Knowing which foods are enhancing your health and which foods are hindering your health can be a very frustrating process.  The amount of conflicting information out there with regards to healthiness of different foods will often lead to confusion.  By default, my general recommendation for patients is Paleo-based diet, which is a whole food based diet that is limited in grains and no processed foods.  For more information please read the following book The Paleo Cure, by Chris Kresser

Most nutritionists would agree that fruits and vegetables are very healthy for everyone.  However, for the millions of Americans suffering from a functional gut disorder the types of fruits and vegetables you consume can significantly impact your digestive tract.  If you suffer from a gut disorder you may need to try a low FODMAP diet.  This method has been shown to reduce gut symptoms in approximately 75% of patients.

The acronym FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols. These short-chain carbohydrates are incompletely absorbed in the gastrointestinal tract and can be easily fermented by gut bacteria.  These sugars also exert an osmotic effect, increasing fluid movement into the large bowel.  The fermentation and osmosis caused by these undigested sugars are a cause of major IBS symptoms such as gas, pain, and diarrhea.

Sensitivity to FODMAPs varies greatly among individuals, and even if you are sensitive to one FODMAP this does not mean you will be sensitive to all.  A good example of this is lactose, which is a FODMAP.  Many people can digest lactose with no problem, whereas many others do not have the enzymatic capability to do so.  Or someone may be able to digest lactose well but they have difficulty digesting apples, which are high in fructose.

What causes FODMAP intolerance?

Often times a person may have no problem digesting FODMAPs but now they can no longer.  Clinically, I found that it is Dysbiosis that drives FODMAP intolerance, specifically something like Small Intestinal Bacterial Overgrowth (SIBO).  If SIBO is present, the consumption of FODMAPs leads to proliferation of bacteria and creates a vicious cycle where a patient eventually becomes FODMAP intolerant.

How to Treat a FODMAP issue

First, the dysbiosis must be addressed in order remove the pathogenic microorganisms that are creating a lot of the symptoms.  Please see the following article.

Second, following a low FODMAP diet is also key to the healing process.  Common foods that are high in FODMAPs are:

  • Apples
  • Peaches
  • Mangoes
  • Watermelon
  • Dried fruits
  • Asparagus
  • Brussel Sprouts
  • Broccoli
  • Garlic
  • Onions

For a more complete list please see the following chart. If you feel you need a very specific protocol to follow you can try either the GAPS Diet or The Specific Carbohyrdate Diet (SCD). Both are designed to lower exposure to FODMAPs and other food intolerances and then slowly add them back in.

Gluten and FODMAPs

In the medical community, there is a lot of discussion as to whether or not gluten intolerance exists.  Many medical practitioners believe that if you do not have celiac disease then you do not have a problem with gluten.  However, many other health providers have seen that benefit that a gluten free diet can have on a patient despite the fact that they do not have Celiac disease.  FODMAPs may be the reason why.

Wheat is a FODMAP and in fact a lot of grains are difficult for people to digest.  Therefore, it people may experience a benefit from gluten free mainly due to FODMAP intolerance. Nevertheless, most people are going to feel better with less gluten and grain intake.

Can You Take A low FODMAP diet too Far

The real purpose of a low FODMAP diet is to take away the fuel source for pathogenic bacteria.  Unfortunately, a diet that is too low carb for too long will eventually starve your good gut bacteria, as well.  Therefore, a low FODMAP diet is often very beneficial for many patients in the beginning of the journey to health but it may not be a recommendation for the long term.  Individual experimentation is required to found out what you can and cannot tolerate.