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Years of canceling plans, anxious car rides, and feeling like my guts are being ripped open from the inside. Colonoscopies, biopsies, allergy tests, more medical visits than I can count, and always back to the doc shrugging his shoulders and telling me I’m out of luck. Enter Patsy Catsos. Suddenly all the pieces are sliding into place, and I understand why I can eat some meals and not others without getting sick. I finally have an explanation that makes sense. I’ve been just 5 days on the low FODMAP elimination diet and the difference has been instantaneous.
— Amazon reader review of The IBS Elimination Diet and Cookbook, March 13, 2018

The best candidates for the FODMAP elimination and challenge process can answer yes to the following questions:

  • Do you have digestive symptoms such as excess gas, bloating, abdominal pain, diarrhea and/or constipation?
  • Have you been properly evaluated by a health care professional and diagnosed with IBS or another condition that might benefit from a low FODMAP diet?
  • Has your doctor or dietitian recommended a FODMAP-elimination diet?
  • Has celiac disease been ruled out?
  • Have you been unable to manage your symptoms with good health habits like regular meals, managing stress, and getting adequate amounts of fiber, fluids and exercise?
  • Are you physically, mentally and emotionally able to limit your diet for a period of time without endangering your health?
  • Are you willing and able to take on a dietary experiment?
This book has been brilliant for us. My daughter’s dietitian introduced us to the FODMAP idea, but she was new to it herself so the information we got was sparse. My daughter improved but she was living on rice, chicken, carrots and dry cornflakes! We’re following the elimination phase of the diet and she’s eaten more fruit, vegetables and nuts than I think she’s ever eaten, which bodes well for her future health.
— Facebook comment on IBS—Free at Last! (now titled The IBS Elimination Diet and Cookbook), April 4, 2014

Some people may not be good candidates for an elimination diet, including people with inflexible eating habits; those who are medically, mentally or emotionally fragile; those who are at risk for eating disorders; and those who do not have full control over their food purchasing and preparation. In addition, diet changes should be delivered with great sensitivity and tact to children. Such individuals are strongly advised to work with a dietitian, who may be able to recommend medically-appropriate changes informed by the FODMAP approach, without requiring a full-fledged elimination diet.

It is important to note that a FODMAP elimination diet has some potential risks. Nutrient intake can be affected, unless care is taken to choose a wide variety of low-FODMAP foods. Prebiotic intake is reduced on a low FODMAP diet. (Prebiotics are food for the good bacteria that are part of a healthy gut microbiome.) We don't fully understand whether this reduced prebiotic intake has any persistent effects or long-term risks. For this reason, people who do not have a medical reason to try a low-FODMAP diet should not do so. Most people with healthy guts continue to be well-advised to eat liberal quantities of valuable high-FODMAP foods such as beans, nuts, seeds, fruits, vegetables and whole grains.