and other short-chain
carbohydrates. Practical gastroenterology . August 2007:51-65.
10
De Roest RH, Dobbs BR, Chapman BA, et al. The low fodmap diet improves gastrointestinal
symptoms in patients with irritble bowel syndrome: a prospective study. International
Journal of Clinical Practice, 2013:67(9):895-903.
11
Barrett JS, Gibson PR. Fermentable oligosaccharides, disaccharides, monosaccharides and
polyols (FODMAPs) and nonallergic food intolerance: FODMAPs or food chemicals?
Therapeutic Advances in Gastroenterology. 2012;5(4):261-268.
doi:10.1177/1756283x11436241.

11
WWW.WHATNOURISHESYOU-NH.COM
603-738-5791
 Cynthia Knipe, RDN, LD
Nutrition Counseling, Consulting
and
Worksite Wellness

12
You're in good hands!Welcome to Shepherd Works. Shepherd Works.
http://shepherdworks.com.au/about/. Accessed October 20, 2016.
13
Barrett J, Halmos E. Gastroenterological society of australia . Gastroenterological society of
australia . 2013. Information about low fodmap diet to improve irritable bowel syndrome
(ibs) symptom control
14
Lacy B, Chey W, Lembo A. New and Emerging Treatment Options for Irritable Bowel
Syndrome. Gastroenterology & Hepatology. 2015:11(4)(S2)
15
Mansueto P, Seidita A, Alcamo A, Carroccio A. Role of FODMAPs in Patients With Irritable
Bowel Sydrome, Nutrition in Clinical Practice. 2015:30(5):665-682.
Doi:10.1177/0884533615569886

Additional Resources/links:
Fodmap Monash University app and website
http://www.med.monash.edu/cecs/gastro/fodmap/
App download: apple app store or google play
Dr. Sue Shepherds website: http://shepherdworks.com.au/disease-information/low-
fodmap-diet/
*Martin Lee website: https://rmdietetic.com/about/
Patsy Catsos: http://www.ibsfree.net/about-patsy-catsos/
Kate Scarlata: http://www.katescarlata.com/

12
WWW.WHATNOURISHESYOU-NH.COM
603-738-5791

Appendix 1: FODMAP foods organized by food categories2,4,12,13.
Food Low FODMAP
Categories (foods to eat)
Grains/Starch Corn starch gravy, xanthum gum,
gluten free grains (rice, brown rice,
wild rice, brown rice flour, corn,
cornmeal, grits/hominy, popcorn, corn
tortillas, oats, oat bran, buckwheat,
quinoa, amaranth, millet) potato,
potato chips, crackers made from rice
or corn, corn/rice/ quinoa pasta
Fruits Blueberries, strawberries, raspberries,
cranberries,
Grapes, rhubarb, honeydew,
cantaloupe, oranges,
clementines/mandarin oranges,
lemons, limes, grapefruit, tangerine,
banana, pineapple, passion fruit,
kumquat, kiwi, dragon fruit
Vegetables Bell peppers, fresh tomatoes,
eggplant, carrots, parsnips, radishes,
potatoes, sweet potatoes and yams,
squash, zucchini, pumpkin,
cucumbers, pickles, Bamboo shoots,
spinach, lettuce, celery, chives, green
onions (green part only), bean sprouts,
corn, bok choy
Protein: Meat, Beef, chicken, tuna, eggs, egg whites,
poultry, fish, fish, pork, shellfish, lamb, cold cuts,
eggs, etc etc
WWW.WHATNOURISHESYOU-NH.COM
603-738-5791
Cynthia Knipe, RDN, LD
Nutrition Counseling, Consulting
and
Worksite Wellness
High FODMAP
(foods to limit/avoid)
Products with wheat, spelt, kamut as
a major ingredient (cereal, bread,
cake, pasta, cookies, pizza crust,
bagels, gravies, muffins, pastries,
crackers, biscuits, sauces), graham
crackers, flour tortillas, wheat
berries, chicory root or extract, inulin
(baked oatmeal, cereal, fiber bars,
etc), fructose, high fructose corn
syrup, molasses, fruit juice
concentrate
Apples, pears, apricots, plums,
peaches, nectarines, cherries,
watermelon, mango, lychee, papaya,
figs, dried fruits, prunes, guava,
avocado, coconut
fruit juices and juice cocktails, apple
cider, apple sauce, fruit leathers
Onions, leeks, garlic, scallions,
mushrooms, beets, green beans,
Broccoli, Brussel sprouts,
cauliflower, cabbage, kale,
asparagus, fennel, artichokes, snow
peas, sugar-snap peaks, okra, onion
powder, garlic powder, tomato paste,
tomatoes canned with paste or
concentrate, dehydrated vegetables
in whole food-type supplements
Avoid foods made with HFCS, wheat
sauce, fruit sauce, etc
13

Plant-based Tofu, Nuts and seeds
proteins
Dairy Lactaid brand products (ice cream,
milk, cottage cheese) Lactose free
yogurt, rice milk, non-dairy creamer,
lactose-free whipped non-dairy cream
(Cool Whip), hard cheeses (cheddar,
colby, parmesan, Swiss), Daiya dairy
free cheese, Toffuti sour cream
Beverages Low FODMAP fruit juices, tea, water,
lactose-free milk
Seasonings, Most spices and herbs are okay,
condiments, homemade broth, flaxseed, olive oil,
And pepper, salt, sugar, maple syrup
sweeteners (without HFCS), marinara sauce,
balsamic vinegar, mustard, olives,
vinegar
Additives Corn starch, modified food starch,
carrageenan, guar gum, xanthan gum
WWW.WHATNOURISHESYOU-NH.COM
603-738-5791
Cynthia Knipe, RDN, LD
Nutrition Counseling, Consulting
and
Worksite Wellness
Tempeh, Veggie burgers
Dried/ canned beans, lentils
Dried/split peas
Chickpeas, hummus
Cashews, pistachios
Coconut milk, coconut cream, soy
milk, lactose containing foods (milk,
yogurt, evaporated milk, eggnog,
cottage cheese, ice cream, frozen
yogurt, sour cream, soft cheeses,
buttermilk, chocolate, sweetened
condense milk, evaporated milk,
whipped cream, ricotta cheese
Any beverages with fructose or high
fructose corn syrup (soda,
carbonated beverages, vitamin
water, fizzy drinks), fortified wines
(sherry, port), soy milk, COFFEE,
sweetened iced tea
Garlic, honey, mams, jellies,
molasses, relish, agave, HFCS,
artificial sweetners, high fodmap fruit
sauces, salad dressing made with
high FODMAPs, honey, sugar
alcohols: sorbitol, mannitol, isomalt,
xylitol
Inulin, Chicory root and chicory root
extract, Corn syrup solids
14