IBS—Free at Last!

Welcome to IBSFree.net

Ibsfree.net is your resource for low-FODMAP living: frequently asked questions about FODMAPS (use the search box in the upper right hand corner of the page), product reviews, recipes, and more. The editor is Patsy Catsos, a registered, licensed dietitian in private practice, and author of IBS--Free at Last! Available from Amazon.com, IBS--Free at Last! Second Edition includes a step-by-step elimination diet, menus, shopping list, and label reading tips to help you learn to manage your irritable bowel syndrome. Please use the "comments" link at the bottom of each blog post to ask questions so that everyone can benefit from the discussion that follows. Follow Patsy Catsos on Twitter (see sidebar) or "like" IBS--Free at Last! on Facebook to be notified about new posts and other interesting tidbits. Thanks for visiting!

How Long to Stay on Elimination Phase of the IBSFree Diet

Let's discuss some considerations around how long to stay on the elimination phase of a FODMAP elimination diet. The short answer is, don't stay on it any longer than you have to!

• An elimination diet is a learning diet, not meant to be a permanent restricted diet.
• The time period should be long enough for it to be apparent whether or not the low FODMAP approach will help the individual person.
• A low FODMAP diet, no matter what the duration, is not going to cure IBS, only successfully manage symptoms. So there is no particular benefit of staying on the restricted phase of the diet for any longer than necessary.
• As it is, even during the challenge process the underlying diet is selected from the foods that are suitable for the elimination phase, so it does last longer than it might seem at first.
• In order to get a balanced diet with a variety of nutrients from food, it is important to liberalize the diet as tolerated, using either food challenges as described in IBS--Free at Last! or a more cautious approach.
• Let's face it, lots of people have a limited attention span for dietary change. If we stretch the process out too long, we may lose focus, and could leave valuable information about how food affects us on the table.
• It is true that several of the clinical studies on low FODMAP diets happen to have been conducted with longish elimination phases of 6-8 weeks--that's where those numbers you read about come from, but I am not aware it has been shown that shorter elimination periods aren't effective.
• In fact, the osmotic effects of FODMAPs (pulling fluid into the gut) literally cannot take place after they have passed out of your body. "They must be present to win." So, for example, if a lactose intolerant person eats ice cream on Sunday night, has a bout or two of watery diarrhea on Monday and passes all the lactose remnants by Monday night, that lactose is gone. It cannot still be causing osmotic effects on Thursday, or 6 to 8 weeks later, for that matter.
• On the other hand, it is possible that people who tend toward constipation and have very slow transit times might still have some lactose on board for days. These may be people for whom the fermentability of FODMAPs is a bigger problem than the osmotic activity. At first it would seem that once the excess gas produced by fermentation has been passed, this effect of FODMAPs would also cease, and I have worked with many constipated patients who did feel much better withing a day or two.
• But, because FODMAPs basically feed the biomass (collection of microbes) in the gut, there could certainly be improvements that could build up over time for some people, as the biomass evolves.
• If you've been on the diet for weeks and weeks and you just aren't feeling better, staying on it longer, sadly, is not going to help. Time to try something else.
• If you are feeling better, its time to move on, using either food challenges or the more cautious approach described in IBS--Free at Last! 
• If you are working with a dietitian, he or she may be using FODMAPs in a slightly different way, with different timelines tailored to your personal medical situation. That's a good thing!

Bottom line, two to three weeks, is plenty of time in most cases to know if the FODMAP approach has worked. Re-read IBS--Free at Last! for help planning the challenge phase, and please consult a registered dietitian if you need individualized advice.

State of Now 2013 (#140conf)

An event that could only take place in 2013 will be happening in New York City June 18 and 19. Internet and communications pioneer Jeff Pulver is putting together an incredible lineup of speakers and panelists, and I am excited and humbled to be among them. As I understand it, State of Now (#140) conferences began several years ago to explore the power of the web and social media to connect and empower people and the effect this can have on the world of today (note the reference to the number of characters allowed in a Twitter post with the #140 bit). This year is a little different, with a wellness theme predominating. Jeff says it best:

"I am happy to announce my friend Mallika Chopra will be co-hosting the conference with me. We will have speakers from across the United States, Canada, Europe and Israel. The conference will be a platform for people to share their health and wellness journeys and connect with others who are also on a similar path. Our conference will offer a great chance to connect with Doctors / Authors and others who are actively contributing to the field of: Health, Wellness, Fitness & Food. There are a number of panels under development to cover some areas which are of specific interest to me including: The One Ton Panel (a panel of people who have lost collectively 2,000 pounds), The Gluten Free Lifestyle Panel, Living with Autoimmune Diseases, Living life with Fitness Gadgets and Apps and several others currently under development." How great is that? 

My talk is called Writer-Reader Collaboration Ferments IBS Revolution. I'll be joined by one of my readers, Lauren Pulver (yes, Jeff's sister), who is a true fan of the FODMAP approach, and who will share her inspirational story.

By my count there are already 70 speakers lined up for this fast-paced conference and it sounds like there could be more to come! If you would like to attend the conference, register today for     only $199 (good only until April 26th.) Afterwards the price will be $495. Wow, that's some early bird discount! Click HERE to register.

Does IBS Get Worse with Age?

Although IBS can affect people of any age, some weeks it does seem as though I see more middle-aged and older patients in my practice than I might expect. What are the diet-related factors that might cause more gas, bloating, abdominal pain, diarrhea or constipation in older folks?

• Lactose intolerance is rare in young children, but common in older teens and adults. 
• Some patients are trying to be responsible adults and eat more healthfully. This might result in increased intake of FODMAP carbohydrates and result in symptoms. (Luckily you can use the IBSFree diet in my book to figure out which healthy foods you can tolerate well).
• Older adults are more likely to have diabetes, or have friends or family members with diabetes; sugar-free candies are popular with this crowd, and they often contain large amounts of sugar alcohols. Sugar alcohols such as sorbitol and maltitol are well known laxatives. Metformin, an oral diabetes medication, decreases sugar absorption, which can worsen IBS symptoms for some people.
• Conditions such as diverticulitis and c. difficile infection are more common in older individuals. The strong antibiotics that are prescribed for these conditions sometimes leave functional GI symptoms in their wake.

IBS related to most of the above age-related factors may respond well to changes in diet, including FODMAP elimination and, later, using probiotics to maintain gut health.

Spanish Translation of IBS--Free at Last! Launches

Exciting news for Spanish-language IBS-sufferers and the health care professionals who want to help them feel better fast, using food as medicine! This book project would not have been possible without the assistance of my two new European colleagues, Mario Bautista-Trigueros and Michela Mancarelli. They did a wonderful job combining their language skills with their professional backgrounds as scientists and nutritionists. 

The paperback book and the Kindle book are both available now on Amazon outlets worldwide. I will let some of Mario and Michela's Spanish-language colleagues tell you about their impressions of the book en español:

¡Por fin un libro sobre la Dieta FODMAP y el Síndrome del Intestino Irritable en español! Desde hace varios años muchas personas se están beneficiando de la dieta FODMAP para el SII y ahora, gracias a este libro, también lo podrán hacer todos aquellos que hablan español.

---Elvira Santamaría, Bióloga, Nutricionista y Blogger

El libro SII-¡Libre al Fin! es una herramienta muy interesante para cualquier nutricionista que quiera estar al día con los resultados más recientes de como ayudar a pacientes con el Síndrome de Intestino Irritable a través de la alimentación. En el libro se recogen las investigaciones de los últimos años sobre los FODMAPs y el SII, desde la explicación científica detrás de este enfoque hasta listas de alimentos con alto y bajo contenido en FODMAPs, recetas,  y lo que más he usado en mi consulta, una estrategia de eliminación y posterior reintroducción de los FODMAPs con el objetivo de conocer los carbohidratos FODMAP a los que cada persona es más sensible. Es una guía completa que me ha permitido establecer un plan de acción eficaz con cada paciente, ya que las fases de desafío con los diferentes grupos de FODMAPs permiten entender cuales son las necesidades específicas de cada persona a la hora de controlar el consumo de estos carbohidratos en la dieta. Es también de gran valor la última parte del libro, dedicada a responder a las preguntas que los lectores de la primera edición ya que ayudan a comprender en mayor profundidad el argumento y solucionan algunas dudas específicas que pueden surgir sobre qué productos pueden consumir las personas con SII.  En resumen, un gran libro que todo nutricionista que quiera estar actualizado respecto a los FODMAPs, el SII y la alimentación debe leer.

---Jorge Dorado Pérez, Nutricionista

Está muchas veces infravalorado el papel de la alimentación para manejar los síntomas de SII. Uno de los primeros pasos que recomiendo como médico gastroenterólogo es una dieta baja en FODMAPs. Es verdad que a veces recomendar que deben comer a mis pacientes se convierte en algo un poco difícil y ahí es dónde este libro se ha mostrado más valioso en mi experiencia, ya que explica que deben comer y que deben controlar o consumir en menor cantidad las personas con SII. La información está presentada al alcance de cualquier persona, no es necesario enredarse con terminología demasiado técnica e incomprensible. Debido a esto he recomendado el libro a algunos de mis pacientes, que querían profundizar sobre el tema. Este método, que ha demostrado su eficacia en los artículos científicos publicados en los últimos años, está respaldado por la investigación seria y no es otro libro más sobre dietas milagro con ninguna base científica. En mi opinión es una buena noticia la aparición de este libro en castellano sobre FODMAPs y SII  ya que existe un vacío en esta materia en lengua española y muchos pacientes y profesionales de la salud desconocen cuanto podemos ayudar a personas con SII a través de la dieta.

---Emilio Muñoz Regueiro, Médico Gastroenterólogo

Haz clic aquí para la versión en español por Hojas De Trabajo Y Listas De La Compra.

Haz clic aquí para Amazon.es

Haz clic aquí para Amazon.com

 

How to Talk to Your Doctor about FODMAPs

It now seems impossible to imagine that a mere 20 years ago you had to rely almost exclusively on the experience and knowledge of your personal physician for help with your medical problems. In today’s information-rich world, anyone with Internet access can personally review the latest research in medical journals, trade notes with other patients around the world, and easily find books that speak directly to the problem at hand. It is quite likely that patients like you may come across effective new therapies for your condition before your doctor does. Enter FODMAPs, the most effective nutrition therapy for IBS to come along in a long time.

Chances are, your doctor has never heard of FODMAPs (extra points for keeping up on professional reading for those who have). Hey, it’s OK to learn something new from a patient—the smartest doctors learn something new every day, and don’t try to pretend they know everything! To help your doctor save a little face, do mention FODMAPs when you make your appointment if you plan to make it a major topic of conversation at your next office visit, so he or she can do a quick bit of research before seeing you.

If your doctor asks you what the heck FODMAPs are, quote the following phrase in doctor-speak: “FODMAPs are rapidly fermentable, osmotically active carbohydrates that can cause symptoms in up to 75% of individuals with IBS. Lactose is an example of a FODMAP carbohydrate, but there are several others as well, including fructose, sugar alcohols, and certain types of dietary fiber.” Then, in a spirit of collaboration, ask your doctor for what you need:

· “Can you refer me to a dietitian for help with a low-FODMAP diet? I’d like to try it, since high fiber diet/fiber supplements/drugs didn’t help me.”

· “It helped, but there is still room for improvement. Are there any other treatments or diagnostics we could consider?”

· It didn’t help, so it would seem that dietary carbohydrate intolerance is not my problem. Can you suggest any other treatment options we haven’t tried yet?”

If you get relief from the IBSFree FODMAP elimination diet, be sure to let your health care provider know. You might inspire him or her to learn more about how FODMAPs can help other patients.