Low FODMAP Diet, What is it and How to Make it Work For You

Low FODMAP Diet, What is it and How to Make it Work For You

The low FODMAP diet was developed at the Monash University in Melbourne Australia. It is a great diet for treating SIBO and IBS and is easier to adopt than an elemental or semi-elemental diet. It helps decrease some opportunistic bacteria in the small and large intestine by starving them of the fermentable FODMAP carbohydrates that they need to survive. Sadly, the low FODMAP diet also decreases probiotic flora as well over time.1 2

FODMAP stands for fermentable, oligo, di, monosaccharides, and polyols. Mono-di-oligosaccharides are different types of carbohydrates. A polyol is a sugar alcohol which has lower caloric content than most other carbohydrates. The goal of the diet is to restrict the amounts of FODMAPS you consume in your diet to a bare minimum. The low FODMAP diet will hopefully reduce your symptoms if you suffer from SIBO.3

The extremely limited diet during the first month is to help reduce opportunistic bacteria in your small intestine to a lower population. During this time, you might have some symptoms of a herx reaction. You might either develop constipation or have diarrhea briefly during this month as your gut microbiome becomes more acclimated (if these issues occur follow the protocols I have outlined in Fix Your Gut.)

The second month of the diet adds a few low FODMAP foods into the diet as a test to see if your gut can now handle FODMAPS. FODMAPS need to be added back slowly into the diet after the second month. I would add more fruit in first, and increase the servings to about two to three daily. If you can tolerate an increase of fructose in your diet then slowly add in lactose and high FODMAP foods like onions and garlic. I would still avoid wheat, polyols, and most FOS’s if possible.

Different Foods That Are Restricted on a Low FODMAP Diet4 5

Foods With Elevated Amounts of Fructans(FOS):

Artichoke, Spelt, Freekeh, Cous Cous, Cho Cho, Bourghal, Garlic, Leek, Onion, Spring Onion (White Part), Shallots, Wheat, Rye, Barley, Inulin, FOS Prebiotic Supplements, Watermelon, Cashews, Pistachios, Asparagus, Broccoli, Peaches, Almonds, Hazelnuts (twenty plus nuts), Persimmon, Tamarillo, Choko, Nectarines, Pomegranates, Chicory Root, Snow Peas, Okra, Brussel Sprouts, Butternut Pumpkin, Amaranth, Savoy Cabbage, Grapefruit, and Beetroot

Foods With Elevated Amounts of Fructose:

Apples, Cherries, Figs, Pears, Peaches, Mango, Watermelon, Guava (Unripe), High Fructose Corn Syrup

Foods With Elevated Amounts of Galactans:

Legumes, Soy Milk, Cashews, Cassava, Pulses, Snow Peas, Hazelnuts (twenty plus nuts), Peas, Taro, Yucca Root, Custard Apple

Foods With Elevated Amounts of Lactose:

Milk, Fresh Cheese, Ice Cream, and Custard

Foods With Elevated Amounts of Polyols:

Apples, Apricots, Avocado, Blackberries, Cherries, Lychees, Pears, Nectarines, Plums, Prunes, Watermelon, Cauliflower, Celery, Mushrooms, Snow Peas, Sweet Corn, Sweet Potato, and Sugar Alcohols / Sweeteners (Xylitol, Sorbitol, Mannitol, Isomalt, Maltitol)

What Foods Can I Eat on a Low FODMAP Diet?

The low FODMAP diet limits a number of different foods you can eat daily. Even though, your choices are limited you can still cook a lot of different meals on a low FODMAP diet. It might be difficult to at restaurants, but most Americans need to eat healthier home cooked meals more often.

There is some conflict about what foods are allowed on the low FODMAP diet and what foods should be avoided. My safe food list is a list of foods that have the lowest amounts of FODMAPS, if any. That way you do not have to worry if you are sticking to the low FODMAP diet or not.

My version of the low FODMAP diet is divided into two months. The first month the diet restricts you to meals that have very little FODMAPS. In the second month, the diet includes low amounts of FODMAPS to acclimate your gut so that when you discontinue the diet you should be able to digest FODMAPS.

Low FODMAP – Low Fermentation Diet Safe Food List 6 7 8 9

Carbs – Must be consumed hot after preparation (NO RESISTANT STARCH)

Arrowroot, Buckwheat Groats, Buckwheat Flour, Millet, Jasmine Rice, Sushi Rice, Corn (non-GMO), Potatoes (red, russet, yellow), Quinoa, Plantain, Tapioca Flour, Sorghum Flour, White Rice Flour, Rutabaga, Butternut Squash (1/4 cup), Spaghetti Squash, Yam

Condiments

Hot Sauce (check for added FODMAPS), Organic Mustard, Organic Tamari Soy Sauce, Apple Cider Vinegar, Tomato Paste (no added FODMAP ingredients Like garlic and onions), Homemade Broth (no FODMAPS), Homemade Mayo (no FODMAPS, good recipe: http://whole30.com/2014/05/mayo/)

Dairy

Hard Cheeses

Fats

Ghee, Lard, Macadamia Nut Oil, XCT Oil, Brain Octane Oil, Organic Extra Virgin Olive Oil, Extra Virgin Sesame Oil, High Oleic Sunflower Oil, Organic High Oleic Peanut Oil, Tallow

Fruit

Limit to Two Servings Daily, Must be Fresh, Not Canned Fruit:

Blueberries, Breadfruit, Clementine, Cumquat, Dragon Fruit, Mangosteen, Paw Paw, Starfruit, Cantaloupe, Grapefruit, Honeydew Melon, Kiwi, Lemons, Limes, Oranges, Papaya, Passion Fruit, Pineapple, Raspberries, Rhubarb, Strawberries

Fish / Meat / Seafood / Eggs

Most fish / seafood / meat / eggs are permitted except processed meat with added FODMAPS.

Nuts / Seeds / Nut Butters

Limit to One Serving Daily:

Chia Seeds, Brazil Nuts, Pumpkin Seeds, Hazelnuts, Macadamia Nuts, Sesame Seeds, Sunflower Seeds, Pecans, Pumpkin Seeds, Walnuts, Nut Butters (made with listed low-FODMAP nuts or ingredients)

Seasoning / Spices

Most are fine except for spices obtained from FODMAPS (for example, no, onion and garlic powder.)

Sweeteners

Dextrose (non-GMO), Maple Syrup (one tablespoon daily), Stevia

Vegetables

Alfalfa, Bamboo Shoots, Bean Sprouts, Bok Choy, Carrot, Chives, Choko, Choy Sum, Collard Greens, Green Beans, Cucumber, Kale, Lettuce, Mustard Greens, Olive, Parsnip, Radish, Red Bell Pepper, Spinach, Squash, Swiss Chard, Tomatoes, Turnip, Turnip Greens, Zucchini, Arugula, Aubergine, Eggplant, Fennel, Okra, Nori, Celeriac

Moderate FODMAP Diet – Moderate Fermentation Safe Food List 10 11 12 13

Carbs – Must be consumed hot after preparation (NO RESISTANT STARCH)

Arrowroot, Buckwheat Groats, Buckwheat Flour, Millet, Jasmine Rice, Sushi Rice, Corn (non-GMO), Potatoes (red, russet, yellow, no sweet), Quinoa, Plantain, Sorghum Flour, Tapioca Flour, White Rice Flour, Rutabaga, Butternut Squash (1/2 cup), Spaghetti Squash, Yam

Condiments

Hot Sauce (check for added FODMAPS), Organic Mustard, Organic Tamari Soy Sauce, Apple Cider Vinegar, Tomato Paste (no Added FODMAP Ingredients like garlic and onions), Homemade Broth (no FODMAPS), Homemade Mayo (no FODMAPS, good recipes: http://whole30.com/2014/05/mayo, http://nomnompaleo.com/post/3440774534/paleo-mayonnaise)

Dairy / Fats

Avocado Oil, Butter (two tablespoon daily), Extra Virgin Coconut Oil, Ghee, Hard Cheeses (cheddar, parmesan), Lard, Macadamia Nut Oil, XCT Oil, Brain Octane Oil, Organic Extra Virgin Olive Oil, Extra Virgin Sesame Oil, Sour Cream (one tablespoon daily), High Oleic Sunflower Oil, Organic High Oleic Peanut Oil, Tallow

Fruit

Limit to Three Servings Daily, Must be Fresh, Not Canned Fruit:

Avocado (1/4 daily), Bananas (ripe only), Blueberries, Breadfruit, Clementine, Cumquat, Dragon Fruit, Mangosteen, Paw Paw, Grapes, Starfruit, Cantaloupe, Grapefruit, Honeydew Melon, Kiwi, Lemons, Limes, Oranges, Papaya, Passion Fruit, Pineapple, Raspberries, Rhubarb, Strawberries

Fish / Meat / Seafood / Eggs

Most fish / seafood / meat / eggs are permitted except processed meat with added FODMAPS.

Nuts / Seeds / Nut Butters

Limit to Two Servings Daily:

Chia Seeds, Brazil Nuts, Hazelnuts, Macadamia Nuts, Sesame Seeds, Sunflower Seeds, Pecans, Pumpkin Seeds, Walnuts, Nut Butters (made with listed low-FODMAP Nuts or ingredients)

Seasoning / Spices

Most are fine except for spices obtained from FODMAPS (for example, no, onion and garlic powder.)

Sweeteners

Limit To Two Servings Daily, Except Stevia:

Dextrose (non-GMO), Maple Syrup, Stevia

Vegetables

Alfalfa, Bamboo Shoots, Bean Sprouts, Bok Choy, Carrot, Celery (two stalks MAX), Chives, Choko, Choy Sum, Collard Greens, Eggplant, Green Beans, Green Onion (green part only), Kale, Lettuce, Mustard Greens, Parsnip, Radish, Red Bell Pepper, Spinach, Squash, Swiss Chard, Tomatoes, Turnip, Turnip Greens, Zucchini, Arugula, Aubergine, Eggplant, Fennel, Okra, Nori, Celeriac, Cabbage, Red Cabbage

How to Improve the Low FODMAP Diet So It Works for You!

Some people have great results with the low FODMAP diet and others not so much. Is there any way to optimize the low FODMAP diet so that it can help more people achieve symptom relief from overgrowth in the gut while addressing its drawbacks? The low FODMAP diet mainly should be used for symptom reduction so if you have overgrowth you can hopefully find some relief and try to reduce it through antimicrobial protocols. The low FODMAP diet does have issues, and long-term use of the diet may increase the time it takes for the gut to heal and recover from overgrowth. Those issues include: 14

  1. It may reduce probiotic bacteria in the gut as well including Bifidobacteria and Lactobacillus.
  2. It may reduce diversity in the gut. Studies have shown the more diverse your gut, the more likely they will have fewer digestive issues.
  3. It may reduce SCFA production in the gut.
  4. May slow motility because of reduction of fiber and probiotic bacteria in the diet.
  5. Increases intestinal pH leading to a greater chance in overgrowth.

So how can these issues be addressed so that the low FODMAP diet can work for you? Supplementation of specific prebiotics, fibers, and foods rich in SCFA’s may help make up the gut health deficits in the low FODMAP diet and improve your outcome when using the diet.

Ways to Reduce the Amount Of Probiotic Bacteria Lost on the Low FODMAP Diet

Most probiotic bacteria require FODMAPS in our diet to ferment so that they can thrive and improve our microbiome. Well-fed probiotic bacteria keep our digestive system happy, helping to maintain our immune system, motility, mental health, and sleep. Even though FODMAPS keep our probiotic flora happy, they also feed some of the opportunistic bacteria as well, like Clostridia and Klebsiella. The low FODMAP diet works well in reducing hydrogen-producing bacterial overgrowth.15 16

What can be done so that the loss of probiotic bacteria is reduced when on the low FODMAP diet? Increased intake of low fermentable fiber like acacia fiber may help. Using the prebiotic GOS (which is a FODMAP) may help as well. GOS, even though it is a FODMAP, seems to feed the opportunistic bacteria less, and increases probiotic bacteria in the gut. Cellulose fiber is a low fermenting bulking agent that might increase Bifidobacteria in the colon. Even know it is not well known as a prebiotic, ingestion of collagen has been found to increase Bifidobacteria. Start with small amounts of any of the low FODMAP fibers or prebiotics, mixed well in filtered water in the morning to see if it improves your gut health. Too much of any of these recommendations may still create digestive issues in people with overgrowth. 17 18 19

Increasing Fiber in the Low FODMAP Diet to Help Motility

Any of the above recommendations may help increase motility in the gut. One of the biggest complaints of the low FODMAP diet is that it seems to worsen constipation. The clean fiber in our diet helps keep our probiotic bacteria happy, and in doing so they accomplish important tasks, including the production of serotonin to help move our food along in our digestive system.

You can also try to get some fiber in your diet eating certain low FODMAP if you can tolerate them. The starches on this list must be consumed hot; resistant starch, when cooled, may cause digestive problems in people that have overgrowth in their digestive systems. Finally, try to purchase organic or locally grown food whenever possible. Some of these foods include:

  • Certified gluten free oatmeal (some people might have issues with the opioid peptide avenin in oats if they have issues with gluten. Avoid if you have celiac disease).
  • Chia seeds
  • Berries
  • Melons (cantaloupe, honeydew)
  • Oranges
  • Spinach
  • Rutabaga
  • Organic potatoes with skin (avoid if you have issues with nightshades)
  • Quinoa (avoid if you have issue with saponins)
  • Brown rice
  • Yam
  • Buckwheat
  • Carrots
  • Parsnips
  • Plantains
  • Low FODMAP nuts
  • Butternut squash (1/4 cup)
  • Spaghetti squash
  • Millet
  • Okra
  • Eggplant (avoid if you have issues with nightshades)

In addition, maintaining proper hydration, using a squatty potty, and magnesium intake may help improve sluggish motility.

Obtaining SCFA’s From Your Diet to Improve the Gut While on the Low FODMAP Diet

Reduction in probiotic bacteria including Bifidobacteria and Lactobacillus from long-term diet changes may reduce SCFA production in the gut. Short chain fatty acid metabolism by the bacteria in our intestinal tract does a lot to improve our health. The production of acetate for example by Lactobacillus creates many beneficial actions in the gut. Acetate has antimicrobial properties, enhances lipogenesis and cholesterol synthesis, improves gluconeogenesis, and reduces intestinal pH. The production of butyrate by some Clostridium strains and Bifidobacteria also improves our digestive health. Butyrate improves the health of our enterocytes, has antimicrobial properties, improves mucosal integrity, reduces the formation of colon cancer cells, and increases energy levels.20 21 22 23

You can take supplemental acetate and butyrate, but these supplements are highly concentrated, and most people seem not to tolerate them as well as obtaining these SCFA’s in the diet.

The easiest way to increase acetate is just to ingest organic raw, unfiltered apple cider vinegar. You may need to avoid this if you have histamine issues, apple cider vinegar does contain histamine. Increasing butyrate ingestion is just as easy. Organic grass fed butter, organic or raw European hard cheese, and organic pastured ghee are sources of dietary butyrate. Most people with digestive issues can tolerate at least one of these foods. Finally, taking a prebiotic supplement if needed like GOS has been shown to increase SCFA acid production in the gut and increase concentrations of probiotic bacteria in the gut. Sadly, if you are suffering from an overgrowth of MAP, dairy consumption, arabinogalactans, and GOS should be restricted. Supplemental butyrate or GOS intake through the diet (small amounts of beans) may be needed in people with MAP overgrowth. 24

  1. http://www.med.monash.edu/cecs/gastro/fodmap/
  2. http://www.med.monash.edu/cecs/gastro/fodmap/
  3. http://www.med.monash.edu/cecs/gastro/fodmap/
  4. http://www.med.monash.edu/cecs/gastro/fodmap/
  5. http://ethicalnutrients.com.au/sites/default/files/fodmaps-tech-data.pdf
  6. http://www.med.monash.edu/cecs/gastro/fodmap/
  7. http://ethicalnutrients.com.au/sites/default/files/fodmaps-tech-data.pdf
  8. http://www.cassandraforsythe.com/blog/complete+fodmap+list+for+a+happy+gut
  9. http://www.eat-real-food-paleodietitian.com/paleo-diet-and-fodmap.html
  10. http://www.med.monash.edu/cecs/gastro/fodmap/
  11. http://ethicalnutrients.com.au/sites/default/files/fodmaps-tech-data.pdf
  12. http://www.cassandraforsythe.com/blog/complete+fodmap+list+for+a+happy+gut
  13. http://www.eat-real-food-paleodietitian.com/paleo-diet-and-fodmap.html
  14. http://www.ncbi.nlm.nih.gov/pubmed/25016597
  15. http://www.ncbi.nlm.nih.gov/pubmed/25016597
  16. http://www.breakingtheviciouscycle.info/knowledge_base/detail/fos-fructooligosaccharides/
  17. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3435782/
  18. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3145055/
  19. http://www.ncbi.nlm.nih.gov/pubmed/16543561
  20. http://www.ncbi.nlm.nih.gov/pubmed/16543561
  21. https://www.sciencedaily.com/releases/2015/09/150929070122.htm
  22. http://foodandnutritionresearch.net/index.php/fnr/article/viewFile/1801/1708
  23. http://gut.bmj.com/content/35/1_Suppl/S35.full.pdf
  24. http://huntgatherlove.com/content/human-colon-evolution-part-4-secrets-butyrate
9 Comments
  1. Hi John. What do you think of Dr. Norman Robillard’s Fermentation Potential concept (as outlined in his book Fast Tract Digestion: IBS)? I find it interesting, because other IBS diets (FODMAP, SCD, GAPS) seem arbitrary in many ways (allowing certain fermentable carbs, but not others), and rarely take normal serving size of these foods into consideration. Although Dr. Robillard’s book falls short in many respects (for example, he seems to think you can just follow this diet indefinitely and shows no specific concern for nutrition or fiber intake), however, the Fermentation Potential measure he’s devised seems like it could be a very promising tool for IBS sufferers.

  2. Hello everyone.

    I had some problems in the recent months, I used to follow a high protein diet (I like body building) and i’m also celiac.

    This summer I got a food poisoning and there all has gone so bad. Vomiting all night and diarrhea, for 3 days I couldn’t touch food, started to have GERD with nausea, bloating, depression, rosacea on the face. After 2 months the doctor gave me PPI and gaviscon, but I had no relief.

    In september I had a endoscopy, where they found Esophagitis and bile in the stomach, continued with PPI and changed a few other meds but got no improvements.

    So I changed doctor, who touching me found out that my liver was a bit too big, sending me to do an ecography (which resulted in nothing bad, just a bit of fat liver) and prescribing prokinetics.

    I’m now one month in to the new cure and still feeling bad after every meal, I dont smoke, I dont drink, my diet is good.

    Do you think I should do a SIBO breath test? Nichel patch test?

    This thing is also ruining my social life cause I feel ill at ease everytime my friends ask me out for dinner.

    Thanks for any help.

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