SPECIAL
ARTICLE
This is not
just any FODMAP diet: Hispanic adaptation of the FODMAP diet and a
reintroduction guide
Esta
no es una dieta FODMAP cualquiera: adaptación hispana de la dieta FODMAP y una
guía de reintroducción
Elena Garicano
Vilar1, Paula Mendive2,3, Maritza G. Ríos4,5,
Sara Sanz Rojo1, Gabriela Alessandra Ferrando Torrontegui6,
Adriana Pérez Chávez7, Stephanie Izquierdo Tinoco8,
Letmarie Sánchez9, Gloria Maricela Morales Morales10,11,
Ana Isabel Rosal Martínez12, José Daniel Núñez Paz13,
Regina Pacheco Blanco14, Estefanía García15, Tatiana
Palazuelos15, Alejandra Ponce Garza15, Luisa García4,
Gissela Armas Espinoza16, Sara López Oliva1, Ismael San
Mauro Martín1, Spanish Speakers
FODMAP Diet Expert Group
1 Research Centre in Nutrition
and Health (CINUSA group). Paseo de la Habana, 43. 28036,
Madrid, Spain.
Elena
Garicano:
https://orcid.org/0000-0001-6327-6758
Sara
Sanz:
https://orcid.org/0000-0003-4737-5857
Ismael San Mauro: https://orcid.org/0000-0002-7415-0293
2 Universidad
de la República. Escuela de Nutrición. Avenida
Américo Ricaldoni 2010, CP: 11600, Montevideo,
Uruguay.
3 Universidad de Belgrano.
Zabala 1837, C1426 DQG, Buenos Aires, Argentina.
https://orcid.org/0000-0001-9610-6683
4 Consultorio
ENNA 324, del Hospital Pacífica Salud, Boulevard Pacífica y Vía Punta
Darién, Ciudad de Panamá.
Maritza G. Rios:https://orcid.org/0000-0002-4663-6085
Luisa García: https://orcid.org/0000-0002-2314-2736
5 Instituto de Investigaciones
Científicas y Servicios de Alta Tecnología (INDICASAT-AIP). Calle Pullpn.
Ciudad de Panamá, Panamá.
https://orcid.org/0000-0002-4663-6085
6 Clínica
Universitaria Colombia. Carrera 66 #23-46. Salitre. Bogotá, Colombia.
https://orcid.org/0000-0001-7776-7152
7 Consulta
Adriana Pérez-Chávez. Online. Guayaquil, Guayas, Ecuador.
8 Nexa
Resources Cajamarquilla S.A. Carretera Central, Km 9.5 Cajamarquilla. Lima,
Peru.
9 Centro de Medicina Deportiva y Rehabilitación MEDKAR. Avenida Francisco
De Miranda. CC Lido, Nivel Parque, Local P-4. El Rosal, Caracas, Venezuela.
https://orcid.org/0000-0003-0818-5962
10 Centro de Hemodiálisis y de
Salud Renal. Calle Gabriela Mistral, 516.
Los Heroes, San Salvador, El Salvador.
11 Universidad Dr. Andrés Bello.
1a Calle Poniente. 1101, Flor Blanca, San Salvador, El Salvador.
12 Universidad
del Valle de Guatemala. Nutrition department. 18 Avenida 11-95. 01015,
Guatemala, Guatemala.
https://orcid.org/0000-0003-2716-813X
13 Universidad
Tecnológica Centroamericana. Frente a Residencial, V-782 Boulevard Kennedy.
Tegucigalpa, Honduras.
https://orcid.org/0000-0002-9355-5579
14 Consulta María Regina Pacheco
Blanco. Online. Honduras.
15 GenoVive.
Avenida Paseo de las Palmas, 745. Lomas
de Chapultepec, Miguel Hidalgo. 11000, Ciudad de México,
México
Estefanía García Ruiz: https://orcid.org/0000-0001-7439-9286
Tatiana Marie Palazuelos:
https://orcid.org/0000-0003-0397-724X
Alejandra Ponce Garza:
https://orcid.org/0000-0002-0321-6830
16
Consulta Gissela Armas Espinoza. Online.
Guayaquil, Ecuador.
* Corresponding
author
|
This work is
licensed under a Creative
Commons
Attribution-NonCommercial-ShareAlike 4.0 International License
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revista no cobra tasas por el envío de trabajos,
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Abstract
Short-chain carbohydrates and sugar alcohols are poorly
absorbed in the small intestine and rapidly fermented by bacteria. Fermentable
oligo-, di-, monosaccharides and polyols (FODMAP) content of a wide range of foods
has been measured. However,
the list of foods allowed, as well as the quantities of FODMAP each food differ
between studies, making the management of
the low FODMAP diet difficult.
The aim of this research was to propose a FODMAP
diet guide culturally adapted to different Hispanic countries for
dietitians-nutritionists and nutrition experts, to facilitate the management of
patients who benefit from this diet.
A consortium of FODMAP diet experts was created among
Spanish-speaking countries. Dieticians from 11 Latin American countries (Argentina, Colombia, Ecuador, El Salvador, Guatemala, Honduras, Mexico,
Panama, Peru, Uruguay and Venezuela) and
Spain elaborated a low FODMAP diet
adjusted each to the gastronomic culture of their own country. They also created a list of foods to be
reintroduced in phase 2 (or reintroduction phase) of the FODMAP diet, along
with typical recipes from the country.
Twelve low FODMAP diets with their corresponding
reintroduction phase were designed, each adapted to the commonly consumed foods
and recipes of each country. The
adaptation of the diet to local gastronomy is pertinent, as it may increase the
likelihood of durable adherence and better response to symptomatology.
There are limitations in
developing tables of FODMAP-rich and FODMAP-poor foods. The cut-off levels of
FODMAP content are not clearly defined. More studies are needed to reach a
unified consensus, as inconsistency
in the data provided between studies has been found in relation to the FODMAP
diet.
Keywords
FODMAP; diet therapy;
practice guideline; hispanic; culture
Resumen
Los carbohidratos de cadena corta y los alcoholes de azúcar
se absorben mal en el intestino delgado y las bacterias los fermentan
rápidamente. Se ha medido el contenido de oligo, di, monosacáridos y polioles
fermentables (FODMAP) de una amplia gama de alimentos. Sin embargo, la lista de
alimentos permitidos, así como las cantidades de FODMAP de cada alimento,
difieren entre estudios, lo que dificulta el manejo de la dieta baja en FODMAP.
El objetivo de esta investigación fue proponer una guía
dietética FODMAP adaptada culturalmente a diferentes países hispanos para
facilitar a dietistas-nutricionistas y expertos en nutrición el manejo de los
pacientes que se benefician de la dieta baja en FODMAP.
Se creó un consorcio de expertos en dieta FODMAP entre países
de habla hispana. Dietistas de 11 países latinoamericanos (Argentina, Colombia,
Ecuador, El Salvador, Guatemala, Honduras, México, Panamá, Perú, Uruguay y
Venezuela) y España elaboraron una dieta baja en FODMAP ajustada cada una a la
cultura gastronómica del país. También crearon una lista de alimentos para ser
reintroducidos en la fase 2 (o fase de reintroducción) de la dieta FODMAP,
junto con recetas típicas del país.
Se diseñaron doce dietas bajas en FODMAP con su
correspondiente fase de reintroducción, cada una adaptada a los alimentos y
recetas de consumo común de cada país. La adaptación de la dieta a la
gastronomía local fue pertinente, ya que puede aumentar la adherencia a la
dieta y una mejor respuesta a la sintomatología.
Existen limitaciones en el
desarrollo de tablas de alimentos ricos y pobres en FODMAP. Los niveles de
corte del contenido de FODMAP no están claramente definidos. Se necesitan más
estudios para alcanzar un consenso unificado, ya que se ha encontrado
inconsistencia en los datos proporcionados en estudios relacionados con la
dieta FODMAP.
Palabras clave
FODMAP; dietoterapia; guía de práctica; hispano; cultura
ABBREVIATIONS
FODMAP, Fermentable Oligo-, Di- and Monosaccharides and Polyols
IBS,
Irritable Bowel Syndrome
FOS,
fructo-oligosaccharides
Introduction
The acronym ‘FODMAP’
(Fermentable Oligo-, Di- and Monosaccharides and Polyols) was created
to describe a group of short-chain carbohydrates and sugar alcohols (polyols)(1).
They comprise fructose, lactose, fructo- and galactooligosaccharides (fructans, and
galactans), and polyols (such as sorbitol, mannitol, xylitol and maltitol). These molecules
are poorly absorbed in the small intestine, they are osmotically active and are
rapidly fermented by bacteria producing gas(2). The additional gas
and water inside the gut stretches the bowel wall and triggers
symptoms such as abdominal pain, gas and bloating, distension, constipation
and diarrhea in some situations and patients(3).
It was in 2005, when
researchers in the Department of Gastroenterology at Monash University(3)
identified this group of short-chain carbohydrates in food. The research team
measured the FODMAP content of a wide range of foods, including fruit,
vegetables, breads, cereals, nuts, legumes, dairy products and processed foods.
This food composition information allowed the team to develop the first low
FODMAP diet. The team used this low FODMAP diet in the first research
studies which showed that a low FODMAP diet reduces symptoms in people with
Irritable Bowel Syndrome (IBS)(3).
The FODMAP concept in the
management of functional gut symptoms relies on a dietary approach that
restricts FODMAP intake globally, not individually; and represents an
opportunity for reducing symptoms(2). Restriction of individual
FODMAP has been used with varying success in the management of functional gut
symptoms for a long time. However, such approaches have not become widespread
in their application, perhaps in part related to their limited success.
Restricting one FODMAP in isolation ignores the likelihood that there is
potentially a range of FODMAP in the diet, all of which have similar
end-effects in the bowel(4). The innovation in the FODMAP concept is
that global restriction should have a far greater and more consistent effect
than limited restriction(2).
There is considerable evidence
that FODMAP induce abdominal symptoms. Acute provocation tests with lactose(5),
fructose(5,6), fructo-oligosaccharides (FOS)(7) or
sorbitol(5,8) cause abdominal symptoms such as bloating, pain,
nausea and disturbed bowel habit (diarrhoea and/or constipation) in many
people, especially those with IBS.
All the research
applying the low FODMAP diet indicates that up to 70% of the patients who
follow a diet low in FODMAP present a significant improvement in symptoms,
especially those related to abdominal pain and bloating(9-13). The
symptom that least improves is constipation, which can be related to the low
fiber intake of this dietary model(14). The low FODMAP diet has
not only shown to have nutritional and symptomatic benefits in gastrointestinal
diseases (e.g. IBS(15), non-celiac gluten sensitivity(16) or celiac disease(17)), but also in patients with fibromyalgia(18),
sclerosis(19) and
endometriosis(20).
A global approach to
restricting carbohydrates that have similar actions (high osmotic effect and
rapid fermentation) should optimize symptom control in patients. Nonetheless,
the low FODMAP diet may not alleviate symptoms of every subject, being compliance
a main factor (2). Because the
diet is fairly complex, advice should be given by a specialized dietitian
trained in the area with appropriate resources, along with a multidisciplinary
team of other health professionals, and food intake should be monitored for
nutritional adequacy(2). Since the first low FODMAP diets were described(21), there
have been modifications to the food lists that have been prompted by new
scientific data on food composition. Robust data now exist describing the
FODMAP content of commonly consumed foods(22). However, not all
studies provide the list of foods allowed in the low FODMAP diet or if they do,
they differ between studies, as well as the quantities of FODMAP each food may
have. Even some studies(23,24) allow foods (peeled apples, pears and
milk) as part of the low FODMAP diet, which are not consistent with a low
FODMAP diet as it was originally described. Inconsistency in the data provided
has not only been found in relation to the FODMAP diet, but also in histamine
content lists for histamine intolerance patients(25). Other
limitations of the low FODMAP diet include lack of clear cutoff levels for
FODMAP content in foods and non-availability of information on FODMAP content
on food packages(2). All of the above make it difficult to
standardize, homogenize and create a tool for clinical practice and research. It is also
important to note that low FODMAP diets are very restrictive. Therefore they
can produce a reduction in the intake of certain dietary components such as
calcium, fiber, iron, zinc, folic acid and vitamin D(26). Thus, in
order to ensure that the diet is not deficient despite the restrictions, it is
necessary that the treatment is controlled by experienced dietitians(26).
Generally, the strict low FODMAP diet is not recommended to be followed long
term, as it may also result in reduced total bacterial abundance(27) and
reduced concentration of bifidobacterial(9).
Despite the disadvantages of a
low FODMAP diet, the diet has
provided symptomatic relief in more patients with IBS compared to a standard
dietary advice consisting of healthy eating principles, alteration of insoluble
and soluble fibers, and limiting sugar-free foods and foods containing sorbitol
(86% and 49%, respectively)(28). There are many studies carried out in the field of a low
FODMAP diet, finding more than 350 results in some search databases, although many of them are retrospective(21,24)
or prospective and uncontrolled(29-31) making the studies
potentially subject to bias and confounding. However, in recent years well-designed
clinical trials have been designed to support the efficacy of low FODMAP
diet in patients with IBS; to date, two controlled trials(24,28) and
six randomized controlled trials (9,11,12,29,32,33). However, more studies are needed to
compare and establish more robust and specific food lists and quantities of
FODMAP in foods. Further research is needed to standardize the information
regarding the FODMAP diet and create reliable guidelines for clinical practice.
The lack of
culturization and adaptation of the diet, through lists and gastronomic customs
of countries where this diet is not very widespread, such as Latin American
countries, can pose a problem in the treatment follow-up. Therefore, the aim of
this research was to propose a FODMAP diet guide culturally adapted to
different countries for Dietitians-Nutritionists and nutrition experts, to
facilitate the management of patients who benefit from this diet.
Material and methods
A consortium of FODMAP diet
experts was created among Spanish-speaking countries between June and
August 2020. Dieticians from 11 Latin American countries (Argentina, Colombia, Ecuador, El Salvador, Guatemala, Honduras, Mexico,
Panama, Peru, Uruguay and Venezuela) and
Spain were enrolled in the project. Universidad
de Belgrano (Argentina), Clínica Universitaria Colombia (Colombia), Consulta
Adriana Pérez-Chávez (Ecuador), Nexa Resources Cajamarquilla S.A. (Peru),
the Nutrition School at Universidad de la República (Uruguay), Centro de Medicina Deportiva y Rehabilitación
MEDKAR (Venezuela), Centro de Hemodiálisis y de Salud Renal and Universidad
Dr. Andrés Bello (El Salvador), the Nutrition department at Universidad del Valle de
Guatemala (Guatemala), Universidad Tecnológica Centroamericana and Consulta
María Regina Pacheco Blanco (Honduras), GenoVive (Mexico), Hospital
Punta Pacífica and Instituto de Investigaciones
Científicas y Servicios de Alta Tecnología INDICASAT-AIP (Panama) and Research Centers in Nutrition and Health CINUSA
(Spain) participated in the elaboration of low FODMAP diets adjusted each to
the culture of their own country.
At enrolment time,
all participating institutions were asked to elaborate a low FODMAP balanced
menu, adapted to the gastronomic culture of their own country (including
typical recipes and ways of cooking and eating). Two examples of a menu were
given to each participant as well as a unique list of foods rich (worst
tolerated) and low (best tolerated) in FODMAP, to serve as a guide. In any
case, participants were encouraged to use the Monash University FODMAP diet app(22) to access the library of low FODMAP foods,
recommendations and recipes. Each diet had to be structured as a 7-day balanced
healthy menu. Each intake must consist of carbohydrate + vegetable + protein or
vegetable + protein, with an approximate distribution of 40-60% carbohydrates
(no ultra-processing products, soft drinks, simple sugars, pastries or fast
food), 15-30% protein (both animal and plant origin), and 20-35% fat (including
blue fish, nuts, oleaginous fruits, and avoiding trans fats). The menus were
revised by an experienced dietician on the FODMAP diet to ensure they all
followed the same criteria.
All the
collaborators were also asked for a list of foods, which are frequently
consumed in their country, to be reintroduced in phase 2 (or reintroduction
phase) of the FODMAP diet, along with typical recipes from the country where
the reintroduction foods could be included.
Results
Low FODMAP diets
A total of 12 low FODMAP diets
were designed, each adapted to the commonly consumed foods and recipes of each
participating country (Tables 1-12).
Table
1. Low FODMAP menu for 7 days adjusted to the Argentinian
gastronomy
|
|
DAY 1
|
DAY 2
|
DAY 3
|
DAY 4
|
DAY 5
|
DAY 6
|
DAY 7
|
|
Breakfast
|
- Almond
drink
- Rice
cookies with homemade strawberry jam
- Banana
|
- Quinoa
drink or Infusion
- Whole
wheat bread (suitable)
- Kiwi
|
- Almond
drink
- Rice
cookies with homemade strawberry jam
- Banana
|
- Quinoa
drink or Infusion
- Whole
wheat bread (suitable)
- Tangerine
|
- Almond
drink
- Whole
wheat bread (suitable)
- Kiwi
|
- Quinoa
drink or Infusion
- Quince
muffins
- Tangerine
|
- Almond
drink
- Rice
cookies with homemade strawberry jam
- Kiwi
|
|
Lunch
|
- Goldfish
with mashed potatoes
- Carrot,
tomato and cucumber salad
- Tangerine
|
- Baked
trout with lemon with pumpkin and eggplant wok and zucchini
- Figs
|
- Meat,
cheese and carrot cake
- Baked
quince
|
- Spinach
pancakes with chicken
- Pineapple
or papaya slices
|
- Zucchini
noodles
- Baked
salmon
- Grapefruit
|
- Yamani
rice risotto with chicken
- Carrot
and boiled beans
- Kiwi
|
- Roast
strip or vacío
- Tomato,
carrot, cucumber and quinoa salad
- Grapefruit
|
|
Afternoon snack
|
- Infusion
- Chocolate
chip cookies
|
- Almond
drink
- Rice
cookie
|
- Infusion/
Mate
- Chocolate
chip cookies
|
- Almond
drink
- Rice
cookie
|
- Infusion/
Mate
- Chocolate
chip cookies
|
- Almond
drink
- Rice
cookie
|
- Infusion
- Chocolate
chip cookies
|
|
Dinner
|
- Chicken
and eggplant muffins
- Baked
pumpkin slices
|
- Carrot
noodles
- Meatballs
|
- Pork
rib
- Pumpkin
puree
|
- Pizza
with tuna dough, grated carrot and cucumber salad
|
-
Pork croquettes stuffed with spinach
|
- Chorizo
steak
- Baked
pumpkin slices
|
- Meatballs
with rice
- Tomato
and grated carrot salad
|
Table
2. Low FODMAP menu for 7 days adjusted to the Colombian
gastronomy
|
|
DAY 1
|
DAY 2
|
DAY 3
|
DAY 4
|
DAY 5
|
DAY 6
|
DAY 7
|
|
Breakfast
|
Beverage
options:
- Chocolate made with
pure cocoa and lactose-free milk sweetened with stevia
- Hot oatmeal made with
lactose-free milk sweetened with stevia
- Infusion, tea or
coffee sweetened with stevia
- Natural fruit juice
(allowed fruits)
Food
options:
- Rib broth with potato
- Chicken broth with
potato
- Corn arepa with
parrot eggs
- Corn arepa with
fresh lactose-free cheese
- Corn arepa with
fried egg in olive oil
- Homemade tamale
(without garlic and onion)
- Gluten-free bread with
fresh lactose-free cheese
|
|
Midday & Afternoon snack
|
One option:
- Chocolate made with
pure cocoa and lactose-free milk sweetened with stevia accompanied by fresh
cheese without lactose
- Fruit plate (allowed
fruits)
- Fruit salad (allowed
fruits) with lactose-free yogurt
- Fruit salad (allowed
fruits) with grated lactose-free fresh cheese
- Gluten-free bread with
pure cocoa chocolate and lactose-free milk sweetened with Stevia
- Homemade pandebono
with fresh lactose-free cheese (no margarine / butter)
- Homemade almojábana
with fresh lactose-free cheese (no margarine / butter)
|
|
Lunch
|
- Rice
with chicken and vegetables (carrot, tomato, green beans and celery)
|
- Beef
stew with vegetables (carrot, zucchini, tomato)
- Creole
potato purée
|
- Baked
mojarra with coconut rice
- Tomato
soup
|
- Chicken
sancocho made with yucca and arracacha
- Spinach,
tomato and grated carrot salad
|
- Mixed
grill of beef and pork loin with grilled cob
- Ahuyama
purée
|
- Seafood
casserole with baked patacón
- Cucumber,
tomato and grated carrot salad
|
- Beef
rib sancocho with mixed potatoes
- Carrot
and green beans stir fry
|
|
Dinner
|
- Grilled
white fish with lemon
- Sautéed
vegetables with spices (carrot, eggplant, zucchini)
|
- Egg
omelette with vegetables (chard, zucchini and carrot)
- Gluten-free
bread
|
- Mondongo
soup with vegetables (carrot, green beans, celery)
- Radish,
spinach and tomato salad
|
- Beef
tenderloin in goulash with carrot and tomato
- Ahuyama
cream
|
- Chicken
cream with vegetables (tomato, carrot, chard, zucchini)
|
- Pork
chop with orange
- Spinach,
strawberry and grated carrot salad
|
- Chicken
sudado
- Baked
aubergines au gratin with fresh lactose-free cheese
|
*
Lunches and meals can be accompanied by water, infusions
or tea without added sugar, allowed fruit juices diluted in water and no added
sugar.
*
Spices and herbs to flavour preparations: oregano, salt, pepper, rosemary,
turmeric, honey, thyme.
*
Maximum 3 tablespoons a day of virgin olive oil to cook or consume raw.
*
Salad vinaigrettes: White / balsamic vinegar with Dijon mustard. Stevia. Lemon
juice. Natural lactose-free yogurt-based vinaigrette with lemon.
Table
3. Low FODMAP menu for 7 days adjusted to the Ecuadorian
gastronomy
|
|
DAY 1
|
DAY 2
|
DAY 3
|
DAY 4
|
DAY 5
|
DAY 6
|
DAY 7
|
|
Breakfast
|
Beverage
options:
- Lactose-free
yogurt
- Infusion / tea /
coffee / lactose-free milk with dark chocolate
Food
options:
- Cassava
omelette / bolón de verde with olive oil / oat pancakes with homemade
strawberry/guava/pineapple/fig jam
- Allowed
fruit (banana, tangerine, papaya, kiwi, melon, strawberry, orange)
- Eggs and fresh
lactose-free cheese without lactose
|
|
Midday & Afternoon snack
|
- Allowed
fruit (banana, tangerine, papaya, kiwi, melon, strawberry, orange)
- Lactose-free
yogurt
|
|
Lunch
|
- Rice
with lentil stew
- Grilled
sea bass in Creole sauce (tomato, radish, cucumber, lemon and coriander)
|
- Rice
with shredded chicken, carrots, turnips and green beans
|
- Fritada:
baked pork loin, cooked corn and creole sauce (tomato, radish, cucumber,
lemon and coriander)
- Yapingacho
(potato omelette stuffed with lactose-free cheese)
|
- Shrimp
sango: green banana, shrimp, tomato, celery, parsley stir fry
- Beans
and carrot salad
|
- Balls
broth: green banana dough filled with meat, chopped eggs and carrots
|
- Ceviche
mixed with tilapia and shrimp
- 1
cup of popcorn
|
- Hayaca
stuffed with chicken: shredded chicken, sliced carrot, cornmeal, annatto,
hard-boiled egg, olives
|
|
Dinner
|
- Humita
(corn dough stuffed with lactose-free cheese) with egg omelette
- Carrot
cream
|
- Tuna
salad with potato, cucumber, tomato, olives, celery
|
- Pumpkin
cream
- Grilled
chicken and tomato, beans and corn salad
|
- Beef
stew: meat, potatoes, beans and carrots
|
- Chicken
seco with rice
- Chard,
carrot and celery salad
|
- Cassava
puree with hamburger
- Swiss
chard and spinach cream
|
- Green
banana omelette with fried egg
- Carrot
and spinach cream
|
Table
4. Low FODMAP menu for 7 days adjusted to the Peruvian
gastronomy
|
|
DAY 1
|
DAY 2
|
DAY 3
|
DAY 4
|
DAY 5
|
DAY 6
|
DAY 7
|
|
Breakfast
|
Beverage
options:
- Soy milk or drinkable
quinoa
Food
options:
- Gluten-free bread with
tuna / lactose-free cheese / scrambled egg
- Chopped fruit:
pineapple, melon, papaya, strawberries, kiwi and orange
|
|
Midday
|
- Whole fruit
- Quince compote
- Oatmeal pancakes
- Lactose-free yogurt
|
|
Lunch
|
- Pavita
fillet with spinach puree
- Radish
salad
- Passion
fruit drink
|
- Pickled
bonito (without onion) with boiled cassava
- Orange
soda
|
- Vegetable
soup (allowed veg)
- Chicken
stew with spinach, cucumber and tomato salad
- Lemonade
with stevia
|
- Vegetable
cream
- Grilled
pork chop with Italian zucchini salad, carrot, peas
- Pineapple
water
|
- Noodles
in red sauce (tomato and carrot) with baked turkey fillet
- Passion
fruit drink
|
- Grilled
trout with parboiled potato and cucumber salad
- Fruit
(allowed)
|
- Chicken
ceviche with quinoa stew
|
|
Afternoon snack
|
One option:
- Tangerine
or 100 g strawberries
- Bread with
frayed chicken without mayonnaise
- 5 quail
eggs
- Passion
fruit or fig Mazamorra
|
|
Dinner
|
- Grilled
hake fillet with tomato salad
- Oatmeal
with drinkable quince
|
- Quinoa
burger with tuna
- Soy
milk
|
- Chicken
thighs with orange
- Boiled
Italian zucchini
- Quinoa
with drinkable pineapple
|
- Baked
pavita fillet with cooked vegetable salad
- Soy
milk
|
- Bonito
fillet with fine herbs
- Fresh
salad
- Oatmeal
with passion fruit
|
- Rolled
chicken breast with spinach, fig and ham
- Cooked
salad
- Soy
milk
|
- Rosemary
chicken fillet with pineapple salad
- Quinoa
with quince
|
Table
5. Low FODMAP menu for 7 days adjusted to the Uruguayan
gastronomy
|
|
DAY 1
|
DAY 2
|
DAY 3
|
DAY 4
|
DAY 5
|
DAY 6
|
DAY 7
|
|
Breakfast
|
- Almond
drink
- Rice
cookies with homemade strawberry jam
- Banana
|
- Rice
drink or Infusion
- Sweet
potato pancake
- Kiwi
|
- Almond
drink
- Rice
cookies with homemade strawberry jam
- Banana
|
- Rice
drink or Infusion
- Sweet
potato pancake
- Tangerine
|
- Almond
drink
- Gluten-free
bread with lactose-free cheese
- Kiwi
|
- Rice
drink or Infusion
- Quince
muffins
- Tangerine
|
- Almond
drink
- Rice
crackers with homemade strawberry jam
- Kiwi
|
|
Lunch
|
- Grilled
steak
- Carrot,
tomato and cucumber salad
- Mashed
potatoes
- Tangerine
|
- Baked
hake
- Baked
zucchini and aubergines
- Ioquat
|
- Broth
- Pork
ribs with applesauce
- Baked
quince
|
- Pumpkin
soup
- Quinoa
pizza
- Kiwi
|
- Salmon
with tomato with oregano, carrot and peas
- Grapefruit
|
- Polenta
with tomato sauce
- Carrot
and boiled beans
- Kiwi
|
- Chicken
breast
- Salad
with grated carrot, radishes and quinoa
- Orange
|
|
Afternoon snack
|
- Infusion
- Coconut
cookies
|
- Almond
drink
- Quince
muffins
|
- Infusion/
Mate
- Coconut
cookies
|
- Almond
drink
- Quince
muffins
|
- Infusion
- Coconut
cookies
|
- Almond
drink
- Quince
muffins
|
- Infusion
- Coconut
cookies
|
|
Dinner
|
- Scrambled
eggs with spinach and boiled potatoes
|
- Chicken
with wok zucchini and aubergines
|
- Sole
- Tomato,
carrot, cucumber and red lentil salad
|
- Zucchini
stuffed with quinoa with pumpkin puree
|
- Chicken
curry with sweet potato and caramelized carrot
|
- Chard
and spinach soup
- Pumpkin,
zucchini, carrot and tofu wok
|
- Pumpkin
stuffed with meat
- Quinoa
paste
|
Table
6. Low FODMAP menu for 7 days adjusted to the Venezuelan
gastronomy
|
|
DAY 1
|
DAY 2
|
DAY 3
|
DAY 4
|
DAY 5
|
DAY 6
|
DAY 7
|
|
Breakfast
7-8 am
|
- Roasted
corn arepa with buffalo or goat ricotta cheese
- Low
fat margarine
- Melon
- Black
coffee
|
- Gluten-free
toast
- Scrambled
egg whites
- Low
fat margarine
- Tangerine
- Black
coffee
|
- Corn cachapa
(natural)
- Buffalo
or goat ricotta cheese
- Low
fat margarine
- Papaya
- Black
coffee
|
- Gluten-free
Andean arepas
- Turkey
ham
- Buffalo
or goat curd cheese
- Low
fat margarine
- Cambur
(banana)
- Black
coffee
|
- Ocumo
(arrowleaf elephant ear) or sweet potato arepa
- Ground
beef
- Low
fat margarine
- Orange
- Black
coffee
|
- Roasted
corn patties with fish sauce
- Cambur
(banana)
- Black
coffee
|
- Cassava
fritters stuffed with shredded chicken
- Natural
orange juice
- Black
coffee
|
|
Midday
10 am
|
- Rice
crackers
- Turkey
ham
- Eggplant
cream
- Ginger
and lemon infusion
|
- Casabe
with guava jam with no sugar
- Ginger
with chamomile infusion
|
- Coconut
yogurt
|
- Gelatine
(no sugar)
|
- Melon
|
- Coconut
yogurt
|
- Gluten-free
cake
|
|
Lunch
12-1 pm
|
- Vegetable
cream
- Grilled
chicken milanesa
- Green
plantain toast
- Rice
with pods
- Milk
- Chamomile
and lemon infusion
|
- Bone
broth
- Tuna
croquettes
- Steamed
cassava
- Sauteed
zucchini
- Parchita
delicacy (cornstarch +
passion fruit juice
+ stevia)
- Lemon
grass infusion
|
- Herb
chicken
- Rice
with carrot
- Steamed
banana
- Papaya
- Lemon
balm infusion
|
- Bone
broth
- Grilled
steak
- Steamed
potatoes
- Sautéed
chayote
- Melon
- Linden
tea
|
- Beef
soup
- Stuffed
fish
- Roasted
aubergines
- Boiled
white rice
- Churros
- Natural
infusion
|
- Chicken
consommé
- Gluten-free
pasta with beef Bolognese
- Green
plantain tostón
- Strawberries
- Chamomile
infusion
|
- Chicken
rolls with vegetables (carrot, green dressings)
- Steamed
cassava
- Papaya
- Natural
infusion
|
|
Afernoon snack
3 pm
|
- Gluten-free
pancakes
- Strawberry
jam with no sugar
- Turkey
ham
- Water
|
- Gluten-free
chocolate cake with vegetable milk
- Chamomile
tea
|
- Gluten-free
zucchini cupcakes
- Water
|
- Cocada
(coconut drink) without milk
|
- Gluten-free
cake
- Natural
infusion
|
- Hot
chocolate (no milk, no sugar)
|
- Rice
pudding with coconut milk
|
|
Dinner
6-7 pm
|
- Zucchini
canoes stuffed with chicken
- Steamed
ocumo
- Linden
tea infusion
|
- Baked
chicken
- Stewed
quinoa
- Sautéed
pods
- Cayenne
infusion
|
- Mixed
grill (chicken and meat)
- Salad
(potato, carrot and coriander)
- Jamaica
flower infusion
|
- Roasted
corn arepa
- Shredded
meat
- Linden
tea
|
- Grilled
steak
- Stewed
quinoa
- Zucchini
salad
- Natural
infusion
|
- Chicken
croquettes
- Sautéed
vegetables
- Steamed
potatoes
- Natural
infusion
|
- Cassava
arepa with fish sauce
- Sautéed
spinach
- Jamaica
infusion
|
Table
7. Low FODMAP menu for 7 days adjusted to the El Salvador
gastronomy
|
|
DAY 1
|
DAY 2
|
DAY 3
|
DAY 4
|
DAY 5
|
DAY 6
|
DAY 7
|
|
Breakfast
|
- Sautéed
bananas with strained ground beans (not fried)
- Fresh
cheese
- Almond
milk
|
- Scrambled
eggs
- Toast
- Bread
with jam
- Apple
juice
|
- Pancakes
with honey
- Rice
drink
|
- Crepes
(homemade bread flour) with strawberries
- Skim
milk
- Banana
with granola
|
- Rancher’s
eggs with fresh salsa,
- Bread
- Orange
juice
|
- Fruit
with Greek yogurt
- Bread
with mozzarella cheese and ham
- Coffee
with skim milk with Splenda
|
- Oatmeal
with apple juice
- Coffee
with Splenda
|
|
Midday
|
- Whole
wheat bread
- Mozarella
cheese
- Natural
orange juice
|
- Granola
bar
- Greek
yogurt
|
- Jam
and seeds on bread
|
- Greek
yogurt
- Whole
wheat bread with turkey
- Chopped
apple
|
- Banana
smoothie with lactose-free milk
|
- Granola
seed bar
- Fruit
nectar (your choice)
|
- Yogurt
and mango smoothie sweetened with Splenda
|
|
Lunch
|
- Roast
chicken breast
- Cooked
rice with vegetables
- Fresh
salad
- Natural
soda
|
- Potato,
steamed broccoli
- Roast
beef
- Natural
soda
|
- Caesar
Salad: fresh salad (tomato, celery, cucumber, lettuce, carrot), shredded
mozzarella cheese, avocado, grilled chicken breast, Italian or ranch dressing
- Natural
soda
|
- Meatballs
- Pasta
with fresh tomato sauce
- Fresh
salad
- Natural
soda
|
- Fresh
vegetables
- Grilled
fish fillet
- Toasted
tortilla
- Lemon
soda sweetened with Splenda
|
- Rice
with shrimp and vegetables: cooked rice, camores, vegetables.
- Natural
soda sweetened with Splenda
|
- Vegetables:
corn, peas, carrot, broccoli
- Mashed
potatoes
- Needle
tenderloin
- Toast
with garlic and butter
- Natural
soda sweetened with Splenda
|
|
Afernoon snack
|
- Chopped
tropical fruit (pineapple, grape, tangerine and strawberries)
|
- Chopped
fruit
- Bread
with cheese (mozzarella)
|
- Rice
pudding (without sugar)
- Whole
wheat bread
|
- Tropical
cup: green mango, cucumber, jicama on medium sticks
|
- Grapes
and granola
|
- Peach
and Greek yogurt ice cream
|
- Chopped
fruit with seeds
|
|
Dinner
|
-
Chicken and apple salad
-
Hot or cold drink
|
- Green
beans with egg
- Bread
with butter
- Chopped
fruit
- Green
tea infusion with Splenda
|
- Spinach
with mushrooms and breaded chicken pieces, almond seeds
- Toast
- Natural
drink sweetened with Splenda
|
- Sautéed
vegetables (carrot, potato, green bean, peas) seasoned to taste
- Mashed
potatoes
- Natural
drink, sweetened with Splenda
|
- Sliced
fresh tomatoes
- Whole
beans or pasta
- Coriander
- Bacon
- Chopped
lettuce, onion, bell peppers
- Corn
- Panela
cheese
- Natural
drink, sweetened with Splenda
|
- Vegetable
and beef skewers: beef, onion, bell peppers, eggplant, pineapple
- Natural
soda, sweetened with Splenda
|
- Vegetable
muffin: Arab bread, turkey ham, lettuce, tomato, mozzarella cheese, dressings
- Carrot
juice sweetened with Splenda
|
Table
8. Low FODMAP menu for 7 days adjusted to the Guatemalan
gastronomy
|
|
DAY 1
|
DAY 2
|
DAY 3
|
DAY 4
|
DAY 5
|
DAY 6
|
DAY 7
|
|
Breakfast
|
Drink
options:
-
Atoles: mosh
with lactose-free milk, lactose-free rice pudding
-
Infusion
/ tea / coffee
Food
options:
-
Tortilla
or corn toast
-
Breakfast
cereals (puffed rice, corn flakes)
-
Allowed
fruit (banana, tangerine, coconut, kiwi, papaya, melon)
-
Egg:
scrambled, starry, hard, with vegetables. You can use tomato, celery or
natural tomato sauce
-
Low
lactose cheese
|
|
Midday & Afternoon snack
|
Options:
-
Corn toasts with tomato sauce
-
Lactose-free rice pudding or almond drink
-
Allowed fruit: papaya, melon, grapefruit, banana
(plantain), tangerine, strawberries, orange, pineapple
-
Yucca
pancakes
|
|
Lunch
|
- Chicken
stew: chicken broth, chicken piece, potato, sweet potato, zucchini, pumpkin
and carrot
|
- Rice
with vegetables: celery, carrot, tomato sauce
- Stewed
chard
- Beef
steak
|
- Rice
soup or watered down rice: rice, potato, chili, red pepper, carrot, tomato
sauce, chicken leg or breast
|
- Steamed
potatoes
- Sautéed
spinach
- Baked
tilapia with vegetables (tomato slices, carrot)
|
- Hilachas:
bolovique or shredded beef, carrot, green bean, potato, natural tomato
sauce seasoned with pepper and coriander
|
- Cooked
cassava
- Radish
mince
- Pork
Milanesa (ribbon loin)
|
- Corn
baked toast
- Vegetable
soup
- Shrimp
ceviche (without onion)
|
|
Dinner
|
- Stewed
potato with egg
- Chicken
broth with vegetables
|
- Tortilla
soup: add low-lactose cheeses
- Green
beans stewed with beef or pork
|
- Rice
with vegetables
- Stewed
chard
- Cheese
Doblada (corn tortilla with low lactose cheese)
|
- Carrot
and celery soup
- Omelette
with vegetables and mozzarella cheese
|
- Green
beans wrapped in egg
- Camote
or sweet potato
|
- Vegetable
soup (allowed)
- Mashed
potatoes (with water or lactose-free milk)
|
- Guicoyitos
stuffed with chicken and low lactose cheese, tomato
|
* Food could
be accompanied by corn tortillas. You may also include a dessert (without
lactose, sugar, fructose, etc.). At lunch, you could include Jamaica rose soda
with cinnamon (without sugar), plain water, herbal infusions or tea
Table
9. Low FODMAP menu for 7 days adjusted to the Honduran
gastronomy
|
|
DAY 1
|
DAY 2
|
DAY 3
|
DAY 4
|
DAY 5
|
DAY 6
|
DAY 7
|
|
Breakfast
|
- Lactose-free
rice pudding
- ½
banana
- 2
corn tortilla rolls with egg
|
- Chamomile
tea without sugar
- Fruit
cocktail (melon, papaya, pineapple)
|
- Oatmeal
with lactose-free milk + fig to sweeten
- Baked
corn toast with tuna
|
- Chamomile
tea without sugar
- Corn
tortilla
- Egg
with potato
|
- Soy
drink
- Gluten-free
bread with margarine
|
- Lactose-free
rice pudding
- ½
banana
- 2
corn tortilla rolls with egg
|
- Lactose-free
rice pudding
- ½
banana
- 2
corn tortilla rolls with egg
|
|
Midday
|
- Lactose-free
plain yogurt
|
- Melon
with grated coconut
|
- Tangerine
- Oatmeal
cookie
|
- Guava
- Oatmeal
cookie
|
- Carrot
and cucumber
|
- Soy
yogurt
- Oatmeal
cookie
|
- Lactose-free
plain yogurt
|
|
Lunch
|
- Chicken
breast
- Natural
mashed potatoes
- Spinach
salad with tomato
|
- Chicken
broth with rice
- Baked
corn salmas
- Radish
with lemon
|
- Aubergines
stuffed with pork, vegetables (allowed), Parmesan cheese and olive oil
|
- White
or blue fish fillet (allowed) with lemon
|
- Yucca
with ground pork
- Spinach,
carrot and tomato salad
|
- Fried
corn cakes with chicken and Swiss chard
- Natural
tomato sauce and parmesan cheese
|
- Chicken
breast
- Natural
mashed potatoes
- Spinach
salad with tomato
|
|
Afternoon snack
|
- Lactose-free
plain yogurt
|
- Melon
with grated coconut
|
- Tangerine
- Oatmeal
cookie
|
- Guava
- Oatmeal
cookie
|
- Carrot
and cucumber
|
- Soy
yogurt
- Oatmeal
cookie
|
- Lactose-free
plain yogurt
|
|
Dinner
|
- Baked
corn salmas with tuna
- Tangerine
|
- Baked
corn toast with tuna salad
- Lactose-free
yogurt
|
- Cooked
potato wedges + comal chicken breast pieces
- Chamomile
tea
|
- Baked
corn salmas with tuna
- Tangerine
|
- Baked
corn toast with sweet potato deep
- Lactose-free
yogurt
|
- Baked
corn toast with tuna salad
- Lactose-free
yogurt
|
- Baked
corn salmas with tuna
- Tangerine
|
Table
10. Low FODMAP menu for 7 days adjusted to the Mexican
gastronomy
|
|
DAY 1
|
DAY 2
|
DAY 3
|
DAY 4
|
DAY 5
|
DAY 6
|
DAY 7
|
|
Breakfast
|
- Melon
- Rancheros
eggs
|
- Papaya
- Pumpkin
flower quesadillas
|
- Kiwi
and strawberries
- Chicken
Enjitomatadas
|
- Pineapple
- Eggs
with nopales
|
- Orange
or tangerine juice
- Egg
with dried meat
|
- Papaya,
melon and pineapple fruit cocktail with orange juice
- Chilaquiles
with chicken in green sauce
|
- Inflated
amaranth with lactose-free milk, banana and strawberries
|
|
Lunch
|
- Nopales
soup
- Chicken
in tinga with white rice or corn tortillas
- Banana
snow with strawberry
- Lemon
water with chia
|
- Zucchini
soup with coriander
- Shrimp
aguachile toasts
- Guava
ate
- Tangerine
water
|
- Chayote
salad with apple cider vinegar and olive oil
- Beef
cured meat tacos with corn tortilla
- Dark
chocolate
- Jamaica
water
|
- Radish
salad with lemon and salt
- Pork
loin with fine herbs and mashed potatoes
- Custard
apple (seasonal)
- Horchata
water
|
- Spinach
salad with cherry tomatoes
- Chicken
fajitas with corn tortilla and steamed purslane
- Guavas
with cinnamon
- Guava
water
|
- Leek
and potato soup
- Veracruz
style fish with white rice
- Chocolate
amaranth wafers
- Lemon
water with chia
|
- Pozole
with corn and pork or chicken
- Kiwi
snow with strawberries
- Jamaica
water
|
|
Dinner
|
- Natural
turkey breast rolls with rice cakes and figs
|
- Chicken
broth with rice (without chickpeas)
|
- Fresh tuna toast with seedless cucumber and fried
leek, olive oil and grain salt
|
- Inflated
amaranth with skim lactose-free milk
- Banana
|
- Fish
cocktail with seedless cucumber and baked corn toast
|
- Roasted
nopales and rice cake with dark chocolate and strawberries
|
- Corn
tortillas with natural gluten-free turkey breast and pineapple slices
|
Table
11. Low FODMAP menu for 7 days adjusted to the Panamanian
gastronomy
|
|
DAY 1
|
DAY 2
|
DAY 3
|
DAY 4
|
DAY 5
|
DAY 6
|
DAY 7
|
|
Breakfast
|
- Roasted
cassava omelette with scrambled patio egg
- Strawberries
|
- Scrambled
eggs with mushrooms and cherries tomatoes
- Melon
|
- Roasted
banana
- Minced
meat + mushrooms
|
- Carimañola
with chicken
|
- Roasted
corn roasts with turkey sautéed with celery and peppers
|
- Spinach
omelette with quinoa toast or brown rice
- Primitive
banana
|
- Roasted
cassava dumplings stuffed with chicken
|
|
Lunch
|
- Minced
steak meat with zucchini and chayote
- Banana
|
- Roast
chicken with 1 roasted potato and carrot sautéed with olives and chayote
|
- Spring
rice
- Grilled
sea bass fillet + carrot and mushrooms
|
- Pumpkin
puree
- Pork
chop with zucchini + spinach
|
- Quinoa
spaghetti with chicken or ground beef
- Zucchini
and coriander salad
|
- Baked
chicken with potatoes sautéed with vegetables (carrot and beans)
|
- Grilled
fish
- Pumpkin
puree
- Arugula
salad
|
|
Dinner
|
- Vegetable
soup with chicken
|
- Carimañolas
with tuna
|
- Ripe
banana balls with ground beef
|
- Chicken
enyucado with zucchini and carrot
|
- Zucchini
soup with balls of ground veal
|
- Grilled
tuna with baby corn salad (preserves) and peppers
|
- Shrimp
cocktail with celery and carrot sticks
|
Table
12. Low FODMAP menu for 7 days adjusted to the Spanish
gastronomy
|
|
DAY 1
|
DAY 2
|
DAY 3
|
DAY 4
|
DAY 5
|
DAY 6
|
DAY 7
|
|
Breakfast, Midday & Afternoon
snacks
|
Beverage
options:
-
Vegetable drink of rice or coconut with pure cocoa with
stevia
-
Infusion
/ tea / coffee
Food
options:
-
Gluten-free bread with olive oil with or without crushed
tomato
-
Gluten-free bread with homemade blueberry / raspberry /
strawberry jam
-
Mix of breakfast cereal flakes (puffed rice, quinoa flakes,
buckwheat flakes, corn flakes)
-
Allowed fruit (banana, tangerine, coconut, kiwi, papaya,
melon)
-
Lactose-free cold cuts
-
Fresh
cheese without lactose
|
|
Lunch
|
- Soupy
rice with vegetables (green beans, carrots), clams, squid and turmeric
|
- Homemade
chicken burger with oil-fried Swiss chard
- Homemade
mashed potato
|
- Red
lentil paste with vegetables
- Grilled
emperor
|
- Stewed
beef or stewed ribs with potato, beef broth, and zucchini, tomato, carrot
sauce, seasoned with oregano, pepper, and rosemary
|
- Vegetable
stew with zucchini, eggplant, tomato, carrot
- Hake
(with fish soup)
|
- Spanish
potato omelette without onion
- Baked
or grilled chicken
|
- Galician
octopus (with cooked potato, chard, oil and paprika)
|
|
Dinner
|
- Baked
turkey sirloin
- Cream
(puree) of zucchini and Swiss chard
|
- Green
bean, carrot and hard-boiled egg salad
|
- Grilled
zucchini
- Baked
chicken wings with spices
|
- Lamb's
lettuce, pomegranate and vinegar salad
- French
omelette
|
- Salmorejo
(cold tomato soup) with oil, vinegar, gluten-free breadcrumbs and pieces of
hard-boiled egg and Serrano ham
|
- Grilled
baby squid
- Fish
broth with allowed vegetables, soft fish and gluten-free noodles
|
- Eggplant
stuffed with minced meat
- Spinach,
tomato and lactose-free fresh cheese salad
|
* Non-wheat
or non-rye bread and a dessert (without lactose, sugar, or fructose) may be
added to lunch and dinner
Reintroduction of food
The FODMAP diet reintroduction
phase involves reintroducing foods back into the diet in a methodical way to
determine which foods and FODMAPs trigger symptoms and which do not. Each
FODMAP subgroup should be reintroduced separately while the background diet
remains low in FODMAPs. The reintroduction step is also best completed under
the guidance of a dietitian, therefore, advise has been given by each country
on when to reintroduce, which foods to reintroduce, the amount of the
reintroduction food to have, and some recipes containing the reintroducing
foods (Tables 14-24). A break of a few days between reintroduction of foods is
taken to avoid any crossover effects. It takes around 6 to 12 weeks
to complete the reintroduction step.
That step sometimes is
complicated, unplanned and not guided by a fodmap diet nutrition expert. This,
together with the lack of consensus, helps the result in practice to be
frequently criticized by other professionals and scientists, who are partly
right.
Starting from the low fodmap
foods, the foods to be reintroduced are clearly and simply the opposite (Table
13). For what they have mostly and as an example, the following foods:
Table
13. List of reintroduction foods according to the FODMAPs:
|
FODMAP
|
Food
|
|
Fructose
|
Fruits:
apple, pear, melon, nashi pear, peach, mango, grape, cherry, watermelon
Sweeteners:
honey, fructose, jam with fructose
Vegetables:
asparagus, artichokes, peas.
|
|
Lactose
|
Milk
(cow, goat and sheep), yogurt
Ice
cream, cream
Soft
and fresh cheese (ricotta, cottage, mascarpone)
|
|
Fructans
|
Cereals:
wheat, rye, barley (bread, pasta, cookies)
Vegetables:
onion, shallot, garlic, beets, Brussels sprouts, cabbage, broccoli, fennel,
leeks, endive
Fruits:
persimmon
Nuts:
walnuts, hazelnuts, pistachios
|
|
Galactans
|
Legumes:
beans, chickpeas, lentils, soy
|
|
Polyols
|
Fruits:
nectarine, apricot, plum, blackberries, avocado
Vegetables:
cauliflower, mushrooms, green bell pepper
Sweeteners:
sorbitol, mannitol, xylitol, maltitol, isomaltitol and others that end in
"ol".
|
Table
14. List of Argentinian and Uruguayan foods to be reintroduced
to the Argentinian and Uruguayan diet after a low FODMAP diet
|
Food
|
Recipes
|
|
cherry
|
Home
made snowy cherry muffins
|
|
Onion
|
Pancitos
saborizados
|
|
Cheese
(lactose) and
|
Meatloaf
with cheese and carrot
|
|
Legumes:
beans
|
Legume
dumplings with beans
|
|
Cauliflower
|
Cauliflower
dough pizza
|
Table
15. List of Colombian foods to be reintroduced to the Colombian
diet after a low FODMAP diet
|
Food
|
Recipes
|
|
Avocado
|
Bandeja
paisa; soups.
|
|
Cheese
(lactose)
|
Arepa
with cheese (queso doble crema)
|
|
Garlic
|
Tamal
|
|
Onion
|
Sancocho:
beef rib, green plantains "viches", yucca, potatoes, corn on the
cob, onions, coriander, tomatoes
|
|
Peas
|
Ajiaco:
chicken, dry guascas (colombian plant), papa criolla potato
(yukon gold), papa sabanera (white potatoes), corn on the cob, chicken
soup, green peas or peas (no onion or garlic)
|
Table
16. List of Ecuadorian foods to be reintroduced to the
Ecuadorian diet after a low FODMAP diet
|
Food
|
Recipes
|
|
Mango
|
Mango
juice or smoothie with lactose free yogurt / mango salad (lettuce, tomato,
cucumber and mango)
|
|
Ricotta
cheese
|
Patacones
with ricotta cheese / vegetable soup with ricotta cheese
|
|
Curd
|
Patacones
with curd / vegetable soup with curd
|
|
Onion,
garlic
|
Refrito
/ tigrillo / encebollado
|
|
Chickpeas
|
Hummus
|
|
Raisins
|
Caldo
de bola with raisins/ cabbage and raisins salad
|
|
Avocado
|
Ceviche
with avocado / avocado, black beans, corn, tomato salad
|
Table
17. List of Peruvian foods to be reintroduced to the Peruvian
diet after a low FODMAP diet
|
Food
|
Recipes
|
|
Pore
|
Leek
cream: leek chunks, Italian zucchini, zapallo macre (pumpkin), pinch
of salt
|
|
Pear
|
Pear
Mazamorra: peeled pears, cinnamon, chuño (thickener)
|
|
Goldenberry
|
Goldenberry
jam: goldenberry, Stevia, lemon
|
|
Yellow
Peper
|
Causa limeña
|
|
Onion
or green onion
|
Ceviche
or Tacu Tacu
|
Table
18. List of Venezuelan foods to be reintroduced to the
Venezuelan diet after a low FODMAP diet
|
Food
|
Recipes
|
|
Mango,
Plum, Watermelon,..
|
Jugo
(common way of taking it) Alone, in compote or juice
|
|
Avocado
|
Reina pepiada (Arepa)
|
|
Mushrooms
|
Steamed
or sautéed or cream soup
|
|
Red
and green peppers
|
Pabellón criollo (ajíes dulces
verdes y rojos)
|
|
Rye
|
Rye
mixed with corn flour in arepa and cheese
|
|
Beans (frijoles bayos /rojos)
|
Pique llanero
|
Table
19. List of Salvadoran foods to be reintroduced to the
Salvadoran diet after a low FODMAP diet
|
Food
|
Recipes
|
|
Onion
|
Radish
leaf stew cakes: radish leaves, 2 eggs, tomatoes, onion.
|
|
Peppers
|
Tamales Salvadoreños (con chiles verdes)
|
|
Letucce
|
Panes
de gallina or “panes migueleños”
|
|
Avocado
|
Enchiladas (with cheese)
|
|
Beans
|
Empanadas made with a
dough made from a ripe banana puree, with which rounded tortillas are made
and stuffed with ground fríjoles, and fried.
|
Table
20. List of Guatemalan foods to be reintroduced to the
Guatemalan diet after a low FODMAP diet
|
Food
|
Recipes
|
|
Yogurt
and cheese
|
Combined
with cereal, fruit smoothies with milk or yogurt, atoles such as mosh
with milk, rice pudding
|
|
Leek
|
Leek
soup, cream
|
|
Cabbage
|
Tortillas
with loroco and cheese and cabbage
|
|
Avocado
|
Natural,
simple guacamole, guacamole combined with tomato
|
|
Beet
|
Enchilada
corn toast with minced meat, cheese, egg, cheese and
beetroot
|
|
Red
Chili pepper
|
Chili
stuffed with beef, chili pepper salad, add to traditional foods that carry
chili pepper
|
Table
21. List of Honduran foods to be reintroduced to the Honduran
diet after a low FODMAP diet
|
Food
|
Recipes
|
|
Black Beans
|
Baleadas
(Tortillas with Beans and Cheese without lactose)
|
|
Beans
or kidney beans
|
Blended
beans toast
|
|
Onion
or green onion
|
Montucas
|
|
Avocado
|
Guacamole:
1 diced avocado, 2 boiled eggs in pieces, lemon and salt
|
|
Skim
milk
|
Skim
milk with blended fruits (banana, strawberries, papaya)
|
Table
22. List of Mexican foods to be reintroduced to the Mexican diet
after a low FODMAP diet
|
Food
|
Recipes
|
|
Avocado
|
Guacamole
|
|
Pepper and onion
|
Frequent in enchilada,
tamales, pozole…
|
|
Beans, lentil,
chickpeas
|
Beans with chicken tinga
|
|
Wheat
Bread
|
Bolillo
|
|
Panela
cheese, plain yogurt or cream
|
Grilled
Panela cheese with roasted Tomatillo and Poblano Salsa
|
|
Cheese
(lactose)
|
Quesadilla
|
Table
23. List of Panamanian foods to be reintroduced to the
Panamanian diet after a low FODMAP diet
|
Food
|
Recipes
|
|
Beans
|
Gallo
Pinto (rice with frijoles)
|
|
Onion
|
Mondongo
|
|
Pepper,
garlic
|
Tamal
|
|
Cheese (lactose)
|
Boiled
cassava with goat cream cheese
Corn patty with roast
beef, cheese egg and orange
|
|
Chickpeas
|
Chickpeas stewed with
Serrano ham, potato
|
|
Peas
|
Patacones + fish +
tomato and cucumber salad
Stewed
shrimp with tomato, garnished with peas and sweet potatoes
|
Table
24. List of Spanish foods to be reintroduced to the Spanish diet
after a low FODMAP diet
|
Food
|
Recipes
|
|
Wheat
|
Wheat
bread toast with ham and tomato (tumaca)
|
|
Green
asparagus
|
Grilled
vegetables (asparagus, zucchini, aubergine, natural tomato) Serrano
ham dices
|
|
Green
onion or onion
|
Spanish
omelette
|
|
Lentils
|
Stewed
lentils with potatoes and carrot
|
|
Red
pepper
|
Seafood
paella
|
Discussion
Numerous studies in other
countries have reported the use of the FODMAP diet(37). However,
the information available in Spanish is scarce(38) and there
are barely no local studies that have estimated the applicability and
effectiveness of this strategy on
the symptoms and the health-related quality of life in patients in the Hispanic setting.
The benefits of restricting dietary FODMAPs appears to be
durable(34). The nature
of the diets used, however, is generally poorly defined. While all FODMAP are
potentially important in the genesis of symptoms, the
relative contribution of different subgroups of FODMAP varies
across ethnic and dietary groups due to the dose delivered in
the diet(2). In Western
European and Central and South American diets, fructose and fructans are by far
the most widespread in the diet and therefore the ones to which nearly all
patients with IBS are exposed in their everyday diet(2).
Using a well-defined diet,
restriction of fructose and fructans, together with general avoidance of other
FODMAP leads to impressive global symptoms response(35). There are
limitations in developing tables of FODMAP-rich and FODMAP-poor foods.
Published lists of foods are generally limited in the description of FODMAP
content. This limitation has been assisted by the development of methodologies
to measure FODMAP content, together with a systematic examination of fruits,
vegetables and cereals(36). The cut-off
levels of FODMAP content, which dictates whether it is classified as ‘high’ or
not, are not clearly defined. This is further complicated by the fact that the
total of FODMAPs ingested (not the individual FODMAP) at any one meal is a
major factor in determining whether symptoms will be induced or not.
More studies are needed on the
use of the FODMAP diet. The current criticism towards the FODMAP diet and the
lack of evidence and robustness for its clinical and dietary use seems to be
justified. There is a great variation between the different lists of FODMAP
content in foods. The intervention studies are mostly of short duration,
usually less than 3-6 months. Besides, the necessary trained professionals are
not always available in hospitals and primary care, therefore, the
recommendation of the diet is limited.
In resume, defining
qualitatively the typical eating practices and style of the patient and the
subsequent adaptation of the diet to local gastronomy is pertinent, as it
provides the basis for a better understanding of food choice and may increase
the likelihood of durable adherence. An understanding of the dietary principles
and allocation of time to work on applying the diet are also important to
ensure success.
This publication is merely
intended as a guide to help professionals manage the FODMAP diet.
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