Functional gut disorders such as IBS are affecting one in five Americans, causing abdominal pain, inconsistent or excessive bowel movements, and even psychological symptoms such as anxiety or depression. (1) If you have experienced IBS, you know that these symptoms can be constant, painful, and can have a serious impact on quality of life.
If there were a dietary intervention that could reduce or eliminate IBS symptoms, would you try it?
There is a strategy that has recently become more popular; it is a dietary approach that I have seen work well for many of my patients, and that evidence is growing in support of. Known as the Low FODMAP Diet, this method has been demonstrated to reduce functional gut disorder symptoms in approximately 75% of patients. (2) Understanding how FODMAPs affect the gut and knowing how to eliminate them from your diet may be the key to getting your IBS symptoms under control.
What are FODMAPs?
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)
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.
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How can you treat FODMAP intolerance?
First, addressing intestinal bacterial overgrowth or imbalance is key; even if you don’t have IBS, gut dysbiosis can lead to poor digestive function as well as contributing to FODMAP intolerance. There are a few gut-healing protocols available today, such as the GAPS Diet or the Specific Carbohydrate Diet; my personal approach is similar to an autoimmune Paleo diet. I often recommend probiotics to my patients to help balance out their gut flora, and occasionally recommend antimicrobial treatments depending on the severity of the individual gut infection. Managing gut flora is a highly individual process, so it’s important to pay attention to your own symptoms when coming up with a treatment plan.
In addition to addressing gut bacteria, following a low FODMAP diet seems to be the most effective dietary intervention to help reduce chronic IBS symptoms. (10) Many clinical trials have shown a high level of success from IBS patients who reduce or eliminate FODMAP containing foods from their diet. (11, 12, 13) In addition, avoiding gluten may help reduce IBS symptoms further, according to some research. (14)
While a “Paleo” or “Primal” diet may eliminate many of these culprits, there are a few Paleo-friendly staples that can worsen FODMAP intolerance symptoms. I’ve written about coconut milk causing digestive distress in some individuals, and coconut milk is an unfortunately high source of FODMAPs. Many fruits such as apples, peaches, mangoes, and watermelon are FODMAP rich, and dried fruits are especially problematic for those with intolerances. Even certain vegetables that are normally quite healthy can be problematic for those suffering from IBS; asparagus, brussels sprouts, broccoli, garlic, and onions are just a few of the vegetables that could be exacerbating symptoms.
To determine which specific foods that may be causing your IBS symptoms, I recommend reviewing this basic but informative chart featuring different types of FODMAPs and the foods they are found in. You may be consuming a FODMAP-rich food without knowing it, and reducing or eliminating consumption of these foods may help alleviate IBS symptoms. This chart also provides a list of low FODMAP foods that can be enjoyed in place of these problematic foods.
For much more information about FODMAP intolerance, as well as an extensive list of FODMAP foods and an in-depth gut healing protocol, check out my Personal Paleo Code. In this detailed guide, I explain how to best adapt the standard Paleo diet into one that can help relieve IBS symptoms without needing to restrict your diet indefinitely. It’s a protocol I use with my patients, and many have found success without drugs or surgical intervention. It’s certainly worth a try for anyone suffering from chronic digestive disorders.
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Hi Chris
This is an interesting article. My son has ulcerative colitis and started the Specific Carbohydrate Diet about 5 weeks ago when it became clear he is not responding to pharmaceutical intervention (Remicade, mercaptopurine and mesalamine have all been tried without success). He’s doing fairly well as long as he sticks to the diet, though he has had to eliminate onions much as he likes them because of an increase in diarrhea. He continues to eat other foods high in FODMAPS like apples and honey, the only sweetener allowed on SCD. He feels pretty limited in his food choices already but I will encourage him to cut back or even eliminate some of these foods.
This is a bit off-topic but I wondered if you could answer this question: does straining the SCD yoghurt reduce the probiotic effects? He really prefers it thick so I strain it over cheesecloth for about 5 hours…
hey Suzanne,
I thought I’d answer your question since I can…
straining yogurt like that separates out the whey…that is what the watery stuff is that you’re left with.
Probiotic content I imagine stays similar in both the whey and the thicker yogurt, but you can save the whey as well and put it a smoothie or make lemonade or something and then the probiotics will still be consumed. Whey protein that’s been cultured like that is good food…it would be a shame to waste it.
People also use it to ferment veggies.
Hi Gianna
Thanks for answering! I will start saving the whey for my son to use in smoothies. He was disappointed when he had to give up protein powder shakes when it became obvious it was making his colitis worse; he lifts regularly and is trying very hard to put on weight…so this would be a great alternative!
Excellent article Chris! Do you have any insights on usefulness of low-FODMAP diet on people with no noticeable digestive problems, like no gas, flatulence or anything like that.
And more specifically I’m interested of the effect of FODMAPs on the skin. Acne (and skin patients) as a group have higher rates of SIBO than people with healthy skin. I’m just wondering if low-FODMAP diet could help acne patients that struggle to get results with Paleo or otherwise healthy diet. I hesitate to recommend strict diets to people without good reason – as they often put people through a lot of stress. Any thoughts on that?
I don’t have any scientific evidence of this, but I will chime in with my n=1 anecdote. I had painful cystic acne before going on the low FODMAP diet. It wasn’t terrible, but it wouldn’t go away, and I had tried both conventional and alternative treatments and many changes in my diet…many of them. Prior to the diet, only a particular brand of birth control would control it, but I didn’t like taking it. Now my skin is much, much clearer. It’s not perfect, but it has done more than any other dietary change or treatment.
I too have discovered that following a low-FODMAP diet (with a slight SCD leaning towards VERY limited grains/starchy veg) has greatly improved my cystic acne. For people who have tried everything else to cure their acne with no success, I would say give the low-FODMAP diet a try and see if it works for you. I saw results in about a week, and continues to get better with every day (I am 1 month into the diet).
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!
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).
I’ve been on a low carbohydrate diet for almost two years and suffer from chronic constipation. Nothing I have tried seems to help. I’ve used probiotics, but they only work for a short time and then stop working. I tried Natural Calm which also worked for a while and now it has stopped working too, even with an increased dose. I’ve varied my diet adding things and then taking some things away but nothing has helped. My doctors are really no help because they are all low-fat high-carb practitioners. I’m really at the end of line with this problem. The only thing left to do is to go back to eating the way I did before which I really don’t want to do but I may not have much of a choice.
Buffered Vitamin C works extremely well for constipation. I mix 1 teaspoon with water in morning and another at night. The dose is individual. For example, you may need 1/2 tsp morning and night or you may need 1 1/2 tsp. Experiment until you find the right dose for you. When you start having diarrhea decrease dose a little and you will find your dose . I take it every day in morning and night. It works like a charm. Good luck.
Alice
Larry
I hope by now you have found a fix for your discomfort but if not have you tried ballerina tea or senna tea?
-Emily
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!
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.
Apologies was meant to comment on constipation letter some way above this letter
Obviously IBS could be IBS-C or IBS-D (or both), but it seems as though you really only mention low-FODMAPS helping with the D since it reduces the potential for the osmolar shift. However, I’m wondering what your experience is, Chris and Diane, with low-FODMAPS helping with C. Not sure if this is relevant, but I recall Dr. Siebecker saying something about different strains of gut bacteria producing different gas, some of which causes more D, while other gas will cause more C. Either way, of course we’d want all pathogenic bugs gone.
Anyway, I have a client that has done an auto-immune paleo elimination with no improvement of her C (will go 10+ days w/o BM, super distended), is negative for fructose malabsorption per breath hydrogen test, but GI doc wants her to try low FODMAPS. I’m just thinking she may need to take it to the SCD or GAPS level for some major healing but not sure which would be optimal (an realistic) for her. Thoughts?
Thanks a bunch! I learn so much from your wonderful resources!
Exactly my concern. I’ve had no issues with paleo but now that I’m nursing I’m having some and my baby is in gas distress. With all my eliminations, I can’t seem to find enough to eat at a time when I need more calories. I’m pretty sure a diet of lots more meat is going to result in stomach issues too plus I hate red meat.
I definitely have SIBO symptoms, but I recently tested for it with a naturopath and found I was in the normal range (levels were really good). Still, the FODMAPs diet does seem to help with gastro distress. I notice my stomach isn’t bloating, and it reduces the problem of food not digesting well in my stomach and causing reflux issues and nausea.
The only issue I have with the diet is that I’m also on the highly restrictive autoimmune protocol (I have ankylosing spondylitis). With eliminating nuts, egg whites, nightshades, potatoes/sweet potatoes, starches, and most fruits, it’s pretty hard to find anything to eat. Very hard to keep the weight up. I would love to see the paleo community begin to lend more support to people in this very limited diet (recipes, food ideas, etc.). Some of us are eating almost exclusively meat at this point to get by.
Lindy Pals I am in the same boat as you… I feel like I can eat nothing and am loosing weight very quickly (and am now to underweight). I am wondering if you have found any help or come up with anything.
Thanks for this post, though it sure is not welcome news. I’ve been on GAPS for a while and not doing well with it. Initial improvements in many areas were short lived, followed by precipitous decline in the areas of energy, sleep, libido, depression, personality, muscle inflammation and desire to eat and cook. I know now that I went too low carb out of ignorance and this seems to be a common story. For now I’m hoping adding more back in will have good effect. I’m trying hard to get enough carbs on full GAPS, but finding it challenging. Eliminating fodmap foods looks like a death sentence right now, but then again, after adding more fruit and vegetables than I was eating the digestive improvements that I saw on the intro diet are not so apparent… I’m still better, but not as better as I was. I’m just not sure I can get enough carbs in a healthy way if the sources are further limited. Would you typically add some starch in this type of situation? I’m hesitant re: Natasha Campbell/Mcbrides entire approach being based on eliminating polysacharrides. I have a considerable investment in the GAPS process so far and don’t want to undo any progress made.
From reading around the blogosphere it is apparent that my story is a common one and that there is a groundswell/backlash away from low carb diets. Many people seem to come out of their low carb coma by adding them back. It seems clear that Dr. Cate thinks that low carb is fundamentally right, and that the people having trouble with it are broken or are doing it incorrectly. It would be good to hear more from you on this subject given the current climate around it. The Ray Peat and 180D stuff is pretty compelling, especially to people in my situation. I’m actually contemplating the idea of RRARFing within the GAPS allowed foods, though it seems difficult without starch and maybe impossible without fodmaps too. I have about 70 varieties of mostly heirloom apples ripening this year and not tasting and just enjoying eating them for the first time ever after years of investment would be SUCH A BUMMER! Ok, done whining.
Stevene,
I didn’t do well on just GAPS for long either…I’ve added sweet potatoes and green plantains and found that very helpful. I too needed a bit of carb. I don’t eat much of them and not even daily, but it helps.
I am in the same boat. I did GAPS for awhile, not much change, then have added FODMAPs and am seeing a ton of improvement. My only problem is not being able to get enough carbs. I have been making juice from carrots, celery, cucumber and ginger and then watering it down and having it with meals, in addition to salads/squash/more carrots cooked with my meals. No more bloating and pain, but kind of extreme. Only fruits that are working for me right now are bananas and berries.
Mickey
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
Did you find the answer to your question? If you are trying the FODMAP diet you may want to purchase the official app that has the latest foods added for the App Store. It is a bit pricey $9 but it is used to fund the research. Also this site is very helpful in the latest info on what is allowed on the FODMAP diet. http://blog.katescarlata.com/fodmaps-basics/fodmaps-checklist/
Regards
I’m of the opinion that people should be able to thrive on a varied diet. If your digestion is poor, ANY kind of food has the potential to be irritating. So trying to eliminate too many foods, and you end up on a very restrictive diet and can’t enjoy life. The goal is to improve digestion to the point where you can enjoy a large variety of foods without suffering or paying for it later. While this can sometimes be accomplished with diet alone, many people will benefit greatly from supplements. Chris has some great recommendations on here and in his personal paleo code. One supplement that I personally love is Just Barley (high in organic sodium which will help you make HCl or stomach acid)…it really improves digestion.
I also resonate with Ray Peat’s ideas. I say try to improve your digestion and enjoy your apples!
My goal is certainly to be able to eat a wide variety of foods. Clearly people have thriven (is that a word? well, now it is!) on a wide variety of foods throughout our evolution. I like the aspect of the GAPS diet, that strives toward the goal of digestive healing and a return being able to digest most foods. Having reviewed FODMAPS now and contemplated adding that to GAPS, it just does not seem possible. I’m wiped out and need to do something different ASAP. I added some Basmati rice, but I don’t think its going that well. I’m not sure I’ve got this right, but GAPS and FODMAPS seem to be trying to starve the same out of balance microbes in the gut, while GAPS also focuses on foods that are alleged to be beneficial in healing the gut. The fact the each one does not take into account the other’s recommendations seems like it might be somewhat remiss. It looks like Norm Robillard’s book listed above might approach the problem in a more refined way by calculating the actual values of potentially difficult to digest foods. That could allow me to tweak my diet without eliminating broad groups of foods that might be tolerated. Since I’m unable to live well on mostly fats and meat, I can’t afford to eliminate the problem foods listed by GAPS and FODMAPS both, because there is just not enough left to eat. I know many other people have this problem as well.
I 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.
I am reading “Fast Tract Digestion” by Norman Robillard. His opinion is that FODMAP diet does not go far enough because it does not limit resistant starch. Amylose must be restricted in order to help digestive issues like ibs and reflux. Dr. Robillard is a microbiologist who cured his own digestive issues. He assigns a “fermentative potential” number to carbs to identify how difficult a carb is to digest. I am very interested in your opinion of his approach.
Thanks,
Alice
I would love to see the list of carbs and numbers. Do you know if it is online anywhere?
Mickey
As far as I know the list is not on line. I think it is only available through the book, “Fast Track Digestion”. I got it as an E book at Amazon. Good luck.
Alice
Thanks forr mentioning this book. I read it and found it boy helpful and confusing. The latter because some of the claims seem to be opposite to those of FODMAPS. Many foods listed as high in FODMAPS on most lists are lited as low FP in his system and vice versa (eg sweet potato). I’m not sure if the difference is simply due to adifferent use of portion size or an actual divergence in opinion. How do you implement the information?
Lilian, You are correct, there are differences driven by a couple of things. First, the Fast Tract Diet Fermentation Potential (FP) calculation limits all carbs that are difficult to digest (using the glycemic index to subtract absorbed carbs) which includes all fiber and resistant starch. So a 5 ounce sweet potato has 21 grams of fermentable carbs that escape absorption and can potentially fuel SIBO. Second, FODMAP carbs also register in the calculation but if there are only a few grams, the food could be considered gut friendly.
Norm Robillard
Thank you, Norm, that is a very helpful clarification. That would mean that the FP calculation leads to more stringent criteria, as all hard-to-digest carbohydrates are considered, not only FODMAPS, am I correct? Would the sugar (glucose/fructose) to fiber ratio explain why watermelon is considered a FODMAP food but low FP according to your system? And would portion size always still remain a big consideration, even with a low-FP food?
Lastly, learning that there’s a difference between Basmati- and Jasmine rice and that the latter is so digestible has made a huge difference for me (I tend to not feel well on a no-carb diet) and explains why I tend to feel so well after dining at thai and chinese restaurants – I just called my favorite Thai restaurant and verfified that they use Jasmine rice – so warm thanks for that!
Do you discuss the use of natural antimicrobial agents for SIBO in any of your books?
Thanks for another great article Chris.
Hi Jenn, The FP system does go beyond FODMAPs in the number of carbs covered. On the other hand, you don’t have to think about what foods have what carbs, just go by the FP which is the same as symptom potential. The FP for watermelon is low most likely because fructose is absorbed more efficiently in the presence of glucose. You are right, portion can matter – not for jasmine rice since the FP is zero – but for other foods that have higher FPs.
Enjoy your Thai food.
Norm
Hi, I bought the book hoping it would help me with my gut issues, I have sibo and fructose malabsorption. I confidently had and omelette with onions today, sprinkled with cheese and sour cream. A little bit later I started having really bad anxiety and shakiness. That’s what normally happens to me when I consume something like onions, apples or pears. Do you think your diet isn’t compatible with fructose malabsorption or could I possibly have yet another issue?
Hi Alex,
Not sure what to make of that. More typical symptoms of fructose malabsorption are cramps, gas, diarrhea, reflux, etc. But if you are having a reaction to them, the best bet may be to follow your instincts and avoid them. Sorry, I couldn’t be of more help there.
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.
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.
Sorry Alexandra, I meant to say you “add” fiber and sugar alcohols – as they contribute to FP.
Add fiber to what? Isn’t it already included in Total Carbohydrates?
MZ,
Only net carbs are affected by the glycemic index. Fiber is not, so grams of fiber are added separately for the final FP. The formula is in this slide deck. http://www.slideshare.net/ancestralhealth/norm-robillard-did-cavemen-get-heartburn
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’.
VSL3 contains wheat and soy so not suitable for those that need to avoid those.
What is FP?
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…
Perfect timing for this article! I am just about to shift from a paleo to a paleo + GAPS intro + low FODMAPs diet to try to heal my IBD which I suspect is caused by SIBO and leaky gut (although my other hypothesis is difficulty with fat digestion or protein digestion, which this approach may not help?) Thanks for the resources and information, extremely helpful! I recently have had an onset of mild daily reflux in the early evenings in addition to my other symptoms (which have not changed/worsened), should I consider HCl as well? The only thing I have changed recently is drinking 8oz of kombucha daily, could this amount of probiotic intake be causing the reflux?? Thanks for your help!!!
I was diagnosed 6 months ago with fructose malabsorbtion, so following this diet with some additional restrictions on fructose load has been huge for me. Added to being celiac and intolerant to dairy( not just lactose, casein causes serious symptoms as well) and soy, this was a huge diagnosis. But it removed pain, nausea, and other symptoms I had been living with for years. I wish more people were willing to change how they eat for their health. It’s really not that difficult. It astounds me how many people would rather continue to eat what they want and feel awful, than make some changes in what they eat and not have to always know where a bathroom is, or stay home for an entire day in pain. I know several who live like this all the time..
Australia seems light years ahead of the US in researching this subject. I suppose it’s because a pill isn’t involved so there isn’t any money in it for the pharmaceutical industry.
Hi Mel,
could you elaborate on the fructose load? Have you been counting grams (of fructose)? If so, how much? I am also celiac, intolerant to dairy…any help would be great.
Thx,
Zsuzsi
Zsuzsi, I don’t count grams in detail, I just know by trial and error that I have a fairly low tolerance. Most generic advice out there says to watch your fructose per sitting. I have just found that making sure I keep my per day fructose vs my per meal fructose low goes much better for me,. I am definitely on the low end of the tolerance scale. In fact, eating vegetables or fruit more than a few times per week usually triggers symptoms for me (except potatoes. I’d starve if not for my meat, eggs and potatoes). My average per day fructose might be closer to what many do per meal.
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.
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…
And avocados are out too, right? (Not listed in the link) And what about coconut butter? And, one last question, is there any benefit to sticking more with cooked vegetables than raw ones or does it not really matter? Thank you so much!
I consider avocados to be “grey area”; some will tolerate, others won’t. Keep in mind that the range and scope of FODMAP intolerance is highly variable. Some patients are particularly sensitive to garlic and onions, for example, but have no trouble with stone fruit. It’s best to eliminate all FODMAPs and then reintroduce each class to see which you are sensitive to.
Avocado contains POLYOLs and is indeed considered a grey area food. Research suggests a quarter of an avocado per meal is ok, so long as rest of FODMAP load is minimal. COCONUT has long been taken off the list of problem FODMAP foods as it only contains small amounts of sorbitol. Many people with IBS react to excess fats though too, or may also react to the GUMs added to most commercially available coconut milks.
I was so excited to find out that I’m okay with avocado! But I can’t go too overboard. Onion and garlic are big no-nos for me though- which sucks when eating out cos they’re in absolutely everything! Many chefs are catering to gluten free ppl now, which is helpful, but they still throw all the other ‘bad’ foods in!!
Chris, Diane, what would you think of Kombucha (for probiotics) on a low-fodmap diet?
Kombucha has very little fructose left in it after fermentation, so I wouldn’t consider it a FODMAP.
Yay! I love Kombucha and I think it helps my tummy troubles .
I’ve started drinking GT’s Synergy Kombucha, a few different flavor/varieties that contain low FODMAP ingredients. But then I was thinking… Since the beverage is already fermented, maybe I can tolerate the other flavor/varieties that contain high FODMAP ingredients? Since the fermenting is already done, it should be okay, right? (I’m going to be giving it a try, very cautiously.)
I’ve had great success on the low FODMAPs diet in the last ~10 months, and my biggest concern has been missing out on the micronutrients that are in certain fruits/vegetables I have been avoiding.
I’ve been trying to kick acid reflux for awhile now… been reading your articles on it, tried reducing carbs/grains/gluten… so many things. Added HCL (it helps, but it’s not a silver bullet). Any connection between these foods and reflux?
These foods (FODMAPs) are known to irritate digestion in people with SIBO, as mentioned above, and that can really irritate the LES leading to the reflux you’re feeling. We talked about this on our podcast together a while back > http://www.balancedbites.com/2011/10/balanced-bites-podcast-episode-8.html
I meant to note that the episode above was on The Balanced Bites Podcast with Chris as our guest talking about digestion.
Thanks, Diane. Just listened to the whole thing. Sounds very overwhelming! I mean, a lot of it was stuff I’ve heard before, but what to choose: Paleo, Whole 30, Fodmaps, Gaps… Yikes. I tried Gaps… did it for 8 days and I could not continue. I got to where I hated cooking and I hated eating those soups. What would you recommend I try at this point… oh, and here’s another possibly important tidbit: I’m 5 weeks pregnant. REALLY want to get a hold of this before the baby goes through the birth canal!!!!!!!!!
Jenni – have you actually tried complete elimination of all grains, not just a reduction? Even tiny amounts of rice caused reflux for me so I would not have figured it out if I had just reduced the amounts. I went very strict with no grains for 2 months and my reflux disappeared. Now that my system has calmed down I can handle a bit here and there but not in the beginning.
I did go completely without grains for awhile. Probably around 2 months. No changes I’ve made so far have made any noticeable difference. Being on vacation seems to make a difference, but it doesn’t go away completely. It does go away for days at a time, but then it always comes back.
My mom used to have to take some meds for acid reflux. Then she started consuming greens (Collard greens, swiss chard, kale, etc) and started making Victoria Boutenko’s green smoothies and her acid reflux went completely away. She was able to get off the meds entirely. Victoria Boutenko discusses this in her DVD titled “Greens Can Save Your Life”.
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.
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.
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.
Hi…is there a specific test to see if you are/have an over growth of intestinal bacteria? Im suspecting. Thanks.
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.
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.
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
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).
For those interested, my book (“Practical Paleo”) contains notes on FODMAPs in all of the recipes as well as alternate ingredients where ever possible. FODMAPs are also denoted on my Guide to: Paleo Foods- available here > http://www.balancedbites.com/useful-guides as well as in an updated/expanded form in the book.
I recommend that people try my sauerkraut recipe simply using carrots if they are concerned with fermented cabbage being tough to tolerate.
Hi Diane- I just made your sauerkraut recipe using carrots today- I’m excited to see how it turns out. Your book has been really helpful for me- so thank you.
Chris- Your site has also been incredibly helpful for me. I am so happy to have read your article on too many veggies- I think that is what caused me to have such digestive distress. When I first started eating paleo, I was eating up to 4 cups of raw veggies a day- it only took a couple of months until I couldn’t tolerate raw veggies in any quantity. Now, i can only tolerate veggies semi-comfortably when they are well cooked- and even then i experience bloating/gas, etc… I will be following your protocol and Diane’s recommendations to heal my leaky gut- Thanks!
I 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.
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.
I have been following the FODMAP diet since October and it significantly reduced my IBS symptoms. Since the studies are new here and FODMAPS are in most everything, it has been hard for me, but I felt so much better and was eliminating much less frequently. However, I was still having some issues on ocassion (bloating, constipation) and two weeks ago I started taking digestive enzymes, Betaine HCL and also a combo pill of bromelain, papain, pancreatin, pepsin, amylase, lactase, lipase, ox bile powder, ginger root, turmeric. I feel so much better now!
Robb, What is the combo pill you are taking? It has tons of good stuff in it!
It’s “Simple Digestive Formula” from Whole Foods. There is also a brand available online from NOW called Super Enzymes that works well if WF isn’t near you, but it does include 200 mg of HCL as well. The great thing is it’s not really expensive (I think it was $6.99 for 100 tablets). I’m still eating pretty low FODMAP but since I started the supplements I’ve been able to be more flexible and eat some of the things I’d cut out in small amounts with no reaction. Good Luck!
Thanks!
Dr Wilson reccomends dehydrocholic acid (in a digestive enzyme called GB-3) instead of Betaine HCL-pepsin (in Super Enzymes) for IBS. See http://drlwilson.com/Articles/gb3.htm
I like Digest Gold. It has made an amazing difference for me. I tried the Now brand and had poor results.
Rob I know this is an old post but if you see this msg just wondering in what doses you took the whole food supplement with the other digestive enzymes? 1 or 2 of each with every meal ?
Sure, Lisa. I take one with every meal. I’ve recommended it to a few friends and they have also had positive results.
How would one know if they had IBS? Abdominal cramping, abdominal pain, bloating after eating a meal?
IBS is a diagnosis of exclusion, which means you end up with it if they’ve ruled out other structural bowel problems like IBD and celiac disease. See this link for the criteria used to diagnose IBS: http://www.helpforibs.com/footer/rome_guidelines.asp
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.
What if I have IBD (diverticulosis and have had diverticulitsis) and IBS? Can I still follow the FODMAP?
Does fermenting FODMAPs prior to consumption make them easier to digest? For example, turning cabbage into sauerkraut and eating it that way.
There’s no data on this, but in my clinical experience many patients with FODMAP intolerance can handle sauerkraut (in moderation) even if they’re sensitive to cabbage.
Funny enough, I seem to be the opposite, I can handle the cabbage, but not the sauerkraut (even when I make it myself).
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???
I am on a low histamine program, and I cook fruit and vegetables, fish, meat (no pork and rabbit), potatoes, polenta, rice.
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.
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?
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.
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.
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.
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
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.
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.
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.
The article was clear that the foods were not a causative factor but could exacerbate the symptoms
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…..
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
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.
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.
Since FODMAPs are short-chain fermentable carbohydrates, many of them can be fermented by the bacteria during the fermentation process, making them easier to tolerate for people with an intolerance to FODMAPs.
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.
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
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.
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.
you don’t vomit from FODMAPS;
see livestrong.com’s
555645-dangers-of-juicing-beets