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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You say that “The acronym FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols. These short-chain carbohydrates …”
My understanding is that monosaccharides are not chain molecules, isn’t this true? I’m trying the specific carbohydrate diet (SCD) now for gut pain and reactivity to foods, so I’m eating fruits and veggies that are mostly monosaccharides, mostly living on peas, carrots, and meat.
It’s interesting that there are so many contradictory stories about which foods or carbohydrates are good or bad, FODMAP says one thing and SCD says something else. I tend to ignore the rationales because someone can always make up an explanation, if they don’t test it with the scientific method it’s just a story. I pay attention to results, and while the traditional MD based research says SCD doesn’t have benefits, there are so many people who testify otherwise that I’m willing to give it a try to see if it works.
Both SCD and FODMAPS elimination removes nutrition from pathogens that are causing symptoms. However, neither approach really leads to lasting healing on its own . I did SCD for four months, and while I initially experienced some partial improvement, I gradually started getting worse and realized that I had effectively painted myself into a corner; I was even less tolerant of fiber, oligosaccharides etc. now. I think this is the biggest problem with approaches such as SCD and FODMAPS – while starving pathogens you effectively starve the rest if the microbiome as well, ultimately leading you farther away from health.
I do not think that these approaches are entirely without merit. They could be a starting point for someone who is incredibly symptomatic. I do think, however, that the overall goal always should be a gradual return back to those foods that are known to be supportive of the microbiome. In my own case, I have found that using intensive (herbal/natural) antifungal / antimicrobial therapy combined with a temporary elimination of simple carbs and known gut irritants, meditation, visualization and gut healing supplements while gradually increasing my intake of foods that are known to be very beneficial for the microbiota, (and effectively all of them FODMAPS!) has led me much father in the right direction than chronic elimination.
Best of luck to all struggling with gut issues – remember that many thought leaders in this area, including Chris, have not only overcome chronic gut issues but beenled to where they are today thanks to them.
I have what I think is GERD ( my doctor and naturopath both are unsure of a diagnosis) with silent reflux and severe bloating under my right ribs. I have been on the Fodmaps diet for over a month and have noticed no change at all. I also suffer from Generalized Anxiety and Panic attacks and I am sure the gut and anxiety affect each other. I prefer natural options and just want some relief. Any suggestions?
I’m not a doctor, but severe bloating under your right ribs makes me wonder whether you’ve ruled out liver and/or gall bladder trouble via palpation and/or lab tests and/or ultrasound.
I agree with Carey, gall/biliary duct sound like the issue
I think you need to give it more time, and it could be due to several factors. Try CBT, Martin Seligman’s books are fantastic. Try quitting sugar ( a journey of it’s own, recommend you research this) and caffiene. Magnesium is fantastic for anxiety, also calcium, avoid oxalates as they strip calcium. Believe you can do it and don’t let negative self talk get in your way. You can and will get better!
Everyone’s symptoms are similar but their food consumption is so diverse, yet we are all lumped into a “you have IBS” group.
I’m sick of elimination diets. Lets get to the real crux of the problem. How can I, an active, healthy male well into their 40’s suddenly stop (read eliminate) foods that I ate, last year, last month, last week WITHOUT symptoms? This is the same or similar story for others on this forum.
Its great we have these “elimination” diets, but that is not the answer. WE are all being pushed towards elimination diets that sadly lack the nutrients obtained via our “normal” diet. Lets not jump into the sustainability of these diets and the softer factors such as peoples “experiences” with foods.
Unless your doing damage to your gut via an autoimmune condition, I don’t prescribe to elimination diets over the medium to long term.
Unfortunately I have turned to traditional science to solve my IBS, as my 18 month “hell” sorry, “elimination diet” has not and will not sustain and manage my symptoms sustainably into my future.
The majority of us have “bacterial” or “flora” imbalances that are were or have been caused by infections that will one day hopefully be corrected by as yet unknown methods.One day each one of us can be targeted specifically to gain control over our intestinal flora and lives..
Elimination or Fodmaps? You are being so inspecific your post does not make sense. And if you are healthy why were you put on it and why did you stay on it for so long? It took me over 20 years to work out my gut aches. 18 months is just impatient. It was worth it though I have never felt better!
Hi there Chris, have printed off and laminated your wonderful FODMAP “Informative Chart” and note a glaring omission…no mention of Nuts and Seeds as a grouping in either the green or the red sections of the chart. Could you clarify this please?
Anna cacao is a no-go. Believe it or not things that are higher in fiber are more likely to cause symptoms. You’re better off with a cheap cocoa that has about 2 grams of fiber.
I’m also curious about the coconut butter. I just tried coconut manna tonight so I guess I’ll know tomorrow morning!
The Paleo community owes Carbsane an apology. She is still waiting.
Is Kefir ok on the FODMAP diet? Also wondering about coconut butter and cacao.
B4 I began my exploration into the Whole 30, Westin Price, Paleo, Refeeding, Mthfr, Low histamine diet etc. I found that my digestive issues were very much influenced by my feelings at meal times. This is since childhood. Whenever there was tension at the table I would get a stomach ache or worse. As I’ve gotten older and tried more and more lifestyle changes it seems that I’ve gotten more sensitive and intolerant of more and more foods. I don’t like this!
Just recently read about psycho-neuro-immunology and it seems like something important to take a look at.
Although all these conditions: SIBO, IBS, Autoimmune, HIT are all very real, I can’t help but think that trying to cure them with food restriction and supplements is, ultimately, not going to get to the real bottom of things.
And then there’s that ever constant anomaly: Anytime I eat a meal out with a friend, and have a good time, that meal can be filled with wheat cheats, bad oils, alcohol, late night caffeine and I’ll still sleep like a baby, have great BM’s and feel no pain from it at all. Is it possible that stress and our conditioned response to it causes our bodies to go so far out of homeostasis that it can severely effect our immune system and the way our system handles foods? And it can do it daily even when we think our stress is under control. I’m curious because I’ve seen the good results that dealing with emotions and stress brings to my digestive issues, as well as any other health problem I’m going through. I am aware of these stress and emotional issues, but chose to focus on food and nutrition as a cure for them as opposed to the other way around. Maybe my diet and nutrition is good enough and it’s time to focus on why emotion, perception, stress and the way the amygdala in my brain may sabotaging my efforts at health. I don’t think I want to restrict any more foods. It’s too complicated. Working on stress and emotions is starting too look easier:)
I really think you’re on to something. I’ve had stuff improve on a dreary, seriously restricted diet, but the stress of adhering to the frikken diet was so great, due to only having about ten food options, that it was sabotaging the benefits. Staying on these horrid diets is only appeasing the intolerance, not healing it. I too have noticed “getting away with” eating certain things under circumstances where I wasn’t stressing and obsessing. I can’t go back to that rigid diet; it made me lose my appetite, and I don’t know if you’ve ever tried to shovel down food you didn’t like that much past a gag reflex when your appetite is gone, but it ain’t happening.
I have chronic watery stools and gas elimination during BMs. I have celiac and Grave’s disease that I treat faithfully. Does it make sense to combine a low FODMAP and high soluble fiber diet. Many of the food choices are not compatible to both; maybe bananas, cooked carrots and various potatoes along with fresh protiens. Is this a bad idea? I’m just starting a paleo diet and have found some immediate benefit (better sleep, less fatigue, less body ache) but the main objective is to get my bowels back to some normality.
I highly suggest that you try the Paleo Autoimmune protocol as it should get your GI system working normally again.
Thank you for the suggestion. I was not aware of AIP protocol and could be on to something. My head and intuition is reeling from all these different diets. I need to sort this all out and at this point I don’t have a trusted other to help guide me. I see from all the comments, I’m no alone. Thanks everybody.
3 great resources for you:
1. Mickey Trescott’s AIP cookbook
2. Sarah Ballantyne’s book on autoimmune diseases
3. Chris’ book
Those should really help you.
I agree, so many diets to consider. It would be great if a chart or some other sort of reference could be created to show similarities and differences.
After giving up gluten 6 months ago, I have experienced a huge amount of relief from fibromyalgia and joint pain. However, I have still suffered from much of my same IBS problems….bloating, constipation, pain, cramping, etc. I saw a story on NPR about FODMAP’s and the light bulb went off!! Since I am already following a healthy, GF diet, it was not hard to eliminate the FODMAP trigger foods. I experienced relief from my symptoms within days. Now I am adding back some foods and seeing what causes the symptoms….I most definitely have a problem with Fructose and Fructans!! I am excited to continue and see how things progress with this plan. I also saw the post from Robb about the NOW Super Enzymes and ordered some from Amazon to add to my routine. Thanks to all for the useful information!
What about protein? I have been following a modified (meaning I cheat) vegetarian diet with occasional chicken and fish. Red meat brings on other issues not related to IBS. Well, related–but in a different way. However, no beans, no lentils. So what is a suggested protein for those who are avoiding FODMAPS?
There is not such thing as “IBS,” and it cannot be prevented by avoiding garlic, beans, pears, etc. Healthy people eat such food all the time, without any problem. One has IBS because one has a bowel infection, more often than not caused by a parasitic infection. Ths is what is not found by US doctors who rush to label every gut related “imbalance” IBS. They simply do a stool sample sample and rule out. But stool samples often dont contain parasites. They have to be repeated. Doctors think US dont have parasites. All the while people are consuming more and more raw food diets, including salads imported from third-world countries.
IBS does not make one “sick.” One gets sick from “IBS” because one has infection. Never listen to those who claim otherwise. You need to approach a good tropical doctor and find out what you have and treat it. Then your IBS will go away. If one was not born with it, one simply got it through an infection. Gastro doctors are the worst. They have never received any training in parasites. They think it is IBS or “Chrons,” another bogus name given to symptoms. All they treat in the US are symptoms!
I agree with everything you have said. I think IBS, SIBO, FOOD ALLERGIES, FRUCTOSE MALABSORPTION, FIBROMALGIA, HISTAMINE INTOLERANCE, CHRONIC FATIGUE etc.etc.etc. is all a bunch of B.S. Doctors are slapping labels on stuff because they DO NOT know what the root cause is.
The body is burdened by something, but what? Also, being even slightly hypothyroid will lower your immunity and allow pathogens to creep further and further up your digestive tract resulting in all of the SYMPTOMS mentioned above.
I picked up Shigella back in the 70’s & was ill for three and a half months. This was the beginning of my “IBS”. You may have a point in saying that IBS is parasitic-induced. I have also ready that it is virally-induced. You mentioned tropical doctors. I would be curious to learn how they treat IBS symptoms. Please share.
Hi I have candida and I suspect leaky gut, would this fodmap way of eating help heal and decrease candida? Has anyone had what I have and have helped with the fodmap way? I was following the scd diet and the bone broth and l-Glutamine to heal the gut, well I got insomnia once again? So I stopped and have been sleeping better, I do not know if that was why I could not sleep or not? Any ideas? Thanks …katri
Your insomnia may be due to histamine intolerance (possibly caused by gut dysbiosis). Bone broth can be high in histamine. Damage to your intestinal mucosal lining (and nutritional deficiencies) can reduce the production of the diamine oxidase enzyme which breaks down histamine. Increased (gut) mast cell degranulation, caused by inflammation, and histamine-producing gut flora can further increase histamine levels internally.
Unfortunately I can’t provide any solutions – I am also still looking for the answer to solving gut dysbiosis. It is worth making sure that your stomach acid levels are not too low and trying to eliminate SIBO.
Katri, I am currently on SCD (no leaky gut though) for frequent severe bloating and gas. I tried elimination diet but my symptoms are so random, it was hard to diagnose what the culprits were (I also suffer if I sit for too long or were restrictive clothing). I also suffer from occasional insomnia–but was not aware that candida and insomnia can be related.
I am interested if you tried FODMAPS and if it affected your symptoms.
I got diagnosed with IBS-D about 20 years ago, but the doc at the time just said I had it with little explanation for what it was or how to deal with it. I thought very little of it then but started taking stuff out of my diet like dairy (tried introducing it again with huge pain!), wheat, etc.
I’ve just recently developed enteropathic arthritis because of the IBS-D and the food I was eating. In my investigation of the arthritis I found the FODMAPS book and have looked more online about it.
I have an issue with animal protein (all of it) and with nightshade veggies as well, as they all cause varying forms of arthritic pain throughout my body. It takes about 2 hours for me to feel pain from what I eat, along with the other IBS symptoms. With nightshades (tomatoes, potatoes, eggplant, capsicum) I feel like someone has pounded my left toe with a hammer (gout). With animal protein I feel pain in my lower back on the right side that radiates down my right leg to the base of my foot (plantar fasciitis).
I feel even more limited to what I can eat than the customary FODMAPS avoidance…and sometimes it can be a bit depressing. Despite missing out on so many types of food, I feel better when I avoid them and I know my body is better for it in the end. I’m also a bit overweight so now that I’ve cottoned on to this whole way of eating, I’m beginning to lose weight! I think the fat I kept on my body was a protection against all the ‘poison’ my body thought it was ingesting.
If anyone else out there has these issues I’d love to read from you or see how you manage with food!
Ava – I have the exact same problems. What have you found helps you? I’m investigating protein, fructose and oxalates. Leaves me with not much.
Do you think there could be a link between Lichen Simplex Chronicus (skin disorder) and IBS?
Yes. Read Sarah Ballantyne’s new book out on autoimmune disease. She’s also known as The Paleo Mom. Great resource.
No such things as an autoimmune disease. It is caused an infection, which is what is not detected. So doctors give bogus names for them.
Many times it’s an out-of-control Epstein-Barr viral infection, which is particularly insidious because it can ‘hide’ from the immune system. Strep is a co-infection. It wasn’t until I addressed the underlying infections and heavy metal toxicity that my health finally began to improve. Oil of oregano and olive leaf extract work really well, along with a variety of NutraMedix tinctures. Be warned, though, that you have to be in it for the long-haul, about a year of rotating the herbs and being on an anti-EPV diet.
So I’m waiting for my GCSA Stool Analysis to come back.
How would you recommend one over comes fructose AND fat malobsotion while on a SCD diet to treat IBS? I don’t see where ever I can get my calories from other than Meat a few veg and nut butters ( Luckily I can tolerate)
I would love it if someone can shine some light onto this.
The paleo autoimmune approach has worked better for me than anything I’ve ever tried regarding diet. It is pretty much a low-to-no FODMAPS diet.
The only other thing that has helped in addition to this is addressing my financial challenges (stress) and also digesting repressed rage with an emotional growth facilitator. The day I did that my depression and anxiety completely transmuted itself into confidence, love and strength with a clear head beyond my wildest dreams!
Thanks for your comment. How will I find an emotional growth facilitator in my area?
I had a perforated colon, emergency surgery and developed a deep pelvic abscess two years ago. Have never been able to regain my ability to eat or digest comfortably. Have had some success w/probiotics, FODMAPs diet and acupuncture, but lost 10% of my body weight and still can only eat a limited number of foods in small quantities. If anyone has suggestions- I would be grateful. I do not digest fats well including animal protein, legumes and wheat. Am wondering about digestive enzymes (but which ones)? Thanks! Jane
I take Digest Gold by Enzymedica. They are an absolute lifesaver.
Thanks so much for this suggestion. I tried a digestive enzyme, Rainbow Light, but it wasn’t effective. Am certainly willing to try Digest Gold. Appreciate you taking the time to reply!
I love Rainbow Light vitamins, but their enzymes actually contain beet root fiber, which is a FODMAP (contains high amounts of Oligos – both fructans and GOS). 🙁 Other supplements like probiotics sometimes contain inulan… what a pain!
I am struggling with many of these issues . . . very severe abdominal distention. I have just begun a low-Fodmap and have been given a script for the antibiotic xifaxan which I hope to fill in the next few days. I also just picked up Florastor today, however, I would prefer to try one thing at a time to see what actually may be working or harming.
I very much miss my daily apple, soy milk, and brussel sprouts!
Just thought I’d recommend a book relating to this conversation involving IBS/SIBO and FODMAPs.
It’s called “Fast Tract Digestion IBS: Science-based Diet to Treat and Prevent IBS and SIBO without Drugs or Antibiotics” by Norman Robillard Ph.D. It seemed scientifically valid and made sense to me and sheds light on the relationship between FODMAPs, carbohydrate malabsorption, and soluble and insoluble fiber.