Instagram Q & A

Hey Friends!

Just a quick post to let you know that I try to do informal question and answer sessions via my Instagram account, a couple times per month.  To follow me on Instagram, click here.

The Instagram Q & A is a great way for you to ask a burning question you may have about the low FODMAP diet, IBS or SIBO.  Your questions are posted anonymously, so you can be as private as you want to be. I try to get to most of the questions posed to me but can’t promise that I will get to every last one.

Per request, I have compiled a few of the questions and answers that I posted on Instagram a couple days ago here on my blog –I added a few of the questions I didn’t get to on my Instagram story, as well.

Let me know if you find this type of post helpful.  I am fairly active on Instagram so encourage you to follow me there!

Questions:

1. Is tea high FODMAP? I’m a big red rose tea drinker and I’m wondering if I have to cut it out.  Answer: 1 cup of black tea per sitting is suitable on the low FODMAP. You could enjoy another cup later in the day. Note: caffeine can stimulate your colon to move–so keep your tea intake in check per your tolerance. FODMAPs are water-soluble–so often the stronger the tea–(the longer it is steeped) –the potential for more FODMAPs.
2. How much does a consultation cost? Can you bill insurance? Answer: Currently, I am not taking on new clients. I do have a list of FODMAP knowledgable dietitians found here. 
3. Can SIBO be treated? Absolutely! Per my experience, many patients have success with just one round of rifaximin and slight diet changes. Some cases are more challenging than others. Getting to the root cause of SIBO can be helpful (when possible) to reduce change of relapse. Some causes are treatable–others are not. For me, I have scar tissue (adhesions) and no ileo-cecal valve between my small and large intestine. I can’t correct that, so I do relapse occasionally, and need antibiotics. The first time I did antibiotics–I was SIBO free for 10 years.
4. Do you have reflux with your SIBO? What do you suggest for those who do without using PPIs? I did not experience reflux with SIBO. When working with patients with SIBO and reflux, I direct patients to GI or PCP to attempt to change from PPI to H2 blocker. The dosing and change in medication is typically done over a slow period to allow the body to adjust. Don’t change your medications without discussing pros/cons with your doctor.
5. Is “leaky gut” a real thing? In those who follow evidenced based medicine, the term leaky gut is often called, intestinal permeability.  There are some conditions that are associated with enhanced intestinal permeability –sibo, IBD (inflammatory bowel disease), and in some cases, IBS (irritable bowel syndrome). In animal studies, a fiber free diet has been shown to reduce the protective intestinal barrier, allowing for greater intestinal permeability. Although we can’t translate animal studies to humans, eating a variety and adequate amounts of fiber seems like a prudent goal to help keep our intestinal barrier healthier and less permeable.
6. When I reintroduce fodmap foods-have I failed in I have 4-5 rotten egg type farts later on? A failed challenge in my book–involves return of pain or IBS flare symptoms. Passing gas is not a failed challenge. Sometimes, the rotten egg gas is due to over-consumption of protein or sulfur containing foods–so you may want to circle back with your dietitian to see about slight modification of your foods to see if that helps.  Passing gas itself is normal –and a sign you are feeding your gut microbes. This is a good thing!
7. Did you make shrimp scampi with spaghetti squash or am I dreaming? Is there a recipe?  No shrimp scampi and spaghetti squash combo recipe, but here is a link to an amazing low FODMAP baked shrimp scampi.
8. How do you find a person for hypnosis for IBS? Here is a listing of practitioners trained in gut directed hypnosis–which is shown to be quite effective in managing IBS symptoms in many people.
9. My GI doctor said I have to be on the low FODMAP diet the rest of my life, is that true? I say, probably not. No disrespect to your doctor, but here are a few important points. 1.) Tolerance to FODMAPs and change over time. 2) A strict low FODMAP elimination diet has been shown to reduce some probiotic microbes in the gut–and we don’t know the long-term impact fo these changes. This is why, the reintroduction and personalization phase of the low FODMAP diet are important! 3) Most people, from my experience working with 1000s of individuals with IBS &/or SIBO, have been able to add back some foods. YAY!!
10. I was negative for SIBO but have all the symptoms. Any suggestions on what to do now? SIBO and IBS have similar symptoms . It could be that you have IBS.  You could talk to your GI doctor about whether a trial of rifaximin (the antibiotic commonly used to treat SIBO) makes sense for you. I would work with a GI doctor and GI dietitian to help better guide you to better symptom control.
11. What is your opinion on antimicrobial supplements vs. antibiotics for treating SIBO?  I am more in favor to the antibiotics as they are regulated. Antimicrobials are not.  Of course, with any drug or herbal therapy there are potential side effects. Additionally, there is only 1 study that I am aware of looking at the benefit of herbal blends for SIBO treatment. One study is not enough. That being said, I have had clients that have tried the herbal products in the one study found here that were effective for SIBO…and they have been helpful for them. I don’t personally prescribe anti-microbials myself–I feel this is out of scope of practice for a dietitian. When patients have opted to go the herbal route, I refer to the GI doctor and we all work together.  It is also important to note, this one study comparing rifaximin to herbals was done using a lower dose of rifaximin but given over a 4 week period.  So in essence, the study is not measuring efficacy of herbals against the current therapeutic dose of rifaximin.  It’s your body though–and you are in charge of it. I strongly believe in patient shared decision making–but you want to be informed correctly about your choices.
12. You once suggested GoMacro bars but you don’t seem to anymore. Are there issues? There are some Go Macro products that appear low FODMAP per ingredients and my clients have tolerated well such as the protein replenishment peanut butter go macro.
13. Pro or Prebiotics?  I say, prebiotics.  A good starting point for individuals on the low FODMAP diet is the prebiotic, resistant starch, found in raw oats, unripe bananas, cooked and cooled rice or potatoes (think rice or potato salad).  I break down these definitions a bit in my Probiotic and Prebiotic post found here.