The Low FODMAP Diet for MCAS and SIBO

This post provides an overview of the low FODMAP diet for MCAS and SIBO.

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What is the low FODMAP diet?

A low FODMAP diet can be a temporary solution when you are first diagnosed with MCAS, if you are treating SIBO, if you have Irritable Bowel Syndrome (IBS), or if you want to reset your digestion.

FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) are fermentable carbohydrates. Many people can tolerate FODMAPS without any issues, but some people are unable to break them down. When carbohydrates ferment too much (often because of gut bacteria dysbiosis) this can cause symptoms of stomach pain, bloating, and diarrhea. See my post on SIBO here.

High FODMAP diets can increase urinary histamine, whereas a low FODMAP diet reduces histamine. High FODMAP foods can therefore activate mast cells. See the list of high and low FODMAP foods below.

What is MCAS?

Mast Cell Activation Syndrome (MCAS) is a chronic condition that affects all organ systems. MCAS is severe and disabling and people with MCAS experience often significant and debilitating symptoms daily, including anaphylaxis, which can be fatal.

MCAS is often found with other chronic conditions such as Ehlers-Danlos Syndrome (EDS) and Postural Orthostatic Tachycardia Syndrome (POTS).

Frequently healthcare providers do not know about MCAS, and the tests for MCAS are problematic because they are not uniformly reliable. MCAS can be difficult to manage. Treatments include blocking mast cell mediators with anti-histamines and mast cell stabilizers, as well as avoiding triggers.

Check out this post on how to manage MCAS.

The bucket theory

The bucket theory offers a helpful analogy for understanding symptom reactions with MCAS.

Think of your body as an empty bucket that you want to keep from overflowing. Different foods and activities fill your histamine bucket at different speeds but they combine to form the total level of histamine in your body (how full your bucket is). A fuller bucket means you have more histamine symptoms. When you manage triggers, reduce exposure to known triggers, and take medications and supplements to reduce histamine, you can manage the level of your bucket.

Know your typical symptom progression

Knowing your symptom progression in a symptom flare is the key to developing your own rescue plan. In this post, I discuss how to determine your own symptom progression. Once you know what typically happens in your symptom progression you can design a rescue plan to address those symptoms.

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Low FODMAP and low histamine food list

Monash University has created the gold standard list of foods for the low FODMAP diet. They also offer a smartphone app that is updated regularly. But the Monash list does not factor in histamine. So the list below is the Monash list adapted to be lower histamine. The best diet for you is going to be the one that supports you to heal while being the least restrictive. The low FODMAP is intended to be a temporary solution to reduce inflammation and histamine, and support healing gut issues like SIBO. So, when reading through this list, keep in mind that it is not a long-term solution. Extended periods of food restriction can create nutrient deficiencies and even malnutrition. Consult with your healthcare practitioner before embarking on any dietary changes.

Beverages

Chamomile tea
Dandelion beverage
Pea protein powder
Rooibos tea
Water, filtered

Breads, cereals, pasta

Cassava flour
Cassava tortillas
Cornmeal, if tolerated
Millet bread, if tolerated
Millet flour
Oats
Oat fiber
Oat flour
Palmini pasta
Rice, if tolerated
Rice pasta, if tolerated
Tapioca starch

Dairy and dairy alternatives

Coconut milk – gum free
Coconut yogurt
Haloumi cheese
Hemp milk
Mozzarella, if tolerated
Oat milk
Oat yogurt
Ricotta, if tolerated

Fats and oils

Avocado oil
Butter
Garlic-infused olive oil
Ghee
Olive oil

Fruits

Avocado, if tolerated
Blueberries
Coconut
Lemon juice
Lime juice
Pomegranate
Raspberry
Tamarind

Herbs and spices

Cilantro
Coriander
Cumin
Mint, fresh
Rosemary
Thyme
Vanilla

Meat, poultry, eggs, and fish

Fish that has been flash frozen, such as salmon
Pastured eggs
Free-range flash-frozen organic chicken and turkey
Flash frozen turkey patties
Free-range organic elk

Misc.

ChocZero sugar-free chocolate chips
ChocZero sugar-free raspberry jam
Cocoa powder
Trail mix made from tolerated nuts and seeds

Nuts and seeds

Coconut
Chia seeds
Flax seeds
Pecans
Pumpkin seeds
Sunflower seeds

Seasonings

Avocado mayonnaise
Pesto – if made with garlic scapes instead of garlic
Sunflower seed butter

Sweeteners

ChocZero sugar-free maple syrup
Monk fruit extract, pure

** I no longer use stevia because it has been shown to negatively affect the liver, thyroid, and cholesterol levels.

Vegetables

Bok choy
Butternut squash
Cabbage
Capers
Cayote
Cucumber
Fennel
Gai lan
Garlic scapes
Horseradish
Japanese pumpkin
Kale
Leek (green parts only)
Lettuce
Mushroom, oyster
Pea tendrils
Scallions (green parts only)
Watercress
Yam
Yucca
Zucchini

High FODMAP foods to avoid on the low FODMAP diet

Agave, high fructose corn syrup, isomalt, mannitol, sorbitol, xylitol
Apples, apricots, cherries, mangoes, nectarines, peaches, pears, plums, watermelon
Artichokes, asparagus, cauliflower, and most mushrooms
Beans, peas, split peas, dried beans
Cashews, chicory, rye, wheat
Dairy milk and milk products
Garlic
Inulin
Onions, shallots

What do you think?

I’d love to have your reply below!