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August 10, 2013


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Gina Casagrande Forster

Hi Patsy, could you please send me the link to the dietitian form? I really need to change my e-mail and phone number; [email protected] thank you


Loving your blog. Just wondering, are people who are gluten intolerant really just intolerant to fructans? Or is there a definite gluten intolerance diagnosis that is made separate to this? Thanks

Patsy Catsos

It is likely that some people who feel better on a gluten-free diet do so because of the fructans, not the gluten. At this time there is no way to distinguish between the two with any sort of diagnostic test. (Some people with non celiac gluten sensitivity probably are truly gluten intolerant, however.)


Hi! I'm on the elimination diet now. I'm an admitted carboholic and have been incredibly constipated for several years. I used to fluctuate between IBS-D and IBS-C, but I realized that I am lactose intolerant which has helped reduce gas and the "D" part - so now I'm an IBS-C loyalist. :)

I'm just a few days in the diet and i'm STARVING. I'm not a huge person, and I'm following the portions in your book. Not sure if there is something else I can eat to snack on? I think I'm just used to eating a lot of carbs as fillers, so this is an adjustment.

Also - I ate a few regular potato chips yesterday. (I was hungry and desperate!) I'm wondering if I should put the kabosh on that.

I'm on day three of the diet and still quite constipated. Hoping to see improvement soon.


Anything not in bold can be eaten in portions to satisfy your appetite. The diet certainly is not meant to leave anyone starving! The discussion in this article might be of interest: http://www.ibsfree.net/ibsfree_at_last/2011/05/need-to-gain-weight-high-cal-low-fodmaps-foods.html

Margarita Cabrera

Dear Patsy,
I have the typical IBS symptoms like bloating, distension and constipation for the last two years, after several tests ( breath H test, endoscopy, colonoscopy and allergy test) to rule out other diseases the doctor said that I have probably IBS with constipation and lactose, fructose and sorbitol. This year I talked to two dietitians but they did not mention the FODMAP diet. I started then a diet to avoid an excess of this sugars but I plan to start the elimination diet soon once I have time to prepare lunch at home. I still have several questions and will be very grateful if you can help me:
1. Is it normal to have lactose and fructose intolerance at the same time? This will mean that the levels of lactase and fructose permease decrease at the same time?
2. Is there specific test to detect SIBO? Can all the breath H test be positive due to SIBO?
3. Could a mild inflammation that is not detected by colonoscopy cause IBS symptoms? Do you think anti-inflammation therapy works against IBS?
4. Do you know a good way to reduce burping and heartburn?
5. I became fascinated about nutrition and bowel diseases and I would like to learn more about this topic,could you recommend me a master in Nutrition online?
Thanks a lot and sorry for having so many questions


It is not unusual for people to have malabsorption of both lactose and fructose. Lactose malabsorption is due to low production of the lactase enzyme, which could be the primary problem, or it could be secondary to inflammation or disease of the small intestine. Fructose does not require any enzymes for digestion or absorption. It is just naturally slowly absorbed by some people, or again, could be impaired by other problems of the mall intesting. There are special breath tests just for SIBO using the sugars lactulose or glucose. SIBO would not be diagnosed based on lactose or fructose malabsorption.

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