IBS Diet Cheat Sheet. Gluten Free, low-FODMAPS....so confused!!!
#372078 - 05/04/15 09:55 AM
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Hello, new to the forum. I am a very very confused IBS-C individual. It was my understanding after tons of research, that a low-FODMAPS diet would help with IBS. Have followed this for several weeks and there are OK days and a lot of bad days. I am looking at Heather's IBS Diet Cheat Sheet and this is where a lot of my confusion comes up. There are so many foods that, according to the low-FODMAP diet are good to eat yet, on the cheat sheet they are listed as trigger foods....I am really at my wit's end with this IBS crap (no pun intended)! With so many varying advice out there, which diet should I be following? I went GF for about 8 weeks and it seemed like it was working for about the first 4-5 weeks but then symptoms returned. Went with low-FODMAP for about 5 weeks now and it has been hit or miss the whole time, some ok days but more bad then OK. Somebody PLEASE help shed some light on the whole thing for me......thx
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Hi there,
For the FODMAP question, I know IBS advice can seem overwhelming and contradictory but there are a lot of clear, easy steps to take that should get you feeling better quickly.
First of all, before you can even accept a diagnosis of IBS, you 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 for everyone 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. It's not a approach that you are supposed to even attempt on your own - it's meant to be used under the guidance of a dietitian specifically trained in FODMAPs, and, I would add, also trained in IBS diet guidelines overall.
Unfortunately, the FODMAPS approach does not even address the well-established dietary triggers for IBS such as fats and other GI stimlulants/irritants (red meat, dairy, fried foods, soda pop, coffee, caffeine, etc.), 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. I continue to hear from people with the same issues you have as a result.
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. The IBS diet cheat sheet you have will give you quick and easy food lists for these concerns.
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.
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 and GI irritants, 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.
Please let me know how things go.
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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The FODMAP does address the "the well-established dietary triggers for IBS such as fats and other GI stimlulants/irritants (red meat, dairy, fried foods, soda pop, coffee, caffeine, etc.)" And it "does it address the critical need for IBS to distinguish between soluble and insoluble fiber"
In fact, in one of the first papers published by the Monash group that developed the FODMAP diet (see second reference in my signature) the authors state
"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 fiber. Other dietary triggers such as food chemicals may need to be considered, as should potential factors such as caffeine, fat, meal size and regularity."
This is one of the reason that the Monash group recommends that one work with a dietitian when follow the FODMAP diet so that one has some guidance about common IBS triggers as well as high FODMAP triggers. And these matters are more fully discussed in some of the Monash books such as
The Complete Low-FODMAP Diet: A Revolutionary Plan for Managing IBS and Other Digestive Disorders
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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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Hi Syl - In this one and only specific instance, yes, they do address other IBS diet issues. But this is one limited source.
Very few readers are going to find and pay close attention to one single sentence in a research paper by Monash, and most of my audience (in the USA) isn't looking at any Australian (where Monash is) resources at all.
The problem is that the (vast) majority of FODMAP websites, blogs, books, recipes, and, sadly, even what I'm hearing about in-person dietitian visits, do NOT address these issues at all.
There may be a few small exceptions scattered among the massive resources, but they're just that - exceptions. And that's the problem. I'm buried by emails from people about this, and they are definitely not being given any IBS diet info at all except FODMAPs. So they're sick, confused, and frustrated, and I'm hearing all about it. I don't blame them one bit.
XXOO
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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Hi Heather - Hopefully someday you will update your web site to include information on FODMAPs to reduce some of this confusion. I have no doubt that it would increase the value of the useful information already on your web site.
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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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Yes! I am so glad to see your response above, Heather. Thanks for the clarifying. I have been following the EFI diet for about 13 years successfully, but this past year, started having difficulty. So am starting to check out the FODMAPs. I want to integrate it with EFI, but was confused, and so empathize with the person who posted above. But this makes it clear. It would be great if you could devote a spot on your website to this!
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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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--------------------
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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