When the Perfect Diet Causes Pain

If you’re reading this, you’re probably interested in building a healthy microbiome by eating all the right foods. Unfortunately, what we find delicious — whether McDonald’s, ice cream, or salami — is often different from what our gut microbes find the most useful. We know which foods can be responsible for creating a healthy environment for our beneficial bacteria — think high fiber, less meat, no artificial sweeteners. The challenge comes when foods we know to be gut healthy actually cause us pain.

For a significant portion of people around the world with digestive sensitivities, there is a class of foods that is healthy for your gut bugs yet cause a slew of uncomfortable symptoms. This class of foods is collectively known as FODMAPs – a mouthful of an acronym that stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. Though the carbohydrates themselves don’t cause problems, they are easily fermented in the intestines by bacteria that may cause IBS or IBS-like symptoms in sensitive individuals. Healthy foods as varied as apples, pears, asparagus, garlic, beans, or milk, can be the exact trigger for a digestive nightmare.

This certainly doesn’t mean that following a low-FODMAP diet means you can’t eat fiber or feed your microbiome well. While you may not be able to tolerate wheat, you can enjoy quinoa; if cauliflower isn’t cutting it, you can substitute with sweet potatoes; if you can’t enjoy store-bought hummus without blowing up like a balloon, it’s pretty easy to make your own, gut-friendly, low-FODMAP version.

Trouble is, it’s hard to determine which foods are triggers for your particular system. To solve this, many doctors recommend following a low-FODMAP diet, a strict but temporary diet designed to help you figure out your particular sensitivities. Once you identify which foods are giving you trouble, you can feel more confident choosing and enjoying foods that fuel your body and microbiome without causing unnecessary discomfort.

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The low-FODMAP diet is designed in three phases. The first phase is an elimination diet in which you temporarily cut out all high FODMAP foods for 2-6 weeks. A patient should look for a Registered Dietitian (RD) who has been trained in the low-FODMAP diet to help make sure they are following this and getting all of the nutrients they need, and to make sure they don’t stay on that restrictive of a diet long term.

The second phase of the low-FODMAP diet is the “testing phase”. With guidance, you systematically reintroduce each of the FODMAP categories of foods to determine which food or foods are causing your symptoms.

The third phase is the personalization phase, in which you work with your doctor or health care professional to come up with a diet that accommodates your tolerances and intolerances. When I work with patients to create that diet, my goal is for them to have as varied a diet as possible, and not to exclude healthy, high fiber foods without reason.

If your healthy diet is causing you discomfort or pain, that’s a sure sign you should take stock of what is truly healthy for your particular system. With help, you can find the best way to make sure that you – and your microbes – are thriving.


Want to know more about your own gut microbiome? You and your healthcare provider can use uBiome’s SmartGut testing to find out how your gut microbiome is functioning and to monitor changes in your gut flora over time.


Danielle Capalino, MSPH, RD, CDN runs a private practice in Manhattan where she provides nutrition counseling services with a specialty in digestive health. While earning her master’s degree in Public Health Nutrition from the Johns Hopkins Bloomberg School of Public Health, she studied under renowned gastroenterologist, nutritionist, and author, Dr. Gerard Mullin. Danielle completed her undergraduate studies at the Massachusetts Institute of Technology with a degree in Brain and Cognitive Science. She is the author of two books, The Microbiome Diet Plan, and Healthy Gut, Flat Stomach, and she also runs a virtual “What the FODMAP” program. You can follow Danielle on Twitter and through her website, www.daniellecapalino.com.