Inside: I suffered with abdominal pain and other symptoms for years. Adjusting my diet around FODMAPs finally gave me some relief. Could it help you too?
For as long as I can remember, I’ve had a sensitive stomach.
As a kid, I complained about belly pain a lot. But when my mom took me to the pediatrician, he wasn’t sure how to explain it.
In my early 20s, stress around jobs and relationships made things worse. I was eventually diagnosed with Irritable Bowel Syndrome (IBS), a cluster of symptoms that includes abdominal pain, diarrhea, constipation, or alternating bouts of both. (Fun times, right?).
It’s not clear what causes IBS. Genetics are likely involved. Stress can aggravate it. So can certain foods.
But I couldn’t figure out which foods were upsetting my system: Was it gluten? Dairy? High-fat restaurant food?
Sometimes those foods seemed to bother me. Sometimes they didn’t. As a registered dietitian, I was frustrated because it felt like a total mystery–but I was determined to solve it.
IBS, meet FODMAPs
When I became a registered dietitian, I learned about something called FODMAPs, categories of carbohydrate-containing foods first identified by researchers at Monash University in Australia.
FODMAP stands for Fermentable, Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. It’s a strange-sounding acronym, but it’s easier to think of them as groups of foods:
- Fructans: Includes wheat, rye, onions, and garlic
- Galactans: Includes beans and lentils
- Lactose: Includes dairy foods like milk and cheese
- Fructose: Includes honey, apples, watermelon, and high fructose corn syrup
- Polyols: Includes sugar alcohols like sorbitol and mannitol and some fruits and vegetables like peaches and cauliflower
What’s vital to know: These are perfectly healthy, nourishing foods that a lot of people eat with no problem.
But for some people, one or more of these categories of foods aren’t digested and absorbed well in the small intestine. That pulls in extra water, which can cause bloating and diarrhea. Then in the large intestine, bacteria break them down and produce gas, which can trigger cramping and pain.
People with IBS may be sensitive to just one category or multiple categories. They may be able to tolerate a small portion of a food in a category–or not.
Bottom line: It can be tricky to figure out what you’re sensitive to.
Putting the pieces together
Instead of one lightbulb moment, I had experiences over the years that helped me put the pieces together. For example:
- When I started snacking on apples in the evening after dinner, I noticed I was going to bed bloated and uncomfortable.
- I made a soup that was heavy in garlic, onions, and mushrooms and was doubled over with abdominal pain after eating a bowl of it.
- I found that having pasta and bread in the same meal caused cramping.
- Having big portions of some of my favorite summer fruits (like watermelon, peaches, and cherries) left me with stomach pains.
- Snacking on pretzels caused me to bloat.
- Inulin/chicory root in Fiber One bars and Kashi cereal made me bloated and gassy (read: Is Chicory Root Giving You Gas?).
How it works: You first eliminate all of the high-FODMAP foods for a couple of weeks, replacing them with lower-FODMAP foods. For example:
- carrots instead of asparagus
- gluten-free pasta instead of regular pasta
- lactose-free milk instead of regular dairy milk
- maple syrup instead of honey
Next you add one category back at a time, making note of changes to bowel habits and symptoms like gas, bloating, and pain as you figure out what your system can and can’t handle well.
The last phase is the “personalization”. You figure out which foods (and portions) you can tolerate well in the long term. The good news is that most people can add back some of the high FODMAP foods they avoided in the first phase–or they may be able to tweak the portion without experiencing symptoms.
This can be a long and involved process, and you need to be sure you’re getting enough food and nutrients along the way. It’s best to work with a registered dietitian to be sure you’re doing things right. (If you have a history of eating disorders, a process like this is not right for you–talk to your health care providers for guidance.)
Here’s what I did
Thankfully my symptoms have been milder lately, so I didn’t embark on the total elimination phase. Instead, I used the clues I had to experiment with foods I thought caused me the most problems. So:
- I reduced my portions of high FODMAP fruits I love like cantaloupe, peaches, and watermelon and found I could tolerate those smaller amounts much better (ex: half a peach was great, a whole one gave me pain).
- I did the the same with regular pasta, and found that a smaller portion of regular pasta didn’t trigger symptoms.
- If I knew I was having pizza for dinner, I avoided wheat-based foods the rest of the day in favor of other grains.
- I tried gluten-free pretzels and used gluten-free flour in some recipes.
- I started cooking with onions or garlic but not both.
- I swapped honey for maple syrup in my recipes.
- I kept dairy like milk and cheese in my diet because it didn’t seem to negatively affect me.
How this has helped me
Within a week or two of making changes, I noticed a difference. I was less bloated. Even better, I was experiencing fewer abdominal pains, and my digestive system became more regular.
Overall I’m feeling a lot better. So I’m motivated to make these changes stick. I don’t feel deprived because I’m able to eat what I want if I adjust the portion sizes and am strategic with my meals and snacks. This is different for everyone of course–some people may do better avoiding a certain food altogether.
Do I still get random abdominal pain and bloating? Yep. Do I think I have this FODMAPs thing totally figured out? Not yet. But I feel a lot less clueless–and a lot less helpless in the face of my symptoms–than I did before.
Want to learn more about FODMAPs?
- If you’re experiencing unexplained abdominal pain and bouts of constipation and diarrhea, talk to your doctor, who may refer you to a GI specialist.
- If you already have an IBS diagnosis and want to try the low-FODMAP diet, I suggest consulting an expert to guide you–especially through the elimination phase, which is only short term but quite restrictive. Here are some dietitians who specialize in FODMAPs and IBS that I recommend:
- Kate Scarlata: A gut health expert and dietitian with 30+ years of experience and multiple books about IBS and FODMAPs.
- Patsy Casto: A dietitian and FODMAP expert. Her book, IBS: Free At Last is where I first turned to learn more about FODMAPs. She also has a state-by-state directory of FODMAP dietitians.
- E.A. Stewart: A blogger and dietitian who specializes in gut health. She’s got lots of FODMAP-friendly recipes on her site and does nutrition coaching.
- Tamara Duker Freuman: An NYC-based GI-health dietitian who earned the nickname the “Bloated Belly Whisperer”. Her new book is called Regular.
- Keeping a journal of your meals and snacks, as well as your symptoms, can also help you (and a health care provider) figure out what foods might be triggering.
- If the elimination diet sounds overwhelming or confusing to you, Monash University provides a simpler “Gentle FODMAP Diet” approach.
Questions about FODMAPs
Is a low-FODMAP diet a weight loss diet?
No. The low-FODMAP diet is NOT designed for weight loss.
Can kids do a low-FODMAP diet?
Yes, but there are cautions. The short-term elimination phase can feel restrictive. And it can take work to make sure growing kids are getting enough food and nutrients during the process. If your child or teen has IBS and you want to explore a low-FODMAP diet, find a dietitian who specializes in this area to guide you. (See: Kids Can Have IBS Too. Here’s How To Help.)
Is the low-FODMAP diet a long term way of eating?
No! The elimination phase is very restrictive and only meant to be followed in the short term to identify the foods that bother you. Most people can introduce some higher FODMAP foods back into their diets and still have their symptoms under control, according to Monash.
You may find, like I did, that an entire category of foods doesn’t actually bother you. Or, like me, you might discover you can tolerate a smaller portion of a high-FODMAP food just fine.
Is a low-FODMAP diet helpful for other digestive issues?
Yes. According to the American College of Gastroenterology, the low FODMAP diet may be helpful in the treatment of inflammatory bowel disease, celiac disease, and small intestinal bacterial overgrowth. It’s not as well researched for those conditions, so talk to your doctor about trying it.
What are examples of high- and low-FODMAP foods?
Below is a sampling of lists from Monash University’s Low FODMAP Diet.
Low FODMAP Fruits
- Cantaloupe and honeydew (limit to 1/2 cup)
- Grapes (limit to 6)
- Kiwi fruit (limit to 2)
- Lemons, limes, oranges, mandarins
- Pineapple (limit to 1 cup)
- Strawberries (limit to 5 medium)
High FODMAP Fruits
- Nectarines, Peaches, and Plums
Low FODMAP Vegetables
- Broccoli (limit to 3/4 cup)
- Cabbage (limit to 3/4 cup)
- Lettuces and spinach
- Spaghetti squash
- Tomato (1/2)
High FODMAP Vegetables
- Mushrooms (except canned and Oyster)
- Snow peas
Low FODMAP Snacks
- Nuts: Pecans, walnuts, peanuts, macadamia, almonds (limit 10 almonds)
- Hard-boiled eggs
- Corn tortilla chips
- Peanut butter and gluten-free crackers
- Mozzarella cheese sticks
- Seeds: Sunflower or pumpkin
- Gluten-free pretzels and other snacks
Here are some recipes from my site that are low FODMAP:
Start with one serving.
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