Updates in/Corrections to Second Edition, 2012

If you own the first edition of IBS--Free at Last! you are in possession of a very effective game plan for managing your IBS symptoms. That game plan is still intact in the second edition: begin by removing most sources of FODMAPs carbohydrates from your diet for a few weeks. If your symptoms improve,  begin reintroducing FODMAPs in a carefully controlled way. Monitor symptoms all the while, to figure out what your problem areas are, and adjust your diet accordingly.

The second edition does contain over 50 pages of extra details about questions raised by my readers, and of course I would be very pleased if you decide to buy it (for less than the price of a single 17.9 oz bottle of Miralax:), but you can still use your first edition successfully. The first edition still works because the big ideas are all there. Here are a some updates on the details of the elimination phase of the diet:

Grains/Starches: Rye is out (fructans). Quinoa, amaranth, millet, oat bran and rice bran are in. Corn meal and popcorn are still in.

Fruits: Blackberries are out (polyols). Cantaloupe, dragon fruit, durian, grapes, honeydew melon, kiwi, papaya, pineapple, prickly pear and rambutan are in. All portions are now 1/2 cup for allowed fruits, 1/3 cup for allowed juices. All fruits are bold (do not exceed portion size shown per meal)

Vegetables: Broccoli and kale are out (fructans/polyols) Cauliflower, sweet corn and mushrooms are out (polyols). Onion and garlic powder are out (fructans). Chives and scallions (green part only) are in. Bok choy, fennel bulb, green beans and turnips are in, but are bold (do not exceed 1/2 cup portion size). Green bell peppers, green peas, okra and sweet potatoes are still in, but are now bold (do not exceed 1/2 cup portion size).  Please correct two errors in your second edition: Strike globe artichokes from the allowed list (fructans). Strike collard greens from the lists of food sources of nutrients beginning on pg. 108 (not analyzed yet but are related to cabbage and other brassica family vegetables). As of October, 2012 arugula/rocket, seaweed/nori, and water chestnuts are allowed on the elimination phase of the diet.

(Note: I am aware that some other resources correctly say that by shrinking the portion sizes on beets, broccoli, Brussels sprouts, sweet corn kernels, and fennel, it is OK to consume them on a low-FODMAP diet. I used the published nutrient data to calculate the FODMAPs in ½ cup portions of these foods. I combined the resulting numbers with my clinical experience and decided to omit these foods from the Elimination Phase of my diet. Even if you discover through the challenge phase that you don’t tolerate fructans or polyols very well, you may find that you can include these foods in small portions .)

Fats: Pistachios are out (GOS). Other nuts and seeds are now bold (do not exceed 2 Tablespoon portion size). Coconut meat, milk, and cream are in. As of October, 2012, Chia seeds are allowed in a 1 1/2 Tb. portion.

Meat/Milk: Lactose-free yogurt and kefir are in. Tofu is in (blocks only, not silken tofu which has not been pressed and drained). As of October, 2012, Tempeh is allowed on the elimination phase of the diet.

Extras: Coconut water, golden syrup, cocoa and chocolate are in. As of October, 2012, sherry, port, sparkling wines, and rum are not allowed on the elimination phase.

 

 

Comments

[Kim Curtis]

WONDERFUL to have all your updates in one place! Do you also have additional recipes in the new edition?

[Patsy Catsos]

There are again very few recipes in the book, just enough key recipes to support the seven-day menu. Recipes included are: garlic-infused oil, pecan pie granola bars, peanut butter cookies, lemon vinaigrette salad dressing, quinoa salad, and pork fried rice. Also lactose-free yogurt and seitan for those who are ambitious in the kitchen. I am working on a recipe collection to go with the book, and would love suggestions. Please reply here if there is a type or category of recipe you are especially looking for!

[Doug]

Good Morning,

When do you expect the paperback 2nd Ed to be available for sale?

[Patsy Catsos]

It should be available by the end of the week, I expect.

[Patsy Catsos]

Yeah!I launched the new book last night! It won't show up on Amazon.com for a few days, but can be purchased immediately on my Create Space e-store for the same price: https://www.createspace.com/3833611.

[jonathan]

Hi Patsy,

I see that nuts are now limited to 2 tablespoon portions. To which FODMAP group do they belong? I may base my challenge on the answer.

Thank you for all your good work!

[Patsy Catsos]

Nuts tend to have both fructans and galactans, but based on what I know so far I would challenge bigger servings of pecans, walnuts and pine nuts with the fructans group and pistachios, peanuts and almonds with the galactans group.

[jonathan]

Thanks for the quick response. How about cashews?

[SH]

Hello there. Could you tell me when the 2nd-edition paperback might be available on Amazon UK? Many thanks.

[Patsy Catsos]

I'm really not sure. Nothing I can do or find out at my end. Apparently a third party seller, even Amazon.UK itself, has to want to order and re-sell the paperback there. You probably already noticed you can get the Kindle version now?

[Jo McGrath]

Hi Patsy, thanks for your book. Would you consider doing a cookbook? Jo

[Patsy Catsos]

Yes, indeed, I am working on it right now! Hope to have it published by late fall.

[Sarah]

Do you have any information about other greens besides kale? I'm wondering specifically about collard and mustard greens. I seem to be able to tolerate them better than kale, but I am curious if there is any data on their FODMAPs levels. Thanks!

[Patsy Catsos]

No, sorry, no data on the other greens. Even no specific data on kale, I treated it as a member of the cabbage family.

[Penny]

Hi Patsy,
I have recently read conflicting views on whether watercress and rocket are low FODMAP on different websites- do you have any information on either? Also would lettuce be a problem in large quantities? (I regularly happily munch through a whole one...)

[Patsy Catsos]

I have no info on watercress or rocket(AKA arugula, I think). The *load* of FODMAPs is what counts, so if there were a small amount of FODMAPs in a particular type of lettuce, eating a whole head could provide a large-ish load. Seems inadvisable for most IBS patients on several fronts.

[Hannah]

Hi Patsy,

Today I started the elimination phase based on the first edition and then went ahead and got the second edition on Kindle after breakfast. I really, REALLY enjoyed my cereal with walnuts and half a banana and was disappointed to see the new edition no longer includes the nuts at breakfast! Is there a good reason for the menu change -i.e. is this likely too much FODMAPs for one meal during this phase? I don't want to deprive myself unnecessarily...

[Patsy]

Hannah, now that I know more about the FODMAP composition of nuts, they are one of those "bold" foods that should be consumed in limited quantities and not in the same meal as other bold foods for the best results. However lots and lots of people have felt better using the menus in the first edition, so if those menus appeal to you more, give it a try. If the results are less than ideal, then try pulling the nuts out of breakfast.

[Sue]

Just want to make a comment about vegs such as Brussels Sprouts, garlic, leeks, shallots, chives, cabbage, onion, kale, cauliflower, broccoli and turnips (rutabaga to you guys!). As well as the fodmaps issue/s with them, these foods also contain sulphur compounds which DOUBLE after only 5 minutes of cooking time. They have a double whammy. My source is the well-respected RPAH Elimination Diet (Sydney, Australia). So, not only can they cause distension & bloating due to the fodmaps they contain; they also cause further distension (flatulence) from the sulphur.

[Katie]

Ugh. So does that mean kale, collards, turnip greens, mizuna, and beet greens are all out? Argh. That's at least half my garden. :( (I also have broccoli and cauliflower and corn and... oh shoot.)

[John]

Hey Patsy, I own the first edition of your book. Would you consider offering a discounted version of the Kindle version for previous owners?

[Patsy]

John, thanks for your interest. I don't have a mechanism to offer such a discount. I hope you'll splurge on the Kindle version of the second edition, it will save you lots of money on Benefiber, Miralax, office visit co-pays and colonoscopies, ha, ha :)

[Patsy]

Katie, there are a lot of unknowns in your list. Don't know when you plan to harvest all of those, but it sounds like you will be all set for the challenge phase.

[Dana P]

Hi Patsy. I have a question concerning nuts. I eat a lot of nut butters because I am a vegan and need to get in as much protein as I can, especially with being on a low FODMAP diet, but I'm still experiencing awful symptoms. I'm thinking it's because of all the nut butter and seed butter I eat to get in extra protein. I have a nut or seed butter pretty much at every meal, and I eat a small meal about every 3 hours. The nut butters I usually eat are peanut butter, almond butter, cashew butter, and tahini (ground sesame seeds). Do you think all these butters could be causing me GI distress? I've been googling and trying to figure out how much nut or seed butter is suggested or recommended per day on a low FODMAP diet, but couldn't find anything, so I've come to you. The FODMAP diet suggests fruits be limited to 1 to 2 servings per day and 1-3 serving per day of vegetables, but what about nut and seed butters? I read your book and you have nut butters bolded as 1 1/2 - 2 tablespoons max, but do you mean only have that much per day or per meal? Also, would you recommend I try eating whole nuts as opposed to the nut butters since the butters are more concentrated and may contain more FODMAPs? Does that make sense? Or am I wrong in thinking that? Hopefully I didn't make that all too confusing and you are able to help me out. Thank you Patsy and I look forward to hearing back from you.

[Patsy]

The main point with the nuts and seeds is to limit the portion sizes per meal or snack (not per day, necessarily, at least in my version of the FODMAP elimination diet. I don't think it would help to eat more whole nuts. A tablespoon of peanut butter might weigh a little more than a tablespoon of whole nuts (no air holes), but not nearly as much of a concentration effect as the difference between grapes and raisins, for example, or fresh tomatoes v. tomato paste. Perhaps rely more on tofu and quinoa for protein and try counting the grams of protein you are consuming for a couple of days to see if you really need to be eating so many nuts to meet your needs.

[K]

How about spelt? What is the latest on this topic?

[Carol]

Can you recommend a calcium supplement? The one I've been using has fructose based inulin as an ingredient!

[Patsy]

Spelt--nothing new on spelt in a long time. It is a variety of wheat; FODMAP analysis of Spelt progducts has not been consistent, perhaps due to different growing conditions. Not suitable at this time for the elimination phase of the diet, but perhaps lower in FODMAPs than regular wheat products.

[Kirsty]

Hi just started the elimination faze today and think Ive already done it wrong. Im from the UK are cheerios in the UK different from American cheerios. Cheerios here contain wheat and barley?

[henrifromparis]

Hi Paty, what about papaya enzyme? Is it possible to take this tro help with digestion when we have FM since I do not know if the papaya enzyme has frutcose on it?
Regards,
Henri

[Patsy]

Enzymes are proteins, so a pure enzyme would not have fructose. I don't usually recommend enzymes for FM, which is not caused by an enzyme deficiency the way lactose malabsorption is.

[Nancy]

I just started reading your book and have a question about 2 of the allowed foods. I have read on-line that carrots are high in fructans and melons are high in fructose respectively. I've also read that grapes have more fructose than glucose and have a small amount of sorbitol. Why are these allowed foods in the Elimination Phase?

[Patsy]

Carrots are definitely in the clear according to published nutrient composition data from AU in 2007 and 2009. Watermelon is the only melon high in fructose. Some older studies showed grapes were higher in fructose but the latest data collected with the newest lab techniques shows that grapes are OK. A published 2009 study J Agric Food Chem Vol. 57, No. 2, 2009 shows that sorbitol was not detected. Don't get distracted by the minutia. Keep your eye on the big picture.

[Nila]

Hi Patsy,

I really love your blog! It really helps me help my IBS patients! Thank you! My question is if what group of FODMAPS sorghum is? Is it allowed in elimination phase?

Thank you so much!

Nila

[Patsy]

Hi Nila,

Thanks for visiting the blog. Unformtunately I don't know anything about the FODMAP content of sorghum. I would probably allow it especially if just a minor ingredient.

[Catherine Montague]

Any data on truffles? How about truffle oil on the elimination diet?

[Anna]

Hi!

I was wondering, in my country we have a lot av glutenfree products where the glutenprotein is replaced by wheat starch. Wheat starch is then the major ingrediens. I find confusing facts about wheat starch, ok or not?
A lot of theese glutenfree products contains soyflour as a major ingrediens, what is your comment on that?
Last question, is pickled vegetables and pizzasalad less likely to cause symtoms? I guess they´re fermented in som way and I seem to be able to tolerate them better.

Thanks!

Anna

[Patsy]

Sorry, nothing is known about the FODMAPs in truffles themselves but the infused oil should be safe. I know it is confusing about the soy and wheat. It might help to remember that fructans are fibers. Wheat starch has all the fiber processed out of it, so it is OK, but soy flour is basically ground up soybeans so it is not OK. I recommend avoiding it in gluten free products during the elimination phase of the diet (although in tiny amounts it may be OK later on). Fermented foods theoretically may have less FODMAPs because the bacteria or yeast in the product may eat some of them up, but we currently have not way to measure it. That's great if you can tolerate them better.

[Steven]

Hi Patsy,

I notice that Tofu is included in the revised list. Can you explain why soy yougurt and milk are still to be excluded as all are made from soy beans?

Thank-you

[Patsy]

As I understand it, the GOS/galactans, being water soluble, are "lost" when the tofu cake is pressed and drained during processing. By this is logic, I am now realizing that silken tofu may be an exception, since is usually not press and drained.

[june norman]

I love your book and I am doing very well on the elimination diet. I have IBS/Gerd - not sure about SIBO. My question is can I snack on oatmeal/porridge or baked white potatoes during the day or will this increase the bacteria in the small intestine. I am 66 years old and under weight.

[Nancy]

Are plantains ok to eat during either phase? What category do they fall into? Thanks.

[Patsy]

Sorry, I have not seen any facts on the FODMAP content of plantains.

[Patsy]

Oatmeal/porridge and baked potatoes are still low FODMAP no matter what time of day you eat them, so they might make good weight-gainer snacks. If you do have SIBO, consult the health care professional who knows you best on the pros/cons of eating between meals. Depending on the degree of underweight, snacking for the extra calories may be very important, despite the theoretical concern that small intestinal "cleansing waves" may be more effective on an empty stomach.

[Nila]

Patsy,

What group is collard green and farro?

Thanks,
Nila

[june norman]

Thank you - that helps. I was just reading about cleansing waves for the first time. I do not have SIBO symptoms other than IBS cramps etc. but have read that most people with IBS have some degree of it. Not sure if that is correct though.

[Patsy]

I think it would be a significant exaggeration to say that most people with IBS have SIBO.

[Patsy]

Nila, Collard greens would be challenged along with the fructans group, at least until we know more about their FODMAP composition. Farro would be in the fructan challenge group, since it is a form of wheat.

[Mary A.]

I'm confused by various blog comments about whether artichokes (globe) and collars are in or out. What's the latest on these? Any info on jicama? Thanks for the great info in your blog!

[Mary A.]

Oops, typo correction to my post -- I meant collards, not "collars". Mary A.

[Patsy]

Neither artichokes (fructans) nor collard greens (unknown, but in the cabbage family so they are out until they have been analyzed) are allowed on the elimination phase. No info on jicama.

[Paige]

Dear Patsy, thank you for your great work. I've bought your book, its been really helpful and aligns with the Australian research. Have you thought about producing a FODMAP "light" diet plan, or something like a list of the top 10 foods to avoid based on the latest research? The FODMAP diet is quite complex. I would like to try an "easy" version as a starting point, eg no apples, no onions, no... I'm not sure what else would be on the list. Perhaps common foods are different for everyone, making this hard to do? I lasted 9 days on the full diet, and began to see some improvements, but really struggled with constant food preparation! If you had any thoughts on the top 10 foods to avoid, it would be greatly appreciated. Kind regards!

[Susan Berger]

Are soy milk and soy cheese allowed in the elimination phase?

[Patsy]

Soy milk is definitely not allowed. Soy cheese I am not so sure about. I don't believe it has been analyzed, so I would not recommend it for the elimination phase.

[Annie]

Under allowed extras in the second edition,page 50, it says "spirits 1 fl. oz.", and later down in the same column it says "spirits 1.5 oz." I'm confused. Are there spirits that are not fluids?

Also, I read that distilled spirits (whiskey, in particular) are FODMAP free.

Will you enlighten me a bit? This is all new to me. Thank you.

[Patsy]

Sorry, that was a typo you found. I guess the main idea is probably good to limit yourself to one drink until we know more about their FODMAP content. They are probably low FODMAP since they have little or no sugar or fiber, but I haven't seen any published data for them using modern laboratory methods.

[Sheri @ Humbled Living]

Hi Patsy. Thank you so much for the updates. I have the first book. Well have had it for a year and I just decided to do the elimination diet. I have suffered with IBS since 1997. This will be something new for you. I started the elimination diet at 10 weeks pregnant. I was so bloated (looked 6 months pregnant) and pregnancy always has made my IBS worse. I am now in my 12th week and feel great except for the other day I ate a ton of bok choy (which I love!) but realized I had the older edition of the book. So thanks for the update! I see that I was only supposed to have a 1/2 cup. Oops! And I have lost weight. I am not trying too. I think it's just back to the normal size less all of the bloating. In the mornings, pre-FODMAP diet I would be 156 and then by evening I would be 162 and very, very bloated and stay that way for at least 3-4 days. Now, at 12 weeks pregnant I wake up every morning at 156 and am consistently 158 at night. I don't know if anyone else has talked about the weight gain in a single day from the IBS symptoms, but it was a huge problem for me. Well, I feel fantastic now. This diet has also improved my morning sickness. It virtually went away after about 4 days on the elimination diet. I already have to avoid corn (in all forms), peas, mustard, milk, sunflower seeds, cucumbers, and many other foods due to allergies, but I was still suffering due to the FODMAP foods. Thank you so much for your research! This is the best I've felt since 1997!!!

[Abby]

Hi Patsy,
Do you have any thoughts on teff? I've had a flare recently and I'm trying to figure out if that might be it.

[Patsy]

Sheri, your note is very interesting on a couple of fronts. That bloated belly people get from FODMAPs has to weight something, doesn't it? I am so thrilled to hear you are feeling great. Wouldn't it be fun if we discovered a new cure for morning sickness? I guess maybe that's a little too much to ask, but hey, we can dream big! Now your body can focus on appropriate weight gain during the rest of your pregnancy, baby not bloat. Thanks for writing.

[Patsy]

I have not seen any published data about teff; it would not surprise me if it does have FODMAPs, after all several other cereal grains do, such as wheat, barley and rye.

[Tara]

I am about to start the Elimination phase Monday, I see coconut milk is IN can I use it instead of the lactose free skim milk? I am not lactose intolerant but any time I drink milk either free lactose or not I vomit.

[Patsy]

Tara, as long as the coconut milk doesn't have any other objectionable ingredients it is OK on the elimination phase of the diet.

[debbie]

Hi, is rocket salad allowed please (rucola in Italy)..I think you call it arugula in US? thanks

[Patsy]

Haven't seen anything published directly about rocket. It is in the same plant family as cruciferous vegetables such as broccoli, cabbage, and cauliflower, so that makes me suspicious it might have FODMAPs. I would say "no" for the Elimination Diet until more information is available.

[Belle]

A question: I know the Namaste all purpose flower is allowed but are the Namaste Vanilla cake mix and chocolate cake mix allowed, I was thinking of baking a cake for a very special day.

[Patsy]

The Namaste cake mixes look okay! No FODMAP ingredients. I worry a little bit about xanthan gum, which is not a FODMAP but is close to being one, but it is low on the list of ingredients in the cake mixes. It looks like there is probably quite a bit more of it in the cookie mix, since it is listed higher on the list than several other ingredients.

[Ninette]

I have a question for a couple of foods, can you please tell me if these are allowable or not? Thank you!

Jerusalem Artichoke Pasta
Shirataki Noodles
Fresh Figs
Freeze Dried Apples/Pears/Bananas/Strawberries/Pineapples
Cream of Coconut

[Patsy]

Ninette,
Jerusalem Artichoke Pasta--no
Shirataki Noodles--not sure, so would say no
Fresh Figs--no
Freeze Dried Apples/Pears/Bananas/Strawberries/Pineapples--no; they are still "dried" and therefore a more concentrated source of fructose
Cream of Coconut--yes

[Shelby Hoff]

What is your opinion on the helpfulness of Probiotics and digestive enzymes with UC and dysbiosis? Do fermented foods help, too?

Any brands u recommend?

Are these meant for longterm use, or if not, how long is the general course?

thanks

[Patsy]

I have written some good posts on these already, so go to the upper right hand corner of the blog and use the search box to find them! Also, of course, I have addressed these topics in IBS--Free at Last! Second Edition.

[Finola]

Hi, thanks for all the updates, I have the first book but student budgeting is preventing me from splashing out on the 2nd ed. I'm confused about the beets. In my 1st ed. they are not bold but in the post you say they are not allowed on the elimination diet? Also you say fennel bulb is in but not on the elimination diet. I'm confused as to whether there are stricter rules for the elimination part than the low FODMAP diet in general? Could you clear this up for me? Thanks!

[Patsy]

If I am getting your question correctly, then yes, we are stricter on the elimination phase of the actual elimination and challenge protocol than we would be if merely trying to eat a "low FODMAP" diet. The elimination/challenge process is a short term learning diet. After you find out what your problem areas are, they you can be more flexible and feel free to experiment so you can eat as much FODMAPs as you can tolerate--this important to get a variety of nutrients in your diet. Say you learn you don't tolerate galactans/GOS. That doesn't mean you never eat them again, as per the elimination phase. No, you get less strict and more experimental over time--can you tolerate 5 beans in your soup? a cup of chili with beans? a giant bowl of lentil soup?

[Nancy]

Is chard an allowed vegetable? I just found some information that indicates it is a cruciferous vegatable.

[Patsy]

Well, I am not a botanist but based on available information I do not believe it is in the same family as the cruciferous vegetables, rather it is in the beet family.

[Ailsa]

Hi, I have a question - is there any data you are aware of on runner beans (aka scarlet runner beans)? I am an RD in the UK and have a patient who grows them.

[patsy]

Sorry, I don't know anything specific about runner beans. Can't really look them up right at the moment. If they are eaten whole like a vegetable chances are they are okay in small quantities. If they are dried and then cooked up as a pulse, they probably are too high in FODMAPs for the elimination phase.

[debbie]

Hi Patsy, i have been doing so well on your diet - on total elimination for three weeks and i really thought i had cracked it. However this morning I have terrible bloating and have put on 2lbs overnight. The only thing i did yesterday evening was cook my peas in with my family's cauliflower and broccoli ( ie, in the same pan). I didnt eat any of the c and b< just the peas....do you think that could be the cause, or can it just flare up for no reason even on this eating regime? thanks so much.

[Patsy]

Well, the cauliflower and broccoli do have some water soluble FODMAPS in the, so just picking them out of a cooked mixture with a water-based sauce or broth isn't really enough to cut out all the FODMAPs. If it was a sautee in oil or butter with no other sauce, then I wouldn't expect it to be as much of a problem. What was the portion on the peas? They should be limited to a small portion only.

[debbie]

thanks Patsy, it was a medium pea portion, but i am so missing all my vegetables. doesnt feel healthy to eat so much meat relative to veg but that said the change in my symptoms is a miracle!

[Heather]

I see sweet corn has been removed from the diet. However, I am not sure about regular corn or corn products (tortillas, pasta, ect). Are these still OK? These are listed as OK in the 1st ed.

[Patsy]

You will still find them in the 2nd edition under the Grains/Starches category. Because they are made from starchier, less sweet varieties of corn, thy don't contain the same sugar alcohols that sweet corn does.

[K]

I was wondering, what kind of FODMAPs do sherry, port, sparkling wine and rum contain?

[Karen Stebner]

Hi Patsy! Thanks so much for your books and online resources! I've just finished reading the second edition of your book, and I'm getting ready to start the elimination phase of the diet. I have a few questions.
1. You said to continue taking your probiotic if you're already taking one and not to switch during the elimination phase. I've been taking a probiotic, but it contains FOS. Should I continue it?
2. Are cashews OK in small amounts? On your website, you have a chart with high FODMAP foods and low FODMAP alternatives. Cashews are on the high side, but in your book you say all nuts are OK except pistachios.
3. I've been on a self-imposed gluten and dairy-free diet for a couple of years, although I'm ready to reintroduce those as well and see how I do. Any recommendations for how to do that along with the FODMAP challenge?
4. I've eaten a very limited diet (gluten, dairy, and soy free, as well as probably 95% FODMAP free) for several months. Won't eating a large amount of a food (as recommended on day 2 of the Challenge Phase) I haven't eaten in months to years produce symptoms just because my body isn't used to it?
5. Are the effects of FODMAPS cumulative? Could eating small amounts of the FODMAPS you're sensitive to over several days eventually cause an IBS attack?
Thank you so much for your time and resources!!

[Emily]

Hi Patsy,

I just received the 2nd edition of your book from amazon. It is totally illuminating, so much of what I have been experiencing makes so much sense now. I question I had was on celery. The book has it listed in approved foods but I had read elsewhere that it should be limited to one stalk. Should this be a bold type food or am I safe to eat it 2 or 3 stalks at a time with my nut butter snacks? Another question I had - I know that bolded items are to be spaced out can we have half of two bolded items in the same meal - meaning for example 1/2 TBSP nuts and 1/4 c blueberries on puffed rice cereal (fodmap free.) also are small amts of dried fruits (from allowed fruits like cranberries or blueberries) allowed during the elimination phase?

[Patsy]

Hi Karen, You sound like you would benefit from talking things over one-on-one with a dietitian so I hope you'll check my directory in the sidebar. I can't give you personal advice here, but will make a few comments that will be of general interest. FOS is a FODMAP and is not recommended on the Elimination Phase of the diet. I don't think cashews are as high in FODMAPs as pistachios, but they are higher than some of the other nuts, according to the latest info from researchers. We should know more specifics soon. The fructan-containing grains can be challenged separately from the fructan-containing vegetables. Yes the effect of FODMAPs are cumulative or additive, that is one of the main principles of the diet. So one shouldn't load up on FODMAPs in a particular meal, snack or even day. Spreading the load out in small servings over several days would be less likely to cause symptoms under the FODMAP scenario.

[Patsy]

In the latest publication from Monash Uni, celery is allowed only in limited portions on the low FODMAP diet, so probably in future will be a "bold" item on my version of the diet. I usually recommend only one bold item per meal or snack during the elimination phase of the diet, or as you have suggested, half portions of two bold items. To make the diet easier to teach and learn I usually say "no dried fruit" because it is so easy to over-do portions of fructose with them, but technically speaking dried "allowed" fruits in very small portions are probably OK.

[Francine]

Hi Patsy. Wanted to know if bacon is allowed on the program?

[Patsy Catsos]

Yes, I get to be one of the first dietitians in history to say bacon is allowed :) as long as it doesn't have any FODMAP sweeteners in it.

[penny]

Hi patsy.
I've been wondering about leeks- do you think that, like spring onions, the green part might be lower in FODMAPs than the white?
Thanks

[Patsy Catsos]

I think that would be a reasonable guess!

[penny]

Fantastic- I love leeks and have a garden full of them (pretty much all that did grow well in the wet british summer we had)!! I'll give the green part a try and let you know what result I get.
Thanks for the very speedy reply.

[Susan]

Hi, I'm starting the elimination diet tomorrow and was just wondering if smoked salmon or lox was allowed. Thank you!

[Patsy Catsos]

Yes, smoked salmon and lox are allowed.  Best, P.

[Karen]

Help Patsy!

I don't know what to do next. I've done the elimination diet for almost three weeks and I'm still having the same symptoms, so I'm planning to eliminate all of the bold foods for a week like your book suggested. However, there's another factor that may be complicating things. When I started the elimination diet, I had already been taking a probiotic with FOS. Since you said not to stop taking probiotics during the elimination phase, I continued until I ran out of that kind a week ago. Since I hate the thought of going without a probiotic because of all the problems I've had, I started taking a different probiotic without any prebiotic a few days ago and all of a sudden I'm having foul-smelling gas again, which I haven't had in a while. I'm wondering if it's due to the new probiotic. Now I'm not sure whether to do the week with all bold foods eliminated because if I continue to have foul-smelling gas and bloating, I won't know if a FODMAP-free diet doesn't work for me or if the symptoms are from my probiotic. What should I do next? I don't want to have to start this all over again if possible. Thanks so much for all your help!!!

[Patsy Catsos]

Although I can't offer you specific personal advice in the forum, I will make some general informational comments. Its not unusual to have an "adjustment period" that can include more/different when changing or adding probiotics, thus the reason for my original recommendation not to change horses in the middle of the stream. I think people learn more from the process of diet change when everything else is stable, so in general I would recommend revisiting the elimination diet when one anticipates no change in probiotics for a while. Good luck, and at the end of this work you will at least have the answer to whether or not FODMAP intolerance is part of your IBS, even if the answer turns out to be "no".

[lisa]

Hi Patsy!

I wanted to ask u about two foods, in terms of their fodmap content:

1. POM pomegrante juice and (whole) pomegrantes
2. Tart cherry juice concentrate

I tried to do some research on their fructose/glucose ratio and content, but wanted your professional opinion. Both are high in antioxidants and help with inflammation, so i'd be thrilled if they are fodmaps-friendly!

Thanks a bunch for all u do! =)

[lisa]

I forgot to ask...

Is nutritional yeast (inactive/dead saccharomyces cervasie) ok to consume in regards to fodmaps and dysbiosis? If not, please explain

Thanks!

[Patsy Catsos]

I haven't seen detailed nutrient data on them, but pure pomegranate juice and tart cherry juice probably fall into the "medium" category. I would probably not recommend them on the Elimination Phase of the diet, but the latest Monash Uni booklet allows very small portions of cherries (less than 3 cherries) and pomegranate seeds (less than 1/4 cup. Nutritional yeast. Hmm. not sure about that one, I'm not aware it has been analyzed for FODMAPs. Interestingly, it is 27% fiber by weight, but not sure what kind. As far as I know the yeast is "inactivated", i.e. dead, so would no longer be able to ferment FODMAPs or other carbohydrates. I am not aware that it has any probiotic effects to help correct dysbiosis. The only yeast-type probiotic in general use is S. boulardii.

[Christina]

Hello!

Alot of great info. Was wondering though, how does one determine exactly what to eat, when they have IBS AND autoimmune Hashimoto's thyroiditis which restricts eggs, nuts, seeds, grains, legumes, gluten, dairy, soy, corn as part of the autoimmune healing protocol. Sure can get confusing and scary that so much food is out! Thank you!

[Sarah]

Hi Patsy,
You say that FOS is definitely out; could the amount in a probiotic supplement trigger IBS reaction on an otherwise FODMAP-free diet?

On another note, can you tell me if your second edition book has the most recent updates from Monash University (I think this is where the analysis is being done?) as found on their app? I'd like to buy the book, but have found so many conflicting FODMAP lists that I'm not sure what is definitive.

Thanks.