If you’ve ever experienced terrible cramping or intense bloating and immediately reached for your computer, there’s a good chance you’ve come across the Low FODMAP diet. As a diet designed for those with chronic gastrointestinal issues or bowel diseases — primarily Crohn’s Disease or irritable bowel syndrome — it may seem like an instant fit for anyone who may be feeling irregular or are hoping to reset their digestive system. The truth? It may work wonders for some by providing relief over several weeks, but it’s not meant for everybody, experts say.
What is the Low FODMAP diet?
FODMAP is an acronym for fermentable oligo-, di-, mono-saccharides and polyols, a subset of short-chain carbohydrates that are resistant to digestion. This means that these kinds of carbs have been shown to trigger digestive symptoms in all kinds of people, from excessive gas to stomach pain, says Michelle Pearlman, MD, a board-certified gastroenterologist and physician nutrition specialist within the University of Miami Health System. “Instead of being absorbed into the bloodstream, [these carbs] reach the far end of the intestine for fuel, and produce gasses like hydrogen, methane, and sulfur, which often cause digestive symptoms like excessive belching, bloating and flatulence in some individuals,” Pearlman explains. “These types of carbohydrates also draw liquid into the intestine, which may lead to diarrhea.”
But not everyone who consumes foods that are high in FODMAPS experience adverse side effects when they’re digesting meals. And some of the foods that are naturally high in FODMAP carbs are actually otherwise highly attractive for their nutritional counts in well-balanced diets. Carrie Walder, MS, RD, a nutritionist who has previously published specialized guidance for those interested in the Low FODMAP diet on her website, says that feeling gassy after eating ingredients high in FODMAP carbs “is a normal process and with most individuals, this will cause no issue … Many high FODMAP foods are actually incredibly healthy, so we want to be able to include as many of them in our diets as possible.”
Understanding the point at which bloating, gas, and diarrhea cross from being unintended side effects into something you should discuss with your doctor can be tricky. Below, we’re reviewing the basic principles of the Low FODMAP diet program, who should actively try the diet at home, and how this diet can help you make better decisions at mealtime (even if you don’t have IBS).
What can you eat on the Low FODMAP diet?
The diet is structured into three different phases; In the first phase, foods that are high in FODMAPs are completely removed from the diet (or only consumed in very limited amounts). The most common misconception about this program, Walder says, is that dieters believe these foods should be removed forever. “The full elimination phase should only last 2-6 weeks, with the goal to re-incorporate as many high FODMAP foods back in as you can individually tolerate,” she says. The second phase allows dieters to slowly reintroduce small amounts of different kinds of FODMAPs back into their diet, which is a great way to understand which kinds of foods high in FODMAPs actually irritate their bodies. The third phase, then, is a longer period where you’re able to customize what you eat on a regular schedule. “The final integration phase of the diet is meant to be personalized to the individual,” Walder explains. “This means that they will only continue to avoid the high FODMAP foods that trigger their symptoms, liberalizing the diet as much as possible.”
Understanding what’s completely off the menu for stages one and two of the Low FODMAP diet may be confusing. Walder explains that many different foods contain moderate amounts of FODMAP carbohydrate subtypes, but you may still be able to enjoy some of these items sporadically. We’re breaking down some of the ingredients that have the highest amounts of FODMAPs and what you might be able to substitute:
- Vegetables: Garlic, onions, cauliflower, mushrooms, asparagus, and artichokes are all consistently high in FODMAPs, and should be eliminated as much as possible during stage one. Walder says it’s tough to avoid things like garlic and onion in prepared products (everything from snacks to sauces and seasonings are often prepared with these staples). Instead, reach for veggies that are lower in triggering FODMAPs, including tomatoes, eggplant, carrots, spinach, zucchini, and bean sprouts.
- Fruits: Another diverse source of FODMAPs, you’ll need to avoid apples, pears, apricots, peaches, nectarines, watermelon, and cherries, Walder says. The best fruits for the first two phases are lower in fructose, which include blueberries, kiwi, mandarins, oranges, papaya, pineapple, strawberries, and rhubarb.
- Grains: Wheat is one of the most controversial sources of FODMAPs, not because it contains egregious levels, but because we tend to overeat it in our diets. It can be found in bread, pasta, cereals, and pastries — alongside rye and barley, it’s off the menu. Reach for brown rice, buckwheat, oats, polenta, quinoa, and millet instead.
- Legumes: You probably have firsthand experience in feeling extra gassy after eating beans, so it shouldn’t be a shock to hear that these nutrient-dense staples are off the menu. To make up for it, you should be upping your tofu intake, alongside protein-rich items like eggs and a few nut varieties (minus pistachios and cashews).
- Sweets: While ingredients containing low to moderate amounts of sugar isn’t a dealbreaker, some sweeteners used in prepackaged desserts and beverages are high in FODMAPs that could impact your digestion. Anything containing honey, agave, or sorbitol should be eliminated from your routine for the first few phases of the diet.
If you’re looking to maximize your Low FODMAP diet meal plans, Walder says there’s a more complete list available to dieters provided by Monash University. The list is also available as part of an interactive app where you can track the foods you eat. “I would recommend it to anyone who has to follow this diet,” she says.
When should you start a Low FODMAP diet?
If you’re experiencing any of the common digestive issues that may be addressed by a diet change — from bloating to constipation or even chronic diarrhea — you may think the Low FODMAP diet is perfect for you by default. But while this diet is intended to eliminate gas production and the symptoms associated with excessive gas, it shouldn’t be the first treatment option, unless you’ve discussed it with your healthcare provider first. “Many of the foods that contain large amounts of FODMAPs are in fact very healthy and nutrient dense — think of some of the items that are excluded, like cauliflower, broccoli, Brussels sprouts, avocado,” Dr. Pearlman says, adding that many people assume the FODMAP diet is an automatic solution for their digestive issues. “It’s key to try to prepare your own food, limit any processed foods, and limit eating out because there are often hidden additives, seasonings, or sauces that can contribute to GI symptoms that people are not aware of if they’re not preparing their food themselves.”
Pearlman stresses that automatically adopting a Low FODMAP diet could actually work against you in the long run. For clinical experts to appropriately diagnose a gut health issue correctly — whether that’s gluten sensitivities, SIBO, gastroparesis, or a parasitic infection — the digestive system needs to be exposed to all issues. “Something like celiac disease or an impacted thyroid can be causing stress within the GI tract, but I need to make sure that I test patients for those issues before prescribing a certain diet, as cutting out entire food groups may skirt the true issue,” Pearlman explains. There’s even a chance that eating foods exclusively low in FODMAPs will still lead to irregular digestion, as highly-processed items (like bacon!) are okay to eat while on this diet plan.
If you’ve previously discussed eliminating extra FODMAPs with your doctor, there’s a good chance you’ve been diagnosed with a chronic issue, such as irritable bowel syndrome. But if you’re living with IBS and haven’t explored this option yet, the Low FODMAP diet may be the relief you’ve been searching for. “IBS affects about 15% of the world’s population, and with it comes an extreme emotional effect and negative impact on quality of life,” Walder says. “In fact, studies have shown that [patients] would be willing to give up 25% of their remaining life for a treatment that would offer symptom relief. This is why the low FODMAP diet is of value and why it’s being talked about — we have finally found a dietary treatment that can help up to 75% of IBS patients find relief from their suffering.”
Is the Low FODMAP diet actually healthy?
Both experts agree: The Low FODMAP diet is not intended for weight loss, and should only be adopted in its entirety if you’ve consulted a doctor. “It’s not a weight loss diet and should only be attempted if medically necessary; It’s not meant as a ‘cleanse’ or ‘reset’ and really should only be followed if your doctor has suggested it,” Walder says. While the diet may help address belching, bloating, excessive flatulence and diarrhea, many of the prohibited foods are actually some of the healthiest options for those who are actively trying to lose weight due to their low calorie counts and high fiber content. “For someone to completely avoid all foods high in FODMAPs for a prolonged period of time is not only very unrealistic, but it can often lead to disordered eating and restrictive dietary patterns,” Pearlman argues.
That being said, there may be a few ways to glean some useful insight from this trending diet, especially if you’re feeling frequently feeling unbalanced after mealtimes. Walder says there’s an abridged version of the diet, so to speak, known as “FODMAP Gentle” that may be able to help you pinpoint exactly which foods are causing you discomfort. “Essentially, a dietitian would look at your current dietary intake and only restrict the highest FODMAP-containing foods that are found in that patient’s diet; mainly onions, garlic, and beans,” Walder explains. “If this patient sees an improvement in their symptoms, they can start to add them back to see if their symptoms return. Perhaps then they may only have to eliminate or lower their intake on a couple of ingredients, and not necessarily go through the full elimination diet.”
At home, pay attention to what you eat without obsessing over their complete nutritional profiles — Pearlman says you might be able to start by process of elimination in the time leading up to a professional consult. “The most alluring part of this diet is the ability to reintroduce items one at a time — did ‘X’ food actually cause you distress? More often than not, though, if people just ate unprocessed, real food, they’d feel a whole lot better to begin with.”