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April 30, 2013

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Michael Edwards

Elimination diet helped me enough that I've more or less been on it for 6 months. I did the challenges, started having trouble again, and retreated. :-)

Lisa Braithwaite

Great post, Patsy! I shared it with the "Low-FODMAP for Foodies" Facebook group.

IBS-Free at Last

Nice to have a safe place to retreat to. Do choose wide variety of foods on elim lists at least!

J

Hi Patsy,
I was wondering if you could give me any special tips for constipation SIBO? I'm trying to plan out my low-FODMAP diet but I'm just not sure how much and which types of grains and meat/fish/eggs to use because I keep reading that some people have had to cut out quinoa, some cut out potato, some cut out rice, some minimized meat, etc. in order to get relief. And/or should I do low-fiber, high-fiber, low residue, low or high fat? Have you noticed any consistencies in these regards in your constipation dominant clients? I know everyone is different but I really want to take in all considerations in order to maximize my chances of getting relief. Plus, within the past few months Magnesium supplements have no longer been working and now I'm onto enemas and I'm afraid they will stop working too so I need to do something that works fast.
I'd really appreciate anything you could tell me!!

Kate

After trying the elimination stage I found it really helped but got bored of eating the same food all the time. Then really struggled with the challenging food stage what with how much to have and only having one of those foods at a time.
I went to get tested by a homeopathic therapist for food allergies and this has helped so much. He basically did my food challenge stage for me telling me what foods were fine and which ones caused symptoms. I would really recommend this to anyone who is loosing the will to follow it as strictly as it requires

Fodmapguy

Same here. All the food groups in the challenge phase gave me trouble so since then it's meant sticking to the basic diet. Must remember to keep my diet varied!

Patsy Catsos

Thanks, Lisa!

Patsy Catsos

J, SIBO is such a poorly understood, new diagnosis that there just is not enough evidence to inform any sensible answer to your question. Overall I would say it would *seem* to make sense that a diet low in fermentable carbohydrates is more important after antibiotic treatment, to keep it from recurring, than during antibiotic treatment, when the abx will be doing all the work. But even this is going out on a limb and just using common sense, rather than based on evidence that is specifically about SIBO. There is no standard protocol for SIBO, so just do your best and try not to sweat the details too much.

Patsy Catsos

Yes, that's the idea. Also, continue to try at least very small portions of foods low on the challenge list to push the envelope. For example, may be able to tolerated a tablespoon of broccoli even if not a whole plateful. Or a tablespoon or two of beans in a soup even if not a whole bowl of bean chili. "Why bother" some might say with exasperation, but I think its important to get that variety, get those small amounts of nutrients in whole food form, and who knows, even train your microbiome and your body's ability to tolerate them.

BB

I've been on the elimination phase for almost three weeks now and have seen GREAT improvement in symptoms but not complete stability. Is it time to try doing the challenge (as in your book) or should I try to stick with the elimination? Thanks!

Patsy Catsos

Every situation is different so consult with your health care provider. For people who tend toward constipation, or those who take a while to get the hang of the diet, it might not be a bad idea to stay with the elimination diet a little longer, of course choosing a wide variety of foods from it.

Jen

I have a question about FODMAPs and food sensitivity test results. I've been on the FODMAP elimination diet for almost 5 weeks now. It took the initial full 2 weeks to see partial results (I have IBS-C and slow motility). But any results were a relief! I've made it through the fructose and fractals challenges with flying colors. Yesterday I got my food sensitivity results. My ND knows nothing about FODMAPs and casually said I could combine the two diets. Is this actually a good idea, or would you say the sensitivity test trumps the FODMAPs? The combined list of forbidden foods is daunting. I have a long list of sensitivities :(

Patsy Catsos

You are going to need some help from a dietitian to sort this out, can your ND refer you to someone who knows how to help you implement the results of the test he or she ordered? All I can say in general is that FODMAPs are not the primary underlying cause of IBS, though they can be the immediate cause of symptoms.I wouldn't say the food sensitivity *trumps" FODMAPs, though, the FODMAP intolerance can still be quite real. But, FODMAP intolerance can improve over time if the underlying problem is treated. Underlying problems could include immune-mediated food sensitivities.

Jen

As I was typing, I realized that it is a complex situation and the real answer would be to consult someone directly... but I thought it would be a good question to share. I can't tell you how comforting it has been to be able to use both your book and site to help guide me through all of this. Thank you again and again!

Patsy Catsos

You are ever so welcome.

A

Hi Patsy
I've been doing the elimination phase for a while and the symptoms improved - much less trapped wind, distension and feelings of incomplete BMs - however I still have several BMs per day, albeit with less urgency. I felt ready to move on to the challenge phase and reintroduced lactose. It seemed to be ok - no extra symptoms - but I am unsure if this means it's ok to reintroduce lactose at this stage, or to wait until I complete the other challenges. I looked in your book but wasn't sure if you meant to wait until all the challenges were finished. Sorry for being silly!
thanks
A

Patsy Catsos

The way I see it, wait until all challenges are done to bring lactose back on a regular basis, just to keep the playing field level for all the other FODMAP challenges. However, if a person is not doing the full challenge process, and if lactose is a high priority item, it might be OK to keep it in...

A

thanks for your quick reply! Your work really is appreciated :)

MJ

i am on the elimination phase right now. however, i noticed that even small amounts of Redmill, gluten free, oats still bring on my IBS symptoms. so does half of a ripe banana; and i am eating those things at separate mills. do you have any advice?

thanks,
MJ

MJ

also, is coconut or coconut oil allowed during the elimination diet?

thanks,

MJ

Patsy

FODMAPs aren't everything so it's possible a person could be sensitive to these foods in some other way (gluten contamination in the oats? Cross reactivity to banana in a person with latex allergy? Or maybe the small amounts of FOMAPs in these foods is too much for someone with a very low threshold.

Anne

Do you have any info (or guesses) about TSP? I am trying to supplement with less expensive protein at some meals but I haven't tried this yet. I saw that tofu is okay but I wasn't sure on this.

Also, if it helps anyone, I am finding that the Philips Colon Health works really well to control symptoms. I have tried many probiotics and some tend to worsen things. This one has really helped, and it's pretty cheap.

Patsy Catsos

Yes, coconut products are fine on the elimination phase of the IBSFree diet.

Patsy Catsos

Can you send me a link to a specific TSP product? I will read the ingredients and comment.

Kathleen

Drinking a smoothie with water, 1 cup of combined berries like strawberries, blueberries and raspberries with 2 tbsp ground chia seeds, a splash of almond milk and nunaturals stevia drops stops me from being constipated. It is the only fruit I eat all day now even though I used to be a huge fruit head:(.

KVO

Hi! Just bought your book and am working through the 2-week elimination diet. Have tried FODMAP before but without making every single meal myself, and without the more restricted diet you recommend. Question: if, at the end of the 2 weeks I'm only 50-75 percent versus 100 percent better, should I still re-enter foods and see their effect? Thank you!

Patsy Catsos

Sometimes it's worth holding out a little longer before making a decision. Occasionally people continue to improve if they stick with it for a month. But then, yes, I usually recommend reintroducing foods. Ask your dietitian if you need individual advice on how to proceed.

Ell Dee

Hi Patsy, I'd like to thank you for all the help and information you've provided on your website and in your book. They're amazingly useful resources. I've suffered from IBS, to varying degrees, for over 25 years and I've tried a huge amount of treatments. The FODMAP diet has probably made the most impact on my condition.

I'm vegetarian and it was tough during the elimination part of the diet, but now I'm in the challenge phase it seems as though Fructans and Galactans are causing most of my problems. The one issue I'm struggling with is that even on the elimination diet when I eat the allowed vegetables I still have varying degrees of IBS, at times really severe. The symptoms are only drastically reduced when I eat rice, potatoes, eggs and cheese. Could I be one of the people you refer to in your book - 'There is also the chance that you may be at the extreme end of intolerance of FODMAPS’? The irony isn't lost on me that I seem to be a vegetarian that can't eat vegetables! Obviously I can't just cut them out from my diet, can you suggest what I should do? Many thanks.

Patsy Catsos

Ell, I'm glad you've found my book helpful. Unfortunately I can't give personal medical advice in this venue. It's probably best to discuss your observations with your own doctor to see if it suggestions any new lines of diagnosis or treatment, for example, has SIBO been ruled out?

JPP

Patsy, I have had IBS symptoms for 3 years. I took xifaxin several times when the symptoms were particularly bad. Unfortunately, the symptoms always returned. After 2 weeks on your elimination diet, I became symptom free! Thank you for sharing your knowledge. I am grateful to you. I did a fructans challenge for 3 days and experienced only very minor symptoms. I then went back on elimination for 3 days and now am on the third day of fructose challenge (adding Part B challenge on Day 3). Again, so far, only very minor symptoms. Am I challenging for a sufficient amount of time? I believe I am challenging with a sufficient amount of FODMAPs.

Patsy

Speculating here...some people can get away with moderate FODMAP intake from any particular source as long as the overall FODMAP intake is moderate to low (you are on an otherwise low FODMAP diet during these challenges, right?). One of my clients with a similar situation says she decides which FODMAP will be the "guest of honor" each day, and can tolerate any of them as long as the overall load is low-ish.

JPP

As a follow-up, at the end of Day 3 fructose challenge (Part B), I had very significant symptoms. (I am on an otherwise low FODMAP diet during the challenges). Right now back on elimination then will challenge polyols next. I'm thinking I should re-do the fructose challenge when I've finished the others and try to determine if it was the cumulative fructose load or the Part B foods (apples, pear nectar). Does this seem reasonable to you? I like the "guest of honor" approach. Thanks for your time, Patsy. I've read many books about this condition and just love your approach.

Patsy

You are on the right track. Glad I could help.

MJ

Hello All,

I am on day 18 of my Dietician monitored FODMAPS elimination diet and I am not seeing results yet. My symptoms are IBS-C (and occasional D), Hem, and discomfort after BM. My Dietician has recommended that I should go one more week on the diet (3 more days) and hopefully I will see results by then. Could the possibility of me having the IBS-C issues mean the diet could take longer to see results? I may go an additional week if that's what it takes to see results.

I was doing the Specific Carb Diet before and had great results, but the diet itself is too restrictive. The FODMAPS diet elimination diet is heaven compared to the SCD.

Thanks

Patsy

Constipation can take longer to respond, yes, for some people. Interesting that the SCD diet was better for you. You and your dietitian will be zeroing in on the subset of foods that were not allowed on SCD but are low in FODMAPs.

Greg

Patsy, your book is a great resource. My question: have you heard from anyone else in my situation, and what have you recommended? I've been in the elimination phase for two weeks. I noticed a clear difference after eliminating high-FODMAP foods. However, my tendency for constipation got worse and after several days without a BM, my discomfort was as bad as my worst bouts of IBS. I've tried supplementing lost fibre with lots of ground flax and vegetables, with moderate success. What low-FODMAP foods might help make me more regular?

Greg

..and what I meant to also ask was, should I stay in the elimination phase until I sort out the long bouts of constipation? Many thanks.

Patsy

Greg, check out this post for some info that might help answer your questions: http://www.ibsfree.net/ibsfree_at_last/2010/10/it-worked-a-little-too-well.html. I don't know your whole situation so can't advise whether or not you should stay on the elimination phase longer, but sometimes it does take constipation predominant people a little longer to benefit from the diet.

Greg

Thanks Patsy, that's a helpful list of suggestions. Where does flax seed rate on the FODMAP spectrum?

Patsy

It hasn't been measured all by itself, only as part of a mixed product, so not sure. I usually recommend chia seed instead because more is known about it.

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