Q. Does sensitivity to individual FODMAPS change over time? Can a food that was formerly well tolerated become problematic at a later time? Or vice versa?
A. The short answers are yes, yes, and yes. But there are many nuances here. Let’s take your questions one at a time.
Does sensitivity to individual FODMAPs change over time? I’d like to use the word tolerance instead of sensitivity. Can one’s tolerance to FODMAPs change over time? Yes. First, let’s recall that it is normal for FODMAPs to pull extra water into the intestines via osmosis, and to be fermented by gut bacteria, producing gas and other substances. These events cause the intestines to stretch, which can trigger pain, bloating and bowel symptoms in those who are predisposed to them.
FODMAP tolerance can change with the passage of time. Could it be time to try higher FODMAP foods once again, even those that bothered you in the past?
Mediating Factors
There are many “mediating factors” which affect your personal experience of consuming FODMAPs, ranging from other components in foods, to stress and anxiety, to medications, to which microbes are currently residing in your large and small intestines and which substances they are producing. Mediating factors can turn the volume up or down on the nerve signals passing from the gut to the brain and vice versa. As the mediating factors change over time, so can tolerance to FODMAPs. Examples would be people who can tolerate more FODMAPs in general when they are not stressed out, after a successful SIBO treatment, at certain times in their menstrual cycle, or when they avoid alcohol. Or people who might who tolerate fewer FODMAPs for a while after a bout of gastroenteritis or antibiotics.
Digestion and absorption
Digestion and absorption can change over time. While it is somewhat arguable whether FODMAP digestion and absorption correlate with symptoms of intolerance, let’s say for the moment that it does. The most important case is loss of the ability to produce the enzyme lactase. Without it, we cannot digest or absorb lactose. The amount of lactase produced can decrease over time as we get older, but it can also come and go depending on the status of underlying medical conditions which affect the health of the brush border surface in the small intestine, where lactase is produced, such as celiac disease or Crohn’s disease.
Fructose, sorbitol and mannitol don’t require enzymes for digestion, but their absorption can be affected by the other food components in the meal as well as how quickly or slowly the contents of the meal are passing through the intestines. If some condition increases transit time in the intestines, less will be absorbed and more will be available to act as FODMAPs. Finally, there are transporters in the cell walls that facilitate absorption of lactose and fructose. The number of transporters that are present can increase or decrease over time; there is some evidence that more transporters become available when you’ve been eating more lactose or fructose, an argument for consuming at least small to moderate amounts of these rather than avoiding them altogether in IBS.
Oligosaccharides are never absorbed, so that doesn’t change over time.
Try FODMAPs again on a regular basis
Can a food that was formerly well tolerated become problematic at a later time? Sure, that happens frequently. Many people can recall a time when they could eat anything, but at a certain point in time they developed a food allergy, FODMAP intolerance, celiac disease, or a food sensitivity. Some children outgrow food allergies they had early in life. For adults, however, once they develop, classic food allergies and celiac disease are for keeps. Food sensitivities and intolerances, on the other hand, can sometimes change in either direction.
So yes to “vice versa”. I advise my patients to re-try poorly tolerated foods on a regular basis. They are often pleasantly surprised! I am currently working with an 82-year-old man who lost 20 pounds after a bout of post-infectious IBS and colitis. No prior history of IBS. His doctor put him on a low-FODMAP diet and though it helped with symptom management immediately and dramatically, he missed the variety in his former diet. We have worked together over the past 7 months to stabilize his weight and we have successfully reintroduced small to moderate portions of many of his favorite higher-FODMAP foods. We both consider this a great success!
Originally published on Feb 5, 2021. Edited and republished on Jan 19, 2024.
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