The first few weeks of undergoing the elimination phase of the low FODMAP diet can be particularly challenging and daunting. One aspect which can pose a challenging and lengthy process is reading food labels. I remember going to the supermarket and spending over an hour there on my 1st low FODMAP shopping trip. At the time no food scanning apps for low FODMAP existed so I had to diligently read every single food label to identify high FODMAP ingredients myself. To this day I still don’t use the apps as I now feel confident enough to be able to read a food label and be able to tell whether the product is suitable on a low FODMAP diet.
UK based app
The app FODMAP by FM was developed in association with Kings College London and Guy’s and St Thomas’ NHS foundation trust. One of the app’s functions is to enable you to scan food labels to assess whether these are suitable on a low FODMAP diet. Not all products are available on the app. Furthermore the app works by scanning the list of ingredients to identify high fodmap ingredients and sometimes it does make mistakes. Example showing lactose free milk as high FODMAP due to recognising the word MILK. Therefore learning to understand and interpret food labels remains invaluable.
The table below highlights some high FODMAP ingredients commonly found in food products (1, 2, 3). This is also available for you to download.
Oligosaccharides: Both fructans and galactooligosaccharides are short chains of 2-10 fructose sugar units. These are malabsorbed as we lack the enzyme needed to digest them therefore end in the large intestine where they are fermented causing bloating, flatulence and abdominal pain.
Lactose: Lactose is made up of one glucose and one galactose sugar unit. Lactose is a sugar found in dairy products such as milk, yoghurt and soft cheese. This is malabsorbed in people who lack the lactase enzyme. Malabsorption leads to more water entering the intestines, and fermentation by gut bacteria leading to distension, bloating, flatulence, abdominal pain and diarrhoea.
Fructose: Fructose is a simple sugar, made up of one sugar unit. It is absorbed slowly and its presence in the small intestine attracts water causing abdominal distension. When excess fructose reaches the large intestine it is fermented and causes gas production and bloating. Fructose absorption is improved when glucose is present in equal or greater amounts. In the EU, fructose content in glucose-fructose syrup varies between 5-50%. If fructose exceeds 50% this is labelled fructose-glucose syrup (4). Therefore fructose-glucose syrup should be avoided but glucose-fructose syrup can be included.
Polyols: These are sugar alcohols. They occur naturally in some fruit such as apples and vegetables such as mushrooms but they are also added to processed foods as sugar substitutes and humectants. They can often be found in sugar free products such as chewing gum. Polyols are absorbed slowly and excess polyols attract water into the small intestine leading to distension. Any unabsorbed polyols are fermented by bacteria in the large intestine leading to gas production causing bloating and flatulence.
Whilst reading food labels you will notice other fibres known as non-starch polysaccharides (NSPs). These include cellulose, hemicellulose, gums and pectins. Whilst these are low FODMAP, gums such as guar, xantham and locust bean gum, and pectins are fermentable and can lead to gas and bloating in some (5,6).
What about oil and protein from high FODMAP foods?
Remember that FODMAPs are carbohydrates therefore if oils or proteins of high FODMAP foods are used e.g. soya, these would be low FODMAP. Examples include:
- coconut oil
- soy lecithin – this is a fat and a common emulsifier used in food manufacturing
- soy protein isolate
Top tips for reading food labels (1, 3)
- Download the Monash University FODMAP diet app. Familiarise yourself with the FODMAP content of foods.
- Check out food products by your country in the Monash University FODMAP app. This is important as the FODMAP content of certain products changes due to the different processing techniques used. This section will also show you products that are certified as low FODMAP. The FODMAP content of these products is laboratory tested. The image below will be on the products.
- Look out for products with the FODMAP friendly logo. These products are tested and certified.
- Watch out for high FODMAP ingredients in gluten free products. Whilst gluten free products are often low FODMAP they are not always.
- Ingredients on a food label are listed in order of weight therefore if a high FODMAP ingredient is listed amongst the first few ingredients this products is high FODMAP. If the high FODMAP ingredient is listed towards the end of the list, the product may be moderate or possibly low FODMAP.
- If you are unsure about the FODMAP content of a product and have undergone reintroduction, you can try the product to assess your own tolerance to it.
I would also encourage you to head over to my Instagram page (@mevsibs) where I will be posting a series of food labels where you have to identify if there are any high FODMAP ingredients. I will be posting answers!
- Monash University FODMAP diet app version 3.0.4, Chapter 8 How to read food labels for FODMAP diet. https://www.monashfodmap.com/ibs-central/i-have-ibs/get-the-app/ [Accessed 9.8.2020]
- Monash University FODMAP for IBS Dietitian course, 2019. Module 2 Dietary Management of IBS. [Accessed 30.7.2020]
- Monash University FODMAP for IBS Dietitian course, 2019. Module 5 Phase 1 low FODMAP diet and practical skills. [Accessed 9.8.2020]
- The European Food Information Council, 2018. What is glucose-fructose syrup? (Q&A). Online: https://www.eufic.org/en/whats-in-food/article/what-is-glucose-fructose-syrup-qa [accessed 8.8.2020].
- Parisi, G., et al., Treatment effects of partially hydrolyzed guar gum on symptoms and quality of life of patients with irritable bowel syndrome. A multicenter randomized open trial. Dig Dis Sci, 2005. 50(6): p. 1107-12.
- Moayyedi, P., et al., The effect of fiber supplementation on irritable bowel syndrome: a systematic review and meta-analysis. Am J Gastroenterol, 2014. 109(9): p. 1367-74.