Low FODMAP Diet ... Could Heather please give her opinion?
#371490 - 09/29/14 01:28 PM
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belinda
Reged: 10/09/03
Posts: 474
Loc: Toronto, Ontario, Canada
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Hello Everyone:
I must admit I haven't been on this message board in quite a few years although I regularly send people to this website for information.
I run IBS Support Canada (http://www.meetup.com/IBS-Canada/), an IBS phone support group for Canadians, eh.
I am very interested in knowing Heather's opinion on an article that appeared today in the Globe & Mail, one of Canada's largest daily newspapers. It says a low-FODMAP diet is supposed to be good for IBS.
Here is the link: http://www.theglobeandmail.com/life/health-and-fitness/health/identifying-a-new-culprit-in-ibs/article20837095/
Some of the diet fits perfectly with Heather's diet, but some of it doesn't agree with it.
I've felt very well on Heather's diet since discovering it a decade ago so I would be grateful if Heather could comment on the low FODMAP diet.
If Heather has already commented on this diet, please just reply with the link so I can read what she has to say.
Thank you!
Belinda
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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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Dear Heather:
Thank you so much for your detailed and thoughtful reply to my question about the FODMAP diet. You actually confirmed pretty much what I thought about it.
I've been following your diet for 11 years now. It has transformed my life. I never have any pain anymore and I am very well. I owe a great deal to you for this.
I educate my members on your diet and encourage them to buy your books.
Having IBS is not an easy journey for anyone, but it's possible to be stable and well. I prepare all of my own food and I never eat in restaurants. It's the only way I can control the ingredients and ensure everything is safe to eat, but it's well worth the effort.
Thank you SO MUCH!
Belinda
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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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No one approach to diet works for everyone when it comes to IBS everyone's bodies react differently. While I can eat certain cheeses with no issue another person could have a painful attack from it. Or for that matter with me some of the recipes in Eating for IBS would give me a terrible attack. Wheat, and garlic are 2 major triggers for me. So for me a lot of the recipes in Eating for IBS would make me very sick. The most important thing when it comes to diet with IBS is to find what works best for you. And for me the biggest dietary changes I made was eliminating; wheat, garlic, onions, and anything contain fructose. By eliminating those my symptoms while they still exist at times, have been greatly reduced. Plus I've noticed by eliminating wheat my skin is less blotchy, I have less seasonal allergies, my appetite is more regulated (I used to either not have any, or I'd be hungry all the time and snack constantly), and finally I've noticed that my moods have gotten more stable and my thinking is more clear.
So in short read up, experiment and find what works best with your body.
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This statement is incorrect "So far there is no study evidence that FODMAPS helps IBS constipation." Here is some research evidence showing it works for IBS-C too.
(1) Check graphs E & D in Figure 2, page 72 to see how IBS symptoms dramatically declined in both IBS-D and IBS-C on a VAS scale when on a low FODMAP diet compared to a normal diet. In the body of the text it says
"Interestingly, of the 70% of subjects who felt better on the low FODMAP diet, this encompassed subjects across all 4 subtypes of IBS"
Halmos, E. P., et al. (2014). "A Diet Low in FODMAPs Reduces Symptoms of Irritable Bowel Syndrome" Gastroenterology 146(1): 67-75
(2) "Initial studies included a retrospective study of the efficacy of the diet, demonstrating that 75% of individuals with IBS had improvement of bloating, abdominal pain, nausea, flatus, diarrhea, and/or constipation when on a diet low in fructose and fructans.33"
"With the osmotic nature of FODMAPs contributing to diarrhea and the fermentation by-products contributing to symptoms of gas distension, the improvements to constipation predominant IBS seen by the FODMAP approach need further exploration. Methane production during fermentation of FODMAPs seems to be a viable option."
Barrett, J. S. (2013). "Extending Our Knowledge of Fermentable, Short-Chain Carbohydrates for Managing Gastrointestinal Symptoms." Nutrition in Clinical Practice 28(3): 300-306.Barrett, J. S. (2013). "Extending Our Knowledge of Fermentable, Short-Chain Carbohydrates for Managing Gastrointestinal Symptoms" Nutrition in Clinical Practice 28(3): 300-306.
(3) "There was a significant positive correlation between adherence and improvement in bloating (rs(83)= 0.273, p = 0.011), abdominal pain/discomfort (rs(87) = 0.271, p = 0.010), flatulence/wind (rs(85) = 0.374, p = 0.000), diarrhoea (rs(72) = 0.310, p = 0.007), constipation (rs(63) = 0.296, p = 0.017) and energy levels (rs(81) = 0.271, p = 0.013)."
"The observation that constipation also improved on a low FODMAP diet may seem counter-intuitive given the proposed mechanism of action for most FODMAPs."
de Roest, R. H., et al. (2013). "The low FODMAP diet improves gastrointestinal symptoms in patients with irritable bowel syndrome: a prospective study" International Journal of Clinical Practice 67(9): 895-903.
This statement is also incorrect "it lumps together gluten, fructose, and lactose intolerances with IBS"
They don't claim that gluten is an IBS trigger. In fact their recent research shows clearly that self-report gluten sensitivity does not exist and gluten is not an IBS trigger . They do show that fructans - a FODMAP and carbohydrate found in wheat, rye and barley is a potential IBS trigger. They do recommend using a gluten free diet because generally speaking gluten free foods are low FODMAP but not always so they warn the user to read the label of gluten free foods to make sure they don't contain high FODMAP foods.
Biesiekierski, J. R., et al. (2013). "No Effects of Gluten in Patients With Self-Reported Non-Celiac Gluten Sensitivity After Dietary Reduction of Fermentable, Poorly Absorbed, Short-Chain Carbohydrates " Gastroenterology 145(2): 320-328.e323.
For a discussion on the difference between 'gluten free', 'wheat free' and the FODMAP diet see the Monash University FAQ (this is the GI group that developed the FODMAP diet). In particular see the answer to this FAQ question 5. What is the difference between 'gluten-free' and 'wheat-free' foods? Do I have to restrict gluten?
The FODMAP diet works so well when combined with the removal/reduction of common IBS trigger foods such as high fat, high insoluble fiber, etc that in the UK Kings College London University trains NHS dietitians about the FODMAP elimination/re-introduction diet. Anyone who lives in the UK can ask their GPs for a referral to one of these NHS dietitian for help managing IBS symptoms
Kings College London FODMAP program
For testimonials from a large number individuals with all types of IBS including IBS-C that have had good results using the FODMAP approach for managing IBS symptoms check the following groups on facebook "FODMaPs Support Group UK." and "IBS (Irritable Bowel Syndrome) Support Group".
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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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make sure you are checked for celiac. Skin issues are common with that true gluten intolerance, so if you had skin issues clear up when you eliminated wheat that might be a red flag worth investigating (if you haven't already).
- H
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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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I got tested for that, and strangely enough it came back negative. And I took the test prior to given up wheat products.
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Heather
#371513 - 10/04/14 05:05 PM
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If you create a new edition of your book are you going to include information on FODMAPS? Maybe in your recipes you can put info on what FODMAPS are in each recipe and if it's high or low in them. I've noticed some of the recipies in your book are very high in FODMAPS and would put me in severe pain!
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