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 helping to relieve SIBO and IBS symptoms and is easier to adopt than an elemental or semi-elemental diet. It helps decrease some opportunistic bacterial colonies in the small and large intestine by starving them of a diet high in fermentable FODMAP carbohydrates. Sadly, the low FODMAP diet also decreases probiotic colonies 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 week is to help reduce opportunistic bacterial colonies in your small intestine and colon that ferment FODMAP’s to a lower populations. During this time, you might have some symptoms of a herx reaction. You might either develop constipation or have diarrhea briefly during this week as your gut microbiome becomes more acclimated (if these issues occur follow the protocols I have outlined in Fix Your Gut.)

The second week to the month of a less restricted FODMAP 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 food sources if possible.

Examples of 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, 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, Apricots, Cherries, Figs, Pears, Peaches, Mango, Watermelon, Guava (Unripe), High Fructose Corn Syrup, Agave Nectar, Dates, Honey

Foods With Elevated Amounts of Galactans:

Legumes, Soy Milk, Cashews, Pulses, Snow Peas, Hazelnuts, Peas, Taro, Yucca Root, Custard Apple, Beans

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?

Best App For the Low FODMAP Diet: Monash University Low FODMAP Diet App

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 phases. The first phase of the diet restricts you to meals that have low to no FODMAP potential and should only be followed for a week. The second phase of 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 – First Week 6 7 8 9

Carbs

Arrowroot, Buckwheat Flour (2/3 cup) Buckwheat Groats (3/4 cup), Buckwheat Noodles, Butternut Squash (1/4 cup), Corn (non genetically modified [GM]), Non GM Corn Flour and Meal (2/3 cup), Non GM Corn Pasta, Non GM Corn Tortillas (no added gums or fiber), Kelp Noodles, Lentils (1/2 cup canned), Mung Beans Sprouted (2/3 cup), Millet Flour (2/3 cup), Oats (oats, coarse oatmeal), Peanuts (thirty two peanuts), Plantain, Non GM Polenta, Potatoes (flour, starch, red, russet, yellow), Pumpkin (1/2 cup canned) Quinoa, Rice (brown, brown rice noodles, jasmine, flour, sushi) Rutabaga, Sorghum Flour (2/3 cup), Sweet Potato (1/2 cup), Tapioca Flour, Tapioca Starch, Taro (1/2 cup), Teff Flour (2/3 cup), Plain Non GM Tofu (2/3 cup)

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 / Dairy Alternatives

Almond Milk (no additives except vanilla extract, one cup), Hard Cheeses, Macademia Milk (no additives except vanilla extract, one cup), Rice Milk (no additives except vanilla extract, one cup), Yoghurt (goat lactose free)

Fats

Pastured Ghee, Pastured 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, Pastured Tallow, Pastured Bacon Fat

Fruit

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

Acai powder (tablespoon), Blueberries (1/4 cup), Breadfruit, Cantaloupe (3/4 cup), Clementine, Cumquat, Carambola, Dragon Fruit, Durian, Grapefruit, Grapes (one cup), Guava (two medium ripe), Honeydew Melon, Kiwi (two small peeled), Lemons, Limes, Mangosteen (two medium), Oranges, Papaya, Passion Fruit (two fruits), Paw Paw, Pineapple (one cup), Prickly Pear, Raspberries (thirty berries), Rhubarb, Starfruit, Strawberries, Tamarind

Fish / Meat / Seafood / Eggs

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

Nuts / Seeds / Nut Butters

Limit to One to Two Servings Daily:

Brazil Nuts, Chestnuts, Chia Seeds, Hazelnuts (ten nuts), Hemp Seeds, Macadamia Nuts (twenty nuts), Pumpkin Seeds, Sesame Seeds, Sunflower Seeds, Pecans (ten halves), Pine nuts (one tablespoon) Pumpkin Seeds, Walnuts (ten nut halves), 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), Honey (one teaspoon daily), Maple Syrup (one tablespoon daily), Stevia

Vegetables

Alfalfa (two cups), Arugula, Bamboo Shoots, Bean Sprouts, Bok Choy (one cup), Carrot, Chives, Choko, Choy Sum, Collard Greens, Cucumber, Eggplant (one cup), Green Onion(green part only), Kale, Kohlrabi, Lettuce, Mustard Greens, Nori, Olive, Oyster Mushroom, Parsnip, Radish, Red Bell Pepper, Silverbeet, Spinach, Squash, Swiss Chard, Tomato (common), Turnip, Turnip Greens, Water Chestnuts, Witlof, Zucchini (1/2 cup chopped)

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

Carbs

Arrowroot, Black Beans (1/2 cup drained), Buckwheat Flour (2/3 cup) Buckwheat Groats (3/4 cup), Buckwheat Noodles, Butternut Squash (one cup), Corn (non genetically modified [GM]), Non GM Corn Flour and Meal (2/3 cup), Non GM Corn Pasta, Non GM Corn Tortillas (no added gums or fiber), Kelp Noodles, Lentils (one cup canned), Mung Beans Sprouted (2/3 cup), Millet Flour (2/3 cup), Oats (oats, coarse oatmeal), Peanuts (thirty two peanuts), Plantain, Non GM Polenta, Potatoes (flour, starch, red, russet, yellow), Pumpkin (1/2 cup canned) Quinoa, Rice (brown, brown rice noodles, jasmine, flour, sushi) Rutabaga, Sorghum Flour (2/3 cup), Sweet Potato (one), Tapioca Flour, Tapioca Starch, Taro (1/2 cup), Teff Flour (2/3 cup), Plain Non GM Tofu (2/3 cup), yam (one cup diced)

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 / Dairy Alternatives

Almond Milk (no additives except vanilla extract, one cup), Hard Cheeses, Macadamia Milk (no additives except vanilla extract, one cup), Rice Milk (no additives except vanilla extract, one cup), Yogurt (goat lactose free)

Fats

Pastured Ghee, Pastured Butter (one to two tablespoons), Pastured 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, Pastured Bacon Fat, Pastured Tallow, Coconut (2/3 cup shredded)

Fruit

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

Acai powder (tablespoon), Avocado (1/2 cup). Blueberries (1/2 cup), Breadfruit, Cantaloupe (one cup), Clementine, Cumquat, Carambola, Dragon Fruit, Durian, Grapefruit, Grapes (one cup), Guava (two medium ripe), Honeydew Melon, Kiwi (two small peeled), Lemons, Limes, Mangosteen (two medium), Oranges, Papaya, Passion Fruit (two fruits), Paw Paw, Pineapple (one cup), Prickly Pear, Raspberries (1/2 cup), Rhubarb, Starfruit, Strawberries, Tamarind

Fish / Meat / Seafood / Eggs

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

Nuts / Seeds / Nut Butters

Limit to Two to Three Servings Daily:

Brazil Nuts, Chestnuts, Chia Seeds, Hazelnuts (twenty nuts), Hemp Seeds, Macadamia Nuts (thirty nuts), Pumpkin Seeds, Sesame Seeds, Sunflower Seeds, Pecans (twenty halves), Pine nuts (one tablespoon) Pumpkin Seeds, Walnuts (twenty nut halves), 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), Honey (two teaspoons daily), Maple Syrup (one tablespoon daily), Stevia

Vegetables

Alfalfa (two cups), Arugula, Bamboo Shoots, Bean Sprouts, Broccoli (one cup), Bok Choy (one cup), Cabbage (one cup shredded), Carrot, Chives, Choko, Choy Sum, Collard Greens, Cucumber, Eggplant (one cup), Green Beans (fifteen beans), Green Onion(green part only), Kale, Kohlrabi, Lettuce, Mustard Greens, Nori, Olive, Oyster Mushroom, Parsnip, Radish, Red Bell Pepper, Silverbeet, Spinach, Squash, Swiss Chard, Tomato (common), Turnip, Turnip Greens, Water Chestnuts, Witlof, Zucchini (one cup chopped)

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 colonies in the gut. Start with a small dose like 1/4 teaspoon daily to see if you can tolerate it and increase per toleration. For people who cannot tolerate GOS because it is a FODMAP, the human milk oligosaccharide prebiotic Holigos might be better tolerated. 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 colonies. Acacia fiber including Heather’s Tummy Fiber also seems to be well tolerated and has a low chance of causing bloating and discomfort. 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 dysbiosis.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. For some proper fiber intake in our diet helps us to keep our probiotic bacteria colonies intact, and in doing so, they help us accomplish critical digestive tasks. Our probiotic microbiome helps us digest our food better and produce serotonin which improves motility.

You can also try to get more fiber and polyphenols in your diet by eating specific low FODMAP sources 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 an opportunistic 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 ingestion. Avoid if you have celiac disease).
  • Chia seeds
  • Blueberries (1/4 cup) and raspberries (thirty berries)
  • Melons (cantaloupe, honeydew)
  • Oranges
  • Spinach
  • Arugula
  • Rutabaga
  • Organic potatoes with skin (avoid if you have issues with nightshades)
  • Quinoa (avoid if you have issue with saponins)
  • Brown rice
  • Yam (one cup diced)
  • Buckwheat
  • Carrots
  • Parsnips
  • Plantains
  • Low FODMAP nuts
  • Butternut squash (1/4 cup)
  • Spaghetti squash (1/4 cup)
  • Fresh cooked organic corn
  • Eggplant (avoid if you have issues with nightshades)
  • Sweet potato (1/2 cup)

In addition, maintaining proper hydration, using a Squatty Potty, movement (walking), chewing your food well, eating only three meals daily and during the daytime, and proper magnesium supplementation 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 or 2-FL (Holigos) 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 Mycobacterium Avium paratuberculosis dysbiosis, dairy consumption, arabinogalactans, beef sourced collagen, and the use of the prebiotic GOS should be restricted and instead be replaced with the prebiotic 2-FL and the use of acacia fiber. Supplemental butyrate or non dairy GOS dietary intake (small amounts of beans) may be needed in people with MAP dysbiosis.24

Conclusion

The low FODMAP diet should only be used for a short period for symptom reduction if needed, and everyone that is suffering from SIBO should not use it. Its effects on the probiotic microbiome are unknown long-term and what two studies that we have shown that it may hinder recovery and cause relapses for people trying to return to a somewhat regular diet from a lack of a probiotic microbiome. There are ways to protect the probiotic microbiome slightly from a low FODMAP diet; they include ingestion of dietary SCFA’s, prebiotics, and low FODMAP sources of fiber. I still recommend the low FODMAP diet for people who are suffering from extremely symptomatic SIBO to see if it brings them some relief.

  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
21 Comments
  1. If you have a Klebsiella Pneumonia overgrowth, should you follow a low FODMAP diet? I knew I should be following a low starch diet, but wasn’t sure about FODMAP’s.
    Thanks!

  2. Do you have a book to follow this special diet? I have methane sibo severely. Thank you

  3. 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.

  4. 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.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.