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March 30, 2012


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Momma of a sensitive little guy

Hi, How often is FM alone the main cause of GI symptoms and other problems? Or is it most often a secondary problem?

Patsy Catsos

Hi Momma, I don't have any stats on this. My impression from my practice is that it is relatively rare to have primary, stand-alone fructose malabsorption. It does seem to usually be part of a package of food intolerances. However, I realize I might have a skewed viewpoint because maybe people with primary fructose malabsorption are managing it perfectly well without needing to seek the help of a dietitian.


Hello Patsy, I purchased a copy of your pricesless book last week here in India and I must say I'm so glad I did! The elimination of FODMAPS has helped me tremendously, thank you very very much! Patsy, I have a question for you. After four years of gradual weight loss and soft stools, I found out that I have some form of IBD. There is no bleeding, my colonoscopies are normal and I do not suffer from pain. Bloating makes me quite uneasy but I cannot call it severe pain. The only way I found out I have some of IBD was after a comprehensive stool analysis (elevated lactoferrin,lysozyme and IgA). Doctors don't want to listen to me because my symptoms are not that severe and they think I'm losing weight just because I'm some sort of 'diet'. I have become fructose and lactose intolerant and it seems to be secondary malabsorption as you have mentioned above. I started out with the SCD about 2 months ago but that didn't help unless I had very little of everything. Since I have read your book and have followed it, I have felt better. However, I'm still not having any grains or sugar. Do you think I should go ahead and try adding oats/rice to my diet? I'm just too scared I must say. Please advise. Thank you so much again!


Well I can't safely give you personal advice in this setting so I will give some general comments. One can theoretically get enough calories to prevent weight loss on a diet without grains and sugar by increasing portions of fats, meats, lactose-free milk products and the tolerated fruits and vegetables. Sugar doesn't do much for us nutritionally so no rush to add that back. Grains can offer nutrients, though, so I encourage trying the low FODAMP grains. When someone is too afraid to try an actual fructan challenge, or if one has another illness like an IBD, it makes more sense to just cautiously introduce small portions of the lowest-fructan foods from the bottom of the challenge list. I am so excited to have heard from my first Indian reader...Amazon recently notified me the book would be available there!


I bought your book a couple of years ago, and charted everything I ate for several weeks and I still had trouble with IBS-D. Recently I asked my PCP to see all my records and I discovered that in a barium follow through, I was diagnosed with rapid transit time. It took 30 minutes from ingestion of the barium until it reached the cecum. I believe the Fodmap diet can help me, but there must be other things I need to watch for in addition. I have stopped drinking with meals. I drink no beverages with carbs. Do you have any other suggestions for diet modification? Where can I find a list of other causes of rapid transit time? Since it is not a "disease", I can't seem to get help from my PCP.

Patsy Catsos

Mcmom, try doing a pubmed search to see if you can clean anything from the medical literature about this. There is some evidence that fats and proteins empty slower from the stomach, which could mesh well with the low FODMAP diet. Suggest you ask your PCP for a referral to a GI dietitian for personalized help, or check the "FODMAP dieitian" directory on the tab at the top of this page.

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