question re FODMAPs and combining this with other diets (and acacia fiber)
#368171 - 09/14/12 08:16 AM
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I am following the FODMAPs diet and am wondering about the tolerability of the acacia fiber sold by Heather. I know that this fiber works for many and is not one of the rapidly fermentable fibers (like inulin), but I'm wondering if for others it could still be problematic.
My reasoning is that this fiber is still indigestible and might therefore promote bacterial overgrowth in the small intestines in those who are prone to this (e.g., those like myself who notice symptom reduction when following a FODMAPs diet).
One thing I am currently exploring is whether I will get more symptom reduction by combining the FODMAPs diet with the EFI diet, or by combining the FODMAPs diet with a lower carbohydrate diet that deemphasizes all grains and starches.
I certainly understand that low-carb is not the answer for many due to the difficulties posed in getting enough soluble fiber (or too much insoluble fiber) as well as the inherent tendency to gravitate toward a more meat-based diet.
For example, I have noticed - but not established definitively - that my symptoms are better when I keep insoluble fiber down (EFI principle), incorporate more lean meats and cut down on some of the starches (esp. root vegetables) promoted by the EFI diet. For example, if I do a strict elimination diet and only eat rice and root vegetables, I will still have lots of symptoms. However, if I only eat rice and lean chicken, I do a lot better.
Again, what I'm wondering is whether for me a key part of the picture is eliminating/reducing certain types of carbs - not just the FODMAPs carbs, but others as well.
Anyone have comments? For example, for those who have responded well to eliminating FODMAPs, have you combined the FODMAPs diet with another type of diet for more symptom reduction?
Thanks,
Chris
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Bacterial overgrowth in the intestine has not been shown to be related to IBS. Some fibers, particularly soluble fibers, act as prebiotics and encourage the growth of friendly bacteria in the colon. You need fiber in your diet for this reason 
Although fiber is indigestible this doesn't automatically mean it is fermentable. Some fibers are not fermentable. Many of us have trouble with insoluble fiber.
Some IBS symptoms are unrelated to food consumption and they can be caused simply by the process of eating. Have a look at Gastrocolic reflex
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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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Thanks for the clarification - it's good to know that some fibers are not fermentable.
What about starches? Is there a high degree of variability in the fermentability of different starches? If so, it would seem prudent to restrict the intake of the highly fermentable starches.
Thanks for the link to the info about the gastrocolic reflex. Am I right in thinking that one of the take-home messages here is that while many with IBS can avoid major dietary triggers, for some, the mere fact that there is a functional problem means that we can sometimes do everything right diet-wise, but still have symptoms?
I guess I ask this because over the years I have invested much energy in trying to find the seemingly ever elusive dietary combination that will resolve my symptoms. Maybe, in some cases, once obvious triggers have been eliminated, further dietary restrictions will result in minimal or no gains (because, again, there's a functional problem with the colon that can be triggered by merely eating, regardless of what is eaten).
Chris
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Starches are taken care of in the FODMAP guidelines.
Yes - many of us continue to have symptoms even though they are better managed by diet.
--------------------
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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in my experience, I get bloated from fibre, whether soluble or insoluble. I have found that while I get bloating from wheat (not FODMAP friendly), other foods such as potatoes and porridge are equally if not even more bloating, due to the v high amounts of fibre (which is mostly soluble, but still). Eating white flour tortillas or white bread actually reduces the amount of fibre in my diet, which may help with overall gas reduction. I am a health food freak, who tries to eat as plant based a diet as possible. Lean meat is IBS friendly and will not bloat you, but I find there are many counter-indications to eating too much meat/protein.
Even the FODMAP diet concludes that you can eat the equivalent of two thin slices of bread safely, which of course is a bit laughable esp if you convert that to how many pieces of pasta you are permitted to eat, but the various foods listed contain different amounts of fructans too, ie I eat white bread/pasta/tortillas and (overcooked, soft) broccoli in largish amounts, but would never eat onions/garlic (which have plenty more fructans than wheat or broccoli).
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now: stable through EFI+FODMAP dieting (no lactose/no fructose/some fructans and some polyols)
before: IBS-D(pseudo-diarrhoea), bloating, often unbearable pain esp from too much fat: Apr 2007- Dec 2010
FODMAPs: http://www.todaysdietitian.com/newarchives/072710p30.shtml
[I've tried VSL#3 -> I could tolerate v good amounts of IF (even with less SF), it worked great (but overall I find it too expensive)]
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Very good points.
I have gone through long periods of taking the acacia fiber, and sometimes it seemed to work for me, but in recent months I came to suspect that it was contributing toward my gas/cramping symptoms. I'm not 100% sure this is true, but I feel like I've seen this link.
Having said this, I do think padding my diet with good amounts of soluble fiber and limiting IF is a good strategy.
I am also a health fanatic, and it pains me to say it, but I think I really do best when fruit and vegetables are kept to a minimum. One, I think the IF is an issue, and two, I think I'm likely sensitive to the various FODMAPs fruit and veg. I would eat in the past.
Having said all this, sometimes it seems my diet just doesn't make a different. There have been periods when I was eating all kinds of problematic foods but doing ok, and periods when I have persistent trouble even following the most rigorous of exclusion diets.
Chris
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Yes I think there are all sorts of things involved, diet is key, but stress is a trigger and there are the hormones! I for instance (you can't sympathise here) find that being on the pill helps a lot with my IBS symptoms, which I only realised when I took a break from it for a month.
I use Benefiber (UK, no inulin) as a SF supplement too, there are some FODMAP friendly fruits and veggies: all sorts of berries are fine, bananas are fine (although exactly because of bananas' high SF content I get a lot of bloating!), oranges are fine (you can drink pulp free orange juice, although I prefer oranges, which I balance out with SF supplement), same for kiwi, cantaloupe, honey dew melon. Figs and dates are also OK. Veg-wise spinach is most certainly not problematic if you eat it with enough SF, peppers are fine (I usually eat them raw even), courgette, carrots, marrow, swedes, parsnips( shame I'm not much into these), tomato sauces, lettuce - all these should be fine from a FODMAP point of view, if not from the fibre point of view, so I eat them with SF supplement.
I have this added thing about smelly gas, which is really a problem. Onions, garlic, cabbage (but dairy and eggs too) cause this, which I am v disinclined to tolerate. So bok choy or bean sprouts is listed as safe as are kale or green beans, but they are not good for me - lots of smelly gas.
I am OK with sorbitol so I sometimes eat plums and apricots. Mannitol is definitely problematic so no mushrooms or cauliflower. And as I said I eat bread and pasta and soft boiled broccoli. The most favourable beans would be black beans as they have the most SF and least IF, so that's the only bean type I would have. Low fat houmous is also OK for me, but not chickpeas as such. Soya milk is v bloating, but I used to have it with porridge and I think you can get more used to it if you regularly have some, as Heather writes somewhere. Tofu is apparently completely safe!
Sunflower seeds and sesame seeds are OK in small quantities (I have a lot of trouble from too much fat). Walnuts are also fine, in fact they are v low in fibre if you eat a tiny amount. Almonds are also v healthy but v high in fibre by comparison. Nuts and seeds are more problematic from a fat point of view than IF point of view, since I never eat them on their own, their IF is almost always balanced out by the other food I'm eating.
Spices are also a great source of antixoidants and apart from garlic I use quite a lot and fresh herbs too, seeing how you're not going to eat masses of the stuff, it's unlikely to cause that much trouble I think.
Hope this helps a bit, I am sometimes crestfallen as I simply love fruit and veg and IBS restricts my natural urge to eat tonnes of these. I'd probably eat vegan (with the exception of keeping salmon in my diet) if I didn't have IBS, but hey, what can you do. there's still some scope for incorporating reasonable amounts of fruit and veg and eating healthily and the fat restriction overall may actually be good from a health point of view.
--------------------
now: stable through EFI+FODMAP dieting (no lactose/no fructose/some fructans and some polyols)
before: IBS-D(pseudo-diarrhoea), bloating, often unbearable pain esp from too much fat: Apr 2007- Dec 2010
FODMAPs: http://www.todaysdietitian.com/newarchives/072710p30.shtml
[I've tried VSL#3 -> I could tolerate v good amounts of IF (even with less SF), it worked great (but overall I find it too expensive)]
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Many great points!
You seem to have done a really good job of figuring out what you can tolerate and what you can't. How did you go about working out which foods are problematic? Did you keep a food journal? Or what kind of challenging system did you use if you were doing an elimination diet? I have had lots of trouble pinning down precise culprits.
I agree with what you said about being a bit crestfallen. I'd certainly be near vegan if I could get away with eating anything. However, I also remind myself that if the choice is between a less healthy diet (but still healthy) and greater digestive stability versus ultra-healthy diet but lots of digestive stress, the former is surely better for me as an individual. Also, if the digestive system is in constant stress, I would surmise that its ability to absorb nutrients is compromised (and, from what I understand about the gut, general immunity would be compromised as well).
Great point about herbs and spices - those are great ways to pack in nutrients (and antioxidants and polyphenols) without any IF or fat.
In a previous post, I also pointed out the potential benefits of juicing vegetables, with several qualifications. If you use the right kind of juicer, you can almost completely remove all the IF. Of course, there may still be a tolerance issue because you are getting concentrated amounts of whatever is in the vegetables. However, I think most would agree that for someone with IBS, the same quantity of vegetables consumed au naturel vs. juiced would be much more problematic (due to all the IF).
I can relate about the gas. For me, a big factor definitely seems to be fruit and veg...I just haven't been able to determine which ones are the worst culprits (although eliminating the FODMAPs fruits and veg. has certainly helped a great deal). I agree about spinach - I really do seem to tolerate steamed spinach very well (I love it Japanese style, sprinkled with toasted sesame oil).
Also, I know that in my case stress is huge. I can be doing everything right, but if there's a lot of background anxiety, I can have lots of trouble. Have you tried the IBS hypnotherapy CDs yet? That definitely helped some for me in terms of the brain-gut connection side of things.
Chris
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Hypnosis hasn't helped me that much, my IBS is less stress and more food related.
I think it's a good starting point to eat entirely FODMAP safe while reducing fat and IF and then adding certain FODMAPs food back in one by one every three days, look at your symptoms and that's how you can figure out whether you can tolerate something or not. At least in theory 
--------------------
now: stable through EFI+FODMAP dieting (no lactose/no fructose/some fructans and some polyols)
before: IBS-D(pseudo-diarrhoea), bloating, often unbearable pain esp from too much fat: Apr 2007- Dec 2010
FODMAPs: http://www.todaysdietitian.com/newarchives/072710p30.shtml
[I've tried VSL#3 -> I could tolerate v good amounts of IF (even with less SF), it worked great (but overall I find it too expensive)]
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