Are FODMAPs Hiding in Your Supplements?

When starting the low FODMAP diet, many of us focus on removing high FODMAP foods and beverages, while sometimes forgetting to look for sneaky FODMAPs in our supplements.

Did you know that high FODMAP ingredients are often added to supplements, vitamins, and probiotics? Surprisingly, even supplements targeted for improved digestive health can contain FODMAPs.

Today we’re going to help you check if FODMAPs are hiding in your medications and discuss when that might be a problem.

Before we go any further it’s important to note that you shouldn’t stop taking any medication or supplements without consulting with your doctor first, and that this article is for educational purposes only.

Can I start taking supplements during the first phase of the low FODMAP Diet?

 The short answer is that we normally don’t recommend it. I want to let you know that as a FODMAP trained dietitian I discourage adding any “new” supplements during the low FODMAP elimination and challenge phase, unless prescribed by your doctor. These include digestive enzymes, probiotics, vitamins, cleanses and detoxes.

Why? The low FODMAP diet is a tool to help you identify foods that trigger symptoms and these “new” variables may muddle the results. Many of these supplements have the potential to worsen or improve IBS symptoms making it harder to identify your FODMAP triggers.

Watch out for sneaky FODMAP in your supplements

Supplements include vitamins, minerals, herbals and botanicals, amino acids, enzymes, and more. They are available in many forms including pills, capsules, gel tabs, melts, liquids, chewables, gummies, extracts, liquids, beverages, and bars.

Supplements that are in chewable or liquid form are designed for taste, and are more likely to contain high FODMAP ingredients to provide flavour and sweetness. The most common ingredient we find are polyols, which are often added to the sugar-free supplements to add a ‘sweetness’ without sugar.

 When checking your supplement labels, you want to keep an eye out for common high FODMAP ingredients.

COMMON HIGH FODMAP INGREDIENTS

• Agave (remember that there is a low FODMAP serving of this sweetener)
• Chicory Root (Fiber)
• Crystalized Fructose
• Dehydrated Fruit and Vegetable Powders
• Fructose
• FOS
• Fructooligosaccharides
• Fruit Juice and Vegetable Juice Concentrates
• High Fructose Corn syrup (HFCS)
• Honey (remember that there is a low FODMAP serving of this sweetener)
• Inulin
• Isomalt
• Lactose (not a problem when used in tablets/pills)
• Mannitol
• Maltitol
• Milk Solids
• Milk Powder
• Sorbitol
• Xylitol

WELL TOLERATED INGREDIENTS

We also thought it would be useful to provide you with a list of common ingredients that are generally well tolerated.

• Acacia Gum or Fiber
• Artificial Flavors
• Cane Sugar (Syrup)
• Cellulose
• Citric aid
• Corn Starch
• Corn Syrup
• Corn Syrup Solids
• Dextrose
• Fruit Flavors
• Fruit Powders used for color
• Glucose Syrup
• Glycerin
• Glycerol
• Guar Gum
• Natural Colors
• Polydextrose
• Soy Lecithin
• Stearic Acid
• Sugar
• Tapioca Starch and Syrup
• Vegetable Powders used for color
• Xanthan Gum

It is less common for high FODMAP ingredients to be lurking in pills and tablets, however we recommend you double check supplement labels. If a supplement has been recommended by your health care provider and it contains a high FODMAP ingredient, then try looking for other brands that might be FODMAP free.

I’m taking a lot of supplements, what should I do?

If you are taking a lot of supplements, then talk to your dietitian. They might recommend temporarily removing some non-essential supplements during the low FODMAP Elimination and Challenge phase.

Where do probiotics fit?

Something that always surprises me is how many digestive health supplements contain high FODMAP ingredients.

Probiotics often contain the prebiotics inulin and chicory root. These prebiotics feed our healthy gut bugs and may be helpful to some healthy individuals, however for those of us with IBS they may worsen symptoms. It is also important to use caution when selecting a probiotic, as only a few specific strains have been shown to help improve IBS symptoms.

Many dietitians do not recommend taking a new probiotic during phase one or two of the low FODMAP diet, however your dietitian may encourage you to continue taking a probiotic/supplement if you have already been taking it for multiple months and there are no high FODMAP ingredients present. Chat to your dietitian or health care professional about probiotics and if they are appropriate for your individual needs.

Let’s talk about prebiotic blends & fibre supplements

Manufacturers are now adding prebiotic blends to supplements and foods, as research shows that these can help support our gut microbiome.  However, these prebiotic blends often contain high FODMAP ingredients, which can be troublesome for those with IBS. Be on the lookout for the words “prebiotic fibers” since they often include inulin, chicory root, and Fructooligosaccharides (FOS).

Another place sneaky FODMAP ingredients like to hide is in fiber supplements. Some fiber sources may trigger gut symptoms such as excessive gas and abdominal pain as they are fermented by our gut bacteria. Avoiding fiber supplements that contain high FODMAP prebiotic ingredients like inulin and chicory fiber can help reduce those symptoms. Also avoid fiber chews that contain polyols and fructose.

It’s common knowledge that the low FODMAP diet can be lower in fiber, so make sure you eat a variety of low FODMAP fiber rich foods. If you think you need a fiber supplement, then talk to your health care team about a fibre supplement made from psyllium, partially hydrogenated guar gum (PHGG), methlycellulose, sterculia, or acacia fiber. Supplements made from these ingredients are less likely to trigger gastrointestinal symptoms.

What about cleanses & detoxes?

It is best to avoid supplements that are advertised as cleansing and detoxifying, as these often contain ingredients that worsen IBS symptoms, and can cause diarrhoea, nausea, and stomach discomfort. Cleanses and detoxes also put you at risk of dehydration and electrolyte imbalances – more reasons to steer clear.

Can I use activated charcoal?

We often see activated charcoal being used by people trying to reduce gut-based symptoms like gas and bloating, however there isn’t strong evidence that shows it is useful in treating IBS symptoms. Although it’s not considered a FODMAP, please note that activated charcoal can result in some unpleasant side effects including nausea, vomiting, constipation, and black stools. Activated charcoal can also interfere with your ability to absorb medications, vitamins and minerals in your food, which may negatively affect your health. Please talk to your doctor before using activated charcoal.

Can I keep using aloe vera based supplements?

There are a lot of claims that aloe vera juice and other related aloe products can help calm your gut… but scientific research does not support its use for the treatment of IBS symptoms.

Aloe vera juice can cause abdominal pain, diarrhoea, dehydration or electrolyte imbalances, low blood sugar levels, allergic reactions and interactions with other medications (1).

The few random control studies that have been undertaken on aloe vera and its effect on IBS have found no benefit to patients (2, 3). Additionally, the NICE Guidelines for treating Irritable Bowel Syndrome recommend that patients should be discourage from using aloe vera as an IBS treatment. So treat aloe vera with care and avoid during the first two phases of the low FODMAP diet.

Final Thoughts

Hopefully this article helps you spot sneaky FODMAPs hiding in your supplements. Our top tip is to always read your supplement labels and check for high FODMAP ingredients. If you are taking a lot of supplements, then check in with your dietitian and make sure they are suitable for the low FODMAP diet.

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