At its heart, the FODMAPs elimination diet is an experiment. The scientist in me wants to keep you off probiotics until you've run through the entire elimination and challenge process. This would keep your experiment protected from those "confounding variables" that might confuse issues of cause and effect. In the ideal experiment, changes in your in symptoms would clearly be due to changes in your diet.
If you are already using a probiotic when you start the FODMAPs elimination diet, you should continue to use it throughout the process.
If you are not already using a priobiotic, I'd suggest removing the fermentable carbs from your diet before you add one, in other words, at least wait until you have completed the elimination phase. When you decide to add one, consider the following tips:
- Choose one that includes bifidobacterium, which consume low FODMAP carbs, produce desirable short chain fatty acids, but do not produce gas; B. infantis is one species of bifidobacterium with good evidence to support its use for IBS.
- Purchase your probiotics from a retailer that cares about temperature-controlled storage and shipping. Although some products are now shelf-stable and don't necessarily have to be refrigerated, their potency can still be diminished by extended storage over 70 degrees F.
- Don't kill the good bacteria by taking them with a hot cup of coffee or bowl of hot oatmeal! Take your probiotics with a cold meal or well before or after a hot meal.
- If you are one of the "very sensitive" people (you know who you are!), open the capsule and begin with just a fraction of a dose of the probiotic sprinkled on some cold food or stirred into a cool glass of water. Work your way up to the full labeled dose over a few day's time.
- Probiotics have a sort of threshold effect. You won't get the medicinal effect if you don't take enough of the product, so don't skimp.
- They don't seem to linger in the system--you should take them "ongoing".
- If you reach the point where you feel you don't need them as much anymore and you want to cut back, you should probably still use them at the full dose for a week or two a month so they can keep up their good work.
- Even if you don't usually take probiotics, consider using them following a bout of food poisoning, gastroenteritis, or antibiotic use.
- Don't take probiotics without consulting your health care provider if you are critically ill or immunosuppressed.
- Check back here often, as I will probably tinker with these recommendation as new information becomes available. Last updated 4/30/2011.