FODMAP is an acronym for fermentable short-chain carbohydrates, called oligosaccharides (fructans, galactans), disaccharides (lactose), monosaccharides (fructose), and polyols (sugar alcohols).
FODMAPs are a group of naturally occurring compounds that are not completely digested or absorbed in the intestines: they move slowly through small intestine, attracting water and are fermented by the gut bacteria when in the large intestine. The extra gas and water cause the intestinal wall to stretch and expand. In those with a highly sensitive gut, this ‘stretching’ of the intestinal wall produces a wide variety of disruptive gastrointestinal symptoms like nausea, gas, bloating, distension, abdominal pain, cramping, diarrhea and/or constipation, as well as fatigue, anxiety, depression, OCD, brain fog and more, that are commonly experienced by individuals with IBS, (irritable bowel syndrome), SIBO (small intestinal bowel overgrowth), or other functional gut disorders.
When individuals with IBS, SIBO, or other gut disorders reduce their intake of these foods, they can relieve many of their symptoms. Some research has found that a majority of people with functional gut disorders can achieve significant symptom relief by eating a low FODMAPs diet. Further studies have demonstrated a high level of success in reducing symptoms of IBS by reducing or eliminating foods that are high in FODMAPs.
FODMAPs are not the cause of IBS or other functional gut disorders, they exacerbate a condition that already exists. The real problem lies in an imbalance of or the types or organisms that are present in the gut, or the lack of enzymes that are needed to break down the particular substances.
- Fructose: A simple sugar found in many fruits and vegetables that also makes up the structure of table sugar and most added sugars.
- Lactose: A carbohydrate found in dairy products like milk.
- Fructans: Found in many foods, including grains like wheat, spelt, rye and barley.
- Galactans: Found in large amounts in legumes.
- Polyols: Sugar alcohols like xylitol, sorbitol, maltitol and mannitol. They are found in some fruits and vegetables and often used as sweeteners.
Foods High in FODMAPs
- Fruits: Apples, applesauce, apricots, blackberries, boysenberries, cherries, canned fruit, dates, figs, pears, peaches, watermelon
- Sweeteners: Fructose, honey, high fructose corn syrup, xylitol, mannitol, maltitol, sorbitol
- Dairy products: Milk (from cows, goats and sheep), ice cream, most yogurts, sour cream, soft and fresh cheeses (cottage, ricotta, etc) and whey protein supplements
- Vegetables: Artichokes, asparagus, broccoli, beetroot, Brussels sprouts, cabbage, cauliflower, garlic, fennel, leeks, mushrooms, okra, onions, peas, shallots
- Legumes: Beans, chickpeas, lentils, red kidney beans, baked beans, soybeans
- Wheat: Bread, pasta, most breakfast cereals, tortillas, waffles, pancakes, crackers, biscuits
- Other grains: Barley and rye
- Beverages: Beer, fortified wines, soft drinks with high-fructose corn syrup, milk, soy milk, fruit juices
Are You Sensitive To FODMAPs?
Although a Paleo diet eliminates some of the above mentioned FODMAP foods, there are many foods that are Paleo friendly, rich in nutrients, and health enhancing, like many of the fruits and vegetables that are not low in FODMAPs.
If you are not struggling with IBS, SIBO, GERD or acid reflux or any other bowel or gut disorder, there is no reason to be concerned about these foods. However, if you have already been following a Paleo diet and continue to have gut disorders or unexplained gastrointestinal or psychological symptoms, then you might want to explore whether FODMAPs are potentially an underlying contributor.
FODMAP intolerance is highly individual and the severity of intolerance can vary greatly from person to person as everyone has a different threshold.
Furthermore, this threshold may not be the same across the board. You may have a different threshold for each of the individual types of FODMAPs. For example, you may have a severe intolerance to polyols, a mild intolerance to fructose, fructans and galactans, but no problem with lactose or vice versa, in many different combinations. having an intolerance to one, does not mean you have to eliminate them all. The amount consumed may also play a role in the severity of symptoms: You may be able to eat a half cup of broccoli or a small number of polyols with no symptoms, but a larger serving may cause severe discomfort. Some data suggests that onions, wheat, apples, and pears tend to be most problematic for the majority of people.
Intolerance may also be affected by whether the food is raw which may produce more symptoms.
Stress levels, the health of your gut, exposure to toxins, degree of gut dysbiosis, and inflammation can also impact your tolerance to some or all of these foods and your level of intolerance may change as there are changes in these areas of your life.
Stress can significantly impair digestion as this triggers the body to direct resources elsewhere. Stress inhibits GLUT2, the transporter in the small intestine needed for transporting glucose and kills friendly bacteria in the gut, which allows opportunistic, pathogenic organisms to overpopulate. These bacteria in are more prone to ferment FODMAPs.
Furthermore, some degree of fermentable carbohydrates is beneficial, because your healthy gut bacteria use them as a food source as well and produce short-chain fatty acids in the fermentation process, which will improve your gut and overall health (when in moderation), so you don’t want to eliminate all of them.
A Low FODMAP Diet
The purpose of a diet low in FODMAP containing foods is not to eliminate them all (which can prove to be extremely challenging) but rather to sufficiently minimize these types of sugars and starches to reduce digestive symptoms.
There is a wide variety of Paleo foods that you can eat on a low-FODMAP diet:
- Meats, poultry, fish and eggs:These are generally well tolerated unless they have added high-FODMAP ingredients in marinades and sauces.
- Fats and oils
- Vegetables: Alfalfa, bell peppers, bok choy, carrots, celery, cucumbers, eggplant, ginger, green beans, kale, lettuce, chives, olives, parsnips, potatoes, radishes, spinach, spring onion (only green), squash, sweet potatoes, tomatoes, turnips, yams, water chestnuts, zucchini
- Herbs and spices
- Nuts and seeds:Almonds, cashews, peanuts, macadamia nuts, pine nuts, sesame seeds (but not pistachios, which are high in FODMAPs)
- Fruits:Bananas, blueberries, cantaloupe, grapefruit, grapes, kiwi, lemons, lime, mandarins, melons (except watermelon), oranges, passionfruit, raspberries, strawberries
- Sweeteners: Maple syrup, molasses, monk fruit and stevia
- Dairy products:Hard cheeses and aged softer varieties like brie and camembert if dairy is part of your Paleo diet.
- Grains:Rice, quinoa, sorghum and tapioca
- Beverages:Water, coffee and tea.
The foods listed above are neither definitive nor exhaustive and personal threshold is key in determining what you can and cannot tolerate.
Pete’s Paleo has you covered – we have a low FODMAP menu so you can Eat What You Love
The best way to determine whether you have an intolerance to any of these foods is to eliminate the foods you suspect may be problematic for 30 to 45 days and see if you have improvements. Keep a food journal to help you remember. You can then begin to reintroduce one food at a time, one week at a time, and monitor your response. Be sure to bring back only one food at a time and wait for a week before trying another food or you will not know which food is producing the symptoms.
There are instances where FODMAPs can be added back to your diet after a short period of removing them along with other foods that are disruptive to the GI tract. The elimination process often eradicates some of the microbes that were dominant, resulting in a rebalancing of the gut flora and a reduction in the inflammatory response. This causes tolerance top improve. Alternatively, you may be able to bring some back, but not others. Since many of the vegetables offer a variety of health benefits, one wants to try and reintroduce as many of these as is comfortable to consume. Rather than simply eliminating these foods eternally, continue to challenge yourself periodically to evaluate if anything has changed.
It is important to remember that FODMAP foods are only one of many issues that can contribute to IBS, SIBO, GERD, and other gut disorders or gastrointestinal symptoms. Other factors that should be considered besides stress include foods that contain phytates, saponins and lectins, as well as depletion of neurotransmitters like serotonin and GABA, heavy metal toxicity, Candida overgrowth, intestinal parasites, chemical sensitivities, and other unfriendly bacteria.
If you frequently experience digestive upset that lowers your quality of life, FODMAPs should be on your list of suspected triggers and provokers. Though a low-FODMAP diet may not eliminate all digestive problems, chances are high that it may lead to significant improvements.