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FODMAPS: Could Common Foods Be Harming Your Digestive Health?

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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.

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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. (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.

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316 Comments

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  1. Starting the fodmat soon. Starting to set up a shopping list. Seems so confusing! Especially when eating out.

  2. 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.

  3. 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.

  4. 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?

    • 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

  5. 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?

    • 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.

  6. 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

  7. 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!

  8. 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

  9. 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”.

    • 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.

      • 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.

        • Predominant C.

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

        • 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).

      • Many probiotics contain FODMAPs!

        In 2011-2012 I took Florajen 3 every day, and it seemed to help my IBS-D (this is before I heard about low FODMAPs diet). When I started to get worse diarrhea, I thou it was time to change up my probiotics and tried another– wow, worse diarrhea! So I stopped taking probiotics altogether.

        In the summer of 2014, I eliminated wheat from my diet as a 30-day experiment, and wow– within 2 weeks I was 80% better. Found out about low FODMAPs diet that August from a GI doc (during my cinsultation before getting my first screening-colonoscopy).

        Following low FODMAPs diet to eliminate more than just wheat from my diet, I got to 99% relief of IBS-D symptoms.

        This April, a dietician advised me to try a certain brand of probiotics containing sacchromyces. Guess what? It is a FODMAP! So is FOS (duh, it was the offending ingredient in the probiotic I switched to in 2012). So I started taking Florajen-3 again, and all is well.

        Also – I woul like to mention 1 thing that I haven’t seen anyone else mention in all these comments- sometimes the worst of the IBS symptoms can occur 48 hours + from eating the food. So when you look to last meal, or last night’s meal or what did I eat yesterday – go back farther — what did I eat 2+ days ago. This helped me identify trigger foods that had evaded detection by me for more than 15 years.

  10. 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”.

  11. 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.

  12. Simone- I am also curious about this. I used to eat everything without any issues. I changed the way I ate- started a Paleo diet, from there I developed big sensitivities to certain veggies- mostly the FODMAP’s- which is quite the list of veggies. I can’t eat anything w/onions in it 🙁 and cruciferous veggies are also a no-no. I was tested for H-pylori- negative. I think the reason i developed sensitivities is b/c I was eating a lot of veggies- which is something Chris has written about. When I eliminated all of the other foods- grains, legumes, dairy, etc…there isn’t much left except for veggies and meat- so I filled up on veggies which are hard on the stomach- especially raw veggies. I eliminating most raw veggies, FODMAP’s, and nightshades for 30 days to see if that helps. I am open to other suggestions.

    • The sharp increase in the fiber intake may support certain bacteria and contribute to dysbiosis. A test such as metametrix could tell you what’s going on in that department.

      If there is a direct sensitivity to something, there is a great treatment approach called AAT (Advanced Allergy Therapeutics) that very effectively and comfortably can help eliminate food-related and other sensitivities. (And no, I am not an AAT practitioner, just a grateful recipient of the treatment modality :^). Chris might be familiar with it, since it was created by an american acupuncturist (however, it is not an acupuncture treatment).

    • 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.

  13. I’m interested to know why and where the tolerances stem from? It’s great to have diets that help reduce the symptoms, but really I don’t believe that’s getting to route cause and really as someone said, you just end up eliminating more and more things, which I don’t think is the answer.

    How did everyone else start off with their symptoms. I remember when I was 15 I would get severe cramping from rich dairy, but didn’t notice anything else, now everything seems to be an issue, from watermelon, nuts, legumes, protein shakes, tomatoes etc So my question is why do more foods become intolerable over time? I have a feeling it is to do with bacteria, the question is if some bacterial issue is found, what can be done about it…apart from doing these low FODMAPs diets? Has anyone been diagnosed with SIBO, and what were you given? I’ve heard there are antibiotics to help this? Any reports of how it helped? What about Helicobacter pylori? Anyone being tested for that? Result?

    • Simone, I was just diagnosed with SIBO by hydrogen breath test. I am finishing a course of xifaxan, which my doctor was kind enough to provide me with samples of when insurance refused to cover it. I had already been on a very restrictive diet for a year because they suspected fructose malabsorption since I was having horrible reactions to almost everything I ate. Because I did not significantly improve on the elimination diet, and seemed to actually be getting worse, they sent me for the breath testing and found out it is SIBO not FM. I also follow the FODMAP restrictions because they told me I have IBS, which I don’t know if I believe, but I do feel better avoiding FODMAP’s.

      • Well I thought I would report back, been on FODMAP diet for a month and half. Feeling pretty good. Occasionally I will have a trigger, mostly when I eat foods that I shouldn’t, but it last only a day compared to a week. My main thing is nausea, lethargy and bloated stomach when triggered.

        Other major thing that has reduced is migraines and headaches. I wasn’t thinking about this when I went on this diet, but it has made a huge difference. I had a headache everyday up until the diet, for four weeks straight. Since on diet…very occasionally and they are very minimal. I think it’s been the cutting out of the gluten from my diet.

        Anyway, I have noticed an increase in energy, which has gotten me more to do more exercise which is another good thing.

  14. 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.)

  15. 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.

  16. 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!

    • “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…”

      Is there any evidence for this?

  17. 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.

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

    • No, sorry, it doesn’t work that way. In fact, juicing is problematic even with low FODMAP foods.

  19. Deb, r u eating nuts raw? If so could be problem. Soak the raw nuts and then dehydrate. Chris K. Has articles on how to do it.

    • I’m buying raw but not soaking / dehydrating. I have an 11 week old and 3 dogs and I’m about to return to work F/T. Think elimination is going to be more efficient for me! 🙂