Figure 3.

‘Top-down’ and ‘bottom-up’ approach to the low-FODMAP diet (adapted with permission from reference [46]; Copyright 2019, John Wiley & Sons, Inc). Reducing a few specific foods/subgroups in the ‘bottom-up’ approach implies an adequate diet history, for example, that in a patient who consumes chewing gum and/or candies, these are withdrawn; if he/she consumes large quantities of fruits and fruit juices, they may benefit from the restriction of only excess fructose and polyols to start with; or if he/she consumes large amounts of wheat, onion, artichokes, and pulses, they may be more likely to benefit from a restriction of fructans. Furthermore, in the ‘bottom-up’ approach, a gluten-free diet has been claimed to be the easiest way to reduce fructan intake (see text).