Low-FODMAP Diet – Foods to Avoid in IBS and Bloating

Short-Chain Carbohydrates May Cause Chronic Bloating and Diarrhea

It was found out that certain people complaining about abdominal bloating, excessive gas, chronic diarrhea or constipation, diagnosed with ‘dyspepsia’, irritable bowel syndrome (IBS) or functional bowel disease (FBD), actually cannot tolerate certain short-chained carbohydratescalled FODMAPs (1).

What Are FODMAPs?

FODMAPs (Fermentable Oligo-, Di-, and Mono-saccharides, And Polyols) are short-chain carbohydrates that are:

  • Osmotically active, so they, after ingesting, drag water from the intestinal vessels into the intestinal lumen, thus causing diarrhea
  • Fermentable (degradable by intestinal bacteria yielding large amount of gases, like hydrogen or carbon dioxide, thus causing abdominal bloating

FODMAPs include:

  • Oligosaccharides:
    • Fructans – chains of fructose with one glucose molecule on the end. Only minimal amounts of fructans may be absorbed in human intestine. They may interfere with absorption of fructose, thus aggravating symptoms in fructose malabsorption. Fructans-rich foods are: wheat (white bread, pasta, pastries, cookies), onions, and artichokes; other not commonly problematic foods with fructans are asparagus, leeks, garlic, chicory roots and chicory based coffee substitutes. Fructans with over 10 molecules of fructose in a chain are known as inulins and those with less than 10 fructoses are referred as fructo-oligosaccharide (FOS) or oligofructose. Fructans cause problems mainly in fructose malabsorption.
    • Galactans (like stacchyose and raffinose) are chains of galactose molecules with one fructose molecule on the end. They act much like fructans. Main galactans-rich foods are legumes (soy, beans, chickpeas, lentils), cabbage and brussel sprouts.
  • Disaccharides:
    • Lactose (milk sugar). Lactose is in dairy products, but it may be also found in chocolate and other sweets, beer, pre-prepared soups and sauces, and so on. Lactose is poorly absorbed in lactose intolerance, SIBO and in small intestinal inflammation (Crohn’s disease, celiac disease).
  • Monosaccharides:
    • Fructose (fruit sugar). Fructose-rich foods are honey, dried fruits like prunes, figs, dates, or raisins, apples, pears, sweet cherries, peaches, agave syrup, watermelon, papaya. Fructose is often added to commercial foods and drinks as high fructose corn syrup (HFCS). Fructose causes symptoms even in healthy people, if ingested in excess, especially in fructose malabsorption, but also in SIBO.
  • Polyols, also known as sugar alcohols (appearing as artificial sweeteners in commercial foods and drinks):
    • Sorbitol  may appear in “sugar-free chewing gum”, “low calorie foods”; naturally it appears in stone fruits: peaches, apricots, plums).
    • Xylitol naturally appears in some berries. A pack of chewing gum containing sorbitol or xylitol may cause bloating or diarrhea in a healthy child and especially in persons with fructose malabsorption or SIBO.
    • Other polyols, like mannitol, isomalt, erithrytol, arabitol, erythritol, glycol, glycerol, lactitol, ribitol, may be problematic in fructose malabsorption and SIBO.

Approach to a Low-FODMAPs Diet

In unexplained chronic diarrhea or bloating, FODMAPs should be considered as a possible cause, so their amount in the diet should be LIMITED (not necessary totally excluded).

General approach is to take off as much as possible FODMAPs from the diet for six to eight weeks. If FODMAPs are the cause of the symptoms, they should lessen considerably in the first week. Additional weeks of diet bring some rest to the small intestine and cause reduction of overgrown intestinal bacteria.

After six weeks, some foods that will least likely cause symptoms can be introduced back into the diet (diet challenge), one type of food every fourth day. For example, on the first day of the seventh week, a piece of food low in lactose, like yogurt, can be tried, and if in the next 72 hours no symptoms appear, other dairy products can be tried, and waited 72 hours again. If still no symptoms, it is not likely that dairy is problematic, or at least not problematic when taken in a limited amount. If symptoms appear, this speaks for lactose intolerance, so dairy should be avoided and next type of foods tried. This can be some low-fructose food like banana, then after 72 hours orange and then other foods with increasing amount of fructose. If you can eat 5 prunes in a row without having abdominal symptoms thereafter, it is not likely you have fructose malabsorption.

A registered dietitian may be needed to give instructions about introduction of the low-FODMAP diet and diet challenge.

Possible Symptoms of a FODMAP-Rich Diet

Excessive FODMAPs intake may cause:

  1. Diarrhea, since FODMAPs are osmotically active, so they drag water from the intestinal vessels into the intestine
  2. Bloating and flatulence, since FODMAPs are broken down (fermented) by intestinal bacteria to gases like hydrogen, carbon dioxide or methane
  3. Excessive belching (burping)
  4. Abdominal pain
  5. Unintentional weight loss
  6. Symptoms of vitamin and mineral deficiency, like paleness, tingling, tiredness, depression
  7. Headache

FODMAPS may also aggravate symptoms of:

How Long Should a Low-FOODMAP Diet Last?

When problematic FODMAPs are identified, some people will need to strictly avoid them for life, if they want to be symptoms free, others will be able to ingest them in a limited amount. General rule is: do not eat FODMAPs-rich foods in large amount in one sitting and do not eat them every day.

If Low-FODMAP diet does not lessen your abdominal symptoms, consider having tests for food allergies, dumping syndrome, celiac disease, and inflammatory bowel disease (Crohn’s disease).

Can a Low-FODMAP Diet Be Dangerous?

Low-FODMAP diet should not be introduced by any person with diabetes, hypoglycemia or other metabolic disorders, or in malnutrition, without prior consultation with a doctor. It may be necessary to interrupt Low-FODMAP diet in any severe acute disease, after injury or surgery and in other urgent situations.

None of FODMAPs (fructans, galactans, fructose, lactose, polyols) is essential nutrient for human, though, meaning they are not necessary for life.

Foods to Avoid in IBS

Foods that irritate individuals diagnosed with IBS, differ from person to person. It was found out that in many of them FODMAPs-rich foods are the culprit (1).

Related Articles:

References:

  1. Low-FODMAP diet (healthsystem.virginia.edu)
  2. Polyols – sugar alcohols (sugar.org)
About Jan Modric (249 Articles)
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  • kim kelson

    I am an Australian Dietitian.Can I suggest you amend the information here and specify that cheese(hard types)DO NOT contain lactose.soft types such as ricotta cheese do contain lactose.it is a common misconception–patients frequently confuse lactose intolerance with cows milk protein intolerance or allergy

  • Jan Modric

    Hello, I appreciate your input. I’ve put yoghurt as the first testing food for lactose intolerance instead of cheese, which probably don’t cause any symptoms in most persons with lactose intolerance.

    You may also want to check my article about lactose intolerance:
    http://www.healthhype.com/what-is-lactose-intolerance-symptoms-test-diet-medicine.html

  • Ali

    hi Jan — the list is fairly extensive and rather disturbing, as it leaves out so many “healthy foods” for people that want to pursue FODMAP diet. Can you suggest a list of foods that CAN be consumed while on FODMAP diet? I know the simple rule would be to just avoid everything listed on this page, but still, perhaps even someone prepared such a list.

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  • Jan Modric

    Ali,

    wheat, legumes and onions are disturbing only for some people with IBS, so these foods are “to try”.

    Most of vegetables, if not sweetened, can be OK.

    Meat, fish and eggs should not be problematic in IBS.

    Dairy products are problematic for those with lactose intolerance or milk allergy.

    Listed foods are commonly problematic for people with IBS, but anyone should make his own list – so it’s not that *all* listed foods are problematic for everyone.

  • suncity

    I am so happy to see this. I suffer from diagnosed SIBO and these foods are exactly those that cause problems for me. Thank you for posting this.

  • petesy

    Does the low FODMAP diet mean excluding FOS. Most pro-biotics include FOS to feed the probiotic.

    • Jan Modric

      Petesy,

      Complete low-FODMAP diet means excluding FOS, yes. FOS is not always disturbing in IBS, but it could be. As I currently believe, probiotics may help in food poisoning and during antibiotic treatment (also chemotherapy) to prevent antibiotic-associated diarrhea, but not likely in IBS.

  • dave w

    Wow this is funny, i JUST bought all these foods to switch to a “alkaline” diet, to combat my chronic acidity/reflux…and OF COURSE a ton of it is listed here to avoid haha. Raisins, hummus, soy, garlic…

    Anyway, i was thinking very strongly at trying Probiotics, or another off-shoot of the same thing to help my IBS i supposedly have (pain in side/lack of appetite overall..though it has gotten better). I don’t like taking Bentyl, too many side-effects. I know walgreens had one called SUPER (pro)Biotics that you only need to take once per day, vs. the others where you need to take like 8 pills.

    So thoughts on probiotics etc to clean out your colon and whole system down there?

    • Jan Modric

      Dave,

      I’ve searched a lot about probiotics – there’s no proof they help, except in food poisoning and antibiotic-associated diarrhea. Probiotics, no matter how “super” they are, won’t likely help you, if you ask me. Not sure, why are you taking bentyl, though. Treating IBS with bentyl pushes you in a vicious cycle, because of its side effects. IBS is not treated with drugs, but diet. Anyway, diagnosis of IBS is given only in absence of other abdominal problems, and reflux is not a part of IBS. Cramps can be due to constipation…Have you been tested for H. pylori infection of the stomach? It’s a common cause of excessive acid secretion.

      X-ray cannot reveal disc problems; CT or MRI are needed for that. Stiff back/neck muscles may be the cause or result of the back pain…If anxiousness results in a limb falling asleep, this can be only mediated by nerves – discs disorders could make you prone to such episodes. I’m not trying to convince you that you have DDD, though.

  • jen

    Hi Jan, thanks for your post on the Low-FODMAP diet. This is one of the best diets I have seen to deal with SIBO. I was recently diagnosed with both SIBO and a hiatal hernia which both cause me chronic distress. I follow a very healthy diet and workout regularly so this problem is very disconcerting for me. Unfortunately, the antiobiotic treatment that I was perscribed (Flagyl) did not work and I had an allergic reaction to it. In addition to the diet, do you have any other recommendations for managing this problem?

    • Jan Modric

      Jen,

      there are other antibiotics besides Flagyl…a gastroenterologist should know what’s appropriate. FODMAPs are food for bacteria, so a strict low-FODMAP diet could reduce amount of bacteria. Avoiding sweets (sucrose) and alcohol could also help. However, if you avoid short-chain carbohydrates, it means you probably take more fiber. Soluble fiber may produce quite some gas, but some people with IBS claim that taking soluble fiber as the first thing in the morning help them a lot. Soluble fiber feed bacteria, though…You might want to experiment with different types of fiber.

      Hiatus hernia — it depends on the type — can be treated with losing some weight, if necessary, or by operation.

  • dave w

    I have tested negative for everything so far, H Pylori included. The GI doctor who prescribed me Bentyl obviously thinks it helps the symptoms/side pain. But like i said the side pain has gone away i’d say…75% at least, it used to be daily/nightly, now it’s just a short term pain after SOME meals. Just did Barium test, all ‘looks’ good on that too.

    HOWEVER, i do have a 5 yrs older sister who had a problem with her Galbladder…and had to have it removed, as many others have. My doctor thinks mine is fine because of lack of pain to stomach pressure etc. However again, after asking my sister about what she went through, she said her galbladder problems were very asymptomatic, and did not exhibit the classic signs of having a problem either.

    So my next visit i may insist on checking it anyway, and i will also suggest a food allergy test.

  • Ellen

    Hi Jan

    Thanks for your input on these foods.
    I suffer terribly just from bloating. Not very often that I experience any pain. Just the pressure of the bloating/distention is very uncomfortable. I had a colonoscopy and everything was normal. Had an abdominal ultrasound for gallbladder etc, and that was normal. I tried the probiotics, because everyone seemed to think its the miracle pill…did nothing for me. I tried them all. Doctor gave me some meds to relax my muscles in the abdomin (librax), also does nothing. Except makes me sleep like the dead. The dietician worked out a diet for me. This included pasta (which makes me swell up horribly) and that really surprised me that she would add that to my diet. So for the next 6-8 weeks I will most definitely try your suggestion!
    What fruit and veggies would you recommend to eat?
    And is brown bread ok to eat?

    • Jan Modric

      Ellen,

      what exact type of pasta made you swell up? Was it a plain, non-sweetened pasta from wheat or have you added some sauce? Brown bread could be ok, if you can tolerate wheat, you don’t have celiac disease, and the actual bread is not sweetened.

      If you have a will for a 4 days diet trial, excluding:
      – all fruits, fruit products, sweets and anything containing fructose, HFCS, sorbitol (check the list of these foods) (causing bloating in fructose malabsorption (FM))
      – legumes (beans, peas, lentils, soy), cauliflower, brussel sprouts, onions, leeks, artichokes, asparagus (possibly causing bloating in FM)
      – all dairy and anything containing lactose (check labels…) (causing bloating in lactose intolerance – check lactose free diet)
      – wheat, barley, rye and anything containing gluten (problematic in celiac disease – check gluten free diet)
      – foods, high in soluble fiber: oats…

      This way you exclude most of foods that cause food-related bloating at once. During this diet you could eat meat, fish, eggs, green leafy vegetables, like salad and spinach, potatoes, white (not brown) rice, cornmeal (polenta) and other corn products (but not HFCS). If this do not help, helps in 4 days, I recommend you to have tests for small intestinal bacterial overgrowth (SIBO), fructose malabsorption and celiac disease (one after one). If the diet helps, it means a cause of bloating was in certain excluded foods. Then, in one morning you try a cup of milk – if no bloating during the day, it’s not likely, you have lactose intolerance. The next morning you try barley (contains gluten) – if no bloating, it’s not likely you have celiac disease. Then you try an apple or a pear or few prunes – if you don’t get bloated (not likely…) you don’t likely have fructose malabsorption.

  • Ellen

    Hi Jan

    Thanks for your reply.

    The pasta I made was mixed with tuna and sauce yes.
    I had a colonoscopy done, can they not pick up celiac disease from that?
    Basically they just told me I had IBS-A, and that my bowels were lazy.
    The dietician told me to eat foods high in soluble fiber and gave me Benefiber (the one with wheat dextrin in it)…do you think that would cause bloating?
    I can never really pinpoint the exact cause of anything because I’m forever bloated!
    The food that makes me bloated the most is scrambled eggs, made with some low fat margerine in a pan on 2 slices of brown toast with the same low-fat margerine.
    If I eat fried (in olive oil) fish with a potato and no skin I also bloat. Nothing seems to pass through me without causing bloating! It’s possibly the most frustrating problem to have.

  • Ellen

    Also forgot to mention that I’m on the contraceptive pill, and I take vitamin supplements: vitamin C, magnesium, calcium and a multivitamin…could there be any traces of above ingredients in them?
    One other thing, I had severe food poisoning about a year ago. I was put on a course of antibiotics and probiotics. Would there have been anything that could have survived/overgrown even with the meds?

    • Jan Modric

      Ellen, would you mind to check a personal medical history questionnaire – it could remind you on certain important circumstances…just go from question to question and put all issues into a time line..

      From what exact reason do you take vit. supplements? It can be fructose or sorbitol in them, this could cause bloating, if you have fructose malabsorption. Wheat dextrin could be problematic if it contains gluten and you have celiac disease, which is diagnosed by investigating a sample of duodenal mucosa during upper endoscopy, not colonoscopy.

      Bacteria from food poisoning would not likely survive for a year, and antibiotics or probiotics from then would not likely cause this bloating. But intestinal parasites could persist for this long. Stool test for “ova and parasites” exist.

      Soluble fiber (beans, peas, lentils, soy, oats, oranges..) typically causes gas

      Roughly said, bloating can be caused by 1. certain foods (see my previous comment) or 2. microbes: bacteria (in SIBO) or intestinal parasites.

      Gluten or lactose may be problematic in even tinny amounts, but fructose, sorbitol and other substances mentioned in the article can be usually tolerated in small amounts.

      If you want to find a cause, you have to start somewhere and do it in an organized way.

  • Ellen S.

    Jan, I’m desperately searching for answers, is this IBS or SIBO?? I’m very allergic (skin tests reveal wheat, yeast, potato, peanut, tuna, plum, sesame, and have a familial history of stomach problems– both grandmother and mother. My issues have been increasingly bad, mostly diarrhea then turning to constipation both accompanied lack of appetite, some acidic burning near the stomach and some belching but rarely bloating or gas. My gastroenterologist suspects C-difficile, despite a negative stool test. I did respond to Flagyl, ceased treatment and then after a bout with relentless diarrhea, began again accompanied by a super limited diet. (chicken, rice, eggs, fish, avocado, and turkey and occasional meringues (egg white and sugar) for my sugar fix!!
    I’m definitely intolerant of cabbage, onions, legumes, sorbital, milk products, stevia, splenda, peas, oats, nuts, and wheat, so the FODMAPS may well work for me. I cannot get the doctor on board to try it. I’m losing lots of weight which is a good thing, but want to be healthy too. I have made an appt with a dietitian to discuss this further, but wanted your input too. Also I’ve seen squash on some lists, zucchini on others. What types of squash are of issue?

    • Jan Modric

      Ellen,

      were those allergies confirmed by an official allergologist? Do you actually have any symptoms after eating potatoes? When engaging into diets, like a FODMAP diet, it is good to know what you can eat. Do you know what exact disorders your mother and grandmother had? Were they sensitive to wheat (gluten)?

      IBS is more or less only a term that tells a person gets irritated by certian foods (and/or stress). What’s often hidden under IBS, is:
      1. fructose malabsorption (FM). Being intolerant to sorbitol and legumes may speak for FM. Not sure, but I think most types of squash are high in fructose. Zucchini is something “to try and see”. Here’s a nutrition guide for FM.
      2. lactose intolerance.
      3. SIBO – can be a cause of bloating, but can be also a result of FM or lactose intolerance, since unabsorbed fructose and lactose are food for intestinal bacteria. There is a test for SIBO, but, if SIBO results from FM or lactose intolerance, a low-FODMAP diet should be tried first. If after that bloating still persists, test for sibo can be done.

      Burning stomach may be, among other, from FM, from Helycobacter pylori infection (diagnosis is by an “urea breath test”), acidic foods, vitamin C or acidic medications, like Aspirin or ibuprofen.

      In FM or lactose intolerance, it is an amount of fructose, sorbitol..or lactose rather than a substance itself that is problematic. Many people with FM can tolerate oranges, grapefruit or bananas. Corn (corn bread, cornmeal…) is a good source of carbohydrates, often well tolerated in all mentioned disorders.

      LOW-FODMAP diet
      Test for H. pylori
      Test for FM
      Test for lactose intolerance
      Test for celiac disease (intolerance to gluten: wheat, barley and rye)

      Above steps, one by one can be tried, if necessary.

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  • Ellen S.

    Jan, thank you so much for your insight! I was diagnosed by a board certifed allergist using skin tests. My endocrinologist suggested using the blood tests and rice was reacted to by a trace amt and my beloved chocolate was reacted to at low level.

    My grandmother is long gone and whatever they knew then doesn’t really apply now–she was just told that she had colitis. She certainly didn’t break out in hives like I did! Mom barely eats any raw veggies and makes different food choices so it’s hard to tell. She seems to have some mild allergies but hasn’t(won’t be) been diagnosed. But she bloats, constipates, runs and belches, so it seems very similar.

    I know that I react to wheat so I’m loathe to try a celiac test that requires me to consume it.
    Can’t touch aspirin or ibuprofen, I get terrible stomach pain and the runs.
    Haven’t been able to eat any dairy products (except some hard cheeses) for many years. It totally upsets my gut!

    I haven’t taken any supplements in almost two months. I take tylenol and prescribed drugs only and have really cut back on those with doctor’s permission, only take the most essential ones.

    I’m so frustrated!!! I’ve got an appt to see a registered dietician tomorrow to try and get find a workable diet. I thought I was restricted before, this is a killer!

    I’m allergic to pistachio’s too. How’s almond butter?

    • Jan Modric

      Ellen,

      you can safely eat almond butter, if there is no substances (fructose, sorbitol, lactose, gluten(?)..) that irritate you in the exact product you use. If you’re allergic to pistachios, you could be (not necessary) also allergic to some other nuts, including almonds.

      The problem with multiple fod intolerances can be solved with eliminating diet. Either you remove all posibly irritating foods from your diet at once or one by one and observe the effect.

      One way to go is making a list of foods you think you can safely eat and were not mentioned as problematic after the tests you had.
      Examples of foods that are often well tolerated by people with various intolerances (not necessary that this will fit to your situation): lean meat, fish (if no fish allergy), potatoes, eggs, corn, buckwheat, green salad, spinach, bouillon, celery, escarole, hash-browns, mushrooms, mustard greens, Pea Pods (immature), shallots, oranges, grapefruit, bananas, margarine (without hydrogenated fats). Probably some other foods, but it is important that you strictly stick with only what does not irritate you for a short time, like a week. If this helps considerably, you can start to add other foods one by one and observe their effect. So, first you should find out what you can safely it.

      Besides wheat, barley and rye contain gluten. If you can safely eat barley or rye, you do not likely have celiac disease. Many people who do not have celiac disease can not tolerate wheat.

  • Ellen S.

    Jan, thanks for your quick reply. I seem to tolerate (or was tolerating non-wheat rye bread with margarine. However since the first of the year, I’ve excluded it from my diet as a possible irritant. I agree that I most likely don’t have celiac disease, just an intolerance to wheat. It (among other things) makes me itch and upsets my gut.
    Yes, most protein sources seem to be okay, corn tortillas used to be ok, polenta the same, but eating the actual piece of corn or popped corn in any form, sends me into spasms.
    I”ve never been able to tolerate nuts, but nut butters were fine. However this last round of tests showed that I’m allergic to peanuts. That’s when I switched to almond butter. I seem to be ok with avocados too, but will keep them in moderation. When I eat plain protein, I need something a bit fattier to help me feel satisfied.
    The concept of eating salads when my stomach is upset is so confusing. In the past I eschewed salad green eating daily as they would cause stomach upset for certain.

    I’ll retest potatoes, not sure I understand “new” potato or “immature” pea pod descriptions. I think the potato will be easier to figure out at the market.

    After reading the lactose intolerance, I’m confused. I’m not sick w/in hours, I may get a rumbly gut, but not sick. That will take a couple of days to kick in.
    I guess I continue to be a medical enigma!

    • Jan Modric

      Ellen,

      itch (lips, mouth or skin) after eating wheat can be from wheat allergy. Polenta can be an useful source of carohydrates, especially if you have problems with wheat and rice.

      Potatoes are “new” for some days and weeks after being dug out from the soil. Not sure if this is important in your case. Potatoes may be constipating. Search online about immature pea pods.

      In lactose intolerance, unabsorbed lactose is broken down by normal intestinal bacteria, which yield gas causing rumbling. Symptoms usually appear within 48 hours. Lactose intolerance and fructose malabsorption do not necessary make you sick as food allergies or celiac disease usually do.

      Certain random foods can irritate you without apparent reason. On the other hand, not all foods mentioned in low-FODMAP diet will necessary irritate you.

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  • Ellen S.

    Met with the dietician and came up with a model diet for this week. She’s NOT familiar with FODMAPS but was working with your chart. I think she added in too many things at once. So I’ll go slow. She suggested avoiding eggs for a few days, but while dubious, I’ll give it a try.
    Lunch today contained six corn torilla chips with a small amt of avocado. I’m happy to eat something that isn’t rice. I do have a tube of polenta in the pantry so I’ll try that too. She gave me a good idea about rice pudding made with rice milk and cinnamon, other than constipation, I think I could like that!

  • Ellen S.

    Oops, forgot to say that I ordered “IBS–Free at Last!: A Revolutionary, New Step-by-Step Method for Those Who Have Tried Everything. Control IBS Symptoms by Limiting FODMAPS Carbohydrates in Your Diet.”by Patsy Catsos MS. RD
    from Amazon so I’ll have more recipes and a shopping guide!

  • mradams

    Hi,

    I have just embarked on an exclusion diet based on FODMAP advice after failing to find a solution to my IBS via nay other methods. I was just wondering, re; fructans, if wheat is out, why is barley included on the safe to eat list, as far as I know, from the research I’ve seen, barley contains fructans.

    I guess I’m asking if i should treat barley like wheat and exclude it.

    Many thanks

    Steve

    • Jan Modric

      mradams,

      fructans are in barley leaves, and in a kernel of young barley. I would need to do more research to see what effect may this have on digestion.

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  • mradams

    Thanks Jan,

    I was thinking specifically about processed barley flakes, that is, barley with the outer hull removed. I’ve also read that Spelt (flour, pasta etc) should be avoided, any thoughts on this?

    • Jan Modric

      mradams,

      fructans can trigger symptoms in some individuals and not in others. It also depends on amount – small amounts are often tolerated. So, fructose, sorbitol, fructans do not necessary be excluded completely in all cases. It depends on the personal tolerance limit for those substances. If you can not tolerate wheat (high in fructans), you can have problems with other types of wheat or related grains, including spelt.

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  • SarahJNZ

    Hi,
    I am Coeliac and have just been suggested to try the FODMAP diet to sort out other ongoing issues, but my biggest problem is sugar cravings. How do I beat these? Any suggestions would be apprectiated.
    I would be keen to hear what others have done to beat this.
    Also am currently feeling like there is not going to much that i can eat except Meat and Nuts/Seeds & Rice.

    • Jan Modric

      SarahJNZ,

      if you can reveal what pattern your sugar cravings have, it may help. “Organic” causes of sugar cravings can be rapid stomach emptying resulting in transitional hypoglycemia, and small intestinal bacterial overgrowth (SIBO). Such an overgrowth could be caused by fructose malabsorption – when fructose is not absorbed properly, it stays in the intestine and promotes overgrowth of bacteria, which then “demand” more sugar. Sugar craving may also be a habit, when you think you need sugar, but you actually don’t. It’s a difference between a need and a wish.

      Few days after starting low-FODMAP diet, sugar cravings may even worsen. It’s important you eat regularly and drink enough water to prevent dizzines. I’m pretty sure sugar craving should lessen within a week on this diet. If not, you can consider to have stomach emptying tests, test for SIBO and fructose malabsorption.

      What is your experience with these foods:
      – potatoes
      – corn bead, polenta (cornmeal) and other corn products (should be labeled as gluten free)?

  • SarahJNZ

    Hi Jan,
    I go in phases with cooking Polenta, corn meal bread and other corn based items.
    Potato as well, it just depends. I will have to start using them more.
    My Gastroenterologist wants me to go FODMAP for at least 4 weeks before he organises further testing. But he believes it is fructose Malabsorption which is causing my ongoing bloating and stomach pains.
    Thanks for comments, I think your website is the most informative that I have found on FODMAP diet.

    • Jan Modric

      SarahJNZ,

      in low-FODMAP diet, as you see, lactose, fructose, sorbitol, fructans and galactans are excluded, meaning this is a diet for lactose intolerance plus fructose malabsorption. If you are positive you can tolerate lactose, then you do not need to exclude it. In this case you can try low-fructose diet If you have fructose malabsorption, results would be obvious within few days.

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  • Helenmou

    Hi Jan
    I get severe bloating from a “normal” diet. It keeps me awake at night if I have it. I have been told that I have acid reflux and was given medication by one doctor to stop acid production. However, this medication only works for awhile and then it comes back. I tried to eliminate acid forming foods like coffee, oranges etc but that was not very effective. What is the relationship bewteen acid forming foods and acid reflux? Do you think that the elimating the foods plan you have suggested on this site would help me with the belching and therefore the acid reflux or is there something else I should be doing. I tend ot be constipated most of the time.
    Ellen

    • Jan Modric

      Helenmou,

      acid reflux with upper (?) abdominal bloating and belching can be caused by Helicobacter pylori infection of the stomach. Diagnosis is by blood or breath test or gastroscopy and biopsy; treatment is with antibiotics. In this infection anti-acid drugs alone usually do not help. Low-FODMAP diet could ease the symptoms in this case, but would not likely treat the condition.

      Low-FODMAP diet is basically a combination of lactose-free and low-fructose diet. Symptoms in fructose malabsorption usually include abdomianl gurgling, bloating, belching, diarrhea (not always)…

      Low-FODMAP diet may also help in IBS, but, according to definition of IBS, having gastric reflux excludes the IBS.

      Acidic foods add to existing gastric acidity, but they are mostly large fatty meals (especially before sleep) that trigger reflux. Stomach distension from gas formed by H. pylori may also aggravate reflux.

  • janet

    hi there could you please direct me to a dietician in auckland, newzealand that deals with fod maps diet an ibs . im at wits end and am attempting it myself but would like some direction and help

    • Jan Modric

      janet,

      I guess every dietitian should be familiar with a FODMAP diet; you may want to check by phone before visiting one.

  • Hi Jan
    I am actually trying the diet you suggested and cut out all fruit, veggies, milk etc and I have noticed a tremendous improvement. I do have the gurgling tummy. I NEVER eat large fatty meals before bedtime. Is it possible that it is some kind of intolerance and wrongly diagnosed?
    Thanks
    Ellen

    • Jan Modric

      Ellen,

      main symptoms of gastric reflux are heartburn and burning stomach. Acid reflux is a condition caused by other disorders, including fructose malabsorption (FM). You might want to read more aboute fructose malabsorption. Bloated stomach, burping and abdominal gurgling by themselves are not symptoms of gastric reflux, but can occur in lactose intolerance and fructose malabsorption, among other.

      A person with a fructose malabsorption can often absorb a certain amount of fructose, but when this (varies from person to person) is exceeded, unabsorbed fructose remains in the small intestine and drags water into it, also normal intestinal bacteria break fructose down and yield gas – from here gurgling. In fructose malabsorption fruits and foods high in fructose or sorbitol are problematic, and to some, wheat and legumes. Here is a table showing which foods may be problematic. Plant foods, like potatoes and rice, and most green vegetables are usually ok. Some people report that within one week of a strict low-fructose diet, their symptoms went away completely.

  • Leesie

    Hi Jan

    My teenage son, after neuro-imaging, has been diagnosed with very low levels of delta brainwaves. Besides certain nutrients being suggested to optimise cellular integrity, the FODMAP diet was mentioned. I’d never heard of it, but having read all the comments on this page, I realise it’s something he’s probably needed all his life. At age 4, I took him to a naturopath because whenever he ate fruit he bled with his bowel movements. The naturopath told me to take my son off fruit because it was like ‘sandpaper’ in his intestines. He also did iridology and said he’d never seen a child with such high levels of intestinal candida. He’s also allergic (not just intolerant) to peanuts/legumes. He’ll complain of stomach pain which is only relieved by a bowel movement.

    Of course, it’s been difficult for my son to completely stay away from fruit, so especially in summer, he’ll eat some and just put up with the bleeding. At age 12 he had a colonoscopy/biopsy which showed nothing. (By then, he hadn’t eaten fruit for months.)

    My question is, could my son have SIBO or FM? Would that explain the bleeding? Does it sound like he would benefit by following the FODMAP diet

    • Jan Modric

      Leesie,

      SIBO and FM often occur together, since unabsorbed fructose is a good food for intestinal bacteria. I believe bleeding can be caused by these disorders and FODMAP diet could help – this should be guided by a sensible dietitian, though. A breath test for both SIBO and FM exist. A low-FODMAP diet (plus exclusion of foods that cause allergy) should result in obvious improvement within a week. If not, eventual additional SIBO might be necessary to treat with antibiotics. The diet should be probably prolonged for some weeks, and then gradually some of excluded foods could be introduced back one by one and effects carefully observed.

      Fructose malabsorption is neither allergy nor intolerance, meaning some FM sufferers can safely have a certain amount of fructose (fruits, low in fructose, like banans are often well tolerated by some).

      Intestinal candida overgrowth is not a likely condition; if there is any overgrowth it’s probably SIBO.

      You may want to read more about fructose malabsorption and SIBO (links are in the first section of the article above).

  • FODMAPResearcher

    Dear Jan

    Thank you for all your postings to help people with fructose malabsorption, SIBO and FODMAP intolerance. I am one of the leading researchers involved in development of the low FODMAP diet (you have cited my article). I just wanted to add that the list of problem foods has changed over time because until recently foods hadn’t been tested for their FODMAP content. Our laboratory in Melbourne Australia is the only place measuring foods for FODMAP content. As such, the information in many old articles, in published books and on the internet is now out of date and confusing for patients.

    However, the new details may only be relevant to those who are more sensitive to FODMAPs. We do not freely give out the list of foods because it can be restrictive and we encourage anyone wanting to follow a low FODMAP diet to seek the advice of a dietitian. Afterall, we can assess their diet and symptom profile and make suggestions regarding how strictly they need to follow the advice. We can also assess which of the FODMAPs need to be avoided (fructose, fructans, galactans, sorbitol, mannitol, lactose).

    I would encourage readers to obtain the advice of an Accredited dietitian who has experience with the low FODMAP diet. There will be several, particularly in Melbourne, Australia where we conduct our research. Alternatively many of us offer telephone/Skype consultations if people would like to discuss their own diet. The website for my practice is dietsolutions.net.au.

    Best wishes
    Dr Jaci Barrett

    • Jan Modric

      Dr Barrett,

      if you want, you may make some comment about listed foods in the above article or reveal a bit of info about what was discovered lately about FODMAPs.

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  • Carollene

    Hi, I just wanted to post here in response to the general view that Pro-biotics aren’t helpful for people with IBS. I have had IBS-D all my life (am 36 now) and have been taking a pro-biotic for the past 4 years and have had considerable improvements. Yes I follow an IBS friendly diet (one that I have suited to my own personal needs) and have done so for years which helped a lot, but with my diet and the pro-biotic I have had the most beneficial improvement and believe (whether evidence shows it or not) that diet and pro-biotics go hand-in-hand to truly helping to control IBS with little pain, symptoms and even able to lead a ‘normal’ life and go out to dinner (taking diet into consideration of course). As every IBS person is different, I think that trying a pro-biotic cannot be bad thing.
    Thank you.

    • Jan Modric

      Carollene,

      have you tried a probiotic alone, or a diet alone, and what were results?

  • Daonna

    I tried many probiotics ( dairy free and FOS free) for my extreme IBS C and one worked for 1 week and the stopped. The others did nothing.

    • Jan Modric

      Daonna,

      did FODMAP diet have any effect in your case?

  • carollene

    Hi Jan,

    I firstly followed a diet specifically for IBS and found fairly good results, but still have practically constant IBS-D with severe pain, but then I used a food diary and over several months found that a more personalised diet worked really well, with only IBS symptoms weekly or fortnightly (instead of daily), but I still had pain associated with my bowel movements. Then I discovered pro-biotics and after trying 3 different ones with varying degrees of effect (from no help to very helpful) I finally found a pro-biotic that works extremely well for me..I now only have IBS symptoms once a month (due mainly to monthly hormonal changes), but with minimal pain to no pain. Though if I do not stick to my diet my IBS will react and I will be in pain with my bowel movements (from minimal to severe) and will have to take half an imodium, sometimes for a couple of days) and use a special diet to get back on track. So pro-biotics work very well in conjunction with really good diet.

    • Jan Modric

      carollene,

      can you say what are exact ingredients in the probiotic product you use? As I understand you, probiotic alone without appropriate diet won’t work…

  • Carollene

    Hello Jan,

    Yes Jan you are pretty much correct, pro-biotics alone, without an appropriate diet do not work. Alone they can minimally help to reduce associated IBS pain with bowel movements, but only slightly.

    The exact ingredients are:

    * Lactobacilllus rhamnosus – 15.55B Billion CFU
    * Lactobacilllus casei – 9.45 Billion CFU
    * Lactobacilllus acidophilus – 7.4 Billion CFU
    * Lactobacilllus plantarum 3.15 Billion CFU
    * Lactobacilllus fermentum – 1.35 Billion CFU
    * Bifidobacterium lactis – 4.05 Billion CFU
    * Bifidobacterium breve – 1.35 Billion CFU
    * Bifidobacterium bifidum – 450 Million CFU
    * Streptococcus thermophilus – 2.25 Billion CFU

    There are 45 Billion CFU’s per Capsule and is a multi strain probiotic.

    If you need any more information or want the manufacturers name etc please let me know.

    • Jan Modric

      Carollene,

      I was expecting there would be some other ingredient, like some carrier, in the product you use. I’m just trying to find out if there is some logic behind it, since probiotics, as I know, are usually not effective in food intolerances…

  • Sal

    Dear Jan,

    I was wondering if you could offer any advice specific to my situation. I’ve had diarrhea related IBS for many years (loose stools, not watery, just in the morning). It is quite stress related, but in the last year there hasn’t been much let-up, and I suspect my health is suffering.

    So I visited a nutritionist a few weeks ago and have been on a gluten and diary free diet for 2 weeks or so. My IBS seems to be worse in the last few days. She advised me I could still have sheep/goats milk and soya, which I have been taking only in very small amounts. I’ve been almost totally gluten free.

    I have a number of concerns that I hope you can shed some light on, now that I am considering this FODMAPS diet.

    1. Is it OK to take gluten free products that still contain certain grains (I am buying alternatives to pasta, bread, baking flour, etc). And oats?

    2. Is it important to be completely lactose free during the elimination stage, given that the nutritionist said certain diary were not too problematic?

    3. I am very thin already, I suspect because of my IBS. What can I take to increase my weight on the FODMAPS diet as I feel I am losing weight on this gluten/diary free diet.

    4. Given my weight/health concerns on going on such a strict diet, is it possible to phase out one group at a time, for say 2 weeks each, reintroducing, or not as the case may be, and then doing this for the next food group. But all separately. Or is there a logic apart from time saving that makes you suggest the total elimination diet at once?

    Many thanks in advance for your advice. I am at my wits end now as to where to go, given the anxiety this is all causing, especially since the gluten/lactose diet hasn’t seemed to help.

    Sal

    • Jan Modric

      Sal,

      IBS, as you know, may be a vague diagnosis. Still there are some rules about IBS. Symptoms in IBS are typically triggered by meal and relieved by having a bowel movement. Symptoms may be also triggered, or the whole problem being present or aggravated by stress.

      Elimination diets may be tried one by one (to some extent).

      Gluten-free diet means completely gluten-free, avoiding even traces of gluten. Wheat, barley and rye contain gluten, and oats may contain gluten due to contamination from other grains during processing…Gluten can be in various packaged products, which are completely unrelated to grains. Gluten can be even in explicitely “gluten-free products”. The safe way is to avoid grains and to avoid packaged, canned, processed foods as much as possible. In gluten free-diet you can eat corn, buckwheat, rice, potatoes, fresh meat, fish, eggs, oil, fruits, vegetables, legumes and nuts.

      In lactose-free diet you go completely lactose-free. No dairy of any kind, and again, lactose may be added to several commercial products. If you have lactose intolerance (which I doubt), symptoms should reduce considerably within 4 days. Besides lactose-intolerance, milk allergy is possible, not sure how likely is this in your case.

      In a low-fructose diet you reduce amount of ingested fructose, sorbitol and other polyols, fructans and galactans. Here’s a detailed nutrition guide for fm. If you have fm, symptoms should again reduce considerably within 4 days.

      A low-FODMAP diet is basically a combination of lactose-free and low-fructose diet.

      To make all simple, you could stick with plain or mineral, but unsweetened water as the only drink during your elimination trials. I want to say, fruit juices are often problematic, since they contain fructose and polyols…

      One cause of loose stools in otherwise healthy people is a diet rich in soluble fiber (oats, oranges, legumes…), so reducing (not eliminating) them might help. Alcohol and caffeine may stimulate the bowel, so this is to avoid during trials.

      High-calorie foods include: meat, fish, oil, potatoes, rice, nuts, seeds, eggs, cheese. Nuts may be problematic in fructose malabsorption and cheese in lactose intolerance (but hard cheese often containes close to zero lactose). Anxiousness may burn a lot of calories. Being active, concentrated on things makes you hungry…

      It is important to say if you experience excessive bloating, gas or belching.

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  • Mahua

    Dear Jan, thanks for the helpful information you’ve posted here.

    Could you please comment on whether for someone who is intolerant to Fructans but doesn’t have Coeliac’s, could single-malt whiskeys be considered FODMAP-safe given it is made of barley?

    Best, Mahua

    • Jan Modric

      Mahua,

      fructans themselves usually do not cause problems by themselves by priciple of “intolerance” or “allergy”. I don’t know how much problem do you personally have with fructans, but some (not all) individuals with fructose malabsorption may have problem with wheat and onions, which are practically only foods that contain fructans in *considerable amount*. Other grains, including barley, and certain vegetables, like asparagus, Jerusalem artichokes, leeks, chicory are so low in fructans that are usually not problematic.

      Fructans are fibers, and I’m not sure if any fibers can apper in distiled beverages, like single-malt whiskey, at all. So, you may consider it “FODMAP-safe”, but then the alcohol itself or eventual sweeteners (fructose, sorbitol, sugar) could irritate your bowel.

  • Mahua

    Dear Jan

    I’ve noticed that I inevitably get severe flatulence and awful cramps especially on eating wheat and onions, along with lactose and Polyols.
    It’s great to know that single-malts may be considered safe, I hope I can find one without the unsuitable additives. It’s also good to know the fibre aspect of Fructans and it’s hence expected absence in distilled alcohol.
    Thanks a lot for your reply.

  • funnytummy

    Hi Jan,
    I’ve been suffering with ‘IBS’ for years and after tests for every kind of intolerance or parasite possible my doctor has prescribed some drugs to help, which I’m not that keen on taking. I’d rather see if it was something food related, and another doctor told me about fodmaps. I’ve previously tried many elimination diets for fructans/fructose, then lactose, then gluten, but never all at once, which seems to be the case with fodmaps. If I’ve tried them all separately do you think it’s still worth a shot to try them all together?

    • Jan Modric

      funnytummy,

      it may be worth to try, since if you have both frutose malabsorption and lactose intolerance, for example, low-fructose diet alone will not help you. Also, diets have to be strict.

      Here are detailed diets, may be you can take low-fructose diet as a basis and additionally exclude lactose (check here where all lactose can be), and gluten.

      Fructose, lactose and gluten can be added to various commercial food products, so try to avoid them as much as possible. If you have fructose malabsorption or lactose intolerance (or both), with this diet symptms should diminish considerably in 1-4 days. Symptoms in celiac disease may need a week or two or longer to go away, though. One “complication” of fructose malabsorption or lactose intolerance is small intestinal bacterial overgrowth (SIBO) – in this case this diet may help to some extent, but not completely. Diagnosis of SIBO is made by a specific breath test, treatment is with antibiotics.

      Instead of checking what you should not eat during these diet, write down foods you may (theoretically): fresh meat and fish, oil, eggs, potatoes, white rice, corn products, vegetables from the “safe” list in low-fructose diet list (link above).

      Symptoms (constipation, diarrhea, bloating, gas) in IBS typically appear within 20 minutes after the meal, and disappear with a bowel movement, while symptoms in abovementioned intolerances may appear from few minutes to several hours after the meal and do not liely disappear with a bowel movement.

  • Alice

    IBS-Free At Last may have food that do not pass the sugar test. Double check.

  • pbeaty

    I was recently diagnosed with celiac disease. I have been gluten free for 2 months. Recently I have been having a lot of bloating. Where should I begin. Are there some tests available I should have or should I start with diet?

    • Jan Modric

      pbeaty,

      by which test celiac disease was diagnosed? What were your symptoms before and after starting gluten-free diet? Some persons with celiac disease additionally have fructose malabsorption or lactose intolerance; in these cases gluten-free + low fructose diet or gluten-free + lactose-free diet would help..Other causes of bloating and gas.

  • pbeaty

    I was diagnosed through blood test and endoscopy at the same time. The endoscopy was ordered after I had been anemic for a couple of years. I never really had much reaction to gluten. I suffered from constipation my whole life though. No bloating before starting a gluten free diet. Last couple of weeks have been really bad. I just don’t know where to start.

    • Jan Modric

      pbeaty,

      if both blood test and endoscopy has shown celiac disease, you probably have it, even if it is mild. Possible causes of bloating:
      – you’ve started to eat more foods containing soluble fiber (oats, beans, soy, oranges…) – these can yield a lot of gas when normal colonic bacteria break them down. If so, you can try to reduce these foods a bit in your diet.
      – you have developed a fructose malabsorption – a low-fructose diet (link in my previous comment would help in this case
      – intestinal parasites: Diagnosis is with a stool test for parasites.
      Certain disorders, mentioned in the article about bloating and gas could also be a cause.

      So,you can start with limiting foods high in soluble fiber for few days and see if it helps. If not, you can try a low-fructose diet for few days. If still not better, you can try a lactose-free diet for few days. If bloating would still persist, then a gastroenterologist can judge which, if any, test would be necessary to find a cause.

  • pbeaty

    I never saw any of my test results. Doctor just said both tests were positive. I don’t know what else I was tested for. My doctor never mentioned celiac disease before endoscopy.

  • lookingforhelp

    Wonderful, informative article. We have started looking into fructose malabsorption as a possible contributor to my son’s severe abdominal pain, which he’s had for nine years now. Many doctors later, his diagnosis is the same: IBS. Having exhausted the list of “western medicine” providers in our area and weary of disappointment/no improvement, we now drive some distance to an alternative practitioner. Basic allergy test showed no problem foods; dysbiosis and candida were discovered & aids were prescribed and taken — but the severe pain continued. In July, on our own, we began a restricted diet of no gluten, dairy, eggs, soy, yeast, and corn. Again, no let-up in pain. Now our internet research is pointing us towards fructose malabsorption, as we had necessarily increased fresh fruits and veggies in his diet; our practitioner is getting information for us on the FM breath test. In the meantime, we continue on the restricted diet, with small dabbling into the low-FODMAPS diet – and hence an initial question. The bread mix we use (no gluten, yeast, corn, dairy, soy, nut) includes bean flours: chickpea, pinto and navy. Would these flours be a problem on a low-FODMAPS diet? Deepest thanks.

    • Jan Modric

      lookingforhelp,

      chickpea, pinto and navy beans as well as other legumes contain galactans (composed from galactose and fructose molecules) and can produce gas and trigger diarrhea in *some* (not all) individuals with fructose malabsorption.

      A reliable test for fructose malabsorption is a breath test with fructose. Here is a nutrition guide for fructose malabsorption.

      IBS is a diagnosis often made instead of undiscovered fructose malabsorption or other food intolerance.

      Dysbiosis and candida or yeast overgrowth is a popular diagnosis made by alternative practicioners, which make them able to prescribe and sell some medications. Candida is a normal microorganism in the bowel, and candida overgrowth was not identified in people, except in those with terribly deranged immune system (like in AIDS).

      When thinking about dietary causes of GIT problems, you should consider:
      – fructose malabsorption. Dx: breath test. Solution: low-fructose diet
      – lactose intolerance. Dx: breath test. Solution: lactose-free diet
      – small intestinal bacterial overgrowth (SIBO), which can be either the cause or result of fructose malabsorption or lactose intolerance. Dx: breath test. Solution: prescribed antibiotics
      – celiac disease. Dx: blood test, upper endoscopy with biopsy of duodenal mucisa. Solution: gluten-free diet.
      – food allergies. Dx: skin tests. Solution: avoiding triggering foods
      – intestinal parasites: Dx: stool test for parasites. Solution: Treatment with prescribed medications.

  • lookingforhelp

    Thank you for prompt and helpful response. I think we’ll remove the bread w/bean flours. My son had violent gastro pain when he got up this morning (lots of time sitting on toilet in pain with NOTHING coming out), and the only possible “bad foods” would be the bread w/bean flours or an ENJOY LIFE gluten free bar w/5g sugars from evaporated can sugar and date paste (which we hoped could take the place of the fruits he is stopping). Which brings me to the question: can FM cause such terrible pain? My son will be taking the FM breath test as soon as the MD ofc gets it. Since we have started seeing the alternative practitioner at beginning of this year, the pain/bathroom time has only worsened, so we are pretty discouraged. Many supplements were prescribed and faithfully taken. Only small success was stopping the small mucus balls, which may have been the candida for which my son was prescribed Nystatin. We are so hoping this pain can stop. Thank you again.

    • Jan Modric

      lookingforhelp,

      I have made an extensive research about gastrointestinal candida overgrowth and have found not even one reliable source claiming this issue even exists in otherwise healthy people. Candida is a normal bowel resident and it pretty much always shows up in stool tests, but there was no quantifying method developed, so alternative practicioners may abuse these circumstances to prescribe Nystatin and other anti-fungal medications. Nystatin itself may have several side effects.

      I’ve listed common food intolerances in my previous comment, and it could be good to try them one by one, not all at once, since this may be hard for a child. If you try to check for fructose malabsorption (fm), these are general principles:
      1. Possibly problematic nutrients include: fructose (most fruits, especially all dried fruits, and aples, pears, plums, peaches) table sugar (which is fructose + glucose), polyols (sorbitol, xylitol…and other “-tols” added as sweeteners to various drinks, chewing gum, commercial foods), HFCS, fructans (in wheat and onions), and galactans (in legumes, cauliflower, Brussel’s sprouts). In this chart you can see which foods are probably ok and which may be harmful.

      When the fm is the only problem, the following foods should be ok: all unbreaded and unsweetened animal foods, white rice, potatoes, all cereals (except wheat), green leafy vegetables. If the fm is the only disorder, such diet should result in considerable improvement in 2-4 days. If no relief, it can still be fm, but with added small intestinal bacterial overgrowth (SIBO), which needs another breath test to be diagnosed.

      Consipation, bloating and abdominal cramps caused by fm or other food intolerances CAN cause such pains you’ve described. Symptoms are prevented by appropriate diet, not with medications. An exception is SIBO, which is treated by prescribed antibiotics.

  • KP

    Hi Jan,

    First of all I’d like to say thanks for putting this resource together and for taking the time to leave the comments here, it’s be very helpful to me 🙂

    As you’ll see, I have gone around the website and compiled a list of foods that appear to be safe on the FODMAP diet, can you please confirm that these all correct? Should I remove any? Any big ones that I have missed? Here’s the list:

    VEGETABLES:

    Bouillon, celery, escarole, hash-browns, mushrooms, mustard greens, pea pods (immature), potatoes (white), shallots, spinach, Swiss chard, green leafy salads.

    FRUIT:

    Grapefruit, lemon, lime, cumquat.

    GRAIN:

    Rice (white), buckwheat, corn.

    ANIMAL PROTEIN:

    Meat (fresh, not commercially breaded), fish (fresh or tinned without sauce), other seafood, eggs.

    NUTS AND SEEDS:

    Amaranth, flax seed, millet, poppy, pistachios, pumpkin, sesame, tahini, sunflower.

    DAIRY:

    Yogurt, hard cheese.

    SAUCES AND SPICES

    Basil, bay, cinnamon, cumin, curry, maryoram,oregano, parsley, rosemary, thyme.

    DRINKS

    Water: tap water, non-flavoured bottled water, mineral water, tea, coffee (not chicory based coffee substitutes).

    Also, where would almonds and almond butter come fit into the FODMAP diet? Would soaking them and remvoing the skins make a difference?

    Thanks again 🙂

    KP

    • Jan Modric

      KP,

      a low-FODMAP diet is some sort of combination of low-fructose and lactose-free diet, which can help people diagnosed with “IBS”, but who actually have either fructose malabsorption or lactose intolerance or both. In case you have only a fructose malabsorption, a less strict low-fructose diet would be enough. In lactose intolerance, lactose-free diet would be enough.

      In a full low-FODMAT diet, you can exclude mushrooms on the start (they may contain xylitol), and, when (if) symptoms wean off, you can introduce them back slowly and see if you can tolerate them. All types of nuts *may* be problematic in fructose malabsorption. In severe lactose intolerance, yogurt could cause diarrhea.

      You can add barley and oats (oats is high in soluble fiber and can cause bloating if taken in a large amount). Bananas and oranges are often well tolerated in fructose malabsorption. Pure glucose should not be problematic. Wheat is problematic only for some individuals with fructose malabsorption and often only when taken in a large amount, so you can exclude on the start, and try it carefully later, when free of symptoms.

      Some random food not listed anywhere may be problematic for you, so it may be a good idea if you run a diary with foods eaten and eventual symptoms triggered by them.

  • Mick1

    Hi Jan,
    I have been chronically and severely bloated for 25 years, and recently tried avoiding gluten, lactose, and Salicates, Amines and Glutamates, for about 4 weeks with no effect. Would you suggest trying the FODMAP diet as a stand-alone alternative to the low chemical diet, or are the two diets in any way related?

    Thanks very much.
    Mick

    • Jan Modric

      Mick,

      low-chemical diet sounds pretty vague and the substances you’ve mentioned do not likely cause bloating. In general, there are two approaches possible: 1) you eliminate all possibly irritating foods on the beginning, and wait until you are free of symptoms (should happen within a week), and then introduce them back one by one every other day to see, which one triggers symptoms, or 2) you try particular diets one by one.

      Food ingredients that can cause bloating include:
      – foods high in soluble fiber, such as oatmeal or legumes
      – gluten in celiac disease (gluten-free diet could help in a week)
      – lactose in lactose intolerance (lactose-free diet would help in 2-4 days)
      – fructose, HFCS, (and often table sugar), sorbitol, xylitol and other polyols, fructans and galactans in fructose malabsorption (low-fructose diet would help in 2-4 days)
      -(a low-FODMAP diet is basically a low-fructose + lactose-free diet)

      Besides that, a small intestinal bacterial overgrowth (SIBO) may occur as a complication of other food intolerances. Dx is with a breath test, treatment is by antibiotics.
      – any random food in food allergies

      Certain disorders of the gallbladder, bile duct, liver, pancreas or small intestine can cause bloating, but in all these cases other symptoms would be very likely, so the elimination diet ca be tried first.

      Foods that would be not likely problematic in any of above food intolerances (except eventual food allergies) include: fresh unbreaded meat and fish, eggs, oil, white rice, potatoes, corn, buckwheat, spinach, Swiss chard, lettuce. In this diet, symptoms should go away within a week. If not, the problem could be SIBO (Dx with a breath test) or food allergy (not sure how likely this is, though). But if you become symptoms free, you can try a food high in fructose, like an apple, pear and wait two days to see what happens. If OK, you can add something with lactose, like milk. Then something with gluten. You can write down all foods and their effects in a diary. If this approach doesn’t work, you can visit a gastroenterologist and ask for certain tests.

  • Sherry

    Hi Jan,

    I read here that sibo is often accompanied by whitish things in stools,
    now are those things the bacterias or undigested foods ?

    Thank you in advance

    Sherry

    • Jan Modric

      Sherry,

      small intestinal bacterial overgrowth (SIBO) could cause a translucent mucus, produced by bacteria or secretions of the intestinal wall. Undigested foods are usually accompanied with diarrhea and often the exact food can be identified…Clumps of bacteria could be in the form of white or black pepper-sized specks. White things could be also parasites or their eggs.

  • Lola

    I’d like to know if you have any recipes for the low-FODMAP diet. It seems like the diet is very exclusive in the sense that most “staple foods” are ruled out.

    • Jan Modric

      Lola,

      A low-FODMAP diet is not so terribly exclusive as it might look. You could still eat: potatoes, corn, rye and buckwheat products, white rice, non-wheat pasta and many vegetables. You can check a list of non-problematic foods in a low-fructose diet, which is the same as a low-fructose diet, only that milk products are allowed here, but not in a low-FODMAP diet.

  • Vanessa

    Hi there,
    I have suffered with IBS for over 4 years now and im 25 years old. It effects my everyday life and after dr to dr I have never really had a positive or working treatment. I suffer with very severe bloating, very high sugar cravings and I do not eat dairy as it makes me quite ill and i stay off wheat (except for the occasional biscuit or tiny piece of cake i cant resist!) I really dont know what step to take next, I have followed the FODMAPS diet for several months now and have not felt much better. I have lost a significant amount of weight due to my non existent appetite and am now quite underweight. Please if you have any advice possibly now on allergy testing could you let me know. I have only had a a sigmoidoscopy examination where the dr said my bowel was completely full of mucus and could not see through- although nothing was ever followed up from there! I have been on Creon tablets 3 times a day with food- as the specialist found that his patients bloating improved significantly after using this medication. I agree but after 2 months now I am not feeling the effects the medication like I have built a tolerance.
    I am quite desperate for help this condition is severely taking over my life.
    Many Thanks

    • Jan Modric

      Vanessa,

      bloating, sugar craving and large amount of mucus may occur in intestinal parasites, and small intestinal bacterial overgrowth (SIBO). SIBO can be a complication of certain food intolerance, such as fructose malabsorption, lactose intolerance or celiac disease. I can’t exclude food allergy, but this sounds less likely to me.

      Food intolerances such as fructose malabsorption and lactose intolerance may be standalone conditions or can be caused by intestinal inflammation caused by a celiac or Crohn’s disease. Tests for all mentioned disorders are available. Few days lasting diet trials are also available: lactose-free diet for lactose intolerance, low-fructose diet for fructose malabsorption, gluten-free diet for celiac disease, and low-FODMAP diet for IBS. But, when you have SIBO, diets alone may not help at all, and SIBO needs to be treated first (with antibiotics).

      I really don’t know which test you should try next, but you can visit an experienced gastroenterologist and discuss with him/her about:
      – breath test for SIBO, fructose malabsorption and lactose intolerance
      – blood test for celiac disease
      – regarding 4 years history of your symptoms, intestinal parasites are less likely
      – food allergy, to me, also sounds less likely, but a good doctor should know which tests to order first

  • Vanessa

    Hi Jan thankyou so much for your help. Could you please advise me on what antibiotics I should ask for.
    Many thanks

    • Jan Modric

      Vanessa,

      first, the doctor should decide will he/she order a test for SIBO, and if SIBO will be confirmed, he/she will decide which exact antibiotic to prescribe.

  • Skip

    I was diagnosed with Fructose Malabsorption and have been diet compliant for over a year. My weight has fluctuated from day to day, but now I am rapidly putting on weight – no matter how much I limit my food. I only eat eggs, chicken, plain unsweetened whey protein, white rice, spinach, white potato, lettuce, snow peas, snap beans, grits, butter, oatmeal, olive oil, plain popcorn, pumpkin seeds, peanut butter (limit of 1 TBSP/day), Trader Joe’s O’s cereal. Water is my only beverage. I have tried Peptamen Plain, hoping for a food substitute but get severe abdominal pain after only 1/2 a serving.
    So here’s my question: What mechanism can make someone with a malabsorption disorder GAIN weight, even if very little food is eaten? I really need help. Thank you

  • Pam

    Hi Skip,

    If you are not eating enough calories while on a low Fodmap diet or are eating to many calories you can put on a lot of weight regardless if you are eating less food.

    If you are not eating enough your body maybe going into starvation mode.
    If you are eating to many calories even though you are eating a little then this may cause weight gain.
    I have fructose malabsorption intolerance also and I notice when I am not being strict with my diet I put on a lot of weight.
    If I watch what I eat and stick to my calorie controlled diet my dietian had set out for me, with regular exercise then I seem to be able to loose weight approx 3 kilos a week.
    If I don’t stick to my Low Fodmap diet and don’t watch my calories then my weight can increase greatly.
    It seems in Fodmap intolerant people our metabolisms do not work like normal and if exercise is not a large part of your recovery or health regime then we can suffer more.
    I have suffered from this for the past year and find that weight control is something that will be part of this intolerance.

  • Sick of it

    Hi, Ive had problems with my stomach since I was a teen, in particularly a couple of years after I started menstruating. I’ve had every test done known to man to be told time and time again it’s IBS! I’m 36, so been putting up with this since I was 12/13 years old. I’ve had several endoscopies and colonoscopies over the years all came back with the result – it’s IBS. I had my appendix removed and part of my bowel cause it had wrapped itself around my appendix at the age of 15. I have also suffered from reflux for as long as I can remember and I am on Losec 20mg twice a day (for the rest of my life so I have been told). I was diagnosed as lactose intolerant in my early teens but over the years can now stomach a little milk,cheese and yoghurt. I cannot stomach onions in the last year and garlic can upset my stomach as well. I have not been able to stomach spicy foods, oregano, coconut milk, curries, rich cheeses, to name a few since being diagnosed with IBS. I seriously C R A V E CHOCOLATE and sweet things daily, especially in the evenings, when I have been exercising or busy at work (feeling flat)and around that time of the month. I have never had this breath test you are talking about for SIBO, fructose malabsorption and lactose intolerance. My blood test results for celiac disease came back negative. I suffer from anxiety attacks, depression and very painful periods and I have been overweight all my life. I seem to have “very bad attacks” of IBS at least 4 -6 times a year. I am currently having an attack and i’ve been in agony now and off work for 15 days!!! Started off with diahorrea for 3 days than constipation. Bloating, gas, extremely tender lower left side of tummy. Thought I had Diverticulitis, was put on Flagyl. Spent nite at hospital last weekend. Bloods – normal, urine – normal, xray – showed I was constipated with parts of bowel inflammed. CT scan/ Barium meal on Monday just gone – not diverticulitus! Been on enimas last two nights to get things moving again. Tummy still bloated,tender and in pain. Can anyone P L E A S E tell me what they think is going on with my tummy as I am SERIOUSLY OVER ALL OF THIS!!!! My latest Doc things I may have an intolerance to gluten and has suggested seeing a dietitian for FODMAP diet. He’s stumped!

    • Dr. Chris

      Hi Sick of It

      Much of your symptoms are indicative of IBS. In fact a diagnosis of IBS can be made based on the fact that no other pathology has been detected. Even the infections should not distract from the fact that the underlying problem can be IBS. Remember that a diagnosis of IBS does not entirely mean that no doctor knows what is wrong and is just chalking it down to IBS. There may be a disruption in gastrointestinal motility which is not linked to any underlying disease – if it is faster than normal then it may give rise to diarrhea-predominant IBS while with slower than normal motility it may be constipation-predominant IBS. Certain foods, stress, depression and so on are known to exacerbate IBS. A FODMAP diet MAY therefore help but this is not a guarantee that it.

      Gluten intolerance is a separate and specific condition than should be diagnosed with proper investigation. Until this has been conclusively established, there should be no assumptions about it being a factor in your case. I say case because it is unlikely that all your symptoms can be chalked down to a single disorder here.

      Patients with chronic gastrointestinal problems often are not satisfied with a diagnosis of IBS. But it is debilitating condition which is present with no underlying detectable pathology. Until you tend to a few of the problems that you mentioned, there is no way to exclude IBS for sure – seek help for your anxiety/depression, ascertain the cause of painful periods (contrary to popular belief period pain is NOT the norm, there may be mild discomfort but actual pain indicates possible underlying pathology like PCOS) and weight control is essential. You may be surprised to find that many of your GI symptoms will resolve or your IBS will come under better control.

      Nevertheless, you should have this investigated further. You need to see a gastroenterologist who can work with you in the long term. Conduct different tests to exclude other pathology that may have not been detected as yet. Elimination diets and a FODMAP diet won’t do any harm and is definitely worth a try. If you have not done so already, you should keep a food diary where you record the food you ate, symptoms, general state of wellbeing and so on on a daily basis. This is of huge benefit when assessing your case and verifying your history.

  • Sick of it

    Is this site still active? Is anyone still answering questions or giving feedback? Anxiously awaiting reply ……:(

    • Dr. Chris

      Hi Sick of It

      Responses from the Health Hype team are not instantaneous. It may take anywhere between 3 to 7 days. Even responses from other users will only be live once it is screened and approved. If you need urgent assistance, you should speak to a health care professional. Alternatively you can click on Ask a Doctor Online link above (if active) and have an online chat with a doctor immediately (paid service). This comment/question-answer platform that you are using is a free service and only intended to guide readers but not serve as a medical consultation or means of diagnosing, prescribing or managing a condition.

  • Sick of it

    Thanks Dr. Chris. I understand what you are saying was just waiting to hear someone elses point of view that understands it all. Nearly every Doctor I have seen has just put it down to IBS – not to many know about the FODMAP stuff. I’ll keep checking back for other comments…. Thank you

  • Kelly Herzog Kerchner

    I love to go to [BRAND REMOVED] and have the chicken strips (without breading) and medium sauce. Can you tell me if any of these ingredients are ok? I can’t seem to find a low fodmap list of ingredients that are not food. Thanks! margarine, water, salt, soy lecithin, natural flavor, vegetable mono and diglycerides, annatto and tumeric, vitamin A,palmitate, whey, soybean oil, cayenne pepper, vinegar, brown sugar, sald, water, mono and diglycerides, sodium benzoate.

    • Hi Kelly. We cannot comment on the specific food in question. In all likelihood it should be fine but we are not privy to the recipe of the restaurant in question. I think you may have some misconceptions about certain ingredients. Vitamin A for example is not an ingredient that you can add into food but rather a micronutrient that is present in certain foods in varying quantities. Of course, vitamin A itself is not a problem but the foods that it may be within could be problematic. Best you consult with a dietitian/nutritionist in your area who can advise you further.