Pictured recipe: Low-Carb Blueberry Cobbler
Anyone with irritable bowel syndrome (IBS) or other digestive issues has likely read up on the low-FODMAP diet, be it at the recommendation of a doctor or dietitian, or just a Google search. If you're lucky enough not to fall into this camp, you may have seen the diet mentioned on Instagram, or heard about it from a friend. But there's a lot of confusion and misinformation about what the low-FODMAP diet is, why it exists and who can benefit from it. Here we dive into what FODMAPs are, what foods you can eat on a low-FODMAP diet and what foods you should limit or avoid during the elimination phase.
Literally, FODMAPs are fermentable oligosaccharides, disaccharides, monosaccharides and polyols, "a group of commonly malabsorbed carbohydrates (sugars and fibers) that have been shown to trigger symptoms in individuals with irritable bowel syndrome (IBS)," says Kate Scarlata, R.D.N., L.D.N., author of The Low-FODMAP Diet Step by Step.
In layman's terms, FODMAPs are more difficult for the digestive system to break down and absorb, which isn't a problem for most people but can cause serious discomfort for people with IBS, and for people with certain forms of inflammatory bowel syndrome (IBD) like Crohn's disease and ulcerative colitis.
"We know that the low-FODMAP diet helps the majority of IBS sufferers, but many individuals with IBD such as Crohn's and ulcerative colitis are prone to IBS symptoms as well, and the low-FODMAP diet has been shown to help manage symptoms in these individuals too," Scarlata says.
"Common symptoms of IBS include abdominal pain, gas, bloating, diarrhea and constipation, that occur at least one day a week for at least three months. If you suspect you have IBS, visit with your primary care doctor to discuss your symptoms and get a diagnosis," Scarlata says. A doctor can help design a treatment plan, and can diagnose or rule out conditions that may present with similar symptoms, such as celiac disease.
The diet consists of three phases, and should be done under the supervision of a dietitian. First is the elimination phase, during which high-FODMAP foods are completely eliminated. This phase typically lasts two to six weeks, depending on how a person responds to the elimination. If all IBS symptoms disappear within the first two weeks, the supervising dietitian may recommend moving onto the next phase; if symptoms are slower to disappear, the elimination phase may last longer.
The second phase is a reintroduction phase. "FODMAPs are systematically added back into the diet to identify which FODMAPs trigger symptoms," explains Scarlata. Typically, you'll reintroduce a single high-FODMAP food for three days to see how you react, then eliminate it again and move on to another high-FODMAP food. This is when it's especially crucial to work with a dietitian, who will guide you through reintroduction and help monitor your reaction to different foods.
After the reintroduction phase is the personalization phase. In this phase, you add back high-FODMAP foods that didn't trigger symptoms and monitor how you feel. This phase of the diet is meant to be sustained long-term, so it's important that you reintroduce as many foods as possible, both to make the diet sustainable and to protect against possible nutrient deficiencies that might result from being overly restrictive. Because this phase looks different for everyone—it's about personalization!—there's no official list of foods that you can and can't eat.
When people talk about a low-FODMAP diet, they're usually talking about the elimination phase. The personalization phase isn't necessarily a low-FODMAP diet, since you reintroduce all the high-FODMAP foods that don't cause problems.
The elimination phase is incredibly restrictive. That's why it's only recommended for people with IBS or IBD and should be done under supervision and guidance from a registered dietitian. The foods listed below are high in FODMAPs and would be cut out during the initial, very strict elimination phase.
Dried fruits and fruit juice concentrate
High-fructose corn syrup
As you can see, most of these are healthful, nutrient-dense foods that should not be limited long-term unless they cause IBS symptoms for you.
During the elimination phase, you can eat certain grains, fruits, vegetables and legumes, plus meat, seafood and most nuts and seeds.
Because FODMAPs are carbohydrates, foods made up of mostly fat and protein are fine to eat on a low-FODMAP diet. Meat and seafood is fine, as are oils, most nuts (except cashews and pistachios) and seeds, lactose-free dairy products and most cheeses. Tofu and tempeh are also OK in small amounts, although other soy products are not.
Coffee, black tea, green tea, white tea and peppermint tea are allowed on a low-FODMAP diet, as are most sweeteners, including brown sugar, palm sugar, pure maple syrup, raw sugar, rice malt syrup and white sugar.
When it comes to fruits, vegetables, grains, beans and legumes, commonly allowed foods are:
When eating these allowed carbohydrates, you'll likely need to watch portions—most have small amounts of different FODMAPs, so too large a serving can trigger symptoms.
"This is a learning diet that helps people with IBS identify their triggers," says Scarlata. "It is not a fad diet for weight loss—it is prescribed as a form of medical nutrition therapy. If you don't have IBS symptoms, the low FODMAP diet is not for you."
Even people with IBS aren't meant to sustain the restrictive elimination phase of the diet long-term. "This is an elimination diet, not one you're meant to stay on forever—some people do not understand this," says Sharon Palmer, R.D.N, author of The Plant-Powered Diet and nutrition editor for Today's Dietitian. The end goal is to create a personalized diet that's as varied and inclusive as possible without causing discomfort, not to follow a super-restrictive (and potentially nutrient-deficient) diet forever.
The diet is very restrictive, which can have a negative effect on both your physical and mental health if sustained long-term. If you're curious about FODMAPs, chances are it's because you're experiencing digestive issues and aren't sure what to do. Schedule an appointment with your doctor to talk through your symptoms and get a diagnosis, then work with a dietitian and use a low-FODMAPs diet to identify which foods might be causing these issues.