FODMAPs: Could common foods be harming your digestive health?

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? Tweet This

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. (111213) 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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Digestion

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  1. KDS says

    I have been put on the FODMAP diet by my dietician after nearly 2 years of being tested for everything under the sun and failing to get a proper diagnosis. If you have SIBO please ask your doctor for a test as they can test for it and treat it.

    During my first consultation, the dietician went through my diet and food diary and made some suggestions to remove some foods containing FODMAPS and replace them with the low FODMAP foods and also gave me advice on how to prepare, store and reheat food and which foods I should never reheat such a rice. The dietician also provided me with some recipes and created some recipes for smoothies for me. Within the first few days of the diet (that I was following loosely) I noticed a significant improvement in my symptoms although they didn’t disappear but I was no longer in pain, just bloated and constipated for a couple of days.

    On my second consultation, the dietician told me to follow the low FODMAP diet strictly for 2 months and I have been doing that. As the diet is so restrictive I have been able to identify additional foods that trigger my symptoms such as butter and cheese (I have lactose free cheese now and soya spreads instead of butter), eggs, potatoes (I can only tolerate small quantities) and oats. I also cook fresh meals all the time now and avoid any ready meals of any sort. I had no bloating, pain or constipation for a full month since following it strictly and eliminating the additional foods that were problematic but then I had to go away on business and was not able to eat freshly prepared low FODMAP meals and had to rely on ready made salads and restaurant foods that were low FODMAP. My symptoms started to worsen when I was away and I actually didn’t eat lunch for a few days to try to calm my symptoms down again.

    That has led me to think that perhaps its the ready made, prepackaged foods that are causing the problems. My dietician had told me to avoid these at all costs and that’s what I had been doing until I had to go away. I am back to home cooked freshly prepared meals. Hope that bit of information will help others on here.

    Also it is trial and error as we will all have a different reaction to different food groups. I know for certain that I am gluten, lactose (and dairy) and fructose/fructans intolerant.

    • Sandy P says

      This is really helpful, KDS. I’m on FODMAPS but still reheating foods. Can you say more about how to prepare and what not to reheat? Do you have a reference?
      I do know that reheating changes the carb structure.

  2. Janet says

    I was recently placed on the low FODMAPS diet and I have a few questions about this list. First of all, I was given my food list from Cleveland Clinic and it is the original list from Susan Shepherd. My list is quite a bit different than other lists that I am finding. I have tried to find the most up to date list I can, but all of the versions are different. I did print the list in your information because it was the easiest to read for me. Is pumpkin acceptable to eat? Unfortunately, 75% of my diet was taken away according to the foods listed that are unacceptable. I am struggling to find vegetables to eat. Meat is no problem as I have 1/2 a grass fed cow in my freezer, but other than carrots and green beans, most of those vegetables on that list cause me issues. Spinach is a huge problem for me as well as raw foods like lettuce. What can I substitute in there? And I have seen sweet potatoes on the no list. Is this true?

  3. says

    My wife, who is a registered dietitian, has experienced a literally life-changing experience thanks to the low FODMAPs diet. On our honeymoon, she was in so much pain due to gas and bloating that we were about to check into a hospital – and it was not parasites or food poisoning, but simply the mal-absorbed carbohydrates – FODMAPs.

    This has been such a huge shift for us that we’ve decided to launch the world’s first protein bar that’s designed to be low-FODMAPs, and to cater to people with food sensitivities. Those interested can check it out here:

    http://fodmapbar.com

  4. Vince says

    Coconuts and coconut milk are now on the low FODMAP list – I can’t even stomach lactose free milk, but coconut milk is fine.

    As for bananas, they’ve been moved to the high list if ripe.

    One thing I’ve found is all the conflicting information online. Eating pretty much the same thing every day for 4 weeks (non dairy and gluten), and then re-introducing foods was key for me to working out the trigger foods, rather like a logic puzzle.

    As for bacterial infection…hmmm. I live in cold, rainy UK, haven’t been abroad for over a decade, and rarely eat raw salad. Guess it could be, but I’ve other family members who have the same thing, so I’d bet not.

  5. Kathy says

    Maybe you could give me some advice, Chris. I’ve been on the autoimmune protocol – AIP – for about three months. I’m not seeing a way forward yet with this diet – still having onset of Hashimotos symptoms – sometimes severe, sometimes mild. I’m wondering if it’s maybe FODMAPs. I don’t have IBS – that basically disappeared when I went on paleo two years ago and especially when I adopted AIP. I do have intermittent constipation, abdominal pain and gas – not often enough to concern me deeply. I’d say the Hashimotos symptoms bother me more than the digestive. I’m considering trying out low FODMAP and AIP at the same time but it’s very restrictive. I’ve already lost a lot of weight and don’t want to deprive my body. I live in a place without understanding doctors so I’m in a bit of a catch 22 situation. And also have very limited finances to buy expensive supplements or pay for consultations. Do you think a low FODMAP diet may help? How long should I try it before I reintroduce FODMAP foods? Or should I rather look at addressing the Hashimotos or SIBO? I cannot fathom living so restricted long term.

  6. Wesley says

    What the heck do you eat then?!? Seems like most vegetables have FODMAPs and all of the fodmap charts are contradicting each other.

  7. AngelsPixie says

    I was recently put on the FODMAP diet by the University of Michigan GI dietician. Aside from helping me out greatly with my digestive issues the other wonderful side effect is that my soft tissue pain that I’ve suffered with for over 40 years is GONE!! The Australian dietician, Sue Shepherd, has several cookbooks and other titles available on the FODMAP. She has also started her own line of FODMAP foods. I’ve been in contact with her assistant and hopefully, in the near future, her food products will be available here. If you are looking for other FODMAP recipes, go over to Pinterest where there is at least one person who has some wonderful FODMAP recipes as well.

  8. Eric says

    I’ve read quite a bit recently about the benefits of resistant starch. Now I’m confused, as resistant starch would appear to have negative effects on digestive health re. FODMAPS. Your thoughts…

  9. Melissa says

    I am really interested in the FODMAP diet but am a vegan. I also do not do soy. Can anyone give me suggestions of what I can have? Would soaking the beans help? I am in so much pain.

    • says

      For those of you looking for help, my wife and I offer online FODMAPs support at the Watson Center. My wife is a registered dietitian with IBS (and also a vegetarian), and I am a life coach, and this is what we specialize in… IBS and the low-FODMAPs diet. We have free weekly calls every week, and free give-aways, so come check us out.

    • Julian says

      Hello Mellissa, Being vegan in my experience is essential for gut problems but you still have to avoid those fermentable foods that cause problems( e.g. beans- except string beans). I would advise a buckwheat/millet based diet but you do need to be careful where you source your foods from. You need to eat only organic and not from polluted areas( e.g. china ukraine india). So a typical days food for me would be buckwheat porridge with almonds/hazel roasted nut mix chopped on top. I use soy or almond milk( soy may not be suitable for you). NO sugars or sweetners of ANY kind!( having said that stevia may be OK- I have not found any need for it though). Lunch is buckwheat/linseed/sesame flatbread with avocado/raw onion/celery/artichoke hearts/olive oil +/- lemon juice followed by almond paste on flat bread if you’re still hungry. Dinner is either buckwheat or millet with cooked onion +/-celery/cabbage/broccoli/string beans/. Don’t snack if possible(eat a few of your toasted almond/hazel/brazil nut mix if desperate). One of the main problems is that we are such good consumers that we pay such little to regard to where or how are food is produced.

  10. Natalie says

    Would love some clarification on a couple of foods! Started a Paleo + Low Fodmap diet recently to help with SIBO and related issues. While I know it’s all dependent on one’s body and everyone is different, I see a lot of conflicting info on the following:

    Coconut milk
    Greens of onions
    Chives
    Nutritional yeast
    White rice
    Sweet potatoes
    White potatoes (skin or no skin?)
    Jicama

    Any solid knowledge of these foods specific to Paleo + Low Fodmap would be so apreciated!!

    Thank you so much! :)

    Natalie

    • Brooke says

      It is very individual. The advice is always “try and see”.

      I also do low fodmap paleo, so my research/experience is:
      Coconut milk – cannot tolerate
      Greens of onions – small amount ok
      Chives – small amount ok
      Nutritional yeast – ok
      White rice – not strictly paleo
      Sweet potatoes – ok
      White potatoes (skin or no skin?) – not strictly paleo

  11. John says

    You say that “The acronym FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols. These short-chain carbohydrates …”

    My understanding is that monosaccharides are not chain molecules, isn’t this true? I’m trying the specific carbohydrate diet (SCD) now for gut pain and reactivity to foods, so I’m eating fruits and veggies that are mostly monosaccharides, mostly living on peas, carrots, and meat.

    It’s interesting that there are so many contradictory stories about which foods or carbohydrates are good or bad, FODMAP says one thing and SCD says something else. I tend to ignore the rationales because someone can always make up an explanation, if they don’t test it with the scientific method it’s just a story. I pay attention to results, and while the traditional MD based research says SCD doesn’t have benefits, there are so many people who testify otherwise that I’m willing to give it a try to see if it works.

    • Webraven says

      Both SCD and FODMAPS elimination removes nutrition from pathogens that are causing symptoms. However, neither approach really leads to lasting healing on its own . I did SCD for four months, and while I initially experienced some partial improvement, I gradually started getting worse and realized that I had effectively painted myself into a corner; I was even less tolerant of fiber, oligosaccharides etc. now. I think this is the biggest problem with approaches such as SCD and FODMAPS – while starving pathogens you effectively starve the rest if the microbiome as well, ultimately leading you farther away from health.

      I do not think that these approaches are entirely without merit. They could be a starting point for someone who is incredibly symptomatic. I do think, however, that the overall goal always should be a gradual return back to those foods that are known to be supportive of the microbiome. In my own case, I have found that using intensive (herbal/natural) antifungal / antimicrobial therapy combined with a temporary elimination of simple carbs and known gut irritants, meditation, visualization and gut healing supplements while gradually increasing my intake of foods that are known to be very beneficial for the microbiota, (and effectively all of them FODMAPS!) has led me much father in the right direction than chronic elimination.

      Best of luck to all struggling with gut issues – remember that many thought leaders in this area, including Chris, have not only overcome chronic gut issues but beenled to where they are today thanks to them.

  12. Margaret says

    I have what I think is GERD ( my doctor and naturopath both are unsure of a diagnosis) with silent reflux and severe bloating under my right ribs. I have been on the Fodmaps diet for over a month and have noticed no change at all. I also suffer from Generalized Anxiety and Panic attacks and I am sure the gut and anxiety affect each other. I prefer natural options and just want some relief. Any suggestions?

    • Carey says

      I’m not a doctor, but severe bloating under your right ribs makes me wonder whether you’ve ruled out liver and/or gall bladder trouble via palpation and/or lab tests and/or ultrasound.

  13. RODGER says

    Everyone’s symptoms are similar but their food consumption is so diverse, yet we are all lumped into a “you have IBS” group.

    I’m sick of elimination diets. Lets get to the real crux of the problem. How can I, an active, healthy male well into their 40’s suddenly stop (read eliminate) foods that I ate, last year, last month, last week WITHOUT symptoms? This is the same or similar story for others on this forum.

    Its great we have these “elimination” diets, but that is not the answer. WE are all being pushed towards elimination diets that sadly lack the nutrients obtained via our “normal” diet. Lets not jump into the sustainability of these diets and the softer factors such as peoples “experiences” with foods.

    Unless your doing damage to your gut via an autoimmune condition, I don’t prescribe to elimination diets over the medium to long term.

    Unfortunately I have turned to traditional science to solve my IBS, as my 18 month “hell” sorry, “elimination diet” has not and will not sustain and manage my symptoms sustainably into my future.

    The majority of us have “bacterial” or “flora” imbalances that are were or have been caused by infections that will one day hopefully be corrected by as yet unknown methods.One day each one of us can be targeted specifically to gain control over our intestinal flora and lives..

  14. Bob says

    Hi there Chris, have printed off and laminated your wonderful FODMAP “Informative Chart” and note a glaring omission…no mention of Nuts and Seeds as a grouping in either the green or the red sections of the chart. Could you clarify this please?

  15. Ericka M says

    Anna cacao is a no-go. Believe it or not things that are higher in fiber are more likely to cause symptoms. You’re better off with a cheap cocoa that has about 2 grams of fiber.

    I’m also curious about the coconut butter. I just tried coconut manna tonight so I guess I’ll know tomorrow morning!

  16. says

    B4 I began my exploration into the Whole 30, Westin Price, Paleo, Refeeding, Mthfr, Low histamine diet etc. I found that my digestive issues were very much influenced by my feelings at meal times. This is since childhood. Whenever there was tension at the table I would get a stomach ache or worse. As I’ve gotten older and tried more and more lifestyle changes it seems that I’ve gotten more sensitive and intolerant of more and more foods. I don’t like this!
    Just recently read about psycho-neuro-immunology and it seems like something important to take a look at.
    Although all these conditions: SIBO, IBS, Autoimmune, HIT are all very real, I can’t help but think that trying to cure them with food restriction and supplements is, ultimately, not going to get to the real bottom of things.
    And then there’s that ever constant anomaly: Anytime I eat a meal out with a friend, and have a good time, that meal can be filled with wheat cheats, bad oils, alcohol, late night caffeine and I’ll still sleep like a baby, have great BM’s and feel no pain from it at all. Is it possible that stress and our conditioned response to it causes our bodies to go so far out of homeostasis that it can severely effect our immune system and the way our system handles foods? And it can do it daily even when we think our stress is under control. I’m curious because I’ve seen the good results that dealing with emotions and stress brings to my digestive issues, as well as any other health problem I’m going through. I am aware of these stress and emotional issues, but chose to focus on food and nutrition as a cure for them as opposed to the other way around. Maybe my diet and nutrition is good enough and it’s time to focus on why emotion, perception, stress and the way the amygdala in my brain may sabotaging my efforts at health. I don’t think I want to restrict any more foods. It’s too complicated. Working on stress and emotions is starting too look easier:)

  17. John R says

    I have chronic watery stools and gas elimination during BMs. I have celiac and Grave’s disease that I treat faithfully. Does it make sense to combine a low FODMAP and high soluble fiber diet. Many of the food choices are not compatible to both; maybe bananas, cooked carrots and various potatoes along with fresh protiens. Is this a bad idea? I’m just starting a paleo diet and have found some immediate benefit (better sleep, less fatigue, less body ache) but the main objective is to get my bowels back to some normality.

    • devona says

      I highly suggest that you try the Paleo Autoimmune protocol as it should get your GI system working normally again.

      • John R says

        Thank you for the suggestion. I was not aware of AIP protocol and could be on to something. My head and intuition is reeling from all these different diets. I need to sort this all out and at this point I don’t have a trusted other to help guide me. I see from all the comments, I’m no alone. Thanks everybody.

        • devona says

          3 great resources for you:
          1. Mickey Trescott’s AIP cookbook
          2. Sarah Ballantyne’s book on autoimmune diseases
          3. Chris’ book
          Those should really help you.
          Good luck!

        • Mary says

          I agree, so many diets to consider. It would be great if a chart or some other sort of reference could be created to show similarities and differences.

  18. Christine says

    After giving up gluten 6 months ago, I have experienced a huge amount of relief from fibromyalgia and joint pain. However, I have still suffered from much of my same IBS problems….bloating, constipation, pain, cramping, etc. I saw a story on NPR about FODMAP’s and the light bulb went off!! Since I am already following a healthy, GF diet, it was not hard to eliminate the FODMAP trigger foods. I experienced relief from my symptoms within days. Now I am adding back some foods and seeing what causes the symptoms….I most definitely have a problem with Fructose and Fructans!! I am excited to continue and see how things progress with this plan. I also saw the post from Robb about the NOW Super Enzymes and ordered some from Amazon to add to my routine. Thanks to all for the useful information!

  19. Ruthann says

    What about protein? I have been following a modified (meaning I cheat) vegetarian diet with occasional chicken and fish. Red meat brings on other issues not related to IBS. Well, related–but in a different way. However, no beans, no lentils. So what is a suggested protein for those who are avoiding FODMAPS?

  20. crypto says

    There is not such thing as “IBS,” and it cannot be prevented by avoiding garlic, beans, pears, etc. Healthy people eat such food all the time, without any problem. One has IBS because one has a bowel infection, more often than not caused by a parasitic infection. Ths is what is not found by US doctors who rush to label every gut related “imbalance” IBS. They simply do a stool sample sample and rule out. But stool samples often dont contain parasites. They have to be repeated. Doctors think US dont have parasites. All the while people are consuming more and more raw food diets, including salads imported from third-world countries.

    IBS does not make one “sick.” One gets sick from “IBS” because one has infection. Never listen to those who claim otherwise. You need to approach a good tropical doctor and find out what you have and treat it. Then your IBS will go away. If one was not born with it, one simply got it through an infection. Gastro doctors are the worst. They have never received any training in parasites. They think it is IBS or “Chrons,” another bogus name given to symptoms. All they treat in the US are symptoms!

    • Meme says

      I agree with everything you have said. I think IBS, SIBO, FOOD ALLERGIES, FRUCTOSE MALABSORPTION, FIBROMALGIA, HISTAMINE INTOLERANCE, CHRONIC FATIGUE etc.etc.etc. is all a bunch of B.S. Doctors are slapping labels on stuff because they DO NOT know what the root cause is.

      The body is burdened by something, but what? Also, being even slightly hypothyroid will lower your immunity and allow pathogens to creep further and further up your digestive tract resulting in all of the SYMPTOMS mentioned above.

  21. Katri says

    Hi I have candida and I suspect leaky gut, would this fodmap way of eating help heal and decrease candida? Has anyone had what I have and have helped with the fodmap way? I was following the scd diet and the bone broth and l-Glutamine to heal the gut, well I got insomnia once again? So I stopped and have been sleeping better, I do not know if that was why I could not sleep or not? Any ideas? Thanks …katri

    • J says

      Your insomnia may be due to histamine intolerance (possibly caused by gut dysbiosis). Bone broth can be high in histamine. Damage to your intestinal mucosal lining (and nutritional deficiencies) can reduce the production of the diamine oxidase enzyme which breaks down histamine. Increased (gut) mast cell degranulation, caused by inflammation, and histamine-producing gut flora can further increase histamine levels internally.
      Unfortunately I can’t provide any solutions – I am also still looking for the answer to solving gut dysbiosis. It is worth making sure that your stomach acid levels are not too low and trying to eliminate SIBO.

    • Blanka says

      Katri, I am currently on SCD (no leaky gut though) for frequent severe bloating and gas. I tried elimination diet but my symptoms are so random, it was hard to diagnose what the culprits were (I also suffer if I sit for too long or were restrictive clothing). I also suffer from occasional insomnia–but was not aware that candida and insomnia can be related.
      I am interested if you tried FODMAPS and if it affected your symptoms.

  22. says

    I got diagnosed with IBS-D about 20 years ago, but the doc at the time just said I had it with little explanation for what it was or how to deal with it. I thought very little of it then but started taking stuff out of my diet like dairy (tried introducing it again with huge pain!), wheat, etc.

    I’ve just recently developed enteropathic arthritis because of the IBS-D and the food I was eating. In my investigation of the arthritis I found the FODMAPS book and have looked more online about it.

    I have an issue with animal protein (all of it) and with nightshade veggies as well, as they all cause varying forms of arthritic pain throughout my body. It takes about 2 hours for me to feel pain from what I eat, along with the other IBS symptoms. With nightshades (tomatoes, potatoes, eggplant, capsicum) I feel like someone has pounded my left toe with a hammer (gout). With animal protein I feel pain in my lower back on the right side that radiates down my right leg to the base of my foot (plantar fasciitis).

    I feel even more limited to what I can eat than the customary FODMAPS avoidance…and sometimes it can be a bit depressing. Despite missing out on so many types of food, I feel better when I avoid them and I know my body is better for it in the end. I’m also a bit overweight so now that I’ve cottoned on to this whole way of eating, I’m beginning to lose weight! I think the fat I kept on my body was a protection against all the ‘poison’ my body thought it was ingesting.

    If anyone else out there has these issues I’d love to read from you or see how you manage with food!

    • Meg says

      Ava – I have the exact same problems. What have you found helps you? I’m investigating protein, fructose and oxalates. Leaves me with not much.

    • Devona says

      Yes. Read Sarah Ballantyne’s new book out on autoimmune disease. She’s also known as The Paleo Mom. Great resource.

      • crypto says

        No such things as an autoimmune disease. It is caused an infection, which is what is not detected. So doctors give bogus names for them.

  23. Jonny says

    So I’m waiting for my GCSA Stool Analysis to come back.

    How would you recommend one over comes fructose AND fat malobsotion while on a SCD diet to treat IBS? I don’t see where ever I can get my calories from other than Meat a few veg and nut butters ( Luckily I can tolerate)

    I would love it if someone can shine some light onto this.

    Jonny

  24. Ian says

    The paleo autoimmune approach has worked better for me than anything I’ve ever tried regarding diet. It is pretty much a low-to-no FODMAPS diet.

    The only other thing that has helped in addition to this is addressing my financial challenges (stress) and also digesting repressed rage with an emotional growth facilitator. The day I did that my depression and anxiety completely transmuted itself into confidence, love and strength with a clear head beyond my wildest dreams!

  25. Jane says

    I had a perforated colon, emergency surgery and developed a deep pelvic abscess two years ago. Have never been able to regain my ability to eat or digest comfortably. Have had some success w/probiotics, FODMAPs diet and acupuncture, but lost 10% of my body weight and still can only eat a limited number of foods in small quantities. If anyone has suggestions- I would be grateful. I do not digest fats well including animal protein, legumes and wheat. Am wondering about digestive enzymes (but which ones)? Thanks! Jane

  26. lorna says

    I am struggling with many of these issues . . . very severe abdominal distention. I have just begun a low-Fodmap and have been given a script for the antibiotic xifaxan which I hope to fill in the next few days. I also just picked up Florastor today, however, I would prefer to try one thing at a time to see what actually may be working or harming.

    I very much miss my daily apple, soy milk, and brussel sprouts!

  27. Jonathan Steinhurst says

    Hey Chris,
    Just thought I’d recommend a book relating to this conversation involving IBS/SIBO and FODMAPs.
    It’s called “Fast Tract Digestion IBS: Science-based Diet to Treat and Prevent IBS and SIBO without Drugs or Antibiotics” by Norman Robillard Ph.D. It seemed scientifically valid and made sense to me and sheds light on the relationship between FODMAPs, carbohydrate malabsorption, and soluble and insoluble fiber.

  28. Amy says

    Thank you for all of your thoughts. I have learned so much in reading your posts. I am new to the Paleo diet (3 weeks in) and have had IBS almost 20 years. That being said, I began taking Florastor probiotic per my GI 2 years ago and have been very satisfied with it as long as I stay away from certain foods. I’m finding now that those certain foods fit into some of the FODMAPS. Recently I overdid it with vegetables that I don’t usually eat and paid the price, even with the Florastor on board. Does anyone else use Florastor? I’m going to try and go back to restricting from the FODMAPS list and slowly re-introducing.

  29. Chris says

    Hi I have recently restricted FODMAPS in my diet all together with drastic improvements in my digestion. I have a question though, would a ripe banana contain less FODMAPS than an under ripe banana because if I recall I remember having less of an issue digesting really ripe bananas because I guess in the ripening process it kind of digests the FODMAPS for you.

  30. Marlys says

    Thank you,Simone. I was taking the high dollar,keep refrigerated, doctors only place to buy probiotics. No kidding, they do not work,Yikes!

    Stricter than Fodmaps. I do not want to know! So you mention eggs. I thought they were okay. Is this an allergy on the side,separate from Fodmaps?

    Are you working with a dietitian?

    • Simone says

      I have been working with a dietitian.

      I was getting actually sicker on the FODMAP diet, and it didn’t make sense, because I was eating much better in that period…she doesn’t think FODMAP was the issue towards the end. She just thought my stomach has an upper limit of being able to handle foods, and when I go over too much that’s when my stomach problems kick in. Which I have found true, because I just got back from travelling in Europe and I wasn’t that careful with what I ate, and felt fine, but a week back and I am starting to notice symptoms again, and I think it’s because a)I am more sedentary (I was all day for a whole day) and so the food doesn’t digest as well b)I didn’t have much eggs when away.

      So eggs shouldn’t be a problem for most people, not everything on the FODMAP list will work well with you stomach anyway, it’s just a guide….you need to observe closely what triggers the symptoms.

      She does think I have some sensitivites to chemicals within some foods. I can’t remember the chemical, but they are ones in garlic, onions etc

  31. Marlys Connor says

    IBS has been truly dreadful. After 4 years of it being so bad I had to quit working, my Doctor found Fodmaps last Friday and sent it to me. After reading the cans and cannots, I was so depressed I cried more than once. Not because I could not have my favorite foods, but because Everything I had been told to do was so terribly wrong. I was adding fiber to get from an average of 20 grams a day to 30 with blackberries,inulin added foods, and every cruciferous vegetable. No more white foods for me, very little meat. Devastating IBS was my reward.

    Now I am starting on another diet. I am exhausted. But four days on this path, a very strict path I might add, and am still nauseous, have diarrhea, and slightly bloated. God, I hate those words!
    Enough tragic history!

    My question is if I tested negative for celiac and negative for gluten allergy do I still need to go wheat and rye free on the FoDMaP s diet?

    • Simone says

      It took me about 2-4 weeks to stop feeling nauseous and bloated. It takes time. You will notice you get longer times between bouts of nausea and then something will trigger it off again and you will be back to square one for a few days.

      I too went on an ever stricter diet than fodmaps towards the end, this was good because I actually noticed I was getting a lot worse, so it made me really nut out what was the issue.

      As mentioned above, probiotics made my IBS much, much worse. Since eliminating probiotics I am so much better, just eggs, and garlic are really no good for me still.

  32. judith says

    I have felt very alone /scared with my severe abdominal pain, my digestive specialist performed a colonoscopy, found 2 polpys removed 1 and will remove the other soon he also diagnosed ibs and suggested i take buscapina as often as i like ! having read about fodmaps i emailed to him to see what he thought, his reply, “well try it if you like ?”
    and I have, and i do like, !!since 1 week ago I have had no drugs and no pain, I have swum every day and followed the FODMAP diet, I still dont know what the trigger foods are , its early day s but its been a joy not taking so many pills……….I live in Galicia near Vigo and I would love to be intouch with anyone near me who is suffering too, I have given the low fodmap list of foods to lots of people here who have never heard of it , to me it makes such sense, BUT, at 55 what kick started this all off for me,?? could it have been a gynae procedure I had last Oct when coincidently it all started, did the menopause and its plethora of symptons kick it off i just dont know? and will I have to b careful all my life ?> so many unanswered questions and NOTHING to indicate with the diet which drinks to avoid, for me white wine I think is a trigger ? but thankyou monash i will continue with this

  33. Adam says

    With so many different diets out there and so many possible food sensitivities, do you have any recommendations for where to begin (for IBS-D)? I think that I am sensitive to gluten/oats and have been following the low-FODMAP diet for 2 weeks. While I definitely feel better 2 weeks into the diet, I still don’t feel 100% better (I have no more diarrhea but much more gas/bloating, which I never really have). I’ve read that IBS could actually be misdiagnosed gluten/fructose/other intolerance, and that there are other food sensitivities that people with gluten intolerance can typically have (e.g. casein, corn, even rice…), so this makes me wonder whether I should be eliminating those types of foods rather than following the low-FODMAP diet (since my IBS may actually be gluten/other intolerances). I’ve also had hydrogen breath tests for lactose and fructose, both of which came out negative (though I’ve read that these tests have relatively high false-negative results). I think removing every suspected culprit (which in my case, include gluten, dairy/casein, corn, eggs, and possibly fructose) AS WELL AS following the low-FODMAP diet would be impossible, so I am completely overwhelmed and don’t know where to start. All I know is that I’ve certainly feel better on the low-FODMAP diet but that it doesn’t seem to be enough. Also, I’ve never really had issues with gas/bloating; my main symptoms are sudden urgency/pain when I need to have a bowel movement (though not every BM), the feeling of an incomplete BM, and stool that definitely seems to have malabsorbed food (floating/smelly..sorry for the info).

    Does anyone else feel that all their symptoms are due to food sensitivities rather than “IBS” and are therefore unsure whether to follow a specific diet or simply cut out all suspected foods?

    Thanks so much!

  34. Sandy says

    If I make, say, vegetable broth using dandelions, or drink dandelion tea, are the FODMAPS in the broth? Do FODMAPS remain as food is transformed in various ways?
    Thanks. Sandy

  35. Simone says

    Ok reporting back again. I ended up noticing my symptoms of nausea, lethargy, brain fog and bloated stomach was getting worse on the FODMAP diet, it didn’t make sense. I ended up getting more and more sensitive to food. Something just didn’t add up. Then I looked outside my diet for things like supplements. I was taking Vitamin D and probiotics. It then dawned on me it could be the probiotics, because this was something I added when starting the diet and in the past I had gotten stomach pains and diarrhea from them ( I didn’t get those symptoms this time around so I didn’t think it was the culprit). Since removing probiotics I am able to eat most foods without any issue. I think probiotics needs to be really looked at in the picture of IBS, no one is saying ‘hey probiotics ain’t so good for really bad IBS cases”.

    • DH says

      I agree and this is rarely talked about. I found that probiotic supplements were a big problem for me. I tried many, many different kinds, for many years, including ones with strains specifically recommended for IBS, but found IBS symptoms increasing over time. Then, one day, I ran out of probiotics and was really low on cash. Oddly, I began to feel better. When I started to take probiotic supplements again, I started to feel worse. Now, I no longer take probiotic supplements. I do eat fermented foods on occasion, though, such as greek yogurt, milk kefir and Bubbies pickles….sometimes even a little bit of sauerkraut. I don’t eat fermented foods every day. I don’t think that massive amounts of probiotics on a daily basis are good for everybody. Maybe it works for some people but it made my life a living hell.

      • Daniel says

        What kind of probiotics did you guys use, and were you D or C predominant or alternating? One theory I encountered is that probiotics which aren’t enteric coated (e.g. probiotic wafers, yogurt) can worsen the condition, as it can increase bacterial overgrowth in the small intestine; another theory is that small intestinal bacterial overgrowth’s (oftentimes) the cause of IBS.

        • Simone says

          Predominant C.

          I took the brand Inner Health Plus, in Australia. It was refrigerated capsule with a coating.

        • says

          Don’t forget to avoid prebiotics – as the prebiotics may feed any type of bacteira good or bad. Buy probiotics without prebiotics (Natrens are aware of this requirement – check the label of your own supplier and avoid if has prebiotics or added sugars / polysaccharides).

  36. says

    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”.

  37. Michelle says

    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.

  38. Sophie says

    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.

    • Lili says

      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).

    • Susan says

      Where can I find Chris’ article about the problem with eating too many veggies? I’d really like to read it.
      I just learned that I have methane positive SIBO, and I’m going thru a self-study crash course on FODMAPS. There are definitely some foods on the list that have given me repeated distress, and now I see why. But in addition, I know that for many years I’ve been guilty of eating huge quantities of vegetables, even at one sitting, often lots of them raw. While I’m making meals I also tend to load up on raw veggies. So I think this may have helped cause the problem to begin with, or at least exacerbate it. I’ve noticed his especially with large quantities of greens like lettuce, baby spinach and baby kale.

  39. Simone says

    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?

    • Mel says

      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.

      • Simone says

        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.

  40. blogblog says

    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.)

  41. Courtney says

    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.

  42. Anne Van Couvering says

    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!

  43. Sarah says

    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.

  44. Wade says

    Is it possible that eliminating FODMAPS would help my silent reflux?
    Having trouble getting rid of it using other natural methods I’ve tried.

  45. kim says

    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.

    • deb says

      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! :)

  46. says

    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.

  47. Aaron says

    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 :(

  48. says

    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?

    • Sarah says

      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.

  49. Sarah says

    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.

  50. Nuttmegs17 says

    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!

  51. Michael says

    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.

  52. Brenda says

    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.

  53. says

    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.

    • Michael says

      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.

  54. Tom says

    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.

    • says

      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?

  55. Ginger says

    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.

    • Ginger says

      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).

  56. Pete says

    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.

  57. says

    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!

  58. says

    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!

  59. says

    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!!

  60. says

    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.

  61. Suzanne says

    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…

    • says

      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.

      • Suzanne says

        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!

  62. says

    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?

    • Sarah says

      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.

      • Jason Sherrett says

        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).

      • Alyssa says

        I had the same issues.. gluten/dairy/soy free diet, then paleo, finally low fodmap paleo. It has improved my skin as well. I am looking into birth control now. All past birth controls I’ve tried broke me out and made me miserable. I too would rather not take the pill, but am looking into it again. You say there was a particular pill that worked for you? Would you mind giving me the name of it? Thanks!

    • Stephanie says

      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).

  63. Larry says

    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.

    • Alice says

      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

    • Emily says

      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

    • says

      I have been over the years diagnosed with IBS, SIBO, malabsorption, Dysbiosis and Fibromyalgia (latter due to digestive problems) plus get bouts of chronic pancreatitis if touch alcohol. I found a lot of positive results from following Elaine Gottschall’s SCD, having read her book “Breaking the Vicious Cycle” and her emphasis on eliminating difficult to absorb ‘complex’ carbs certainly reduced my bloating and SIBO. Also Kefir is helpful plus I agree with the comments above about needing good digestive supplements (I use Natrens acidophilus and bifidobacterium, powders added to Kefir once every three or four days) and magnesium and malic acid for energy. SCD allows plenty of fruit (regarded as a simple carbohydrate) and low carb veg which helps with bowel movement. I seem to have no problem with fruits or cabbage and indeed, eating large amounts of cabbage (the equivalent of a whole cabbage a day) helps make bowels work fine. Since I like to cheat on the SCD and have something sweet occsionally, I became interested in how increasing motility could reduce SIBO’s gassing and bloating by shifting the bacteria and fementing sugars out of the bowel faster. My IBS does not present as Diarrhea and I do not feel ‘constipated’ but I came to realise that poor motility anywhere in the small intestine (not necessarily the large bowel alone) will increase bloating and fermentation within the gut of undigested foods. I find large amounts of green veg, cabbage and generally large amounts of fruit and veg with lowish amounts of meat generally most effective. Once I get motility increased through the gut generally, I find I can be less strict with the SCD and tolerate a few SCD ‘illegal’ foods.. So a lot of food intolerance issues are not just down to malabsorption and difficulty digesting, causing fermentation and bloating, but also down to slowed up elimination somewhere in the gut – most probably the Ileum. High veg consumption also needs to be accompanied by highish water intake – a couple of pints of water during the day in addition to routine beverages (but reduce or eliminate irritants such as coffee) will get more out of the regulatory /increased motility effect of fruit and veg fibre. Drinking more water will flush things through. Lowish water intake may increase constipation / inflammation issues. Too much attention may be given to what we are eating, not enough to what and how much fluid we are drinking, in order to improve elimination. Getting everything moving through and out smoothly and regularly is, for me, the key to improving tolerance of foods. Reducing complex carbs, increasing fruit, veg and water, massively reducing tempting sugars (including alcohol) – all takes a bit of lifestyle change and self-discipline, but when you get the balance right, you know it is worth the effort. We now consume 100 times more sugar in our modern diet than we did 200 years ago, so excess processed sugar (a complex carb) is a problem, though honey is allowed under SCD. Though it is old now, Elaine Gottschall’s Breaking the Vicious Cycle is worth reading, also Patrick Holfords “Impove your digestion!

    • Iskra Holstein says

      The only thing that works with me is fluid intake. I was born in the Mediterranean and drinking has been low priority. Hot drink at bedtime? Only learned about the custom when I moved west.
      I have to drink around 4 litres a day, more if I am very active. When I neglect this there is an immediate reaction . Drinking plenty when I am organised again gets things back on track.

  64. PaleoPlateRD says

    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!

    • Deb says

      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.

  65. Lindy Pals says

    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.

    • AMac says

      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.

  66. says

    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.

    • says

      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.

    • says

      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

      • devona says

        Hey Mickey,
        I was just told I most likely have SIBO and fungal overgrowth (in my Health Coaching Session w/ Chris Kresser!). So, I will go on an antibacterial/microbial/fungal regimine and also for 30 days a no-FODMAP diet. I’m on a strict AIP diet too. So, what is left to eat?? Seems like meats/seafood and carrots and greens! I’ve looked at the different sites and there’s some disagreement on what is allowed or not. I’m unclear on whether summer squash, sweet potatoes/yams, turnips, pumpkin or nuts are okay. Do you know?
        Thanks!!
        Devona

    • Evan says

      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!

      • says

        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.

        • Mmom says

          I am on GAPS Diet for 1.5 years. I had a very difficult start. I also got in to a stage where I had low energy feeling tired all the time. I found lots of these kind of comments like yours about GAPS being too low on carbs. I even tried to add potatoes in after 1 year mark hopping it will be okay. I could not tolerate them yet, so I had to remove them again. I don’t bake much since I don’t tolerate coconut and nuts should not be consumed in access. After researching it a bit more I come up with a conclusion that those who is on a diet like GAPS eating lots of fat and protein needs more magnesium. The problem is that we don’t eat wild plants which are high in magnesium and our cultivated vegetables and fruits (nuts and grains as well) are low in magnesium. Fat and protein requires more magnesium; well, here is the problem. I added good magnesium supplement and it resolved a problem in a week. I finally start getting restful sleep and in fact I slept for 9-10 hours at first to regain all my energy. I am still on low starch, but I have more energy then ever. My internal clock got fixed as well. I crush at appropriate time when it gets dark outside and get up yearly in the morning. I’ve lost it long time ago and that made my adrenal exhausted. Once I started GAPS, I feel so bad that I thought GAPS Diet was a bad diet for me. I am sure there are too many of us who is magnesium deficient already and high fat and protein diet depletes it even faster. Try adding magnesium. I take Perque Mg Plus. It has 4 forms of magnesium which are highly absorbable. I tried just salt bath and even CALM Mg, but it was not so effective with bad deficiencies. I needed something easy to absorb and retain it to fix my health problems. I hope it helps.

  67. Alice says

    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

      • Alice says

        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

    • Lilian says

      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?

      • says

        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

        • Lilian says

          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?

          • says

            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

            • Alex says

              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?

              • says

                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.

                • Alexandra says

                  After 3 years of trying to figure out my reflux and IBS, this Fast Tract diet seems to be the first that is working for me (astonishing!). That said, I’m very limited b/c the book only includes a limited list of foods and I’m finding calculating using the formula (thank you) difficult. I’m not sure I’m figuring out the net carbs correctly (so you subtract fiber but what about sugar?) and also finding the glycemic index online for any prepared food is really tricky/non-existent. Any tips? In future editions of the book, it would be great if you could include an actual nutrition label and show what numbers you are pulling to run the calculations. I’m really winging a lot of foods here, have horrible reflux when I screw up so I’m feeling wedded to the 100 or so items you’ve included but what about when you want to go off? If I continue to feel like this I will be eating this diet for the next year (life?) so any help would be appreciated.

                • says

                  Alexandra,
                  Glad the Fast Tract Diet is working for you. The FP tables list approximately 300 foods. The glycemic index database is in the public domain so there are numerous web sites to look up GIs. You can also get a copy of “The New Glucose Revolution” for a comprehensive list of GIs. True, you subtract fiber (and sugar alcohols) but other carbs, including sugar, are included in the calculation because they are part of the “net carbs”. Good suggestion on using a food label in an example. Will consider this for the next book. In time, your gut should heal and allow you to include some higher FP foods, but it also depends on addressing any other factors that may contribute to SIBO. The chapter on contributing factors is one of the most important chapters in the book.

              • Jill says

                Hi Alex,

                This is rather late in the day but in case you (or others) are still suffering from the symptoms you mentioned I thought I’d put my two cents in: I think your reaction could be due to histamine intolerance, probably caused by SIBO (very rarely it can be due to a mast cell disorder). Most of the foods you were eating before you suffered from “anxiety and shakiness” are considered histamine triggers.

                I would recommend having a stool analysis test (including a bacteriology culture) in order to try to pin down which strains of bacteria are out of balance/pathogenic. (Genova Labs is one lab I am aware of which offers this test.)

                You may need a course of antibiotics. Either way repopulating your gut flora with probiotics is essential (VSL3 probiotics was recently recommended to me by a gastroenterologist, but I have not tried them as yet). And of course following a low-starch or FODMAPS diet may help too.

                Following a low-histamine diet will definitely help in terms of alleviating symptoms of histamine intolerance in the short-term. Anti-histamines will also of course alleviate symptoms during a ‘histamine attack’.

                • MaryEllen says

                  VSL3 contains wheat and soy so not suitable for those that need to avoid those.

  68. Cassidy says

    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…

  69. Megan says

    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!!!

  70. Mel says

    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.

    • Zsuzsi says

      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

      • Mel says

        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.

  71. colleen says

    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.

  72. says

    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…

  73. Kitty says

    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!

    • Chris Kresser says

      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.

      • JadPatrick says

        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.

      • says

        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!!

  74. Jenni says

    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?

        • Jenni says

          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!!!!!!!!!

    • Jill says

      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.

      • Jenni says

        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.

        • Jodi says

          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”.

    • JRo says

      You should read Dr. Robillard’s book, FAST TRACK DIGESTION. I’m following the IBS protocol with great success. He also has a book on GERD. There is definitely a connection.

      • JI says

        I read the book “Fast Tract Digestion” heartburn; and have been on the diet for a week. I have SIBO that the antibiotic Xifaxan did not eliminate. I also have GERD. The diet has made my GERD and SIBO die down a lot. The SIBO may even be gone. I think the diet is the key to healing my gut and perhaps curing acid reflux. The explanations of how diet can lead to SIBO that develops into GERD makes sense to me.

        • Alexandra says

          If you are like me – same symptoms – it is not gone, it is just blissfully dormant. As soon as you go off the diet, it will be back with a vengeance. I’ve tried re-adding GERD triggers b/c the diet says you can have them with almost no success (tiny amounts of vinegar seem okay but wine, garlic (so bad), etc. just do not work for me at all). That said, if I stick with the diet and avoid those triggers I feel pretty normal. When I go off (or mistakenly eat something that bugs me) I feel crappy for a good 48 hours. While it’s better to not go off, at least now I can ‘plan’ if I want to go off (special dinner) and not have a mishap before I have to do something where I need my body to be in good shape. Helpful.

          I’m still on some H2 blockers, cannot get off without horrible flares but I was able to reduce my medication with this diet which is a score (no more PPIs for example). I’m hopeful eventually to get off the medicine but understand it just may not be in the cards for me. Any sort of carbs including fruits and veg seem to stop my motility entirely. We’ll see.

            • JI says

              Yes, it is called a hydrogen breath test, and uses either a glucose or lactulose sugar water solution. The glucose test may only pick up on advanced cases of small intestine bacterial overgrowth, such as mine. I think the lactulose one will detect if you have SIBO, even if it is not advanced. The facility I went to only offered glucose testing.

              • Bea says

                I am considering trying out the Fast Track method too. I just found out I have SIBO pretty bad. I have tried the SCD/paleo diet in the past with lots of anti microbial herbs and I still had my “itchy bitichies” driving me crazy plus and extended abdomen, rls, insomnia, white tongue etc. etc. I now know I have histamine intolerance pretty severely as well as gluten intolerance also severe. SIBO apparently contributes to both conditions. My preliminary forays into the GAPS diet made my histamine condition a lot worse by the way. So I am trying out using jasmine rice etc. I do think however that I need to use ground flax seed in my diet since otherwise I get constipated. It also is one of the few proteins I can manage. I can eat chicken now every other day, but not every day. Same with eggs. And am sensitive to all nuts and even now to sunflower and chia seeds. Thankfully coconut is fine. Roughage like that does not bother me since I do not have IBS. Though I do have GERD. So I plan to do this diet in my own way, combining what seems to agree with me, while avoiding foods with high fructose or resistant starch. Unfortunately that means I need to go off beans for now. But so be it! I really am motivated to get rid of the SIBO. I will be using antibacterial herbs again after I take two weeks of refraxamin. Am hoping that by doing so, my histamine intolerance will be greatly reduced.

        • Conie says

          JI
          I am reading the book you mentioned and trying to follow it. The term “Fermentation Potential” confuses me. I thought fermented foods were good for me and yet the chart in the book seems to indicate that a “high fermentation potential” is bad. I am going with “low fermentation potential” foods and hope I am right. Can you throw any light on this? Thanks

          • says

            Hi Connie, Fermentation potential refers to the likelihood that foods will be fermented producing gas in your gut. Fermenting foods in a mason jar removes most of the troublesome (fermentable) carbs thus lowering the fermentation potential (in the gut).

  75. says

    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.

    • Sophie says

      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!

      • DH says

        I too found veggies to be problematic. Which was a bummer because I’d always loved veggies, ate a lot of them and had a large veggie garden. Limiting my veggie intake to those that are Fodmap friendly, using a good digestive enzyme (Digest Gold), eating them well cooked or juiced has been very helpful. This year I planted a lot of herbs in my garden. Now I have been eating fewer veggies but more herbs and was surprised that, even though most of my digestive problems are gone, eating more herbs has made me feel even better. Then I read Chris’s recent post on wild veggies and the benefit of bitter and then it made more sense.

  76. Nick says

    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.

  77. Robb says

    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 says

        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!

  78. David says

    How would one know if they had IBS? Abdominal cramping, abdominal pain, bloating after eating a meal?

      • Tara says

        Or in my case, they didn’t bother to test me for anything else for years and years until I finally demanded it. Same with my friend who was diagnosed with IBS in her teens and was refused to be tested for celiac by her GI doc until she finally went to a different doc and was diagnosed with celiac at age 30. I think the problem was that we were both overweight and doctors think celiac is a wasting disease. It’s really upsetting.

  79. Stephanie says

    Does fermenting FODMAPs prior to consumption make them easier to digest? For example, turning cabbage into sauerkraut and eating it that way.

    • Chris Kresser says

      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.

      • devona says

        Funny enough, I seem to be the opposite, I can handle the cabbage, but not the sauerkraut (even when I make it myself).

        • Alice says

          Being able to tolerate cabbage but not sauerkraut generally means one is Histamine Intolerant. I am so interested in a personal paleo approach BUT what about the foods HIGH in histamine which I DO NOT tolerate at all. The FODMAP contains such veggies/foods in the Low fodmap but they are High in histamine. So how does one sort this out??? I would have to go LOW fodmap and Low Histamine. Chris, Is that possible???

          • Ana Sofia Pinho says

            I am on a low histamine program, and I cook fruit and vegetables, fish, meat (no pork and rabbit), potatoes, polenta, rice.

        • crypto says

          This is absolute garbage. There is not such thing as “IBS” caused by garlic, beans, pears, etc. One has IBS because one has a gut infection, more often than by a parasitic infection. THis is what is not found by US doctors who rush to label every gut related “imbalance” IBS. IBS does not make one “sick.” One gets sick from IBS because one has infection. Never listen to idiots like these. You need to approach a good tropical doctor and find out what you have and treat. Then your IBS will go away. If one was not born with it, one simply got it through an infection.

          • Carl says

            I’m very interested in your idea that infection causes IBS. How does one find a tropical doctor in the U.S. or even find one that understands IBS?

            • mhikl says

              Carl, I wonder if adding both boron (borax) and Lugol’s iodine (homemade without the alcohol-check out Tony Pantalleresco on YouTube on how to make) might not give some answer to what crypto is suggesting regarding infection.
              Walter Last’s article on The Borax Conspiracy http://www.health-science-spirit.com/borax.htm may or may not have some possible ideas. I am not that familiar with IBS.

              • Daniel says

                who cares what he is suggesting, he called Chris Kresser an idiot… who is basically a genius. And then told us to go see a tropical doctor.

          • Magnum says

            That’s an AWFULLY broad statement to make, Crypto, that IBS is always caused by infection. I have been to so many specialists (GI, internal medicine, immunology, holistic nutrition, TCM…) over the past 6 years to try and discover why I can’t eat ANYTHING, despite the fact that all of my tests come back perfectly normal. I have been tested for parasites, infection, Crohn’s, Celiac, allergies, you name it, all to no avail. The only thing that has even remotely helped has been eliminating FODMAPs from my diet.

            FODMAP intolerance is no different from lactose intolerance, do you deny its existence as well?

            The truth is we don’t know very much about the intricacies of how the gut works. One thing we DO know is that the many systems of the body do not operate in isolation, they are all inter-connected. Symptoms presenting in the gut may have root causes in other body systems – psychological, immunological, endocrinological, etc.

            • Larry Zinter says

              Hi My Wife has been dealling with many of the same issues anything she eats makes her sick can you call me Larry 619 249 3684

            • Mikaela says

              Have you been tested for candida, and what comes along with it – a leaking gut and then your are sensitive for carbs, especially quick carbs and gluten. You should try going on a diet without dairy, sugar and cereals. no quick carbs like white rice, potatoes. eat avocados, make green juice, grasfed meat, organic chicken and non farmed fish, seefood, lots of vegetables, berries, almonds and cashewnuts, olive oil, cocooil and cocobutter. drink lots of water. no fermented food and no industrial food because it has so much “shit” in thats bad for you. no soy no corn. google for green juice recipes and smoothies on rawfood pages! Thats what I am eating ordinated by my nutritionist and Im feeling better and better, I have candida and all whats comes along with that.

              • Colleen says

                Amen to that. Agter suffering 20 yrs /i diagnoses myself. After a trip to Cancun, Ive never been the same. Yests always cime back negative including endos/colonoscopies.
                If I can help 1 person and spare them rediculous and costly medical procedures and multi docs doing the same tests over and over I will be happy.

                First, I have always been athletic. It didnt matter whether I was size 5 or a10; my stomach would blow out like I was in my 7th month of pregnancy.

                Crazy as ot sounds people need to tell the gastro they want them going into the lower intest/small bowel. “SIBO”, then get a hydrogen breath test to measure the gas built up om your gut from fermenting foods. I avoid gluten. Recently, I
                discovered my healthy eating habits wete actually hurting me too. Avoid brussel sprouts, white rice, soy sauce replace with tamari for sushi. Natures promise gf ketchup vs other ketchup, no balsamic vinegar, broccoli, beans, onion, potatos or corn. Most acohols as well.
                Watermellon and more than 10 nuts at a sitting..also cause pain/swelling, lactose/dairy no good.

          • JAI says

            You may have misread the article:
            “While most IBS patients are FODMAP intolerant, consuming FODMAPs does not actually cause IBS; it simply exacerbates symptoms”
            Thank you for the input about gut bugs, however, many people do not consider that as one of the possible sources of these types problems in our society.

          • sarah says

            Woah, this is a strong reply. I have been using the FODMAP approach for 1.5 years and it has made an enormous difference to my life. So long as I stick to the foods ‘allowed’ I have no symptoms. If I stray off the FODMAP list the symptoms reappear. It has been well tested by a University in Australia and adopted by the UK NHS and I believe has a 75% success rate…..

          • Ivan Gill says

            The infection argument is something I find interesting too. It’s also why I find foodmap inetresting becuase effectively it is providieng a link bewteen commonly eaten foods and intestinal flora. We all have gut infections, bacterial, viral and fungla, known as intestinal flora, and this flora varies from person to person and varies with diet. Fodmaps focus on on a set of flora that thrive on particular foods

        • Ashley Martin says

          I found out that I have a severe yeast intolerance, so fermented foods are out for me!

          All that time, I thought I was doing myself a favour by eating already fermented foods – it’s taking a long time to reverse as I now have to kill off the yeast overgrowth with the help of my nutritionist.

          She did a stool test to see what was growing too much and not enough.

          • Kathy says

            Hi Ashley,

            What test did the doctor do to find out your yeast intolerance? Want to get the same test as kefir makes me feel horrible. I also seem to respond negatively to other foods but can’t work out which is causing the problem.

    • Angela says

      Hello. I was wondering if you can juice some of the non-fructose fodmaps successfully? Like cabbage and broccoli? And does anyone else also have a problem with all leafy greens and any kind of fiber? It seems as time goes by I am more and more intolerant to things. Feeling very discouraged.

      • lou says

        hi angela,
        from my own personal experience i have no trouble when i juice the offenders life cabbage and broccoli. but that’s just me. i am also able to juice leafy greens, daily, with no tummy troubles. if i were to eat the foods, that would be another story….
        i would just try it out and see how you feel. i hope you’re able to enjoy all the glorious goodness that juice offers!!

        xX

      • Lisa H. says

        I actually have had the reverse experience with juicing. Juicing concentrates the FODMAPs, and make it a huge load on your system.

        I once attempted to drink a beet and cabbage juice and about 1/3 of a cup and I was running to the bathroom to throw it back up. So, be very careful.

        • Alice says

          I once put veggies/fruits/greens in a vitamix and consumed this variety which I now realize contained very high amounts of high histamine/fodmap/salicylate foods and I went into anaphylaxis. It was one of the most horrible experiences I have ever had. All the veggies/fruits/greens were organic and they nearly killed me. I would think juicing would concentrate such things and not be good. It surely does for me but the vitamix concentrate was the worst ever for me.

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