FODMAP Food List Discrepancies

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Hello FODMAPers.

So here’s the scoop:ff app

This week, dietitian, Sue Shepherd, one of the developers of the low FODMAP diet, and her team launched their FODMAP friendly app. It became readily available on iTunes just yesterday. For the most part, most of the foods on Sue Shepherd’s FODMAP Friendly app and Monash University’s low FODMAP diet app are in agreement BUT…there are some foods that yielded quite different results.  Monash app

For instance, three tablespoons of chia seeds showed to be a HIGH FODMAP food in Dr. Shepherd’s app, while Monash University’s low FODMAP diet app notes 2 tablespoon of chia seeds are LOW FODMAP. Rice drink passed as low FODMAP on the FODMAP friendly app, while recent updates via research at Monash yielded rice milk as HIGH FODMAP. Serving sizes posted on the apps vary too…so do pay attention if you are using both apps and comparing foods.

If you are a rule follower and like to play by the book, the low FODMAP diet might be leaving you a bit frustrated of late. The ever-changing food lists have been a challenge for dietitians in the field and for many FODMAPers trying to prepare a low FODMAP meal in their kitchen.

Why the discrepancy? It could be testing methods vary or that the sample sizes used to test are different. Food analysis for FODMAPs is time-consuming and complex. Food is variable….growing conditions, sourcing and manufacturing can contribute to changes in food.

I have been following the diet closely for the past 7 years and I can tell you the diet is still a baby. It has much growing to do. Much more food testing. Much more clinical research to understand the long-term impact of restricting FODMAPs to our health. But, there is no question in my mind…the low FODMAP diet has been life-changing for many people who suffer with digestive distress.

And despite the ongoing food list updates with new food analysis, the diet has been therapeutic for my patients since 2009… even when the foods allowed looked a bit different then they do now.  So here is my message: Stay calm. Don’t get too caught up in the low FODMAP food list nuances. Think BIG picture and pull out the majority of the FODMAP rich foods and assess the benefit to your IBS symptoms.

Remember, FODMAPs are not toxic to your body! Making a general reduction in high FODMAP food intake will be enough for most folks to notice significant changes in their IBS symptoms. If you are still troubled with symptoms despite adhering to the low FODMAP diet, you may have an overlapping medical condition that needs to be addressed, see my post here on When Diet is Only a Piece of the Pie… or you may be following the diet incorrectly! Perhaps you may be indulging in too many food products, which due to different additives and manufacturing processes, may have hidden FODMAPs in them. The food product industry is really an uncharted area of the low FODMAP diet as there are billions of food products–and only a small percentage have been officially tested for FODMAP content. You may have to do a little trial and error with your diet. For instance, if you are drinking a rice milk product and still are troubled by digestive woes perhaps switch to lactose free cow’s milk or try another brand of rice milk to see if you notice any reduction in your symptoms.

Work with a FODMAP knowledgeable dietitian to guide you. Innately, FODMAP rich foods are healthy for humans and the gut microbes that reside in our gut. Long-term, you only want to reduce your FODMAP intake to the amount necessary to manage your troublesome gut symptoms.

Some general tips for you while you navigate your way through the low FODMAP elimination phase:

  • Don’t alter your diet without seeking advice from a health professional first.
  • Choose mostly low FODMAP whole foods vs. food products.
  • Vary your diet! Don’t eat the same thing every day.
  • Eat a well-balanced low FODMAP diet! Enjoy protein rich foods (meat, fish and eggs are FODMAP free), low FODMAP grains/seeds/starchy vegetables (rice, quinoa, baked potato, 1/2 sweet potato), and a serving of low FODMAP fruit and vegetables PLUS a dose of healthy fats (olive oil, suitable nut butters)
  • Work with a dietitian.  Don’t try to navigate the complexities of the low FODMAP diet alone.
  • Stick to the STRICT low FODMAP elimination diet for the short-term (2-6 weeks).
  • Be patient.
  • Focus on the foods you can eat vs. the foods that are HIGH FODMAP.
  • If you are afraid about re-introducing FODMAPs back into your diet, go s-l-o-w-l-y.  Small amounts over the week can be added.
  • Remember FODMAP-rich foods are not bad or illegal (I hate that term!).  Fructans and GOS feed healthy gut microbes that produce butyrate, a short chain fatty acid that is healthy for our colon. Incorporate FODMAP-rich foods to your personal tolerance after the elimination phase.
  • A diet of potato chips and chicken are indeed, low FODMAP, but not healthy, right? Nourish your body (and gut) with nutrient dense foods such a brightly colored, antioxidant rich low FODMAP veggies and fruits.
  • Keep in mind, the low FODMAP diet, is the new kid  diet on the block. Food analysis and clinical research is ongoing. As the diet evolves, so will my resources for you here on my blog.  Stay tuned…we are working on it!

 

33 replies on “FODMAP Food List Discrepancies“

  • Julie Delorme

    Hi Kate,

    Yes, it is quite confusing on beetroot, white nectarine, tofu, coconut milk, chamomille tea! because only a variation of testing method or samples could explain that.
    My biggest concerns are about rice and coconut milk which are “big” ingredients for cooking. What is your opinion about that?

    Cheers

    The french FODMAPer dietitian

    • katescarlata

      I am not sure I have an opinion on the plant based milks…yet. There are so many variables– brand to brand. It truly is a trial and error process–I think for some of these food products that have been shown to have varying FODMAPs amounts with different testing–that FODMAPers should add them in slowly and test their tolerance to them in the setting of an otherwise low FODMAP diet.

  • Veronica Hoskins

    Hi Kate,

    I’ve been following FODMAP for a almost a year (haven’t been entirely successful) but in working with my dietician she has pointed out that there are different standards for Australia, USA and Canada. I live in Canada. Wondering how these new findings fare in Canada? And/or what is your opinion on the differences across regions?

    I’m disappointed about the coconut milk but assume almond milk is still OK!

    Thanks
    Veronica

    • katescarlata

      I am not sure that we have standards on FODMAP content in the US at this point as we have little testing being done at the moment. Like I said in my post, the diet is fairly new–there will be ongoing changes and more standardization in time. When you look at the changes seen in the gluten free diet–we have come very far. But even still, with gluten, there is more do be done with standardization of foods and supplements.

  • DrAmyG

    The Monash University app does not distinguish between fructose and fructans, so I find it to be useless for me. Unfortunately, I’ve been unable to get someone to reply to my emails for a refund. But I found this approach to be very odd and I don’t understand why they would be lumped together. Do you mind sharing whether the “filters” on the Shephard app are separated into six categories and not 4? My problems are lactose, fructose and polyols. Thank you, Kate!

    • katescarlata

      Dr. Amy, Yes, the Monash University app does distinguish btw fructose and fructans. Oligosaccharides–GOS and fructans are often lumped together because foods that contain Oligosaccharides often have both fructans and GOS….not always…but often. I did not see any filters on the FODMAP friendly app. They might be there–but they were not obvious to me.

  • Jo

    I’m so surprised and disconcerted about these discrepancies. It makes it hard to know which ones to believe and which ones to follow. For someone like me who finds that almost everything with any quantity of FODMAPs is a trigger, it makes it very difficult to pinpoint which foods are the problem. But that’s the whole point of the low-FODMAP diet, right — to make it easier, not harder, for us. I hope they’re able to get more in sync with each other soon. Thank you for staying on top of this, Kate, and looking out for us.

  • Trish

    Thanks for the wise words, Kate! I’ve had such good success with the low-FODMAP diet over a year and a half that I am willing to continue. I’ve recently done some travelling and it reinforced that I am able to manage OK with different foods, and eating what is available, for a short time. Also I am interested in the gut biome and have been trying to add in small amounts of the FODMAP-rich foods to nourish the gut bacteria. So far, so good!

  • Donna

    It would be interesting to know what it is in rice milk that causes the problem. Rice or the additives? I find rice and quinoa to be difficult to digest but maybe that’s a different issue – or maybe we’re learning that rice is not as low FODMAP as we thought it was. I admire you, Kate, because there are so many variables with this diet and you’re still dedicated to helping people navigate through it. Thanks for all you do.

    • katescarlata

      I do wonder about the additives in the plant based milks. Drives me a bit crazy that they add so much additives to the commercial varieties. Some processing of rice seems to increase fructan content. Puffed rice in 1 cup serving is rich in fructans. So could be partially due to additives and partially due to processing. And, I do believe, that different rice milks will vary in FODMAP content. So if the rice milk you use doesn’t pose a problem…then keep on using it! It’s all about finding what works for you. And thanks for your kind words, Donna, this diet has numerous variables that KEEP changing. But…I see how it makes a difference in the lives of so many who suffer with digestive woes…and so I will hang out in the trenches and keep following the research trail.

  • Ashley Stewart

    Hi Kate,
    Great post! I’ve been having a look at the new fodmap app and also was a bit concerned about the varying results. I do really enjoy that the app gives specific numbers for each of the sugars. I’m very sensitive to Fructose so its good for me to have more detail. Do you think Monash ever plans to give more detail in their app?

    I’ve been following this way of life for nearly 3 years now and am happy that new resources are coming out for us foddies! especially because it was only a few dollars.

  • COLLEEN FRANCIOLI

    Very well said Kate. I agree with you about disliking when sources say FODMAPs are “bad.” Some FODMAPs might not be great for some people but there’s other FODMAPs that could be very beneficial! The more calm and balanced a person is to their approach on this diet, the better!

  • FairyFodmother

    Thanks for this post Kate, it really helps being able to access expert advice so easily! Sometimes the low FODMAP diet can be so fustrating, especailly at the beginning when you’re trying to get your symptoms in control, knowing what/ how much to eat can be so confusing! Reading this though has helped ease my mind. Having been following the diet for some time now, the biggest thing i’ve learned is that there are no set rules as everyone’s tolerance levels are so different; you’re diet has to be individual to you.

  • Sarah Berriman

    Hiya Kate

    One of the difficulties and frustrations I have is that I read everywhere about the recommendation to work with a dietician and even in recent twitter chats via the IBS network, this is repeatedly stressed about the importance of this.
    However where I live, there are no support or resources for people with IBS. I have asked my GP about it and I am told that the NHS dieticians are very short staffed and under pressure from funding cuts and won’t take anyone with IBS. Only diabetes or heart problems.

    There are no fodmap trained dieticians or clinics available and so I, like many people I suspect, do not have access to dieticians or other medical health professionals to help. It is obviously not the fault of people like yourself but it is frustrating to be advised to access a service that is not there. It seems to vary regionally and I have heard that are clinics in some areas but I have never had a referral or being told about any such services or offered any support for my IBS.

    It would be helpful if some of these websites and support groups were aware that when they are telling people to work with a dietician when following a low fodmap diet that they may be recommending a service that does not exist for some patients to access.

    I appreciate your article and the help you offer via your website.

    Kind regards

    Sarah

    • katescarlata

      Sarah, I completely appreciate your comments and frustration. I just wrote a post for health professionals on how to receive education on the low FODMAP diet. There is a shortage. I fully agree.

  • Kathy Miller

    I have gotten some mixed information regarding Chokecherries. I have heard that Chokecherries are OK on the FODMAP diet and I have heard they are HIGH in FODMAPS. I tried the Monash Website and I can’t find anything about Chokecherries there. Do you know are Chokecherries ok on the FODMAP?

  • Ashleigh

    Hi Kate!
    Thanks for always having such great info to share! Any plans to have the FODMAP Friendly app for Android users? I would love to get it. Also, what has your research shown on avocados? Thank you in advance!

    • katescarlata

      Hi Ashleigh. I will check about the FF app for android use. Not sure what the plan is for that. And avocado is low FODMAP in small portion–about 1/8 of the avocado. A few slices on a salad, taco, etc.

  • batya

    dear kate
    my sentiments echo sarah above. after 7 years of IBS/digestion/bloating/fatigue issues, and seeing numerous and various MD’s, ND’s, RD’s…to get to the root cause, i found an MD that suggested the sibo test. when the results came she told me its positive, to get help with the diet ( i came to this site-which is awesome btw) and i went to see a dietician (in nyc) you mentioned in your blog; she told me the test is negative. my results from genova lab are under 20ppm at baseline and 20min, and at 40 min 27ppm, at 60min 23ppm and at 90min 25ppm. by 120 min it was 80. this dietician said in order for the test to be positive it needs to above 20ppm from baseline to 90min. and genova lab is wrong in saying that at 120 it reaches the small intestine, where in fact by that time its the colon, therefore having high ppm by that time is quiet normal. she said to try the low histamine diet, which after 4 days made me sick. who is right, and who is wrong? one doc says positive, one says negative? where does one find a competent and knowledgeable doc?

    • katescarlata

      The reality is that there is no set standard for the breathe tests–different labs around the globe have different levels that constitute a positive test (frustrating!) And unfortunately, there still is much need for research in this area. Many practitioners have no clue about SIBO: what it is, how to treat & what are the potential underlying causes for this condition etc. I work closely with the GI doc and if a patient does not have a rise >20 PPM for hydrogen on the breath test from baseline–BUT experienced symptoms during the test or has other diagnostic testing that points to the potential of SIBO such as fat malabsorption (fat in stool), elevated folate, low B12, I would discuss with the GI doctor about trying a trial of rifaximin to see if the patient benefit.

  • batya

    in general i find the whole stomach area a big conundrum. i have heard it over and over again, its IBS and there is nothing you can do about it…. but the pain is real and you have to eat. my symptoms hours after the test (maybe 5 hours or so) where terrible tummy pains that went up the esophagus to the point of nausea. i told myself, i am not repeating this test! i took rifaximin but honestly i felt the same -there is a long list of symptoms and i have been on restricted diet for a while to manage it-incomplete bowels, constipation, gas, cramps, pain by the ileocecal valve, inflated tummy, undigested food in stool, insomnia, adrenal fatigue, cold hands and feet, hives… it could be anything and everything at this point. fodmap was a minor adjustment, so far has not made me sick, but have not seen a huge improvement (after 6 weeks i stopped and tried the histamine) believe me fodmap is much safer than the histamine diet, i ate watermelon and my stomach almost turned into one! my fat soluble vitamins are forever low, A, E, D also Iron, especially Feritin, B12 was originally low, but with supplements got better. I have terrible fatigue and if i don’t watch myself, it can become flu very easily. the dietician i saw works with a GI, I’m seeing him to rule out, histamine, crohn’s, autonomic nerve dysfunction. really? its like being in a twilight zone.

  • JoAnn

    How does one get a Monash U app update?
    What is the date of the latest app update?
    What I downloaded end of 2014 seems obsolete.
    Thank You!

    • katescarlata

      JoAnn–the app has had some updates. If you have the Android version–it was updated this summer. The lastest iPhone version should be ready for its latest update in the next week or two. Check app updates on your smart phone.

  • Sara

    I always appreciate the information you offer. I’ve been on the low fodmap diet for over two years, and it was an absolute lifesaver for me! I pretty much just eat foods in the low fodmap list and don’t venture too far from it. I have SIBO, and that is the reason I’m on the diet. I’ve read your fabulous articles on SIBO and the low fodmap diet, and they were hugely helpful to me. I did all the antibiotic regimens the docs put me on, and they would help for a while, but then it would start all over again. I wasn’t willing to keep doing that if there was a dietary approach. My symptoms were truly horrible and debilitating, and I think that has made me reluctant to reintroduce as many foods as I perhaps should. I did meet once with a dietician, the only one in the area who I’ve found who is familiar with the diet. I do hope to see her again when I can afford it. People think I am so restricted because of being on this diet, but really, there are so many foods available on the low fodmap list that I don’t feel particularly deprived. My issue has been a lot of weight loss in the last year. I went from 118 to 103 in about 7 months, then I brought that back up to 110. I am just under 5′ 8″, but I have always been underweight for my height. In addition to the diet, I had lost my job and my father was very ill and passed away, so there were certainly some emotional issues that have probably contributed to my weight loss. I saw my doctor when I hit 103 and she did lots of tests and ultimately told me to try to eat more since nothing bad showed up in tests. I got back up to 110, so she was satisfied as long as I didn’t start losing again. I know weight loss has been a problem for others on the diet as well. I occasionally try to add foods back into my diet, and admit that the slightest stomach difficulty sends me right back to the strictly low fodmap foods I have found work for me. But I will keep working at it. I know this is a long post, but I thought others might read it and relate to it. Despite the weight loss, I feel SO much better. I never get sick anymore, and that is a HUGE statement. Thanks again for your commitment to educating people on this diet.

    • katescarlata

      Thanks for sharing your story, Sara! Did you know that in one study that surveyed patients with IBS, the researchers found that IBS patients would be willing to give up 25% of their life (an average of 15 years) to be symptom free. My point is that IBS sufferers are suffering. And to feel better and not get sick anymore is a huge success story for you. Ideally, I would LOVE you to gain a bit more weight and keep slowly trying to expand your diet—and I encourage you to try to work with a dietitian that can advise and provide insights on the overall nutrient content of your diet.

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