This diet is best done in conjunction with a trained dietitian so they can help identify which FODMAPs may be contributing to your symptoms. Find a dietitian.
People with endometriosis may suffer abdominal symptoms (such as bloating, pain, diarrhoea and/or constipation) and many get diagnosed with irritable bowel syndrome (IBS) before endometriosis. A wide variety of foods have been reported to trigger abdominal symptoms by people with endometriosis. If this sounds like you, you could benefit from the FODMAP diet.
The low FODMAP (fermentable oligosaccharide disaccharide monosaccharide and polyol) diet has become the main dietary treatment for IBS over the last 10 years. FODMAPs are small, poorly absorbed molecules found in certain foods. They readily ferment by bacteria in the gut, which can trigger IBS symptoms.
The aim of the low FODMAP diet is to avoid foods high in FODMAPs and stick to low FODMAP foods. In a recent study, 72% of patients showed reductions in their abdominal and bowel symptoms when they eliminated high FODMAP foods from their diet for four weeks. This elimination diet is recommended to only be followed for 4-6 weeks. The next step is to re-introduce high FODMAP foods to determine which ones are triggering symptoms.
Where FODMAPs are found in foods
FODMAPs are found in a wide variety of foods, including fruit and vegetables, grains and cereals, nuts, legumes, lentils, dairy foods and manufactured foods. This makes following the FODMAP diet a little tricky, as you cannot simply guess which foods will be high or low in FODMAPs.
The information below will help you to understand which food groups typically contain which FODMAPs. However, for the most comprehensive information about the FODMAP content of food, see the Monash FODMAP App.
Fruit
The main FODMAPs present in fruit are sorbitol and excess fructose. Fruits particularly high in excess fructose include apples, pears, mangoes, cherries, figs, nashi pears, pears, watermelon and dried fruit.
Fruits particularly rich in sorbitol include apples, blackberries, nashi pears, peaches and plums. Many fruits contain both fructose and sorbitol, for example, apples, pears and cherries.
Vegetables
The main FODMAPs present in vegetables are fructans and mannitol. Vegetables particularly rich in fructans include artichoke, garlic, leek, onion and spring onion. Vegetables particularly rich in mannitol include mushrooms, cauliflower and snow peas.
Grains and cereals
The main FODMAPs present in grain and cereal foods are fructans and to a lesser extent, GOS.
Grain and cereal foods particularly rich in fructans include wholemeal bread, rye bread, muesli containing wheat, wheat pasta and rye crispbread.
Legumes and pulses
The main FODMAP present in legumes and pulses is GOS. Legumes and pulses particularly high in GOS include red kidney beans, split peas, falafels and baked beans.
Dairy foods and alternatives
The main FODMAP present in dairy foods is lactose. Dairy foods that are high in lactose include soft cheeses, milk and yoghurt. There are also many dairy foods that are naturally low in lactose, for example butter and cheese. For this reason, dairy foods are definitely not excluded from a low FODMAP diet.
Meat, poultry and fish
Protein foods such as meats, poultry and fish are naturally free of FODMAPs. However, processed and marinated meats may contain FODMAPs due to the addition of high FODMAP ingredients such as garlic and onion.
Low FODMAP choices include plain cooked meats, poultry, seafood, eggs, while high FODMAP options include marinated meats, processed meats (e.g. sausage / salami) and meats served with gravy/sauces that may include high FODMAP ingredients.
Nuts and seeds
Most seeds are low FODMAP. The main FODMAPs present in nuts are GOS and fructans. High FODMAP nuts include cashews and pistachios, while low FODMAP nuts include macadamias, peanuts and pine nuts.
Sugars and sweeteners
The main FODMAPs present in sugar sweetened foods and beverages are fructose and sugar polyols (e.g. sorbitol, xylitol, erythrytol). It is a good idea to read the food labels to identify high FODMAP sugars, especially on artificially sweetened drinks and confectionery.
High FODMAP sugars include honey, high fructose corn syrup and sugar-free confectionery. Low FODMAP options include dark chocolate, table sugar, maple syrup and rice malt syrup.
Condiments and sauces
Some dips, condiments, sauces and marinades contain garlic and onion. Ask for them separately or on the side if you are unsure of their FODMAP content.
High FODMAP options include garlic / onion-based marinades and sauces, vegetarian mince. Low FODMAP options include barbeque sauce, mayonnaise, soy sauce, chutney, cranberry juice.
This sample food list highlights some key examples of high and low FODMAP foods. It is essential to consult with a dietitian before commencing a FODMAP diet. You can also use the Low FODMAP Diet App | Monash FODMAP – Monash Fodmap. It does cost $13.99 for the app.
| High FODMAP foods | Low FODMAP alternatives | |
| Vegetables | Artichoke, asparagus, cauliflower, garlic, green peas, mushrooms, onion, sugar snap peas | Aubergine/eggplant, beans (green), bok choy, green capsicum (bell pepper), carrot, cucumber, lettuce, potato, zucchini |
| Fruits | Apples, apple juice, cherries, dried fruit, mango, nectarines, peaches, pears, plums, watermelon | Cantaloupe, kiwi fruit (green), mandarin, orange, pineapple |
| Dairy & alternatives | Cow’s milk, custard, evaporated milk, ice cream, soy milk (made from whole soybeans), sweetened condensed milk, yoghurt | Almond milk, brie/camembert cheese, feta cheese, hard cheeses, lactose-free milk, soy milk (made from soy protein) |
| Protein sources | Most legumes/pulses, some marinated meats/poultry/seafood, some processed meats | Eggs, firm tofu, plain cooked meats/poultry/seafood, tempeh |
| Breads & cereals | Wheat/rye/barley based breads, breakfast cereals, biscuits and snack products | Corn flakes, oats, quinoa flakes, quinoa/rice/corn pasta, rice cakes (plain), sourdough spelt bread, wheat/rye/barley free breads |
| Sugars, sweeteners & confectionery | High fructose corn syrup, honey, sugar free confectionery | Dark chocolate, maple syrup, rice malt syrup, table sugar |
| Nuts & seeds | Cashews, pistachios | Macadamias, peanuts, pumpkin seeds/pepitas, walnuts |
So, if you would like to follow a low FODMAP diet to see if it improves your gut symptoms:
- Chat to your GP about any gut symptoms you have been experiencing so they can check for any gastrointestinal diseases, such as coeliac disease or inflammatory bowel disease, prior to any elimination diet.
- Find a dietitian who has been trained in the low FODMAP diet. They can provide you with information about the low FODMAP diet, lists of foods to include and avoid, and great recipe ideas. They can also help you keep motivated and introduce foods back into your diet too. Find a dietitian.
Information originally published by Endo Zone Australia and Monash University