Low Fermentable Carbohydrate Diet

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8 Low Fermentable Carbohydrate Diet

Meal suggestions

Breakfast: • cereal, such as Corn Flakes, Rice Krispies or oatmeal with lactose free milk or almond or rice milk and blueberries or sliced bananas

• smoothie made with lactose free yogurt, lactose free milk and strawberries • egg omelette made with spinach, bell peppers and cheddar cheese Low fermentable carbohydrate diet • gluten free toast with peanut butter • gluten free waffles/pancakes with blueberries and pure maple syrup How can a low fermentable carbohydrate diet help me? Lunch: • corn or rice pasta with chicken, tomatoes, bell peppers and herbs This diet is recommended for people who have these symptoms: • gluten free sandwich with filling (canned salmon, sliced turkey, cheese), • gas lettuce, tomato and mayonnaise • homemade soup with allowed vegetables and rice crackers • bloating • green salad with dressing (olive oil, lemon juice) and canned tuna • burping • corn tortilla wrap with chicken, lettuce, tomato, olives and feta • abdominal cramping or pain

Dinner: • diarrhea and/or constipation • beef stew with carrots, potatoes and celery • baked fish with quinoa and carrots • stir fry chicken with bok choy, carrots, bean sprouts served over Carbohydrates (or sugars) of short chain length are often poorly brown rice absorbed, highly osmotic (meaning they pull water into the intestine) • gluten free pizza with cherry tomatoes, basil, ham, pineapple and and quickly fermented by the bacteria in the large intestine. mozzarella cheese This leads to increased water and gas in the bowel and causes the above symptoms. Snacks: • rice crackers with cheddar cheese or peanut butter If you are sensitive to fermentable carbohydrates, reducing your • ½ cup chopped pineapple or honeydew melon or small orange intake may help improve your symptoms. You may see an • small banana with 1 Tbsp peanut butter improvement within a few days or weeks. Symptoms generally • berry crumble (made with blueberries/raspberries and topped improve in 3 out of 4 people. with oatmeal crumble)

• popcorn

The low fermentable carbohydrate diet is also called the low FODMAP diet (Fermentable Oligosaccharides, Disaccharides, Monosaccharides

2 7 Low Fermentable Carbohydrate Diet Low Fermentable Carbohydrate Diet

Which carbohydrates are fermentable? Tips to help you follow a low fermentable carbohydrate diet

Fructose or fruit sugar, is a natural occurring simple sugar found • Follow the low fermentable carbohydrate diet for at least 2 to 3 weeks. in fruits, vegetables and honey. Fructose is also added to many • Record your food and symptoms in a diary to identify bothersome food products as glucose-fructose. How well you absorb fructose foods. depends partly on the amount of other sugars such as glucose, • Read food labels. Avoid foods made with fructose, glucose-fructose, sucrose (table sugar) and sorbitol in the foods that you eat. fruit sugar, inulin, fructo-oligosaccharides, fruit juice concentrate, Foods with excess fructose compared with glucose will likely invert sugar, honey, wheat and rye. trigger symptoms. Foods with excess fructose combined with • Buy gluten free breads and pasta as they are wheat free. Gluten free naturally occurring polyols, such as apples and pears, will likely grains made with potato, quinoa, sorghum, rice or corn are allowed. trigger more severe symptoms. You do not need to follow a 100% gluten free diet as it is the fructans (carbohydrate) not the gluten (protein) that triggers the Lactose is a natural occurring simple sugar found in milk and symptoms. Foods that contain small amounts of fructans such as milk products. Lactose intolerance is caused by partial or complete oatmeal, cornflakes, rice crisps, soy sauce are allowed. lack of the enzyme lactase which helps you digest lactose. • Limit foods that are okay to one serving at each meal or snack with no more than 1 to 2 servings a day of allowed fruit and Fructans are made up of chains of fructose. They are found naturally in 1 ½ to 3 servings a day allowed vegetables. This will slow down some vegetables and wheat based foods (breads, cereals and pasta). the break down and absorption of the food. They are completely malabsorbed because the intestine lacks an • Avoid foods that list sorbitol and other sugar alcohols. Most of them enzyme to break the fructose-fructose bonds. On a food label, fructans end with “ol” (lactitol, mannitol, xylitol, maltitol, isomalt). Since these are often called fructo-oligosaccharides or inulin and are often added sweeteners are low in calories you can usually find them in a low of to foods such as yogurt, bread and pasta. “diet” or “sugar free” products such as chewing gum, candies or mints. Galactans are made up of chains of the sugar galactose, and are • Talk to your pharmacist if you are taking liquid medications, such as malabsorbed for the same reason as fructans. syrup or cough medicine, as sorbitol may be an ingredient.

They are found in legumes such as kidney beans, chick peas and lentils

and also found in some vegetables such as onions and peas. This chart may help you with serving sizes: Polyols are also known as sugar alcohols. They are naturally found in Imperial and Metric Sizes some fruits (apples, pears and their related juices and in “stone fruits” 1 cup = 250 ml such as nectarines, peaches, plums, apricots, cherries, avocados and ¾ cup = 175 ml dried fruits such as prunes, figs and raisins) and vegetables ½ cup = 125 ml (mushrooms, sweet corn). ¼ cup = 60 ml 1 tablespoon (tbsp) = 15 ml They are also often added as sweeteners to sugar-free candies, 1 teaspoon (tsp) = 5 ml gums, mints and medications. 1 ounce (oz) = 25 grams (g)

please turn over  ______

6 3 Low Fermentable Carbohydrate Diet Low Fermentable Carbohydrate Diet

Food Group Foods to Eat Foods to Avoid Do I need to avoid glucose-fructose? Desserts chocolate (limit to 30 grams) custards, puddings Fructose is added to many foods as glucose-fructose, also called high custards, puddings made with ice cream, candy, cookies fructose corn syrup in the United States. lactose free milk sweetened with fructose sorbet from allowed fruits Glucose-fructose is present in soft drinks, sports drinks, chocolate milk, Sweeteners aspartame, sucralose, stevia, agave syrup, glucose-fructose, condiments, breakfast bars, flavoured yogurts, jams and jellies. acesulfame K, cyclamate honey, mannitol, maltitol, Glucose-fructose can be created with various amounts of fructose sugar, white or brown molasses, sorbitol, xylitol, and glucose, but most often contains 55% fructose and 45% glucose. (sucrose), corn syrup, glucose (tablets, powder, Since the amount of glucose to fructose is not listed on food labels, syrup), golden syrup (limit to limit or avoid foods containing glucose-fructose. 1½ Tbsp a day), pure maple syrup Do I need to avoid sucrose? Alcohol coffee, tea (black, green, tea: chamomile, dandelion, Although sucrose contains fructose, it also contains glucose in an and white, peppermint) fennel, oolong, strong chai tea, equal amount and is generally well tolerated by many people when Other (limit to 1 cup a day) any fruit based teas with eaten in moderation. beverages glucose sweetened chicory root sports/energy drinks chicory-based coffee substitute Low fermentable carbohydrate meal plan sucrose sweetened soft drinks beverages (limit to 355 ml a day) coconut water Serving sizes are provided for the foods that may cause you symptoms. vodka, gin glucose-fructose sweetened (limit to 1.5 oz a day) soft drinks Food Group Foods to Eat Foods to Avoid wine, dry glucose-fructose sweetened (limit to 4 to 5 oz a day) sports/energy drinks Protein Beef, chicken, lamb, pork, foods made with fruit sauces turkey, fish, shellfish or breaded beer, cider, rum, sherry, port, sparkling wine, sweet wines eggs silken tofu

Other foods baking powder, baking soda, cocoa firm tofu (blocks) chickpeas, hummus vanilla extract inulin, fructo-oligosaccharides, Nuts: tempeh kidney beans butter, olives, margarine, galacto-oligosaccharides 10 to 15 a day mayonnaise, vegetable oils jams, jellies with fruits to avoid or nuts: black beans coconut meat and/or glucose-fructose, relish Seeds: almonds, chestnuts, baked beans 1 to 2 Tbsp homemade broth made from with glucose-fructose, sweet and macadamia, peanuts, pecans, a day pine nuts, walnuts navy beans allowed vegetables sour sauce, plum sauce, or chestnuts (20 a day) soy beans, edamame ketchup, mustard, pickles, barbeque sauce with Nut butters: relish, soy sauce glucose-fructose, chutney 1½ to 2 Tbsp seeds: soy milk most spices and herbs a day chia seeds, flaxseed, lentils including chili powder, hemp seeds, pumpkin seeds, pistachios, cashews pepper, salt sesame seeds, sunflower psyllium seeds salad dressing without glucose-fructose nut butters (peanut, almond) vinegar

4 5 Low Fermentable Carbohydrate Diet Low Fermentable Carbohydrate Diet

Food Group Foods to Eat Foods to Avoid Food Group Foods to Eat Foods to Avoid

Dairy beverages: almond, coconut, cheese sauce Fruit bananas, blueberries, avocado*, apple*, applesauce*,

hemp, rice or oat cheese: marscapone, ricotta, boysenberries, clementine, apple juice*, apple cider*, 1/2 cup whole (If you are cranberries, cantaloupe, apricots*, blackberries*, butter cottage cheese fruit, 1/3 cup lactose cheeses such as blue, creams, all (if more than 1 Tbsp) allowed juices dragon fruit, durian, grapefruit cherries*, dried fruit (dates, intolerant) cheddar, camembert, cream milk: cow, buttermilk, evaporated, (1/2 medium), grapes, raisins, figs, prunes*), guava, cheese, dry curd cottage chocolate, goat, sheep, soy Limit to 1 to 2 honeydew melon, kiwi fruit, lychee*, mango, nashi fruit*, servings a day kumquat, lemon, lime, nectarine*, peach*, pears* and cheese, colby, processed, soups made with milk or cream mandarin, orange, papaya, pear juice*, persimmon, parmesan, limburger, sour cream Fresh or frozen mozzarella, swiss, brie, feta passion fruit, paw paw, plums*, quince, tamarillo, sweetened condensed milk fruit may be coconut cream better tolerated pineapple, prickly pear, watermelon* yogurt and yogurt-based drinks pomegranate (limit to 1/4 cup canned fruit packed in pear juice cottage cheese – lactose free than canned fruit seeds), raspberries, rhubarb, or heavy syrup. ice cream – lactose free star fruit (carambola), kefir – lactose free Eat ripe fruit strawberries, tamarillo, tangelo * Contain sugar alcohols milk (cow) – lactose free yogurt – lactose reduced Vegetables alfalfa, bamboo shoots, bean artichoke (Jerusalem sour cream – lactose free sprouts, green beans, bok and Globe), asparagus, choy, carrots, celery (limit beetroot, broccoli, brussels ½ cup for most Grains wheat-free grains/flours: wheat based products: vegetables, to ½ stalk), chives, cucumber, sprouts, burdock, cabbage, amaranth, arrowroot, couscous, breads, cereals, pasta, 2 cups leafy choy sum, eggplant, fennel cauliflower*, chicory roots 1/2 cup cooked buckwheat, corn, corn bran, tortillas, baked goods (cakes, green bulb (½ cup), ginger, bell and and greens, sweet corn*, grains, pasta corn meal, millet, quinoa, cookies, muffins, pastries), vegetables hot peppers, green leafy herbs dandelion greens, garlic and cereals rice, rice bran, sorghum, crackers, biscuits (parsley, cilantro, oregano, dill, and garlic powder, leek, rosemary, mint, thyme), kale, mushrooms*, onion (brown, 1 slice bread tapioca Limit to 1 to wheat flours (durum, enriched, 3 servings a kohlrabi, leafy greens (endives, white, spanish, onion Limit to gluten free bread, cereals, farina, graham, semolina, cake day spinach, arugula, swiss chard), powder), radicchio lettuce, 6 to 8 servings pastas and crackers without and pastry, white flours) lettuce (butter, iceberg), okra, relish, shallots, spring onion a day honey, apple/pear juice, green peas (1/3 cup), parsnip, (white part), tomato paste barley Cooked agave or glucose-fructose vegetables may pumpkin, radish, rutabaga, scallions or spring onions * Contain sugar alcohols chicory root (inulin) be better hot/cold cereals: Corn Flakes, tolerated (green part only), nori seaweed, Rice Krispies, Cheerios, grains made from wheat winter squash (acorn, cream of rice, grits, oats, (einkorn, emmer, triticale, kamut) butternut), snow peas oatbran (limit to 5), tomato, turnip,

rye white and sweet potato, water corn tortillas (1), chestnuts, yam, zucchini tortilla chips (10 to 15),

popcorn (1 ½ cup), polenta (1/2 cup) corn and rice pasta

spelt bread and spelt pasta

4 5 Low Fermentable Carbohydrate Diet Low Fermentable Carbohydrate Diet

Food Group Foods to Eat Foods to Avoid Food Group Foods to Eat Foods to Avoid

Dairy beverages: almond, coconut, cheese sauce Fruit bananas, blueberries, avocado*, apple*, applesauce*,

hemp, rice or oat cheese: marscapone, ricotta, boysenberries, clementine, apple juice*, apple cider*, 1/2 cup whole (If you are cranberries, cantaloupe, apricots*, blackberries*, butter cottage cheese fruit, 1/3 cup lactose cheeses such as blue, creams, all (if more than 1 Tbsp) allowed juices dragon fruit, durian, grapefruit cherries*, dried fruit (dates, intolerant) cheddar, camembert, cream milk: cow, buttermilk, evaporated, (1/2 medium), grapes, raisins, figs, prunes*), guava, cheese, dry curd cottage chocolate, goat, sheep, soy Limit to 1 to 2 honeydew melon, kiwi fruit, lychee*, mango, nashi fruit*, servings a day kumquat, lemon, lime, nectarine*, peach*, pears* and cheese, colby, processed, soups made with milk or cream mandarin, orange, papaya, pear juice*, persimmon, plums*, parmesan, limburger, sour cream Fresh or frozen mozzarella, swiss, brie, feta passion fruit, paw paw, quince, tamarillo, watermelon* sweetened condensed milk fruit may be coconut cream better tolerated pineapple, prickly pear, canned fruit packed in pear juice yogurt and yogurt-based drinks pomegranate (limit to 1/4 cup or heavy syrup. cottage cheese – lactose free than canned fruit seeds), raspberries, rhubarb, ice cream – lactose free star fruit (carambola), * Contain sugar alcohols kefir – lactose free Eat ripe fruit strawberries, tangelo milk (cow) – lactose free yogurt – lactose reduced Vegetables alfalfa, bamboo shoots, bean artichoke (Jerusalem sour cream – lactose free sprouts, green beans, bok and Globe), asparagus, choy, carrots, celery (limit beetroot, broccoli, brussels ½ cup for most Grains wheat-free grains/flours: wheat based products: vegetables, to ½ stalk), chives, cucumber, sprouts, burdock, cabbage, amaranth, arrowroot, couscous, breads, cereals, pasta, 2 cups leafy choy sum, eggplant, fennel cauliflower*, chicory roots 1/2 cup cooked buckwheat, corn, corn bran, tortillas, baked goods (cakes, green bulb (½ cup), ginger, bell and and greens, sweet corn*, grains, pasta corn meal, millet, quinoa, cookies, muffins, pastries), vegetables hot peppers, green leafy herbs dandelion greens, garlic and cereals rice, rice bran, sorghum, crackers, biscuits (parsley, cilantro, oregano, dill, and garlic powder, leek, rosemary, mint, thyme), kale, mushrooms*, onion (brown, 1 slice bread tapioca Limit to 1 to wheat flours (durum, enriched, 3 servings a kohlrabi, leafy greens (endives, white, spanish, onion Limit to gluten free bread, cereals, farina, graham, semolina, cake day spinach, arugula, swiss chard), powder), radicchio lettuce, 6 to 8 servings pastas and crackers without and pastry, white flours) lettuce (butter, iceberg), okra, relish, shallots, spring onion a day honey, apple/pear juice, green peas (1/3 cup), parsnip, (white part), tomato paste barley Cooked agave or glucose-fructose vegetables may pumpkin, radish, rutabaga, scallions or spring onions * Contain sugar alcohols chicory root (inulin) be better hot/cold cereals: Corn Flakes, tolerated (green part only), nori seaweed, Rice Krispies, Cheerios, grains made from wheat winter squash (acorn, cream of rice, grits, oats, (einkorn, emmer, triticale, kamut) butternut), snow peas oatbran (limit to 5), tomato, turnip,

rye white and sweet potato, water corn tortillas (1), chestnuts, yam, zucchini tortilla chips (10 to 15),

popcorn (1 ½ cup), polenta (1/2 cup) corn and rice pasta

spelt bread and spelt pasta

6 3 Low Fermentable Carbohydrate Diet Low Fermentable Carbohydrate Diet

Other foods baking powder, baking soda, cocoa firm tofu (blocks) chickpeas, hummus vanilla extract inulin, fructo-oligosaccharides, Nuts: tempeh kidney beans butter, olives, margarine, galacto-oligosaccharides 10 to 15 a day mayonnaise, vegetable oils jams, jellies with fruits to avoid or nuts and seeds: black beans coconut meat and/or glucose-fructose, relish Seeds: almonds, macadamia, baked beans 1 to 2 Tbsp homemade broth made from with glucose-fructose, sweet and peanuts, pecans, pine nuts, a day walnuts navy beans allowed vegetables sour sauce, plum sauce, or chia seeds, flaxseed, soy beans, edamame ketchup, mustard, pickles, barbeque sauce with Nut butters: relish, soy sauce glucose-fructose, chutney 1½ to 2 Tbsp hemp seeds, pumpkin seeds, soy milk most spices and herbs a day sesame seeds, sunflower lentils including chili powder, seeds pistachios, cashews pepper, salt nut butters (peanut, almond) psyllium salad dressing without glucose-fructose vinegar

2 7 Low Fermentable Carbohydrate Diet Low Fermentable Carbohydrate Diet

Which carbohydrates are fermentable? Tips to help you follow a low fermentable carbohydrate diet

They are found in legumes such as kidney beans, chick peas and lentils

and also found in some vegetables such as onions and peas. This chart may help you with serving sizes: Polyols are also known as sugar alcohols. They are naturally found in Imperial and Metric Sizes some fruits (apples, pears and their related juices and in “stone fruits” 1 cup = 250 ml such as nectarines, peaches, plums, apricots, cherries, avocados and ¾ cup = 175 ml dried fruits such as prunes, figs and raisins) and vegetables ½ cup = 125 ml (mushrooms, sweet corn). ¼ cup = 60 ml 1 tablespoon (Tbsp) = 15 ml They are also often added as sweeteners to sugar-free candies, 1 teaspoon (tsp) = 5 ml gums, mints and medications. 1 ounce (oz) = 25 grams (g)

please turn over  ______

8 Low Fermentable Carbohydrate Diet

Meal suggestions

Breakfast: • cereal, such as Corn Flakes, Rice Krispies or oatmeal with lactose free milk or almond or rice milk and blueberries or sliced bananas

• popcorn

The low fermentable carbohydrate diet is also called the low FODMAP diet (Fermentable Oligosaccharides, Disaccharides, Monosaccharides