Have you been following the FODMAP Elimination Phase yet are still experiencing diarrhea? In my book, I purposely focused very narrowly on FODMAPs. The protocol is specifically meant to help you find out whether FODMAPs are contributing to your symptoms. Although the FODMAP approach is very effective for many IBS sufferers, the fact remains that FODMAPs are far from the only cause of diarrhea. Perhaps this would be a good time to review other possible causes. As you know, my philosophy is that the causes below will NOT apply to everyone, but each one should be considered in turn to see how it might apply to you.
- Caffeine can stimulate a bowel movement. Try going "de-caf" if this is unwelcome.
- Smoking, especially the first cigarette of the morning, can trigger a bowel movement.
- Alcohol can be a GI irritant. We are talking the alcohol itself, not the beverage it is in. Try abstaining from all forms of alcohol. Or, to assess the affects of alcohol in isolation, next time you indulge try a small serving of vodka, which is essentially pure ethanol and water, and see if you notice any ill effects.
- Supplements and medications. Magnesium supplements can cause diarrhea, in fact are often used as laxatives. If you have diarrhea, don't take a magnesium supplement unless it has been prescribed by your physician for a specific reason. Discuss your prescription medications with your pharmacist to find out whether any of your medication might be contributing to your diarrhea or might contain hidden FODMAPs. For example, lactose is often used as a filler, binder, or coating on tablets. Sorbitol is often used to sweeten liquid medications. Really study your pharmacy records or medical records to see if your symptoms began soon after beginning a new medication.
- Fatty foods can cause bouts of diarrhea. Many people can tolerate a teaspoon of olive oil on salad or in cooking but not fried food or greasy meats. Try forgoing the chicken wings and barbecued ribs but don't give up the essential fatty acids in small servings of healthy fats.
- Complete lack of fiber in the diet can leave some people with "unformed" stools. Try some FODMAP-friendly forms of fiber such as oat bran, rice bran, ground flax or chia seeds. These may gel the stool into a more formed state.
- Dysbiosis--the wrong balance of microbes in your gut--may be a factor. This may be especially likely if your IBS developed after a bout of gastoentiritis or antibiotic use. Now that you've reduced the fermentable carbs in your diet, introduce a probiotic. Try one for a month. If it doesn't help, try another. Good candidates: Lp229V (Jarrow, Goodbelly or TuZen (Canada)), B. infantis (Align), LGG (Culturelle), VSL#3, or S. boulardii (Jarrow or Florastor).
- Stress and/or anxiety. "Bowels turning to water" is more than a literary phrase to describe that response to anxiety or fear that many of us have experienced. The gut-brain connection is very real. A stress management practice of some kind can help, whether it be deep breathing, yoga, meditation, prayer or whatever interests you. "Practice" is the key word, so that you will be well-prepared to calm yourself when stress inevitably comes along.
- Hormones. Discuss your symptoms with your gynecologist. It is common for women to experience bouts of diarrhea at the beginning of the menstrual period. Endometriosis can play a potential role. Hormone replacement therapy can occasionally cause diarrhea.
- Food allergies. Classic food allergies can include a GI component such as diarrhea. If you have ever had symptoms such as hives, facial or oral swelling, or shortness of breath related to a bout of diarrhea, consult an allergist for a proper evaluation.
- Food (or food chemical) sensitivities. There are a number of of types of bad reactions to food that do involve your immune system but are not considered classic food allergies. You can still experience diarrhea when eating particular foods (or food chemicals) that your immune system over-reacts to, even if you are not "allergic" to them. There is growing evidence in the scientific literature that inflammatory changes in the gut are present at the cellular level in many cases of IBS. Examples of food chemicals that one could be sensitive to are amines, salicylates, solanine, benzoates, nitrates, food dyes and more. Many of them occur naturally in food, so cannot be spotted on the food label.
- Diseases of the gastrointestinal tract. Don't diagnose yourself with IBS. Discuss your symptoms with your healthcare provider so that diseases or disorders such as ulcerative colitis, Crohn's disease, celiac disease, diverticulitis, bile salt or fat malabsorption, pancreatic enzyme deficiencies, and cancer can be ruled out.
- Oh my gosh, lets not forget parasites, either current infections or past infections that have left residual damage to the small intestine...polluted or unprotected well water, drinking water while camping or backpacking, or eating unsafe food at certain travel destinations are common sources of parasitic infection.
I will stop here for now, but may add to this already overwhelming list as I think of more.
You just can't possible take on all these "maybes" at one time without affecting your life beyond reason, which is why I cut the project down to size to just FODMAPs in my book. Still, reviewing this list with the health care provider who knows you best might shed some new light on your symptoms if FODMAP elimination hasn't done the trick.