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April 17, 2011


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Thanks for this great information. Do you know if the pro-biotic "Align" is acceptable for people who do respond to the fodmap diet? Is has just one strain and it is the Bifidobacterium infantis.

Patsy Catsos

Yes, Align would be an example of a product that contains B. infantis.


You write: "People with IBS (and eating a FODMAP-restricted diet) need a gut stocked with critters that like to ferment non-FODMAPS carbohydrates, don't produce gas, and do produce large amounts of desirable SCFAs."

I thought the whole idea of the FODMAP diet was to significantly reduce intake of all carbs that have the potential to be fermented. What would be left for a probiotic such as Align to ferment (thereby producing desirable SCFA's) if they are not provided any "food"? Put another way -- aren't IBS symptoms the collateral damage of a healthy process, i.e. SCFA production via fermentation of carbs? And vice-versa, doesn't a symptom-free life come with the risks associated with a reduction in SCFA production, i.e., increased inflammation and compromised repair and regeneration of colonocytes?

Patsy Catsos

I would agree that a *potential* risk of a low FODMAP diet would a reduction on the beneficial products of fermentation. However, the goal of the diet is do reduce *rapid* and *excessive* gas production, not to stamp out all fermentataion. We are definitely not removing all fermentable carbs from the diet, nor would we want to. There are other, stricter diets out there that might do so, but this isn't one of them. Part of the definition of FODMAPs is that the carbohydrate is *rapidly* fermentable. Those that are fermented more slowly are still allowed in the diet. This might include starches and other carbohydrate molecules with really complex structures that take more time to be fully digested by commensal bacteria. Thank you for this interesting question.


Thank you for the clarifying answer!

Ideally, the slowly fermented substrate would come from food, but another option might be an acacia fiber supplement, which seems to fit the bill (or so I've heard). And just so you know, I do NOT sell fiber supplements or anything else, for that matter!

I would be interested to know if anyone has experimented with acacia....

Stacy Jones

Ive already been diagnosed with dysbiosis, so would a probiotic, in addition to FODMAPs diet, be beneficial, or should I just stick to the diet?

Is ReNew life a good brand?


I think eventually a probiotic would be helpful along with a low FODMAP diet, but would caution against introducing it during the learning process of the Elimination/Challenge process. ReNew life might be OK if there are no FODMAP additives, but it is not one I am aware has had clinical testing for effectiveness with IBS.


Reading this thread has made me wonder whether by cutting out Fodmaps and thereby reducing the food source for some of these 'good' bacteria are we causing their numbers in the gut to decline and thereby increasing sensitivity to FODMAPs in the future (as there are lass bacteria left in the gut to help digest them)? I may be totally wrong here as I don't fully understand the processes going on.

Mary Ann Van Houzen

I am getting ready to begin the FODMAP diet. I am presently taking the PB8 probiotic. On the bottle it states the "The microflora growth concentrate selected for PB8 is inulin, a natural carbohydrate from chicory root....Inulin promotes the selective growth of beneficial bacteria in the intestine and is considered a "Prebiotic." Because Inulin is the growth concentrate, would this eliminate it as safe to take? Thanks!

Patsy Catsos

I would normally not recommend a probiotic with inulin during the elimination phase of the diet because inulin is a FODMAP. However, it is also good not to change too many things all at once, unless you take it sporadically anyway, because it is confusing and hard to tell which changes are due to diet. Talk over with your doctor or dietitian if you need help deciding whether to continue taking it at this time or not.

Margarita Cabrera

Dear Patsy,
I just get to know this web and order your book in Spanish.I read Dr.Shepherd diet books but I have to recognize I could not manage a complete low FODMAPs diet because I always had lunch outside. I plan to start after holidays preparing the meals at home.
About probiotics, did you hear about Yakult drink? It is quite popular in Germany and you can find it easily in any supermarket. Do you recommend it although it contains minor amount of lactose?
Thanks a lot!


It is a big help to prepare more meals at home. Yakult does appear to have lactose in it and I would not think it is suitable for the elimination phase of the diet.

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