An interview with a FODMAPs dieter

In my last blog entry I wrote about the low FODMAPs diet that seems to be gaining in popularity among IBS sufferers. The diet basically involves avoiding a certain type of carbohydrate to stop fermentation in the gut. One of my lovely readers, Bernadette, has tried the diet with great success and has kindly answered a few questions about her own FODMAPping experience.

Sophie: Hi Bernadette! Can you tell us a bit about your IBS background please?

Bernadette: I have had IBS-C for 26 years, and I first heard about fructose malabsorption in 2005. Fructose is the M in FODMAPS as it is a monosaccharide, a single sugar. It is found in all fruit and some vegetables, honey and high fructose corn syrup. I had a breath test for fructose malabsorption which measured the amount of hydrogen my body produced after eating fructose, and this test was negative.

A few years later (2007) I had a new GP who, after hearing my symptoms of bloating, pain, constipation etc, thought I should have another breath test for fructose malabsorption, but this time one that measured methane, as she thought I might be a methane producer and not a hydrogen producer.

I had a lactulose breath test to check whether I produced methane or hydrogen when fermentation was happening in my gut – nobody can digest lactulose, so it gives a baseline level. You produce both gases naturally, but some people produce more methane than hydrogen, and some more hydrogen than methane, and very high levels of either gas indicate high levels of fermentation.

The lactulose test showed that I was producing too much methane, and so I had another breath test specifically for fructose malabsorption, but this time one that measured my levels of methane after I had ingested fructose. This test was positive.

Interestingly, they say that methane producers are more likely to have constipation than diarrhea as a symptom. I was also tested for lactose intolerance, and that test was positive as well.

At this time I heard of the Royal Prince Alfred Hospital (RPAH) elimination diet from a girl doing the breath test at the same time. This is a very strict, low food chemical diet, where you limit the food chemicals salicylates, amines and glutamates. I had allergy problems as well as bowel symptoms, so I thought this may be more relevant to my allergy and gut problems.

I went to an allergy specialist here in Melbourne who supervises this diet, and I found the diet helped my allergy symptoms but not my gut symptoms, although the RPAH diet does help some people with gut symptoms. There is debate over here in Australia as to which is the better diet, the RPAH diet or the low FODMAPs diet. Some dietitians prefer one over the other, and a few are trying both.

Sophie: When did you first hear about the FODMAPs diet?

Bernadette: After trying the low food chemical diet for six months and still suffering from gut pain, bloating and constipation, I went to a dietitian who specialised in fructose malabsorption. By this time the research had advanced to the FODMAPs diet although the research was new so not all foods had been tested yet. They are slowly testing all the foods against the diet here in Australia.

When I tried the FODMAPs diet I found a definite improvement in my symptoms. After more than 20 years I wasn’t in pain and I could see a direct relationship between the foods avoided and my gut reactions. I feel very angry to think of all those specialists who told me my IBS was due to stress.

Sophie: What foods do you have to avoid?

Bernadatte: It is said that onion is the food that most commonly causes symptoms. This is one of the hardest things to avoid in everyday life as a lot of processed foods have onions or onion powder in them, and most restaurants use onions extensively in their cooking. Other vegetables to avoid are garlic, asparagus, sugar snap peas, legumes and lentils.

A few of the fruits to be avoided are apple, pear, watermelon and peaches. You also need to avoid chicory, inulin and pistachio nuts. Testing has just been done on other nuts and it’s advised that they are eaten in very small amounts, ie: no more than 12.

The whole list of alloweds and avoids is too long to go into here, but a good starting point is to visit http://dietsolutions.net.au

Sophie: Do you think that other IBS sufferers should try FODMAPs?

Bernadette: I would strongly recommend this diet to all IBS sufferers. As a support group leader I constantly tell our members that ‘individual tolerance’ is always to be assessed when eating anything, even allowed foods. The quantity of ‘allowed’ foods is an issue for people with FODMAP sensitivity.

We cannot necessarily eat a large amount of ‘allowed’ foods, ie: you might manage to eat six blueberries but seven might take you over your individual tolerance level, so you have to learn what that level is with all food by experimentation. And as all IBS sufferers know, some days you can get away with eating things that you suspect you react to and some days you can’t.

Sophie: Thanks for your help!

Bernadette: I hope this helps some of you. I know how awful it is to be in pain day after day and not have any answers. The low FODMAP diet is worth a go.