#FODMAP chat recap

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We were SO lucky to have Jaci Barrett and CK Yao, two of Monash Uni’s low FODMAP diet experts and researchers on a worldwide twitter  FODMAP chat  last night. For those of you that stay clear away from twitter or simply didn’t have time to follow along (or it was too late to join in…it started at 11 PM UK time), here is a little recap.

First, I have to say, the chat was well attended and it is clear the interest in the low FODMAP diet is increasing.  I really loved seeing a global presence on twitter last night for this chat on FODMAPs.  How cool is that?

Here are some of the questions and answers that we discussed:

Where can we get the most up to date FODMAP food info?  The Monash Uni low FODMAP diet app was the overwhelming response.  And be sure you select the Monash University app which has the latest and most accurate info!  The app will be updated in a few months.  Another great place to look for new info on FODMAPs is the Monash site found here! Recent tea updates can be found here.  And know that by purchasing this app you are supporting more FODMAP research….which helps all of us!!

If a person only experiences minimal improvements on the low FODMAP diet what should be trialled next? There were a few ideas suggested including:

  • Evaluate for small intestinal overgrowth (SIBO) but the researchers cautioned that current testing methods are not very accurate.
  • Make sure the low FODMAP diet is being followed accurately.
  • Consider food chemical sensitivity–salicylates, amines
  • Get evaluated for pelvic floor dysfunction.
  • Be sure fiber intake is adequate
  • Gut directed hypnotherapy

Fiber intake can be reduced for some on the low FODMAP diet.  What are some good low FODMAP fiber sources? Low FODMAP fruits and veggies were recommended. Oat bran, rice bran, linseeds (flaxseeds), chia seeds, buckwheat, quinoa were also mentioned as top fiber without FODMAP food sources. Linseeds (flaxseeds) have been difficult to test due to their gelling nature–so limit to tolerance since we don’t have an exact cut off limit.

Any thoughts on the use of digestive enzymes, fructosin, beano for those with IBS? These have not been thoroughly tested in those with IBS.  Here is a paper on fructosin for those interested in learning more.  There are more studies forthcoming in this area.

Malto-oligosaccharides are being added to yogurt in the US.  Are these fibers FODMAPs?  This added fiber supplement should be adequately broken down by human digestive enzymes therefore is not a FODMAP.

What about probiotic use? When should they be added to the diet—before, during or after low FODMAP trial? Bifidobacteria infantis 35624 & bifidobacteria animalis have the best efficacy for IBS. Bifidobacteria animalis may increase stool frequency so perhaps not best option for diarrhea-predom IBS.  There is no evidence for use of probiotics pre or post low FODMAP diet.  Likely probiotic benefits are individual and more research is needed in this area for IBS patients.

Does cooking alter FODMAP content? Veggies that are cooked in water will lose some of the fructans and GOS into the water but cooking produce in water also leads to less nutrients in the food. Canned legumes have less FODMAPs as some of the FODMAPs leach into the liquid and then are drained off and removed.  Sourdough processing can reduce FODMAPs (fructans) in breads to varying degrees depending on processing time etc Trial of spelt or oat sourdough bread might be well tolerated!  In the US, Westbrae canned lentils without any onion/garlic may be worth a trial.

Do different varieties of wheat have different FODMAP content–einkorn, spelt, kamut? According to Jaci Barrett, only spelt has been tested for FODMAP content recently at Monash Uni.   So…it will be interesting to learn more about this ancient wheat grains and their FODMAP content at a later date.  Sourdough spelt bread tested in Australia is low enough in FODMAPs to be allowed on elimination phase of the diet.

Should the low FODMAP diet be followed for life? Any risks? Should family members be following along w/ the low FODMAP diet.  The short answer: NO.  The low FODMAP diet reduces beneficial gut bacteria and this may lead to unwanted health risks down the line. Try to limit use of the diet for 4-6 weeks and work with a dietitian to re-introduce/re-challenge FODMAPs to determine what foods you can add back and which may need to be reduced due to triggering symptoms.

We’ll try to connect with the Monash researchers again….maybe later in the year for more updates.  The low FODMAP diet is evolving right before our eyes….and changes with food analysis will be forthcoming!

 

 

17 replies on “#FODMAP chat recap“

  • Emilia

    Hello,
    I have a question. I have ibs and have tried the low food map diet two times (6 months apart) and both times I have gotten very low blood pressure and low blood sugar. My blood pressure is naturally low. I eat oatmeal porridge, vegetables, fruit, glutenfree bread etc, but it still seems like the lack of carbs/sugar is making me feel really bad. Both times I tried the low food map diet I had to end it because of vomiting the second day, and feeling dizzy with head aches. What can I do? Should I change my diet more slowely? It seems my stomach is very sensitive.

    • Well Balanced - Food - Life - Travel

      Emilia–I would encourage you to work closely with a health team well versed in GI/digestive health to help you sort out why you might have had a reaction to the low FODMAP diet.

  • Joey

    I’ve been taking a digestive enzyme with each meal and find that it really helps. There was a really stark contrast between the enzymes before I did the FODMAP elimination diet and after. Before it seemed like the enzymes actually made more gas. After they help tremendously without any side effects.

    • Well Balanced - Food - Life - Travel

      Joey-what digestive enzymes do you find helpful? Do you have a brand you like?

  • Iddy

    “Should the low FODMAP diet be followed for life? … NO”

    This really worries me because I’ve worked a lot with a dietician and all the challenge foods give me big problems. I don’t seem to have any kind of tolerance for any of them, even though I challenge and rechallenge (we’re talking years).

    I feel so much better on low FODMAP. Am I doing damage by eating only this way? Is there anything I can do to increase my gut bacteria? I don’t like the sound of “unwanted health risks down the line.” 🙁

    • Well Balanced - Food - Life - Travel

      Iddy, we just don’t know the long term impact of the low FODMAP diet–and since we know it does reduce probiotic bacteria in the colon–it is presumed that long term use of the diet might contribute to health risk such as colon cancer in the long run. BUT…we really don’t know. We don’t know how many fructans/GOS would be necessary to up these probiotic bacteria–maybe its requires only small amounts — and since tolerance to FODMAPs can vary over time—you can try to reintroduce every couple months. When my clients have very little wiggle room adding back any FODMAPs–I always consider the potential of small intestinal bacterial overgrowth…so this might be something you would want to get evaluated.

      • Iddy

        Thank you so much. So it’s especially good to try and reintroduce foods from the fructans/GOS groups? I don’t know about SIBO but I’ll look into it now you’ve pointed that out. As I say, thank you!

  • Nici

    I’m with Iddy. I have found that I have very little tolerance for fructans, followed closely by galactans, then polyols and fructose. Luckily, I seem to have a very high tolerance to lactose. Sometimes even the allowed amounts of fructans and galactans give me grief, so I pretty much avoid them completely most of the time.

    I tested negative for SIBO, but I see that the researchers say the tests are not very accurate. Is there anything I can do to get a more accurate result on the SIBO test? I have a theory that my stomach empties too fast for the SIBO test to catch the “dump” into my small intestine … my GI doc confirms that my stomach empties very fast.

    Do we know which good bacteria the fructans (for example) support so that we can supplement with targeted probiotics? Thanks so much!

    • Well Balanced - Food - Life - Travel

      Hi Nici, Lots of great questions. The lactulose breath test is the most commonly used breath test for SIBO– sometimes glucose is used as well. Be sure the test you had tested both methane and hydrogen. Not everyone has bacteria that produced hydrogen…so if this was your case–your test would be negative simply for this reason.
      Dumping syndrome can be an overlapping diagnosis w/ IBS– I have had a few patients with dumping syndrome–and this requires some additional dietary changes …for instance–beverages should NOT be consumed at meal time but in between. The meal should include some fat (healthy fats) and some fiber to help delay stomach emptying. Some of my clients do best when the protein is consumed first during the meal. Warm liquids–speed up gastric emptying –so should be limited. Fructans/GOS increase bifida bacteria in the intestine. Certainly trying a bifida based probiotic could be helpful—such as align.

  • Karen Holmes

    My heart also sank when I read you should limit the diet to 4-6 weeks. I’ve been following it for 10 months, and though it has helped, I really related to what Iddy said above. It seemed all the challenge foods made me feel bad, and my diet seems so limited now that I worry about proper nutrition. I suspect SIBO too, but I have questions: My IBS diagnosis came four years ago after having two diverticulitis attacks (treated with antibiotics) within 5 months. After a year of feeling bad I was tested for SIBO and got a “probably have it” result, and I was treated with antibiotics, which helped somewhat. However, after another year of increasing discomfort, I saw my gastroenterologist about the FODMAP diet, and here I am, still not feeling great. If antibiotics got me into this situation, then aren’t they likely to start the cycle all over again? Are the antibiotics used for SIBO different than the ones for diverticulitis attacks? And are there tests for salicylate and amine sensitivity? Thanks so much, Kate.

    • Well Balanced - Food - Life - Travel

      HI Karen, It does seem odd that antibiotics may contribute to SIBO-and yet we treat SIBO often w/ antibiotics!! But I believe the rifaximin often used for SIBO treatment is targeting small intestinal bacteria–so may have less of an impact on altering bacteria systemically in the body. ALSO, it is key to determine why/how you developed SIBO in the first place–SIBO is really not a diagnosis on its own but rather an end result of something else. Lots to learn in this area–the research is just emerging. There are no tests for salicylate and amine sensitivity to my knowledge–individuals undergo an elimination diet and then re-challenge with foods separately. Royal Prince Alfred Hospital in Sydney, Australia has some great educational resources in this area: http://www.sswahs.nsw.gov.au/rpa/allergy/resources/foodintol/salicylates.html

  • Leslie

    Hi Kate. I’m relieved to see that I wasn’t the only one thrown by the statement that following the low FODMAP elimination diet long-term could be potentially harmful. Like the others, I have failed every challenge I have done and after a year and a half on the diet, I know that I feel best when I am eating a healthy variety of low FODMAP foods. One thing I have discovered, however, is that I have a sensitivity to gums, especially guar gum (not a FODMAP, I realize). Recently I took all of the gum-containing foods out of my diet (not a small feat), and I am now rechallenging some of the foods I tried earlier, just to make sure that it was the FODMAP and not the gum that I was having a reaction to. Possibly others may have a similar sensitivity to gums.

    • Well Balanced - Food - Life - Travel

      Leslie, you bring up an excellent point—and that is that gums even though they are not FODMAPs by definition –they are longer chains of carbs (FODMAPs contain small carb chains)–BUT still can be rapidly broken down by gut bacteria contributing to gas. This is why I recommend whole foods in their natural state as much as possible to minimize intake of gums. You are not alone–many individuals are sensitive to gums–especially in large quantity.

  • Christina

    Hello!

    I know you’ve mentioned a brand before but can’t seem to find it (and am going on vacation and would love it beforehand), but which brand probiotic to you suggest for someone with IBS/Symptoms??

    Thanks ! You really should be president of healthcare 🙂
    Christina

    • katescarlata

      Hi Christina! I like Culturelle (health and wellness formula) NOT the digestive version which has inulin OR Align for a good general probiotic for IBS patients. Align has more research–but in my experience both work for many patients. Typically, I review my client’s past history and current symptoms to determine the best probiotic.

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