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Q&A: Understanding the low-FODMAP diet

Q&A: Understanding the low-FODMAP diet
Got questions about FODMAPs? We have answers in this Q&A with Neha Shah, MPH, RD, the certified nutrition support clinician at Stanford Health Care.


Paleo, vegan, gluten-free: These food tribes have seen the spotlight enough that your average person knows what they entail. No grains, no meat, no wheat. 

The low-FODMAP diet is less simple—and less of a permanent lifestyle than its contemporaries. It's also the new kid on the block, so confusion persists about the details. What foods are safe to eat? Which should be avoided? Who exactly should be giving this diet a try, and how long should they stick to it?

We asked Delicious Living readers to submit their burning questions about FODMAPs. For answers, we turned to Neha Shah, MPH, RD, the certified nutrition support clinician at Stanford Health Care who created the FODMAP chart featured in our previous article: Breaking down the low-FODMAP diet.

Here's what she had to say.  


1. Are there specific tests or guidelines regarding who should or shouldn't follow this diet? —Carol and Erica

Shah: At this time, there are no specific tests for who should follow this diet or not. The diet is not meant to be a permanent lifestyle change. Usually, it is recommended for a six-week trial period for patients with IBS, who are experiencing diarrhea, gas, bloating, and cramping. After the six-week trial is over, foods that are high in FODMAPs are slowly re-introduced into the diet so you can learn more about which high-FODMAP foods are tolerated, and which are not tolerated well. This is to help expand the variety in the diet. How the foods are introduced is highly individualized. 

2. Is there a good substitute for beans? For lentils? —Linda

Shah: Beans and lentils are considered to be high in FODMAPs. There is a way to reduce the FODMAP content in the beans/lentils. Consider soaking them in water overnight, and then the next day, throw out that water and cook the beans/lentils with new water. Beans and lentils are high in galactans, which will leach out into water when the beans/lentils are soaked in water. It is also important to watch serving sizes, as eating large amounts can potentially cause gastrointestinal (GI) symptoms. 

3. I guess I hadn't seen that cashews were on the no-no list. Does soaking change any of this? I use soaked cashews in many recipes, like smoothies. Is there another nut I could use? Maybe almonds? —Erica

Shah: I am not sure whether soaking cashews would help or not. It also depends on whether one is in the six-week trial period, where we recommend avoiding all high-FODMAP foods, or whether one is slowly re-introducing foods, at which stage cashews can be added into the diet to explore tolerance. As mentioned above, watch serving sizes, since eating large amounts can potentially cause GI symptoms. You can try almonds or pecans as well. 

4. Does organic matter to FODMAP? —Rachel

Shah: I have not come across any literature on whether organic farming makes a difference in FODMAP content in foods.

5. I am amazed at the 'bad' list. I use honey instead of sugar, now I don't know what to do. I would like to know why this is healthy or better for me? —Robin

Shah: I guess the question to ask is whether you are tolerating honey. If you are, there appears to be no reason to give it up. Do watch your serving sizes. The reason honey is not recommended initially on the low-FODMAP diet is that it is high in fructose. For some, foods high in fructose may not absorb well in the small intestine, and may potentially contribute to GI symptoms. Sugar is an equal mixture of glucose and fructose, so when fructose is in the presence of glucose, it is more easily absorbed.

6. How can the low-FODMAP diet be followed when eating out? Is it possible to take some sort of supplement (like digestive support) when you can't avoid things like garlic and onions? —Samira

Shah: It can be challenging at times to dine out while on the low-FODMAP diet, as there are many foods that could be possibly made with a mixture of low and high FODMAP foods. Be aware of what foods have low and high FODMAPs so you can easily recognize these foods on the menu. Ask if substitutions can be made to replace the high-FODMAP foods in the menu item you are interested in.  

To help reduce wheat coming into the diet, some restaurants do have gluten-free menus that you can choose menu items from, such as gluten-free pasta made with butter and allowed vegetables. You can also consider asking for a salad with the vegetables you can eat, as well as for plain chicken or fish. It is a thought to bring your own salad dressing or spices to the restaurant so you can add flavor to these foods. Or, you can order scrambled eggs made with low-FODMAP vegetables at a breakfast brunch.

Many sauces in restaurants are made with garlic and onions. If eaten in large amounts, this can possibly trigger symptoms. For some, asking for the sauce on the side has been well tolerated if used sparingly. 

Also, remember that the low-FODMAP diet is not a permanent lifestyle change. Once you are in the process of re-introducing foods, you can expand your food choices when eating out. Keep in mind that restaurant serving sizes can be large. Even if the meal is FODMAP friendly, eating large amounts can possibly trigger GI symptoms, as it is a large load of food coming into the body all at once. 

Some people on the low-FODMAP diet do take lactase enzymes to help tolerate dairy, but overall, based on my knowledge, there is no supplement available to help tolerate FODMAPs.

Have you tried the low-FODMAP diet to improve digestion? What was your experience with it?



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