Functional gut disorders such as IBS are affecting one in five Americans, causing abdominal pain, inconsistent or excessive bowel movements, and even psychological symptoms such as anxiety or depression. (1) If you have experienced IBS, you know that these symptoms can be constant, painful, and can have a serious impact on quality of life.
If there were a dietary intervention that could reduce or eliminate IBS symptoms, would you try it?
There is a strategy that has recently become more popular; it is a dietary approach that I have seen work well for many of my patients, and that evidence is growing in support of. Known as the Low FODMAP Diet, this method has been demonstrated to reduce functional gut disorder symptoms in approximately 75% of patients. (2) Understanding how FODMAPs affect the gut and knowing how to eliminate them from your diet may be the key to getting your IBS symptoms under control.
What are FODMAPs?
The acronym FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols. These short-chain carbohydrates are incompletely absorbed in the gastrointestinal tract and can be easily fermented by gut bacteria. (3) These sugars also exert an osmotic effect, increasing fluid movement into the large bowel. (4) The fermentation and osmosis caused by these undigested sugars are a cause of major IBS symptoms such as gas, pain, and diarrhea.
There are many common foods that are high in FODMAPs that can potentially contribute to IBS symptoms, even if they are considered healthy by most standards. Lactose from dairy products, fructose from certain fruit, coconut products, and sweeteners, fructans from fibrous vegetables, and polyols from fruit and sugar alcohols are all rich in FODMAPs and can be difficult to digest for people with functional gut disorders. These foods can cause serious and painful symptoms in those with IBS and Crohn’s disease.
Who may have FODMAP intolerance?
While most IBS patients are FODMAP intolerant, consuming FODMAPs does not actually cause IBS; it simply exacerbates symptoms. (5) Therefore, while many people may be able to consume a large quantity of FODMAPs with no problem, some people will experience an abnormal or exaggerated response to the presence of these poorly absorbed saccharides. (6) And while all FODMAPs can potentially factor in the development of IBS symptoms, the relative contribution of different types of FODMAPs varies across ethnic and dietary groups depending on the amount of each in the diet. (7) Additionally, individuals differ in their amount of malabsorption of FODMAPs such as fructose, lactose, and fructans, and therefore are more or less sensitive to certain FODMAPs in particular.
So what causes FODMAP intolerance? There are a few possible explanations that have been explored in clinical study. In some cases, small intestinal bacterial overgrowth, also known as SIBO, contributes to the development of IBS symptoms and FODMAP intolerance. (8) The presence of pathogenic bacteria in the small intestine causes excessive fermentation of these carbohydrates, increasing gas production and allowing for the proliferation of uncontrolled gut bacteria. In other cases, certain individuals may lack adequate enzymes to break down and absorb the fermentable sugars before they reach the colon, contributing to the osmolarity changes and bacterial fermentation that occurs in the large intestine.
Of course, emotional and physical stress are also known to be contributing factors to the development of IBS, and could induce FODMAP intolerance for reasons not yet fully understood. (9) In these cases, disturbance of gut microbiota is a likely causative factor; as we know, stress alters the gut flora significantly and could be the reason why stress, FODMAP intolerance, and IBS are so closely linked.
How can you treat FODMAP intolerance?
First, addressing intestinal bacterial overgrowth or imbalance is key; even if you don’t have IBS, gut dysbiosis can lead to poor digestive function as well as contributing to FODMAP intolerance. There are a few gut-healing protocols available today, such as the GAPS Diet or the Specific Carbohydrate Diet; my personal approach is similar to an autoimmune Paleo diet. I often recommend probiotics to my patients to help balance out their gut flora, and occasionally recommend antimicrobial treatments depending on the severity of the individual gut infection. Managing gut flora is a highly individual process, so it’s important to pay attention to your own symptoms when coming up with a treatment plan.
In addition to addressing gut bacteria, following a low FODMAP diet seems to be the most effective dietary intervention to help reduce chronic IBS symptoms. (10) Many clinical trials have shown a high level of success from IBS patients who reduce or eliminate FODMAP containing foods from their diet. (11, 12, 13) In addition, avoiding gluten may help reduce IBS symptoms further, according to some research. (14)
While a “Paleo” or “Primal” diet may eliminate many of these culprits, there are a few Paleo-friendly staples that can worsen FODMAP intolerance symptoms. I’ve written about coconut milk causing digestive distress in some individuals, and coconut milk is an unfortunately high source of FODMAPs. Many fruits such as apples, peaches, mangoes, and watermelon are FODMAP rich, and dried fruits are especially problematic for those with intolerances. Even certain vegetables that are normally quite healthy can be problematic for those suffering from IBS; asparagus, brussels sprouts, broccoli, garlic, and onions are just a few of the vegetables that could be exacerbating symptoms.
To determine which specific foods that may be causing your IBS symptoms, I recommend reviewing this basic but informative chart featuring different types of FODMAPs and the foods they are found in. You may be consuming a FODMAP-rich food without knowing it, and reducing or eliminating consumption of these foods may help alleviate IBS symptoms. This chart also provides a list of low FODMAP foods that can be enjoyed in place of these problematic foods.
For much more information about FODMAP intolerance, as well as an extensive list of FODMAP foods and an in-depth gut healing protocol, check out my Personal Paleo Code. In this detailed guide, I explain how to best adapt the standard Paleo diet into one that can help relieve IBS symptoms without needing to restrict your diet indefinitely. It’s a protocol I use with my patients, and many have found success without drugs or surgical intervention. It’s certainly worth a try for anyone suffering from chronic digestive disorders.
Have you tried the low FODMAP approach to IBS treatment? Share your story in the comments below!
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{ 100 comments… read them below or add one }
Does fermenting FODMAPs prior to consumption make them easier to digest? For example, turning cabbage into sauerkraut and eating it that way.
There’s no data on this, but in my clinical experience many patients with FODMAP intolerance can handle sauerkraut (in moderation) even if they’re sensitive to cabbage.
Since FODMAPs are short-chain fermentable carbohydrates, many of them can be fermented by the bacteria during the fermentation process, making them easier to tolerate for people with an intolerance to FODMAPs.
How would one know if they had IBS? Abdominal cramping, abdominal pain, bloating after eating a meal?
IBS is a diagnosis of exclusion, which means you end up with it if they’ve ruled out other structural bowel problems like IBD and celiac disease. See this link for the criteria used to diagnose IBS: http://www.helpforibs.com/footer/rome_guidelines.asp
I have been following the FODMAP diet since October and it significantly reduced my IBS symptoms. Since the studies are new here and FODMAPS are in most everything, it has been hard for me, but I felt so much better and was eliminating much less frequently. However, I was still having some issues on ocassion (bloating, constipation) and two weeks ago I started taking digestive enzymes, Betaine HCL and also a combo pill of bromelain, papain, pancreatin, pepsin, amylase, lactase, lipase, ox bile powder, ginger root, turmeric. I feel so much better now!
Robb, What is the combo pill you are taking? It has tons of good stuff in it!
It’s “Simple Digestive Formula” from Whole Foods. There is also a brand available online from NOW called Super Enzymes that works well if WF isn’t near you, but it does include 200 mg of HCL as well. The great thing is it’s not really expensive (I think it was $6.99 for 100 tablets). I’m still eating pretty low FODMAP but since I started the supplements I’ve been able to be more flexible and eat some of the things I’d cut out in small amounts with no reaction. Good Luck!
Thanks!
I’ve had gut problems since Feb 2011 and it was only this year I’ve been able to narrow down the culprits through deep research and trial and error (more error than success). Keep a diary of everything that passes your mouth. I use myFitnessPal app on the iPhone and I’ve over 6 months worth of data; every meal, the notes on symptoms and quality of ‘outputs’! I’ve managed to cut out the majority of the triggers through controlled and measured elimination. In hindsight, using Chris’s methods and services would have saved me months. Oh, and I can confirm that coconut oil (not milk) does indeed effect me.
For those interested, my book (“Practical Paleo”) contains notes on FODMAPs in all of the recipes as well as alternate ingredients where ever possible. FODMAPs are also denoted on my Guide to: Paleo Foods- available here > http://www.balancedbites.com/useful-guides as well as in an updated/expanded form in the book.
I recommend that people try my sauerkraut recipe simply using carrots if they are concerned with fermented cabbage being tough to tolerate.
Hi Diane- I just made your sauerkraut recipe using carrots today- I’m excited to see how it turns out. Your book has been really helpful for me- so thank you.
Chris- Your site has also been incredibly helpful for me. I am so happy to have read your article on too many veggies- I think that is what caused me to have such digestive distress. When I first started eating paleo, I was eating up to 4 cups of raw veggies a day- it only took a couple of months until I couldn’t tolerate raw veggies in any quantity. Now, i can only tolerate veggies semi-comfortably when they are well cooked- and even then i experience bloating/gas, etc… I will be following your protocol and Diane’s recommendations to heal my leaky gut- Thanks!
I’ve been trying to kick acid reflux for awhile now… been reading your articles on it, tried reducing carbs/grains/gluten… so many things. Added HCL (it helps, but it’s not a silver bullet). Any connection between these foods and reflux?
These foods (FODMAPs) are known to irritate digestion in people with SIBO, as mentioned above, and that can really irritate the LES leading to the reflux you’re feeling. We talked about this on our podcast together a while back > http://www.balancedbites.com/2011/10/balanced-bites-podcast-episode-8.html
I meant to note that the episode above was on The Balanced Bites Podcast with Chris as our guest talking about digestion.
Thanks, Diane. Just listened to the whole thing. Sounds very overwhelming! I mean, a lot of it was stuff I’ve heard before, but what to choose: Paleo, Whole 30, Fodmaps, Gaps… Yikes. I tried Gaps… did it for 8 days and I could not continue. I got to where I hated cooking and I hated eating those soups. What would you recommend I try at this point… oh, and here’s another possibly important tidbit: I’m 5 weeks pregnant. REALLY want to get a hold of this before the baby goes through the birth canal!!!!!!!!!
Jenni – have you actually tried complete elimination of all grains, not just a reduction? Even tiny amounts of rice caused reflux for me so I would not have figured it out if I had just reduced the amounts. I went very strict with no grains for 2 months and my reflux disappeared. Now that my system has calmed down I can handle a bit here and there but not in the beginning.
I did go completely without grains for awhile. Probably around 2 months. No changes I’ve made so far have made any noticeable difference. Being on vacation seems to make a difference, but it doesn’t go away completely. It does go away for days at a time, but then it always comes back.
My mom used to have to take some meds for acid reflux. Then she started consuming greens (Collard greens, swiss chard, kale, etc) and started making Victoria Boutenko’s green smoothies and her acid reflux went completely away. She was able to get off the meds entirely. Victoria Boutenko discusses this in her DVD titled “Greens Can Save Your Life”.
Chris, Diane, what would you think of Kombucha (for probiotics) on a low-fodmap diet?
Kombucha has very little fructose left in it after fermentation, so I wouldn’t consider it a FODMAP.
And avocados are out too, right? (Not listed in the link) And what about coconut butter? And, one last question, is there any benefit to sticking more with cooked vegetables than raw ones or does it not really matter? Thank you so much!
I consider avocados to be “grey area”; some will tolerate, others won’t. Keep in mind that the range and scope of FODMAP intolerance is highly variable. Some patients are particularly sensitive to garlic and onions, for example, but have no trouble with stone fruit. It’s best to eliminate all FODMAPs and then reintroduce each class to see which you are sensitive to.
Avocado contains POLYOLs and is indeed considered a grey area food. Research suggests a quarter of an avocado per meal is ok, so long as rest of FODMAP load is minimal. COCONUT has long been taken off the list of problem FODMAP foods as it only contains small amounts of sorbitol. Many people with IBS react to excess fats though too, or may also react to the GUMs added to most commercially available coconut milks.
I was so excited to find out that I’m okay with avocado! But I can’t go too overboard. Onion and garlic are big no-nos for me though- which sucks when eating out cos they’re in absolutely everything! Many chefs are catering to gluten free ppl now, which is helpful, but they still throw all the other ‘bad’ foods in!!
My IBS cleared up entirely with just intensive probiotic therapy and a somewhat cleaned up diet. I had had severe IBS for over 2 decades and now have not had it for about 6 years. I did continue having other significant health problems though even after my IBS completely cleared up…which leads me to think that others might be like that too. The return of good bowel movements alone does not guarantee the return of good health.
Later I found that for further and deeper healing I did need to do a GAPS like diet…which I’ve modified but and I’m pretty much paleo now….the journey continues…
I had terrible pain all throughout my abdomen and not in any one localized area for over a year, saw many doctors and had many tests. Finally, my doctor told me it was all in my head and to go out, relax and play more. I found a naturopath who put me on a gluten-free diet and within a few short weeks the pain that was interfering with my quality of life was completely gone. It was such a stunning change I have no doubt gluten can be a factor. I do still get bloating from certain foods like onions and will pay closer attention to fodmaps now, thanks to Chris for the helpful chart.
I was diagnosed 6 months ago with fructose malabsorbtion, so following this diet with some additional restrictions on fructose load has been huge for me. Added to being celiac and intolerant to dairy( not just lactose, casein causes serious symptoms as well) and soy, this was a huge diagnosis. But it removed pain, nausea, and other symptoms I had been living with for years. I wish more people were willing to change how they eat for their health. It’s really not that difficult. It astounds me how many people would rather continue to eat what they want and feel awful, than make some changes in what they eat and not have to always know where a bathroom is, or stay home for an entire day in pain. I know several who live like this all the time..
Australia seems light years ahead of the US in researching this subject. I suppose it’s because a pill isn’t involved so there isn’t any money in it for the pharmaceutical industry.
Hi Mel,
could you elaborate on the fructose load? Have you been counting grams (of fructose)? If so, how much? I am also celiac, intolerant to dairy…any help would be great.
Thx,
Zsuzsi
Zsuzsi, I don’t count grams in detail, I just know by trial and error that I have a fairly low tolerance. Most generic advice out there says to watch your fructose per sitting. I have just found that making sure I keep my per day fructose vs my per meal fructose low goes much better for me,. I am definitely on the low end of the tolerance scale. In fact, eating vegetables or fruit more than a few times per week usually triggers symptoms for me (except potatoes. I’d starve if not for my meat, eggs and potatoes). My average per day fructose might be closer to what many do per meal.
Perfect timing for this article! I am just about to shift from a paleo to a paleo + GAPS intro + low FODMAPs diet to try to heal my IBD which I suspect is caused by SIBO and leaky gut (although my other hypothesis is difficulty with fat digestion or protein digestion, which this approach may not help?) Thanks for the resources and information, extremely helpful! I recently have had an onset of mild daily reflux in the early evenings in addition to my other symptoms (which have not changed/worsened), should I consider HCl as well? The only thing I have changed recently is drinking 8oz of kombucha daily, could this amount of probiotic intake be causing the reflux?? Thanks for your help!!!
I haven’t tried the FODMAPs approach to IBS, although I really should. This post couldn’t have come at a better time in my life!
I used to have horrible acid reflux and bowel issues. I have followed the paleo diet for over a year now. My acid reflux is GONE and I have relatively little bowel issues. Recently I had a few “episodes” of my IBS flaring up.
I wanted to rule out fructose and lactose intolerance. My GI doctor ruled out lactose intolerance (I requested even though I wasn’t eating dairy) and the fructose intolerance. I am still curious about SIBO although he didn’t seem to think that was my issue. (He previously ruled out celiac as well.)
The doctor diagnosed me with IBS. He prescribed Dicyclomine to be taken 30 minutes before a meal. The last thing I want is to take any prescription drugs. Not only do I forget to take it, but it has made my IBS symptoms worse. Sadly I am discouraged and will more than likely quit taking it because I’m not seeing the benefits.
I guess I will go back to stricter paleo diet and look into the FODMAPS intolerance. When my acid reflux was at its peak, I couldn’t eat any kind of melon or broccoli. I found it ironic that many of the foods listed in this article caused problems in my past.
I wish you were taking new patients…
I am reading “Fast Tract Digestion” by Norman Robillard. His opinion is that FODMAP diet does not go far enough because it does not limit resistant starch. Amylose must be restricted in order to help digestive issues like ibs and reflux. Dr. Robillard is a microbiologist who cured his own digestive issues. He assigns a “fermentative potential” number to carbs to identify how difficult a carb is to digest. I am very interested in your opinion of his approach.
Thanks,
Alice
I would love to see the list of carbs and numbers. Do you know if it is online anywhere?
Mickey
As far as I know the list is not on line. I think it is only available through the book, “Fast Track Digestion”. I got it as an E book at Amazon. Good luck.
Alice
Thanks forr mentioning this book. I read it and found it boy helpful and confusing. The latter because some of the claims seem to be opposite to those of FODMAPS. Many foods listed as high in FODMAPS on most lists are lited as low FP in his system and vice versa (eg sweet potato). I’m not sure if the difference is simply due to adifferent use of portion size or an actual divergence in opinion. How do you implement the information?
Lilian, You are correct, there are differences driven by a couple of things. First, the Fast Tract Diet Fermentation Potential (FP) calculation limits all carbs that are difficult to digest (using the glycemic index to subtract absorbed carbs) which includes all fiber and resistant starch. So a 5 ounce sweet potato has 21 grams of fermentable carbs that escape absorption and can potentially fuel SIBO. Second, FODMAP carbs also register in the calculation but if there are only a few grams, the food could be considered gut friendly.
Norm Robillard
Thank you, Norm, that is a very helpful clarification. That would mean that the FP calculation leads to more stringent criteria, as all hard-to-digest carbohydrates are considered, not only FODMAPS, am I correct? Would the sugar (glucose/fructose) to fiber ratio explain why watermelon is considered a FODMAP food but low FP according to your system? And would portion size always still remain a big consideration, even with a low-FP food?
Lastly, learning that there’s a difference between Basmati- and Jasmine rice and that the latter is so digestible has made a huge difference for me (I tend to not feel well on a no-carb diet) and explains why I tend to feel so well after dining at thai and chinese restaurants – I just called my favorite Thai restaurant and verfified that they use Jasmine rice – so warm thanks for that!
Do you discuss the use of natural antimicrobial agents for SIBO in any of your books?
Thanks for another great article Chris.
Hi Jenn, The FP system does go beyond FODMAPs in the number of carbs covered. On the other hand, you don’t have to think about what foods have what carbs, just go by the FP which is the same as symptom potential. The FP for watermelon is low most likely because fructose is absorbed more efficiently in the presence of glucose. You are right, portion can matter – not for jasmine rice since the FP is zero – but for other foods that have higher FPs.
Enjoy your Thai food.
Norm
Hi, I bought the book hoping it would help me with my gut issues, I have sibo and fructose malabsorption. I confidently had and omelette with onions today, sprinkled with cheese and sour cream. A little bit later I started having really bad anxiety and shakiness. That’s what normally happens to me when I consume something like onions, apples or pears. Do you think your diet isn’t compatible with fructose malabsorption or could I possibly have yet another issue?
Hi Alex,
Not sure what to make of that. More typical symptoms of fructose malabsorption are cramps, gas, diarrhea, reflux, etc. But if you are having a reaction to them, the best bet may be to follow your instincts and avoid them. Sorry, I couldn’t be of more help there.
Thanks for this post, though it sure is not welcome news. I’ve been on GAPS for a while and not doing well with it. Initial improvements in many areas were short lived, followed by precipitous decline in the areas of energy, sleep, libido, depression, personality, muscle inflammation and desire to eat and cook. I know now that I went too low carb out of ignorance and this seems to be a common story. For now I’m hoping adding more back in will have good effect. I’m trying hard to get enough carbs on full GAPS, but finding it challenging. Eliminating fodmap foods looks like a death sentence right now, but then again, after adding more fruit and vegetables than I was eating the digestive improvements that I saw on the intro diet are not so apparent… I’m still better, but not as better as I was. I’m just not sure I can get enough carbs in a healthy way if the sources are further limited. Would you typically add some starch in this type of situation? I’m hesitant re: Natasha Campbell/Mcbrides entire approach being based on eliminating polysacharrides. I have a considerable investment in the GAPS process so far and don’t want to undo any progress made.
From reading around the blogosphere it is apparent that my story is a common one and that there is a groundswell/backlash away from low carb diets. Many people seem to come out of their low carb coma by adding them back. It seems clear that Dr. Cate thinks that low carb is fundamentally right, and that the people having trouble with it are broken or are doing it incorrectly. It would be good to hear more from you on this subject given the current climate around it. The Ray Peat and 180D stuff is pretty compelling, especially to people in my situation. I’m actually contemplating the idea of RRARFing within the GAPS allowed foods, though it seems difficult without starch and maybe impossible without fodmaps too. I have about 70 varieties of mostly heirloom apples ripening this year and not tasting and just enjoying eating them for the first time ever after years of investment would be SUCH A BUMMER! Ok, done whining.
Stevene,
I didn’t do well on just GAPS for long either…I’ve added sweet potatoes and green plantains and found that very helpful. I too needed a bit of carb. I don’t eat much of them and not even daily, but it helps.
I am in the same boat. I did GAPS for awhile, not much change, then have added FODMAPs and am seeing a ton of improvement. My only problem is not being able to get enough carbs. I have been making juice from carrots, celery, cucumber and ginger and then watering it down and having it with meals, in addition to salads/squash/more carrots cooked with my meals. No more bloating and pain, but kind of extreme. Only fruits that are working for me right now are bananas and berries.
Mickey
I’m of the opinion that people should be able to thrive on a varied diet. If your digestion is poor, ANY kind of food has the potential to be irritating. So trying to eliminate too many foods, and you end up on a very restrictive diet and can’t enjoy life. The goal is to improve digestion to the point where you can enjoy a large variety of foods without suffering or paying for it later. While this can sometimes be accomplished with diet alone, many people will benefit greatly from supplements. Chris has some great recommendations on here and in his personal paleo code. One supplement that I personally love is Just Barley (high in organic sodium which will help you make HCl or stomach acid)…it really improves digestion.
I also resonate with Ray Peat’s ideas. I say try to improve your digestion and enjoy your apples!
My goal is certainly to be able to eat a wide variety of foods. Clearly people have thriven (is that a word? well, now it is!) on a wide variety of foods throughout our evolution. I like the aspect of the GAPS diet, that strives toward the goal of digestive healing and a return being able to digest most foods. Having reviewed FODMAPS now and contemplated adding that to GAPS, it just does not seem possible. I’m wiped out and need to do something different ASAP. I added some Basmati rice, but I don’t think its going that well. I’m not sure I’ve got this right, but GAPS and FODMAPS seem to be trying to starve the same out of balance microbes in the gut, while GAPS also focuses on foods that are alleged to be beneficial in healing the gut. The fact the each one does not take into account the other’s recommendations seems like it might be somewhat remiss. It looks like Norm Robillard’s book listed above might approach the problem in a more refined way by calculating the actual values of potentially difficult to digest foods. That could allow me to tweak my diet without eliminating broad groups of foods that might be tolerated. Since I’m unable to live well on mostly fats and meat, I can’t afford to eliminate the problem foods listed by GAPS and FODMAPS both, because there is just not enough left to eat. I know many other people have this problem as well.
I definitely have SIBO symptoms, but I recently tested for it with a naturopath and found I was in the normal range (levels were really good). Still, the FODMAPs diet does seem to help with gastro distress. I notice my stomach isn’t bloating, and it reduces the problem of food not digesting well in my stomach and causing reflux issues and nausea.
The only issue I have with the diet is that I’m also on the highly restrictive autoimmune protocol (I have ankylosing spondylitis). With eliminating nuts, egg whites, nightshades, potatoes/sweet potatoes, starches, and most fruits, it’s pretty hard to find anything to eat. Very hard to keep the weight up. I would love to see the paleo community begin to lend more support to people in this very limited diet (recipes, food ideas, etc.). Some of us are eating almost exclusively meat at this point to get by.
Lindy Pals I am in the same boat as you… I feel like I can eat nothing and am loosing weight very quickly (and am now to underweight). I am wondering if you have found any help or come up with anything.
Obviously IBS could be IBS-C or IBS-D (or both), but it seems as though you really only mention low-FODMAPS helping with the D since it reduces the potential for the osmolar shift. However, I’m wondering what your experience is, Chris and Diane, with low-FODMAPS helping with C. Not sure if this is relevant, but I recall Dr. Siebecker saying something about different strains of gut bacteria producing different gas, some of which causes more D, while other gas will cause more C. Either way, of course we’d want all pathogenic bugs gone.
Anyway, I have a client that has done an auto-immune paleo elimination with no improvement of her C (will go 10+ days w/o BM, super distended), is negative for fructose malabsorption per breath hydrogen test, but GI doc wants her to try low FODMAPS. I’m just thinking she may need to take it to the SCD or GAPS level for some major healing but not sure which would be optimal (an realistic) for her. Thoughts?
Thanks a bunch! I learn so much from your wonderful resources!
Exactly my concern. I’ve had no issues with paleo but now that I’m nursing I’m having some and my baby is in gas distress. With all my eliminations, I can’t seem to find enough to eat at a time when I need more calories. I’m pretty sure a diet of lots more meat is going to result in stomach issues too plus I hate red meat.
I’ve been on a low carbohydrate diet for almost two years and suffer from chronic constipation. Nothing I have tried seems to help. I’ve used probiotics, but they only work for a short time and then stop working. I tried Natural Calm which also worked for a while and now it has stopped working too, even with an increased dose. I’ve varied my diet adding things and then taking some things away but nothing has helped. My doctors are really no help because they are all low-fat high-carb practitioners. I’m really at the end of line with this problem. The only thing left to do is to go back to eating the way I did before which I really don’t want to do but I may not have much of a choice.
Buffered Vitamin C works extremely well for constipation. I mix 1 teaspoon with water in morning and another at night. The dose is individual. For example, you may need 1/2 tsp morning and night or you may need 1 1/2 tsp. Experiment until you find the right dose for you. When you start having diarrhea decrease dose a little and you will find your dose . I take it every day in morning and night. It works like a charm. Good luck.
Alice
Larry
I hope by now you have found a fix for your discomfort but if not have you tried ballerina tea or senna tea?
-Emily
Excellent article Chris! Do you have any insights on usefulness of low-FODMAP diet on people with no noticeable digestive problems, like no gas, flatulence or anything like that.
And more specifically I’m interested of the effect of FODMAPs on the skin. Acne (and skin patients) as a group have higher rates of SIBO than people with healthy skin. I’m just wondering if low-FODMAP diet could help acne patients that struggle to get results with Paleo or otherwise healthy diet. I hesitate to recommend strict diets to people without good reason – as they often put people through a lot of stress. Any thoughts on that?
I don’t have any scientific evidence of this, but I will chime in with my n=1 anecdote. I had painful cystic acne before going on the low FODMAP diet. It wasn’t terrible, but it wouldn’t go away, and I had tried both conventional and alternative treatments and many changes in my diet…many of them. Prior to the diet, only a particular brand of birth control would control it, but I didn’t like taking it. Now my skin is much, much clearer. It’s not perfect, but it has done more than any other dietary change or treatment.
I too have discovered that following a low-FODMAP diet (with a slight SCD leaning towards VERY limited grains/starchy veg) has greatly improved my cystic acne. For people who have tried everything else to cure their acne with no success, I would say give the low-FODMAP diet a try and see if it works for you. I saw results in about a week, and continues to get better with every day (I am 1 month into the diet).
Chris has a podcast talking about low FODMAPS and acne (sorry, I can’t remember which one). I started eating low FODMAPS after listening to the podcast. I’ve had mild-moderate acne for years and have tried so many things including accutane. I find low FODMAPS helps my acne and makes my underlying skin so healthy looking! Even though I still have some acne, my skin is glowing and smooth. I also take bentonite clay and that seems also helps make my skin healthy. As a side benefit, eating low FODMAPS has also reduced my abdominal bloating! This is an issue I’ve had for years but never knew what it was from. It didn’t seem to matter how many ab exercises I did, it never went away. Sometimes it would be less pronounced but still there. Aside from the abdominal distention, I don’t have major digestive problems (i.e., no pain, gas, bowel movement problems).
Hi Chris
This is an interesting article. My son has ulcerative colitis and started the Specific Carbohydrate Diet about 5 weeks ago when it became clear he is not responding to pharmaceutical intervention (Remicade, mercaptopurine and mesalamine have all been tried without success). He’s doing fairly well as long as he sticks to the diet, though he has had to eliminate onions much as he likes them because of an increase in diarrhea. He continues to eat other foods high in FODMAPS like apples and honey, the only sweetener allowed on SCD. He feels pretty limited in his food choices already but I will encourage him to cut back or even eliminate some of these foods.
This is a bit off-topic but I wondered if you could answer this question: does straining the SCD yoghurt reduce the probiotic effects? He really prefers it thick so I strain it over cheesecloth for about 5 hours…
hey Suzanne,
I thought I’d answer your question since I can…
straining yogurt like that separates out the whey…that is what the watery stuff is that you’re left with.
Probiotic content I imagine stays similar in both the whey and the thicker yogurt, but you can save the whey as well and put it a smoothie or make lemonade or something and then the probiotics will still be consumed. Whey protein that’s been cultured like that is good food…it would be a shame to waste it.
People also use it to ferment veggies.
Hi Gianna
Thanks for answering! I will start saving the whey for my son to use in smoothies. He was disappointed when he had to give up protein powder shakes when it became obvious it was making his colitis worse; he lifts regularly and is trying very hard to put on weight…so this would be a great alternative!
This discussion is fascinating to me, especially since it seems to confirm the idea that “Everybody is different.”
In my case, the FODMAPS foods — especially fruits and vegetables, BUT NO GRAINS — are the ones that are the most beneficial, because they relieve my tendency to have very painful constipation.
Hi Chris, thanks for this information. I went Fodmap free for 4 months because I had a lot of upper gastrointestinal issues. I was already VLC and Paleo, but I started to consume way too many raw dairy and lacto fermented foods. All symptoms disappeared and I lost an extra 5 kilos always a bonus. I have introduced more foods back into my diet because it can be restrictive long term. But I do not eat dairy anymore only the occasional bit of cheese, I do not eat garlic or onion and I limit some of the vegetables like cauliflower, cabbage and broccoli. Overall being on the Fodmap diet has helped me to eat smaller portions not bulk meals up with vegetables, nuts and coconut products which I think a lot of Paleo eaters fall into. Oh and to eat slowly, eat my vegetables overcooked rather than raw salads and chew my food!!
I’ve had IBS for quite some time and recently discovered from a Comprehensive Digestive Stool Analysis that I am totally lacking lactobacillus bacteria (the good stuff). My Dr recommended a high potency probiotic called VSL3. I thought I was on a good probiotic but it only had about 10 billion compared to the 450 billion in one dose of VSL3. So far I haven’t had any painful bouts although it’s not totally corrected yet (it’s only been about 2 weeks).
The CDSA also revealed low fat absorption and high beta glucuronidase activity. Chris, how does that play into everything? I only had low amount of strep (alpha & gamma) bacteria. So I don’t understand what’s producing all the cancer causing beta glucuronidase? (started taking Calcium-D-Glucarate to counteract that, don’t need excess estrogen constantly floating around in my system). I too wish you were accepting new patients. I should have got a consult when I had the chance.
Avoiding FODMAPS will be hard for me but I’m willing to give it a shot. I’ve tried an ellimination diet several times, although symptoms improved when I was avoiding everything, as I added foods back in I couldn’t decipher the culprit as its more likely a food sensitivity (slow consequences that add up over time) rather than an allergy (fast & immediate consequence) eventhough the urgency of IBS sometimes makes it feel like an immediate consequence.
I have noticed that I feel amazing when I eat mainly bone broth (when I’m sick; google it for how to make – it’s easy & really beneficial for your gut), my skin practically glows & no real IBS symptoms but I’d have to be eating soup everyday in sunny Florida & the thought of that makes my stomach churn.
They’ve done some research on this probiotic & IBS specifically:
VSL#3® is a medical food for the dietary management of patients with ulcerative colitis (UC), an ileal pouch (IP), and irritable bowel syndrome (IBS).
http://www.vsl3.com/healthcare-references.asp#ref-35
Hope this helps others and hoping to glean some tips from previous IBS-ers. Thanks!
I’ve had IBS for quite some time and recently discovered from a Comprehensive Digestive Stool Analysis that I am totally lacking lactobacillus bacteria (the good stuff). My Dr recommended a high potency probiotic called VSL3. I thought I was on a good probiotic but it only had about 10 billion compared to the 450 billion in one dose of VSL3. So far I haven’t had any painful bouts although it’s not totally corrected yet (it’s only been about 2 weeks).
The CDSA also revealed low fat absorption and high beta glucuronidase activity. Chris, how does that play into everything? I only had low amount of strep (alpha & gamma) bacteria. So I don’t understand what’s producing all the cancer causing beta glucuronidase? (started taking Calcium-D-Glucarate to counteract that, don’t need excess estrogen constantly floating around in my system). I too wish you were accepting new patients. I should have got a consult when I had the chance.
Avoiding FODMAPS will be hard for me but I’m willing to give it a shot. I’ve tried an ellimination diet several times, although symptoms improved when I was avoiding everything, as I added foods back in I couldn’t decipher the culprit as its more likely a food sensitivity (slow consequences that add up over time) rather than an allergy (fast & immediate consequence) eventhough the urgency of IBS sometimes makes it feel like an immediate consequence.
I have noticed that I feel amazing when I eat mainly bone broth (when I’m sick; google it for how to make – it’s easy & really beneficial for your gut), my skin practically glows & no real IBS symptoms but I’d have to be eating soup everyday in sunny Florida & the thought of that makes my stomach churn.
They’ve done some research on this probiotic & IBS specifically as well as with ulcerative colitis (UC), & an ileal pouch (IP):
http://www.vsl3.com/healthcare-references.asp#ref-35
Hope this helps others and hoping to glean some tips from previous IBS-ers. Thanks!
Hi Chris,
The FODMAPs chart you referenced in the link seems to be a bit more restrictive than the list that is in the Personal Paleo Code. Do you recommend starting with the PPC list or the other list? IAlso, is SIBO diagnosed through a stool test?
Thank you.
Coconut milk is mentioned as being High on the FODMAP list. What about Coconut Oil and Coconut Flour?
But can you ask for Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols in the lunch queue.
Thanks so much for posting this. I have full blown celiac disease, but couldn’t understand why I still had lingering symptoms for years, despite the gluten-free diet. I was absolutely amazed at how effective a low FODMAP diet was! I now know what I can tolerate (everyone’s different right?) and I finally have control over my IBS and it feels great. I’m so grateful to the Australian guys who discovered all this.
By the way, I’d seek out a dietician to get help eating low FODMAP, but I’d also get “IBS-free at last (2nd edition)” by Patsy Catsos. She guides you throught the diet and has answers to everything you need to know. She’s also on Twitter (@CatsosIBSFreeRD) with a bunch of other dieticians and sufferers who are willing to give advice and support (#fodmap).
Hi Chris,
Since removing high FODMAP foods from my diet, my digestive health has improved significantly. However, I seem to have a huge problem with potatoes (even without skin), i know that they contain no FODMAP’s but they give me intense abdominal and back pain shortly after i eat them. Have you found this to be a common intolerance with your patients ? I think you may have mentioned nightshade sensitivity before.
I avoid potatoes where possible. I seem to react better to hot chips actually (but not too many!) I get the same sensation. I also avoid raw carrots- I get weird indigestion and once felt very nauseated after eating some carrot sticks (thinking I was eating a nice healthy snack). Cooked carrots are fine though. Anyone else have the same problem?
Thank you for the article! I had heard about FODMAPs recently, but this finally grabbed my attention. Every time I have tried to discover the foods that cause these kinds of symptoms (basically excess fermentation), using an elimination diet, I have replaced FODMAPs with other FODMAPs. Now I can try eliminating all of them at once.
me too. I didn’t really want to read about it or think about it or eliminate it until I finally decided to with this article. I’m glad I now know what it’s all about. Great article.
Chris, I have been suffering over the past couple of years with gastrointestinal distress quite frequently; i.e., gas, bloating, and occasionally diarrhea. I have tried to pinpoint the problem without much success. Over the last couple of days I have had these symptoms again. A couple of days ago, I purchased a watermelon, some peaches, and apples, and have eaten all of these over the last two days. After reading this article, I feel that this may indeed be my problem. My question concerns coconut. I don’t drink coconut milk, but have recently heard that coconut oil is good for a variety of uses, including just simply taking two to three tablespoons of the oil each day. Would taking the coconut oil have the same effect on my digestive system as the coconut milk? Thanks for any help you can give me.
Hi chris,
And this is where i think the eat right for your blood type comes in
Hi Chris, would it be too much to ask for FODMAPS to be part of the selection options in the meal planner? Or does that restrict it too much with current recipes? I just signed up for it (still in trial period) and I thought it was going to be there already.
Thanks.
I have an article and a FODMAP food list on my website here —-> http://www.eat-real-food-paleodietitian.com/paleo-diet-and-fodmap.html.
It is also important to keep in mind that a study showed that a great percentage of people that seem to react to FODMAPs may actually have SIBO (small intestinal bacterial overgrowth). More about it here —> http://www.eat-real-food-paleodietitian.com/paleo-diet-and-SIBO.html
This is such a timely article! I have been paleo and gluten free for well over a year now (dairy free to boot)…yet still sometimes deal with bloating (and for some odd reason, it isn’t alway restricted to the belly…I ate an apple the other day and noticed my arms, legs, back and chest felt “bigger”/”Swollen” as well…it suddenly dawned on me that perhaps I had FODMAP issues…the more research I do, the more apparent it seems that excess FODMAP food causes major probs. I think apples and cherries are out for me, and am going to limit the problem veggies and add them back in slowly down the line to see how well I tolerate them. Dairy/yogurt is a once in a blue moon treat that I wont eat without lactaid, so will continue to limit that as well.
I’m on the fence with sweet potatoes – seems they cause symptons in some but not in everyone so will experiment. I agree with you that some carbs are necessary so am trying to add starches in slowly as I’m really active.
Thanks for these posts and your help! I’d love to hear a podcast fully dedicated to FODMAPS if you haven’t done one already.
Also – apparently Australia is lightyears ahead of us in this area, there is a FODMAP Yahoo Group that some people find helpful. Worth checking out!
I am so happy to see more people discussing this! I have IBS, and I have had it since I was very young. I have tried almost everything, and it wasn’t until I found the low FODMAP diet a year ago that I was able to completely eliminate my symptoms. I was eating an apple every day before that! I know not everyone experiences the level of relief I did, but for me it really was the main source of my problems. It was so great to see that my symptoms weren’t as random as I thought they were.
Any credibility to the idea of home fermentation of FODMAP containing products (a nice relish of lacto-fermented onions and peppers actually sounds pretty tasty to me) as perhaps a particularly good way to introduce FODMAP-digesting bacteria to the gut?
I have not seen any research that would indicate this is a good idea, and most who require a low FODMAP diet would not recommend it. I am not a dietician, but my family has been on this diet for years, and we get information direct from Monash Univ as much as we can.
I’ve been drinking water kefir daily, Could it be causing my reflux??
I have been fodmap free for a while and it has really helped. The focus is now on restoring gut health to come off PPI’s. Any suggestions on non alcoholic fermented foods i can try and introduce to promote good bacteria? Have tried fermented saurkraut and did OK on tiny amounts, but after day 9 of suarkraut this caused issues. kefir, combucha are all alcoholic so struggling here
I’ve had zero issues on Paleo, in fact felt amazing, but since having a baby in July 2012 I’m starting to have increasing gas and at 11 weeks hers is at its all time worst. I tried a preliminary elimination of FODMAPs but food charts are really inconsistent (coconut milk for ex is on some good AND bad lists as are peppers) and some say soy milk is ok when paleo is very anti soy (and so am I). My baby is in distress and I think my diet can help but I am not confident in the conflicting resources. And what if its tomatoes or nuts causing gas? The nuts I eat are ok per Fodmap, but I do seem to get gas from them (I buy raw w/no added oils). I read fats are good for nursing, bad on Fodmap, but Fodmap charts ok salmon. I honestly don’t know what to eat right now to help her and ensure enough calories for me.
Deb, r u eating nuts raw? If so could be problem. Soak the raw nuts and then dehydrate. Chris K. Has articles on how to do it.
I’m buying raw but not soaking / dehydrating. I have an 11 week old and 3 dogs and I’m about to return to work F/T. Think elimination is going to be more efficient for me!
I make vegetable juice every morning. Would high FODMAP veggies/fruit be okay in juice form?
No, sorry, it doesn’t work that way. In fact, juicing is problematic even with low FODMAP foods.
Is it possible that eliminating FODMAPS would help my silent reflux?
Having trouble getting rid of it using other natural methods I’ve tried.
My daughter developed GI issues at 4 years old after international travel, a long-term course of antibiotics, and a parasite. The low FODMAP diet, which we started at 6, probably saved her life. There is a lot of confusion about how to implement this protocol, and because foods are being tested on an ongoing basis at Monash Univ., the list of approved foods changes. It is very important to keep in mind that individual tolerances vary. Also, and it pains me to write this, elimination of most foods for weeks and then re-introduction of foods carefully, using a food and symptom log, is the most helpful way to determine your triggers. Many people don’t react to different FODMAPs equally.
Our ped gastroenterologist put us on this diet when very few even knew about this protocol in the US, so I had to learn everything myself and then implement it with a little child. I know more about this diet than any RD in my city. It has been difficult but entirely worth it, and i always recommend that people explore it as an option. However, it likely isn’t going to be effective for people who have IBS unrelated to primary or secondary malabsorption.
One quick comment for all you valiant people suffering with reflux: up to 40% of the population has a sliding hiatal hernia of some level of severity. There is an easy manipulation known by some naturopaths and some chiropractors (not all by any means) that can fix that problem, at least temporarily, and get rid of reflux that is caused by the hernia. I have used it on patients with great results – it’s worth looking into if you’re not getting any resolution with your diet changes. My teachers were pretty adamant about not taking enzymes for extended periods of time, as your body will stop making its own after a while, so I’m always trying to find ways to get people BETTER. You’re not better if you have to restrict your diet so tremendously – you are definitely feeling better, but something is still going on. Best of luck to all in their health quest!
I’ve been following a Low FODMAP diet for about 18 months now. I’m sensitive to pretty much everything on the list, however onions, apple, wheat and mushrooms are the worst!
I feel so so much better now and no longer look like I’m pregnant from the ridiculous bloating i used to get.
Coconut is LOW FODMAP food according to Dr Jane Muir. Dr Muir is the definitive authority on FODMAP content. (Dr Muir heads the laboratory at Monash University that developed the FODMAP diet.)
I’m interested to know why and where the tolerances stem from? It’s great to have diets that help reduce the symptoms, but really I don’t believe that’s getting to route cause and really as someone said, you just end up eliminating more and more things, which I don’t think is the answer.
How did everyone else start off with their symptoms. I remember when I was 15 I would get severe cramping from rich dairy, but didn’t notice anything else, now everything seems to be an issue, from watermelon, nuts, legumes, protein shakes, tomatoes etc So my question is why do more foods become intolerable over time? I have a feeling it is to do with bacteria, the question is if some bacterial issue is found, what can be done about it…apart from doing these low FODMAPs diets? Has anyone been diagnosed with SIBO, and what were you given? I’ve heard there are antibiotics to help this? Any reports of how it helped? What about Helicobacter pylori? Anyone being tested for that? Result?
Simone, I was just diagnosed with SIBO by hydrogen breath test. I am finishing a course of xifaxan, which my doctor was kind enough to provide me with samples of when insurance refused to cover it. I had already been on a very restrictive diet for a year because they suspected fructose malabsorption since I was having horrible reactions to almost everything I ate. Because I did not significantly improve on the elimination diet, and seemed to actually be getting worse, they sent me for the breath testing and found out it is SIBO not FM. I also follow the FODMAP restrictions because they told me I have IBS, which I don’t know if I believe, but I do feel better avoiding FODMAP’s.
Well I thought I would report back, been on FODMAP diet for a month and half. Feeling pretty good. Occasionally I will have a trigger, mostly when I eat foods that I shouldn’t, but it last only a day compared to a week. My main thing is nausea, lethargy and bloated stomach when triggered.
Other major thing that has reduced is migraines and headaches. I wasn’t thinking about this when I went on this diet, but it has made a huge difference. I had a headache everyday up until the diet, for four weeks straight. Since on diet…very occasionally and they are very minimal. I think it’s been the cutting out of the gluten from my diet.
Anyway, I have noticed an increase in energy, which has gotten me more to do more exercise which is another good thing.
Simone- I am also curious about this. I used to eat everything without any issues. I changed the way I ate- started a Paleo diet, from there I developed big sensitivities to certain veggies- mostly the FODMAP’s- which is quite the list of veggies. I can’t eat anything w/onions in it
and cruciferous veggies are also a no-no. I was tested for H-pylori- negative. I think the reason i developed sensitivities is b/c I was eating a lot of veggies- which is something Chris has written about. When I eliminated all of the other foods- grains, legumes, dairy, etc…there isn’t much left except for veggies and meat- so I filled up on veggies which are hard on the stomach- especially raw veggies. I eliminating most raw veggies, FODMAP’s, and nightshades for 30 days to see if that helps. I am open to other suggestions.
The sharp increase in the fiber intake may support certain bacteria and contribute to dysbiosis. A test such as metametrix could tell you what’s going on in that department.
If there is a direct sensitivity to something, there is a great treatment approach called AAT (Advanced Allergy Therapeutics) that very effectively and comfortably can help eliminate food-related and other sensitivities. (And no, I am not an AAT practitioner, just a grateful recipient of the treatment modality :^). Chris might be familiar with it, since it was created by an american acupuncturist (however, it is not an acupuncture treatment).
I heard about a naturopath who has had great success treating type II diabetics with a low FODMAP diet. Has anyone heard anything about this approach? Google doesn’t have much to say on the subject.
Oranges, grapes, figs, papaya and guava are other fruits which are very effective in promoting digestion as
well as improving excretory system to help in smooth bowel
movement. Add water, 2-4 cups a day and drink hot liquids in the
morning, to help in removal. A baby’s constant cycle of feeling over-full on formula may be the basis for a lower obesity risk in breastfed infants, based simply on the fact that formula-fed babies are being conditioned to understand that “over-full” equates to “hunger satisfaction”.
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