FODMAP & EFI
#361239 - 10/04/10 02:03 AM
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Dear All,
In this article, (Gibson & Shepherd), 2009, Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach (http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1746.2009.06149.x/full), the authors state that,
'If the symptomatic response is inadequate, specific questioning is required to determine the adherence to the dietary principles and any deficiencies corrected. If adherence was strict, attention may be needed to modify intake of resistant starch and insoluble and soluble fibre. Other dietary triggers such as food chemicals may need to be considered, as should potential factors such as caffeine, fat, meal size and regularity.'
The ambiguity of the above, with regards to modifying resistant starches, insoluble and soluble fibre, led me to contact a specialist and dietician. I asked her about her thoughts on incorporating the FODMAP approach with the basis of the EFI diet, that is, soluble fibre as the basis of meals, soluble fibre supplements and the careful incorporation of insoluble fibre.
In the reply I received, her thoughts were that the problem with adding soluble fibre is that it is fermentable and therefore the two approaches (EFI/FODMAP) are unlikely to ever co-exist successfully. Her suggestion was to trial the FODMAP approach (without the EFI rules & soluble fibre supplements) and if this fails to consider mediator release testing/LEAP elimination diet.
Does anyone have any thoughts on the above? I'd be keen to hear your opinions/experiences regarding the above.
Best wishes
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IBS A. Managing my symptoms with the EFI/FODMAP diet and probiotics.
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Quote:
her thoughts were that the problem with adding soluble fibre is that it is fermentable and therefore the two approaches (EFI/FODMAP) are unlikely to ever co-exist successfully
This statement doesn't make sense. There are a range of different soluble fibers. They range from quickly fermenting fiber such as FOS to slowly fermenting fiber such as acacia fiber or anywhere in between including partially fermentable.
The UK GI society in the Guidelines on the irritable bowel syndrome: mechanisms and practical management says "However, if it is felt that fibre supplementation is needed and this cannot be achieved by diet alone, then the soluble varieties (ispaghula, sterculia, or methyl cellulose) are probably the best choice." And the US College of GI in their report An Evidence-Based Systematic Review on the Management of Irritable Bowel Syndrome says "Psyllium hydrophilic mucilloid (ispaghula husk) is moderately effective and can be given a conditional recommendation".
The dietitian seems to contradict what the western GI doctors have found through clinical trials. Strange!
It cannot hurt to try an elimination test. It is a long and boring process that has help some individuals. The mediator release test is of questionable value as an allergy or IBS trigger identifier.
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STABLE: ♂, IBS-D 50+ years - Science of IBS
The FODMAP Approach to Managing IBS Symptoms
Evidence-based Dietary Management of Functional GI Symptoms: The FODMAP Approach
FODMAP Chart & Cheatsheet
The Role of Food & Dietary Intervention in IBS
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I agree, it also struck me as peculiar, which in part, is why I thought I'd seek people's opinions on this board. I was aware of the quackwatch website that you link to in your posting, and it was the dietician's recommendation re; the LEAP programme, that made me question her advice on soluble fibre supplements. I've already eliminated unsafe FODMAP foods and Heather's 'triggers foods,' therefore, I'm reasonably certain that my diet is as IBS safe, whilst remaining nutritionally balanced, as it is likely to be.
Thanks for posting.
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IBS A. Managing my symptoms with the EFI/FODMAP diet and probiotics.
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