Hello from sunny San Diego! I am so fortunate to be attending Digestive Disease Week, a yearly gastroenterology conference featuring state of the art research from around the globe regarding digestion and gastrointestinal disorders. If you are on twitter, follow the hashtag #DDW16 for real time tweets coming from the conference. You can find me on twitter too: @KateScarlata_RD
I hope to post a little recap from the meeting in the next week or two!
Today’s topic is one that I have covered more or less in past posts…but I think, we can can benefit from some review.
The low FODMAP diet is an evidenced based diet therapy for individuals that suffer with irritable bowel syndrome. The research is variable, but it is estimated that about 70% of those who have IBS will benefit from the diet. For those who have been suffering far too long with debilitating IBS symptoms, the low FODMAP diet provides a sense of hope and for many, a nutritional approach to feel better. Unfortunately, it doesn’t provide symptom relief for all who suffer with IBS. If you note only partial relief or no relief of your IBS symptoms after trying the low FODMAP diet, here are a few thoughts to consider.
You might be following the low FODMAP diet incorrectly! Despite careful nutritional guidance, some FODMAPers inadvertently eat foods rich in FODMAPs. The biggest culprits in my practice include:
- Gluten free foods with FODMAP ingredients such as: agave syrup, honey, chicory root extract, pear or apple concentrate.
- Granola bars with chicory root extract, dates, or honey.
- Coconut milk products with chicory root additives are also commonly found.
Here is more information about common pitfalls following the low FODMAP diet.
You might have small intestinal bacterial overgrowth (SIBO). I find in my clinical practice, that the low FODMAP diet will offer only partial symptom relief for those who are suffering from SIBO. Most of my clients with the overlap of a SIBO diagnosis feel about 65-70% of their desired symptom goal on low FODMAP diet. When this occurs, I will send them back to the gastroenterologist for a SIBO breath test and suggest further work up for other conditions.
ridiculously constipated. If you don’t move your bowels regularly and experience a cleansing bowel movement, you likely will experience bloating, pressure in your intestines and pelvic area. Work with your gastroenterologist to find a suitable bowel regimen, consider being tested for methane + SIBO. Methane gas production in your gut is associated with constipation. I suggest you also discuss with your GI doc if he/she thinks you may be suffering from dyssynergic defecation. Dyssynergic defecation occurs when the muscles and nerves in your rectum don’t work properly to help you have a BM. This condition can be successfully treated with pelvic floor physical therapy (yes, it works) and/or biofeedback.
You are not FODMAP sensitive. 30% of IBS sufferers do not benefit from the low FODMAP diet. You may benefit from another dietary approach. Visit with a dietitian to explore other nutritional interventions based on your full symptom profile and medical history. Rather than try to do all the detective work yourself, work with a forward thinking gastroenterologist and GI nutrition knowledgeable dietitian to explore other nutritional approaches based on your history. For example, individuals with overlapping fibromyalgia, chronic bladder pain, chronic sinuses infections and/or allergy symptoms, might benefit from evaluation of mast cell activation syndrome. I have had a subset of clients with these conditions benefit from a low histamine diet and medication therapies directed toward stabilizing the mast cells. Mast cells release inflammatory chemicals and are more prevalent or perhaps more active in individuals with IBS.
You suffer from bile acid diarrhea (BAD), learn more about BAD here. This can occur if you make more bile than you need or it is dumped into your intestine too quickly. We also see bile induced diarrhea in individuals that suffer with SIBO, as some microbes that can be present in your small intestine (they don’t belong there!) can render your bile inactive. Inactivated bile travels to the colon, pulls in water and encourage colonic motility. The end result: diarrhea. Talk to your gastroenterologist about the possibility of this condition.
Enjoy the week ahead!