Irritable Bowel Syndrome Message Boards | Re: Low FODMAP Diet ... Could Heather please give her opinion?

Hi Belinda,

For the FODMAP question, I know IBS advice can seem overwhelming and contradictory.

First of all, before someone even accepts a diagnosis of IBS, they need to be tested for gluten intolerance (celiac), fructose intolerance, and lactose intolerance. All of these can mimic IBS but they are different problems, and require different dietary strategies. In-depth diagnostic info and problems that need to be ruled out for an IBS diagnosis are here: <http://www.helpforibs.com/footer/ibs.asp>

If you have these food intolerances ruled out and you do have IBS, then I don't think the FODMAP approach is always the easiest, fastest, or best way to start. It can be really unnecessarily restrictive because it lumps together gluten, fructose, and lactose intolerances with IBS, and they are not at all the same things.

Also, it does not even address the well-established dietary triggers for IBS such as fats, nor does it address the critical need for IBS to distinguish between soluble and insoluble fiber. The original author of the FODMAP approach in Australia, Sue Shepherd, touched on these issues in her actual scientific research papers, but somehow that info got dropped as her research was disseminated down the line to America, and from medical papers to more patient-oriented publications. Years later, I don't know why they still haven't corrected this huge oversight.

So, first things first, make sure that you've had the tests for those food intolerances so you know what you're truly dealing with. Then, focus on your soluble fiber safe foods, eliminate the IBS trigger foods, and be cautious with insoluble fiber foods. There is an IBS diet cheat sheet you can print out that will give you quick and easy food lists for these concerns here <http://www.helpforibs.com/diet/heathersibsdietcheatsheet.pdf> .

With IBS, it is also a matter of HOW you eat, not just WHAT you eat. There is info about that on the cheat sheet as well, and more info here <http://www.helpforibs.com/diet/how_to_eat.asp> .

Get your foundation diet of Eating for IBS established and see how you do with that. You might not need to take things any further. If you do, then once you're at that point you can add in the FODMAPS restrictions and see if that gets you additional help, especially for bloating and gas. So far there is no study evidence that FODMAPS helps IBS constipation.

If you take that step, please note that the FODMAPS approach is one that is specifically recommended to be done only under the direct supervision of a dietitian. This is because it is not a blanket exclusion diet. You are supposed to carefully figure out which FODMAPS groups you are sensitive to, if any (fructose, galactans, oligosaccharides, etc.)

What you don't want to do is just eliminate, forever, all of the high FODMAPS foods across the board. You might well have a problem with none of them, or just some of them, and to varying degrees. It is a very individualized diet. It can also be complicated, which is why it's supposed to be done with a dietitian. The concern is that someone would just eliminate all these groups of foods, probably unnecessarily, and end up with a very nutrient-poor diet as a result.

If you do work with someone on the FODMAPS approach, make sure they also address the standard high fat trigger foods for IBS and the importance of soluble fiber safe foods. Excluding high FODMAPS foods without adjusting your diet for the other IBS elements is much less likely to give good overall results.

If you've got your IBS stable through diet without using a FODMAPS approach, then it may or may not even be worth your time to add that on as well. Personally, I'd get no benefits from it, but for others who aren't stable it is yet one more weapon in the IBS arsenal. The more the better!

Best,

Heather

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Heather is the Administrator of the IBS Message Boards. She is the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!

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