If you suffer from constipation, bloating (several times weekly or daily even), IBS, Crohn’s, or GERD, you’re probably frustrated with your symptoms and confused about what to eat and what to avoid. Maybe you’ve tried GAPS, SCD or paleo and haven’t found success. Or if you’re recently diagnosed with SIBO (small intestinal bacterial overgrowth), this post is for you. I’ve had a lot of success working with clients whom I’ve coached through a low FODMAP diet, and they’ve finally found relief from GI pain & bloating (and also the helpless feeling that comes with not know what foods trigger GI distress).

FODMAP is an acronym for Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols. These short-chain carbohydrates contain sugars that are fermented by gut bacteria, causing bloating and discomfort. The foods that are high in these FODMAPs are poorly absorbed in certain people in their small intestine, where the bacteria present ferment them, causing pain, gas/bloating, and diarrhea. In healthy individuals these foods are beneficial. The FODMAP foods also feed bacteria trapped in the small intestine (an overgrowth called SIBO), contributing to GI distress. Click here for more on SIBO.

Here are example FODMAP foods:

Fructose: honey, apple, mango, pear, watermelon, high-fructose corn syrup, agave syrup, dried fruit, fruit juice

Fructans: artichokes (globe), artichokes (Jerusalem), asparagus, beetroot, broccoli, Brussels sprouts, cabbage, eggplant, fennel, okra, chicory, dandelion leaves, garlic (in large amounts), leek, onion (brown, white, Spanish, onion powder), radicchio, lettuce, spring onion (white part), wheat, rye, pistachio, inulin, fructo-oligosaccharides.

Lactose: milk, ice cream, custard, dairy desserts, condensed and evaporated milk, milk powder, yogurt, soft unripened cheeses (such as ricotta, cottage, cream, and mascarpone cheese).

Galactans: legumes (such as baked beans, kidney beans, soybeans, lentils, chickpeas).

Polyols: apple, apricot, avocado, blackberry, cherry, longan, lychee, nectarine, pear, plum, prune, mushroom, sorbitol, mannitol, xylitol, maltitol, and isomalt.

The diet seems high maintenance, but you’ll get the hang of it, and remember: it’s not forever. In fact, you shouldn’t stay on this diet longer than 3-4 months because it starves out your own beneficial pre- and probiotic bacteria. Try avoiding these foods for a minimum of 60 days before you begin reintroducing. I recommend testing to see if other bacterial overgrowths or parasite infections are present so you can treat those at the same time. Here’s a great chart of foods to avoid and include.

Keep in mind that these foods are somewhat variable. Some foods on this list may adversely affect one person but not another. Everyone is so physiologically different that it takes a bit of trial and error, and I think it also depends on the severity of SIBO or other bacterial overgrowth in most folks. The biggest “maybe” foods are nuts, cruciferous, coconut, and avocado–some do fine with these; others not so much. The highest FODMAP foods seem to be onions and garlic, and many of my GI cases really don’t do well with tomatoes, so take care to avoid these three foods initially. If you’re symptom-free for 3 months, you can begin reintroducing. You may be able to tolerate small amounts of FODMAP foods; it’s really a threshold issue.

So what causes FODMAP reactions? If you have IBS, Crohn’s or SIBO, you likely have a problem digesting FODMAPs. SIBO is found in many Crohn’s and most IBS cases, but it is not bad bacteria by nature– it’s just bacteria trapped in the wrong place in your intestinal tract (the small intestine). The cause may be poor gut motility, so bacteria gets trapped in the small intestine rather than being swept down into the large intestine where it belongs. Some people may lack the enzymes or beneficial bacteria needed to break down these FODMAP foods. In the case of IBS, the FODMAP foods will exacerbate symptoms and contribute to inflammation, but they aren’t a known cause.

Better yet, what to do about it? IBS or other sufferers of chronic inflammatory digestive issues do well on this plan, mostly because the inflammation in their gut destroys the ability to break down these foods, and they lack the proper enzymes. Typically if I see someone who complains about a lot of gas or bloating or IBS type symptoms, and they can’t figure out which foods are causing the problem (because they’ve already eliminated the main culprits like gluten and dairy), that’s one good indicator that they’re a perfect candidate for this diet. And 9 times out of 10, they do feel better. So step one is all about eliminating the FODMAP foods to calm inflammation and give the gut a rest.

Step 2 is to kill off SIBO or other bad bacteria that is contributing to dysbiosis. There is a very particular protocol you must use to kill SIBO. You can read more about it here.

Step 3 is to repair the gut with probiotics (you must be careful with probiotics post-SIBO) and a leaky gut healing protocol.

Other helpful tips for healing: lots of bone broth, which contains gelatin and collagen and other gut-healing nutrients. Probiotic foods like raw kraut, kvass or kombucha drinks (skip the dairy!). Glutamine is a great gut healer, and I use that as part of my leaky gut healing protocol. Stress contributes to dysbiosis, so consider measuring your cortisol levels and figure out what works for you in terms of addressing your stress level. Chris Kresser wrote a good article about how stress wreaks havoc on your gut.

Follow this low FODMAP plan for at least 60-90 days while working to correct the cause of FODMAP intolerance, then begin adding the foods back you really miss (like onions and garlic) to see if there’s any improvement. You won’t (and shouldn’t) have to eat this way for life, so don’t give up! Here’s more info about how to curate a FODMAP diet.

Example of FODMAP meal plan for a day:
Wake up, drink a glass of room temp water with a splash of apple cider vinegar to rehydrate. Green tea.
Breakfast: organic sausages with chard, or eggs poached over a bed of greens (kale and chard; spinach can be an irritant).
Lunch: nightshade free meat sauce under roasted spaghetti squash (mmmmm, see recipe, below). Keeps well for days!
Dessert: few squares of 70% or higher dark chocolate
Dinner: roasted wild salmon with butternut risotto and butter or ghee, green beans or roasted zucchini and red pepper
Ginger tea for after dinner digestif
Chia pudding with hemp milk.

Stick to cooked, easy to digest foods during this time. Raw foods are harder to digest.

Nightshade Free Meat Sauce
1 pound grass fed ground beef
About 1/2 cup or so (to taste) grated liver: freeze grass fed beef liver, then grate it into the sauce for added nutrients and richness
1 bunch chives, finely chopped
1 large carrot, grated
1 large zucchini, grated
1 tsp dried oregano
1 tsp dried basil
½ tsp marjoram
Pinch of thyme
1 cup red wine
2 T fresh rosemary leaves, chopped fine (or just use a combo of these herbs and an Italian seasoning)
Sea salt and pepper
Preparation:
Add some garlic infused olive oil to a pan. Brown meat in a cast iron skillet and grate in liver. Season with salt and pepper and remove from pan. Add more olive oil if needed and carrot and zucchini and spices and cook for about 5 minutes, then add meat back, toss everything together, and add wine. Let reduce for about 15-30 minutes. I sometimes add tamari or coconut aminos for extra flavor I usually add some garlic powder and Italian spice blend too. Taste to adjust seasonings.

Mary Vance, NC

Mary Vance is a Certified Nutrition Consultant and author specializing in digestive health. In addition to her coaching practice, she offers courses to help you kick candida and heal your gut. Mary lives in San Francisco and Tahoe in California. Read more about her coaching practice here and her background here.

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