By: Bruno P. Chumpitazi, MD, MPH, FAAP & Ann R. McMeans, MS, RD, LDN
What we eat can have a big impact on our overall health. If you have a child with
irritable bowel syndrome (IBS), you know that certain foods seem to trigger their digestive symptoms. Your pediatrician may have recommended that your child try a low-FODMAP diet. But what are FODMAPs? And what is this diet all about?
Understanding FODMAPs
FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These are sugars (carbohydrates) that are found in a wide variety of foods we eat often. FODMAP sugars include:
Oligosaccharides: Fructans and galacto-oligosaccharides (GOS)
Disaccharides: Lactose
Monosaccharides: Fructose
Polyols: Sorbitol and mannitol
FODMAPs can cause digestive problems in some people, especially those with IBS. That's because scientists have found that our small intestines don't absorb or digest FODMAPs very well. This leads to more water entering the gut. Then when FODMAP sugars reach the colon, they create more gas.
All this excess fluid and gas can lead to symptoms such as:
Abdominal Discomfort
Abdominal Pain
Cramping
Flatulence
Bloating
Diarrhea
Constipation
FODMAPs aren't unhealthy or bad. They just have the potential to make symptoms worse in people with sensitive digestive systems, such as those with IBS.
FODMAP content in foods
There are many foods that are high in FODMAPs. This table gives a list of some common ones, as well as alternatives that kids can eat while on the diet. However, it's not by any means a complete list. We recommend kids work with a registered dietitian when possible.
FODMAP Type
|
High-FODMAP Foods
|
Low-FODMAP Alternatives
|
Fructose | High fructose corn syrup (used in many foods/beverages), molasses, honey, apples, pears, boysenberry, mango, fruit juices, agave syrup
| Grapes, strawberries, cantaloupe, oranges, pineapple, banana, blueberries, maple syrup, rice syrup |
Lactose | Cow's milk, yogurt made with cow's milk, heavy cream, half and half; pudding, custard, any product with milk as a main ingredient | Most cheeses in moderation (1–2 ounces per day); lactose-free milk and yogurt |
Sorbitol and mannitol | Avocado, apples, nectarines, peaches, sugar-free candy and gums, watermelon, mushrooms, cauliflower, pears, whole corn on the cob | Candy and gum made with sucrose or starch; sucrose in foods and beverages |
| Fructans and GOS | Garlic, onion, wheat (bread, pasta), beans, cashews, falafel, cooked lentils, pistachios, hummus, coconut milk | Peanut butter, canned lentils (limited), some nuts in restricted quantities
|
The low-FODMAP diet
This diet is often referred to as simply the
FODMAP diet. But technically, it's a
low-FODMAP diet. That's because it focuses on limiting the intake of high-FODMAP foods. The diet includes three phases and was created in Australia specifically for people with IBS, a common issue in both children and adults. Your pediatrician may recommend a low-FODMAP diet if your child has IBS. Research has shown that this diet has helped many adults and kids with IBS manage their symptoms.
Because the low-FODMAP diet is so restrictive, it's not for people who are otherwise healthy. Your child should only be on this diet if it has been recommended by your doctor. We recommend working with a registered dietitian while your child is on this diet. Your pediatrician can suggest one or you can find one at the
Academy of Nutrition and Dietetics website.
Here's what you can expect in the three phases of this diet.
Phase 1: Elimination
In the first phase, your child stops eating foods that are high in FODMAPs for 2–6 weeks. We often recommend 2 weeks because it can be hard to follow such a restrictive diet. You should know by the end of this phase whether the diet is helping your child's symptoms.
Keep in mind that not everyone that tries the low-FODMAP diet has symptom relief. You may need to work with your child's pediatrician on finding other options if the diet doesn't help.
Phase 2: Reintroduction
You'll move on to the second phase if your child's symptoms have improved. In this phase, you'll introduce high-FODMAP foods back into your child's diet. We recommend reintroducing one FODMAP at a time—for example, lactose—typically over three days. This allows your child to tell which of the FODMAPs are causing symptoms. If the digestive issues (pain, gas, etc.) start again after a FODMAP type is reintroduced, take it back out of their diet.
You may want to take a break if your child's symptoms get worse with one FODMAP before reintroducing another one. It's also a good idea to keep a food diary during this time to track what your child is eating and how they react.
The goal of this phase is to help you pinpoint which foods your child can tolerate and which ones cause digestive distress. If you need to take breaks in between reintroducing FODMAP types, this phase can take up to a month.
Phase 3: Personalization
Once you've figured out which foods cause digestive symptoms, you can personalize the diet to your child's needs. In this phase, you'll have your child limit or completely avoid the FODMAP types that give them problems. Your child can enjoy the others without worrying about their symptoms coming back.
Risks of FODMAP diet
The risks of a low-FODMAP diet are not getting enough nutrients or enough calories. For growing kids, this is a concern. That's why it's a good idea to work with a registered dietitian to come up with a healthy diet for your child during the three phases. This will help reduce these nutritional risks.
Interestingly, our initial research suggests that children with IBS often typically eat a poor diet, similar actually to what healthy kids eat. But kids with IBS who work with a registered dietitian to follow a low-FODMAP diet have some initial improvement, even in the first phase, in their overall diet quality.
Your child shouldn't try a low-FODMAP diet if they have an eating disorder or if they're already following a specialized diet.
You can learn more about the low-FODMAP diet, take online courses, and find recipes at the
Monash University site, where the diet was created. They also have
an app that gives you low-FODMAP food recommendations and lets you look up foods.
Remember
Talk with your pediatrician if you have any concerns about your child's digestive health.
About Dr. Chumpitazi
Bruno Pedro Chumpitazi, MD, MPH, FAAP, is a board-certified pediatric gastroenterologist, Associate Professor of Pediatrics at Baylor College of Medicine, and Director of the Neurogastroenterology and Motility Program at Texas Children's Hospital. From early on in his medical training, he was struck by how common certain disorders of gut-brain interaction, such as irritable bowel syndrome, were and the morbidity associated with them. Dr. Chumpitazi has dedicated his academic career toward applying the most effective, cutting edge, and multi-disciplinary techniques to help children with disorders of gut-brain interaction (DGBI), such as irritable bowel syndrome, and other gastrointestinal disorders. His group's scientific research is focused on understanding the reason behind food-induced symptoms in children with DGBI in order to provide personalized treatment.
About Ms. McMeans
Ann McMeans, MS, RD, LDN, has been a research dietitian for over 20 years, working for Baylor College of Medicine at Texas Children's Hospital. Prior to transitioning to pediatric nutrition research, Ann was a pediatric clinical dietitian at Texas Children's Hospital. Ann participates in research at the USDA Children's Nutrition Research Center and the Texas Children's Hospital Clinical Research Center. Her more recent research activities include multiple studies involving the low FODMAP diet in the pediatric population and various oral food allergy challenge studies. She was the 2018-2019 President of the National Association for Research Nutrition.