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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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.
I have been fodmap free for a while and it has really helped. The focus is now on restoring gut health to come off PPI’s. Any suggestions on non alcoholic fermented foods i can try and introduce to promote good bacteria? Have tried fermented saurkraut and did OK on tiny amounts, but after day 9 of suarkraut this caused issues. kefir, combucha are all alcoholic so struggling here 🙁
I’ve been drinking water kefir daily, Could it be causing my reflux??
Any credibility to the idea of home fermentation of FODMAP containing products (a nice relish of lacto-fermented onions and peppers actually sounds pretty tasty to me) as perhaps a particularly good way to introduce FODMAP-digesting bacteria to the gut?
I have not seen any research that would indicate this is a good idea, and most who require a low FODMAP diet would not recommend it. I am not a dietician, but my family has been on this diet for years, and we get information direct from Monash Univ as much as we can.
I 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.
This is such a timely article! I have been paleo and gluten free for well over a year now (dairy free to boot)…yet still sometimes deal with bloating (and for some odd reason, it isn’t alway restricted to the belly…I ate an apple the other day and noticed my arms, legs, back and chest felt “bigger”/”Swollen” as well…it suddenly dawned on me that perhaps I had FODMAP issues…the more research I do, the more apparent it seems that excess FODMAP food causes major probs. I think apples and cherries are out for me, and am going to limit the problem veggies and add them back in slowly down the line to see how well I tolerate them. Dairy/yogurt is a once in a blue moon treat that I wont eat without lactaid, so will continue to limit that as well.
I’m on the fence with sweet potatoes – seems they cause symptons in some but not in everyone so will experiment. I agree with you that some carbs are necessary so am trying to add starches in slowly as I’m really active.
Thanks for these posts and your help! I’d love to hear a podcast fully dedicated to FODMAPS if you haven’t done one already.
Also – apparently Australia is lightyears ahead of us in this area, there is a FODMAP Yahoo Group that some people find helpful. Worth checking out!
I have an article and a FODMAP food list on my website here —-> http://www.eat-real-food-paleodietitian.com/paleo-diet-and-fodmap.html.
It is also important to keep in mind that a study showed that a great percentage of people that seem to react to FODMAPs may actually have SIBO (small intestinal bacterial overgrowth). More about it here —> http://www.eat-real-food-paleodietitian.com/paleo-diet-and-SIBO.html
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.
Hi chris,
And this is where i think the eat right for your blood type comes in
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.
Thank you for the article! I had heard about FODMAPs recently, but this finally grabbed my attention. Every time I have tried to discover the foods that cause these kinds of symptoms (basically excess fermentation), using an elimination diet, I have replaced FODMAPs with other FODMAPs. Now I can try eliminating all of them at once.
me too. I didn’t really want to read about it or think about it or eliminate it until I finally decided to with this article. I’m glad I now know what it’s all about. Great article.
Hi Chris,
Since removing high FODMAP foods from my diet, my digestive health has improved significantly. However, I seem to have a huge problem with potatoes (even without skin), i know that they contain no FODMAP’s but they give me intense abdominal and back pain shortly after i eat them. Have you found this to be a common intolerance with your patients ? I think you may have mentioned nightshade sensitivity before.
I avoid potatoes where possible. I seem to react better to hot chips actually (but not too many!) I get the same sensation. I also avoid raw carrots- I get weird indigestion and once felt very nauseated after eating some carrot sticks (thinking I was eating a nice healthy snack). Cooked carrots are fine though. Anyone else have the same problem?
Thanks so much for posting this. I have full blown celiac disease, but couldn’t understand why I still had lingering symptoms for years, despite the gluten-free diet. I was absolutely amazed at how effective a low FODMAP diet was! I now know what I can tolerate (everyone’s different right?) and I finally have control over my IBS and it feels great. I’m so grateful to the Australian guys who discovered all this.
By the way, I’d seek out a dietician to get help eating low FODMAP, but I’d also get “IBS-free at last (2nd edition)” by Patsy Catsos. She guides you throught the diet and has answers to everything you need to know. She’s also on Twitter (@CatsosIBSFreeRD) with a bunch of other dieticians and sufferers who are willing to give advice and support (#fodmap).
But can you ask for Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols in the lunch queue.
Coconut milk is mentioned as being High on the FODMAP list. What about Coconut Oil and Coconut Flour?
coconut oil is a fat and therefore not a problem for those sensitive to FODMAPS. I have heard conflicting thoughts on coconut flour and coconut milk. I would avoid it when doing the initial elimination diet then add it back in and see how you feel.
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.
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!
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!
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!!
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.