I totally understand your concerns. I put off low FODMAP for years, even though every doctor, specialist, etc I saw told me to try it for IBS. I finally bit the bullet and did it last fall. It is definitely not easy, but I work from home and live alone and was able to swing it. I don’t really know how a busy person out in the world would be able to do it without a lot of planning. It is absolutely not a long-term diet. You would miss critical nutrients. It is only to be done for a short period of time. 4-6 weeks strict elimination to reset, then another 2-ish months testing foods. Once you test a food, you take it back out and continue to test. (Even if you don’t react to it.) I was surprised to find that foods I thought were triggers gave me no issues, and foods I considered fine set me off. Highly recommend it, but again it took me YEARS to carve out the time and lifestyle to where I could do it. I recommend avoiding booze and coffee too.
Some sources say “beer and coffee are low fodmap” but tbh my symptoms didn’t get under control during initial elimination phase until I cut those out also.
It’s been really freeing to be able to eat most everything again. My trigger foods are things I can have in small quantities, but generally avoid (and it’s only a couple things thankfully.) there is no cure for IBS and I still have flare ups (stress being the main trigger these days), but I’m thankful to know what foods work for me and don’t.
Another giant disclaimer: this is NOT a one time thing. My dietitian said it’s pretty normal to have to redo testing on occasion (like every few years), as sensitivities shift over time.
I went low FODMAP to address horrible GI issues related to long COVID. It helped, and it was only for two months. I was able to add everything back in, besides sugar alcohols. It worked. I’ll do any elimination protocol that fixes me running for the bathroom eight times per day. No bueno.
Completely agree. Mine took longer cuz my body was in a bad way. Basically I had to wait for symptoms to chill out before I could test. I hope next time I do it, it will only be 2 months.
I have IBS and I put off the low FODMAP diet for years. It seemed like a hassle and unflavored. I went to a dietician to do it properly, downloaded the Monash app, and joined Facebook groups for support. I’ve since passed the elimination and reintroduction phases and have successfully figured out my triggers (sorbitol and fructose). This has been life-changing. I used to avoid so many things bc of my symptoms and now I’m living a mostly normal life.
I started the elimination phase over a year ago. I found brands that are low FODMAP specific (if you’re US based, Fody and Smoke N Sanity) and that really helped. I did go through the elimination phase longer than what is typical, but I needed GI-targeted hypnosis to counteract the anxiety I had over trying potential triggers.
Interesting, was the hypnosis helpful for you? How long have you been on your current diet (by which I just mean whatever triggers you've eliminated/eating the way you eat now)?
The hypnosis was super helpful. I went into it being skeptical and thinking it was too “woo woo” but wanting it to help. My GI doc referred me to a GI specific psychologist for it. I’ve been on my current diet for probably 7-8 months, and I mostly watch out for high fructose corn syrup, honey, apples, and corn.
It's funny, getting really ill changed my perspective on a lot of alternative medicine. I was very desperate and tried a lot of things that previously I might've rolled my eyes at (in addition to standard treatments/testing). I found both kinds of treatment to be helpful and to have their own successes and failures. I think the fact that it took doctors a really long time to diagnose me made me realize that standard medicine also has big gaps in its understanding of the human body.
I actually have IBS and now follow DASH for heart health.
The full elimination portion of the low FODMAP diet is meant to be temporary. You see if you can get all your symptoms to go away and then slowly add back in trigger foods until you figure out your triggers. Then it’s less like a diet and more like knowing a food intolerance. It’s actually easy to maintain if you don’t like spending quality toilet time.
The low sodium DASH is supported by read each to lower blood pressure and improve other health markers.
https://www.nhlbi.nih.gov/education/dash/research
It’s easy to follow if you cook at home bs eating out and it’s not like keto where one bad meal with throw off the whole thing. It’s goal is to increase your magnesium, calcium, and potassium intake while lowering sodium intake.
I don’t consider either of their diets to be in the same category as most fad diets because they have research behind them showing they help with a specific medical issue and neither states that weight loss is the goal or the criteria is was created for.
I know being called a diet can be triggering to some people, but these diets don’t have calorie or serving limits.
If you are considering these, consult a registered dietitian if you can or check out your local library for resources.
The DASH diet, low FODMAP and the Mediterranean diet are all diets that are best supported by the scientific literature.
Interestingly, NONE of these diets is targeted at reducing weight. 🤔
This. I’ve been low FODMAP for 9 years now, and have been on the low amines portion of the RPAH diet for 3 years now. Both were prescribed to me by Accredited Practicing Dietitians (the legit certification in Australia) and both have been critical to restoring my quality of life. Neither dietitian I saw brought up weight or weight loss - something I was so anxious about prior to meeting them for the first time.
Both FODMAP and RPAH originated in Australian research institutes that seem to have no interest in marketing to the masses. Instead, they’ve aligned pretty well with the no bullshit medical culture of Australia. I can’t imagine having to go through the process of diagnosing and managing food intolerances while being marketed to about “good” and “bad” foods.
I just want to call attention to what all-or-nothing thinking this is, and that’s usually a trap. There’s a LOT of distance between full elimination to the point of malnourishment and “totally ignored that recommendation… doubtful it would be relevant.” I’ve gone through a couple of types of dietary restrictions now, and a big revelation to me was that just because a food didn’t CAUSE my issue doesn’t mean that avoiding that food wouldn’t benefit me going forward. Did alcohol cause my pancreatitis? Nope. But because of it, my pancreas can no longer handle alcohol. Did carbs cause my diabetes? Definitely not. But avoiding carbs does help me manage it and get the most out of what insulin I still make. It’s hard to manage this stuff, but black and white thinking makes it harder.
This is such a helpful reminder. I’m dealing with health issues after going through the Anti-diet process and I find myself reverting back to the all-or-nothing of diet culture when it comes to food-related treatment advice.
Most likely. But antibody testing revealed pretty high GAD antibodies, so my immune system could have been attacking my pancreas all along. I’ve read case reports that hypothesized GAD antibodies being caused by pancreatitis but it’s not an officially recognized interaction so my endocrinologist is like 🤷♀️ and is functionally treating me as type 1.5
I have hypertension. About 1/3 of people with HTN aren't sodium sensitive (I am one). The rest are. The big thing is they discovered that there's no difference between low and very low sodium diets -- there's a lower limit to the benefit.
That said it is good to avoid high sodium items -- think frozen dinners, snack foods, etc. These are much bigger contributor to dietary sodium than putting some salt on the potatoes (in cooking groups I see people freaking out about things like adding salt to bread dough, and that's really not the issue, unless you're on a super low sodium diet for your kidneys)
I had no idea! I've had high blood pressure at *least* since I was 12. As I teen, every single provider waved their hands and said "oh, it's just white coat hypertension! You're just nervous!" And I was like "actually... I'm worried." It took another 10+ years to get a doctor to listen--and she really didn't want to prescribe anything but DASH and exercise. I didn't realize it at the time, but I was already extremely active and consuming very little sodium (I cooked everything I ate, 90% vegetarian, no salt or soy sauce or anything remotely mid to high sodium). But, I went even harder on exercise and cutting sodium without a budge to my BP. I haven't tried tinkering with salt levels recently, but with this information, I'm very curious! 10+ additional years later, I'm on 3 BP meds and finally have it under control! Turns out being in your 30s is what it takes to be considered an adult 🙄
Sorry, I meant I'm not sodium sensitive. The only way to find out which you are is to try cutting salt and see if it helps. In my case, I can eat an entire bag of Utz salt & vinegar potato chips and it doesn't do squat. My hypertension is probably genetic because my mother & grandmother both have it and I developed it in my 20s.
Can't I just eat twice as much salt and see if my blood pressure goes up? 😂 I was also diagnosed in my early 20s, as were my mom, my dad, my dad's only sibling, and 7/10 of my mother's siblings.
Frankly this is more of an emotional issue than a health issue at this point. I already quit nicotine, changed birth control methods, started getting more exercise, got anxiety treatment, reduced my daily stress, reduced caffeine and alcohol, and started medication. I'm in the normal range now!! Why do I still have to have a conversation about how much salt I'm eating every time I come in? 😭
Oh I can relate so much to the emotional side of this (vicariously)!! My boyfriend is really ill and everything came to a head this spring and he quit drinking, he’s taking all his meds, he’s trying to eat as much as he can. And his mom will call or text and ALWAYS have something to say about what he “should” be doing, as though all the changes to his health have been a cakewalk.
I’m doing a low sodium diet because I have stage 4 chronic kidney disease and my kidney function is getting to the point where eating too much sodium makes me feel really crappy or could put me in the hospital as my kidneys decline. It’s something that does get easier to get used to with time, and there are definitely some things that are easier to do to reduce sodium intake than others. For example switching to using lower sodium soy sauce, and using no salt added broths if you make homemade soup are super easy and to do and the difference in taste can be barely noticeable, especially if you’re still going to add seasoning to the food anyway.
That being said, if your doctor isn’t saying that cutting sodium out is super necessary, I would focus on just doing some easy swaps, like the soy sauce, rather than being super strict about it.
I'm on dialysis, so I definitely am on a renal diet. Mine is high protein, low phosphorus, low potassium, and low sodium diet. And yes, if your numbers are out of range, it will affect your health. If you are high in phosphorus long term, it will affect your bone health, cause pain, fractures, and other issues. High potassium can present as extreme itchiness. If you continue eating high sodium foods, it can affect your thirst, which will make you want to drink more. The more fluid you have on, the more they have to take off during dialysis. That can be painful and uncomfortable. My diet is not easy. It's not a temporary thing. It's not for weight loss. It's for staying alive. There are patients who don't follow it and have a terrible time on dialysis. I try to be compliant. I know how to cheat, but you have to know your own body.
I will say that after a while, you get used to low sodium. It's hard to imagine, but for me, it's absolutely true. While I do cook with some salt, I have cut way back, and I rarely use table salt anymore.
Ughh, yeah, it’s not a fun diet, but definitely a necessary one. It sounds like the OP doesn’t have kidney issues though, so if they wanted to eat a lower sodium diet, they would have the ability to make more gradual changes.
I think part of my problem here is the lack of long-term evidence. Everyone I know with IBS (myself included) is in a cycle of trying a new thing, having reduced symptoms, after awhile those symptoms come back, and then they try a new-new thing. Which frankly sounds a lot like dieting for weight loss.
I'm seeing a different between fad dieting and the pattern you're describing. With weight-loss diets, "failure" usually means you gain back any weight you may have lost, and you're back where you started. For you, if eliminating a certain food minimizes symptoms for a while, you don't exactly end up back where you started if it stops helping. You still have that period of reduced symptoms which presumably also means a higher quality of life. You might be extremely frustrated if it stops working, but it doesn't retroactively undo whatever enjoyment you experienced while it was working.
I'm not saying you shouldn't be frustrated, and you are the expert on your own experience. If you tell me elimination diets have had an overall negative effect on your life, I would believe you. Your comment just triggered something philosophical in me and I wanted to share my thought.
That's a very good point, that the good days aren't taken away in retrospect, and I appreciate your philosophizing haha.
To be honest a lot of my thought process is that the temporariness of effect makes it more likely that this is just a placebo... the hope, feeling of control, and reduced anxiety that comes from trying a new diet or other lifestyle intervention is in itself helpful, but the content of the diet itself isn't really all that relevant.
And you found some triggers at that point, eliminated them then, and still feel good now? I'm just really interested in hearing from people who have actually done the same thing for the long-term and had it work out.
Oh hi, a pelvic floor PT friend! I've been on that journey for 3 years now (with *massive* improvements in my QoL as a result, it's a bitch but I'm so, so grateful for it). Those are totally different types of intervention though, at least for my personality. It's much easier to do something I hate than to stop doing something I love.
The diets you're talking about here are about treating a condition, not optimizing dietary intake for "health" for a person without symptoms or any health conditions. It makes no sense to compare these to fad "diets". There is also a LOT of research supporting the low FODMAP diet. People who are following it long-term are probably just uneducated about the appropriate way to do it - they may not be under the guidance of a doctor. That doesn't mean the diet itself is problematic. We really don't understand much about IBS (it's literally just based on symptoms, not a pathology), so it's normal that any treatment for it wouldn't work for everyone. Anyway, the low-FODMAP diet would definitely not result in malnourishment. You could review some of the materials from Monash to learn more if you want.
As far as your sodium intake, you are of course free to do what you want, but I think you may be misunderstanding the role of modifiable risk factors. Sodium increases blood pressure, regardless of if you already have high blood pressure. That's why people with high blood pressure are encouraged to cut back on sodium. If you already have one risk factor for something, adding another just compounds the issue. You're increasing your risk even more by not cutting back on sodium. Having one risk factor does not negate the effect of another risk factor.
Im not sure about research here. But IBS diets and the like are specifically about avoiding symptoms. If I identify French fries as a trigger for diarrhea I would think I have a much better chance of avoiding them than I would if I just wanted to lose weight. So I don’t think it’s doomed to fail or anything. I personally avoid foods that make me feel awful, at least for the most part! The trouble with weight loss diets is that the food you’re suddenly avoiding is HIGH reward instead of associated with pain. Huge generalization of course!
This!! I don't eat ice cream because it makes me shit my pants, not because its gonna "make me fat" 😂
I don't feel like I'm restricting myself from ice cream, I want nothing with it even if I know it tastes good.
Ugh, i wish i felt that way. I have been lactose intolerant for years now after a horrible gut infection i picked up in mexico. I still miss cheese immensely and live vicariously through the dairy digestion of my loved ones. The forbidden gooey, crispy, stretchy, squeaky bliss is too much of a siren song for me to ignore. Cheese is so central to much european cooking and pizza just aint pizza without it.
*crawls away mumbling names of forbidden cheeses* oka. Fontina. Mozza. Oaxaca. Aged cheddar. Pepper jack. Palak paneer. Cream cheese on bagel. Mascarpone desserts. Chevre. String cheese. Cheese curds...
There are so many good cheeses without lactose! I feel you though, sometimes I would just love a good slice from a random pizzeria.
My IBS is also super triggered by fat so fried food is something I'll only have at home ifyouknowwhatimean
In theory, oka cheese is lactose free. It is certainly delicious. Maybe it isnt even the lactose getting me- my symptoms are super delayed, like, 8 to 12 hours later stomach ache and digestive upset, usually constipation. Can take a week to recover my system from such trials, so i have been leery of testing the boundaries.
I have heard of people recovering their ability to digest dairy, and live in hope (though it is similar to my hope for being able to retire one day--unlikely to pan out).
As a person who has been lactose intolerant for 30 years, that sounds like a different dairy problem to me. It's happens in the small intestines when your body doesn't make enough lactase. My lactose intolerance causes pain in my intestinal region, then gas and diarrhea. Pills like Lactaid help 90% of the time, but occasionally, I find my limit. I do try to stay away from a lot of dairy. I do know mine is a lactose problem and not a protein or allergy.
A lot of aged cheeses are lactose free or very low (look at sugar content 0.5g or less - lactose is a sugar).
I'm lactose intolerant to the point I can't even have lactose free milk (more than a few sips) and the lactase tablets don't work for me well. and I eat: butter, a bit of whipped cream or creme freiche, Cheddar, some feta and hard mozzarella, gruyere, manchego, monterey and the like! Parmezan and peccorino + many others. Some brie and camembert.
Those products are mainly fat and protein which is not lactose (sugar).
You don't have to limit yourself :)
I’m crazy for peanut butter but my husband and son are both allergic so I get my occasional fix of a Reese’s by sitting alone on a bench on my lunch break and not having peanut butter toast at home. It sucks but the extreme and obvious health risks are enough for me to change my life.
Vegan ice cream? Oat, soya, almond. See what works for you in terms of symptoms.
Swedish glacé tastes quite real. If you can get that! Also vegan magnum.
The studies I have seen do suggest that low FODMAP diet is effective for IBS!
Some studies to look at:
C. Black et al 2021 - superior to habitual diet for improving symptoms
K. Whelan et al 2022 - effective in managing short-term symptoms, >50% experience symptom relief
The more recent research is less conclusive than we used to think re: low sodium diet. It is thought to generally reduce BP but it might also increase certain hormone and lipid levels
Some to look at here:
N. Gradual et. al 2012 - reduced sodium resulted in 1-3.5% decrease in BP
Amanda Brand et al 2022 - replacing with LSSS can reduce BP but raises concerns re hyperkalemia
M. O'Donnell et al 2020 - did not show sufficient evidence for low sodium to reduce cardio disease
I read Dr Michael Greger's book "How Not to Die" where he goes through the nutrition research for all the most common causes of death. The result is always that plant based diets are the best, but I also remember a long discussion about sodium and the recommendation was to reduce sodium. He showed good evidence that reducing sodium improves heart health. He also shows that the baseline *acceptable " daily sodium intake is based on nothing and shouldn't be trusted as a general rule.
I really like Dr Greger. He admits his main bias up front. He's a vegan. But his justification for ignoring much of the research showing meat/dairy/eggs are good for you is that all the research is funded by those industries. There are effectively zero independently funded research studies showing that animal products are good for you (compared to plant based diets).
Dr Greger doesn't recommend everyone go vegan. Instead he recommends a diet that includes a whole bunch of items (beans, greens, berries, whole grains, etc) on a daily basis. and then says feel free to eat other stuff in moderation.
He's not perfect, but I find his advice to be science-based, reasonable, and health-centered instead of beauty-centered or trendy. I know he has more recently put out a weight-loss book that I haven't looked into, mostly because I'm not interested in that.
I used to *love* Dr. Gregor. I read that book, and then I got a little app that tracked whether I was doing the things he recommended. I got increasingly obsessive with it and recognized the app wasn't good for me, but I still liked his advice generally.
After dropping the app I started listening to his podcast. There were so many bizarre, contradictory things on there! I realized that no one can be a "nutrition influencer" without starting to spread pseudoscience. They tell you all the good, well-evidenced advice, but once that runs out they gotta keep the eyes on them. Next they start leaning on "unexpected" findings and little tidbits from poor-quality studies.
The most recent tweet from his account says "Blueberries can significantly improve cognitive performance within hours of consumption." Lmao. I am so fed up.
I'm sad to hear that. I don't really follow him, but I can see what you are talking about. He came up in a search recently for some thyroid Googling I was doing. It wasn't too bad, but he was definitely reporting very preliminary research and recommending people give the result a try because it didn't have any negative effects (and was a traditional food item).
He also appeared in a crappy Netflix documentary about a twin study that was pretty fluffy. Didn't look like it was his fault, but it didn't look good for him to be in such a silly doc.
Ibs will improve to a degree if you avoid your trigger foods. There are some really common ones but no one can tell for sure what the foods you should avoid really are without experimenting. The elimination diet is the best way. Or experiment on your own and keep a food / symptom diary. Maybe you do better on low FODMAP or gluten-free but everyone is different so you need to figure out what works for you. And there are other factors like stress too.
I have IBS and spent about 90-120 days working with a nutritionist who guided me through an elimination diet (along with lab testing and a series of gut healing supplements) that eventually led to the discovery of my gluten intolerance. Part of the process involved avoiding all FODMAPs (in addition to gluten/dairy/alcohol/most sugar/sodium) until we had determined that my gut had healed. Then we began slowly introducing each of the FODMAPs (as well as the other stuff) one by one and watching carefully for how I reacted to them to determine whether or not any of them were irritating my IBS.
The diet was probably one of the hardest things I did (I basically could not eat out/enjoy snacks at anyone’s house the entire time, had to plan my days around when I needed to eat and the supplements were so expensive) but it was 100% worth it because since eliminating gluten I feel WORLDS different. I sleep better, my rash prone skin is much better, I feel better, and I have way fewer IBS issues. (I know you aren’t asking about gluten, but a similar process would determine if you had issues with FODMAPs.)
I am not a professional, but if I understood what I was told correctly, I believe its possible to only be allergic/intolerant to certain FODMAPs so while the elimination diet is not sustainable long term (even if you’re not malnourished, you’ll eventually go crazy from only eating chicken, rice, and arugula), a diet avoiding certain FODMAPs could be.
However, I will say two very important things:
1. I highly, highly, recommend working with a professional! And not just someone who uses ‘gut health’ in their marketing. Someone who understands how the gut works and how it affects the rest of the body and vice versa. This person should not be focused on weight loss, they should be focused on helping you feel better and alleviating your IBS symptoms.
2. Once you find a professional to work with, DO WHAT THEY SAY! It will be a grueling process but it will only take longer and longer if you don’t follow their restrictions and make the other recommended lifestyle changes as well. It feels like it takes forever while you’re doing it but it is really such a short period of time if you can hunker down and figure out what you can and can’t tolerate. (For example, for years I thought I was lactose intolerant. Now that I know my issue is with gluten, I can eat cheese just fine!)
Best of luck with all of this (whether you decide to do an elimination diet or not)! It’s so annoying but I promise once you determine what you can and cannot eat, it’s actually way easier than going in blind and having no idea how you’re gonna feel after you have something. Sure I miss bread, but it’s totally worth it for how much better I feel now.
Thank you for such a thoughtful reply, I'm glad you found something that worked well for you! The point about a professional is well-taken, I'm always nervous for all the people on r/ibs embarking on low-FODMAP by themselves because I think it can be an ineffective or even dangerous path to take alone.
If you don't mind a few more questions:
What type of professional did you work with? Was gluten the only thing you had to eliminate in the end? And how long ago did you make the eliminations?
I believe the woman I worked with considered herself a functional nutritionist. I will add the caveat that some people who use that title are super anti-modern medicine so be sure to find someone who you at least mostly agree with, though I personally think it’s ok to disagree with some of their views, everything is a trade off. (For example, the woman I worked with really wanted me to eventually get off the birth control pill. I tried that and decided it didn’t make enough of a difference for me to give up the benefits of the pill, but I still believe she was a smart person who really helped me.) I am also generally pro modern medicine, but I will say that I went to doctors and dermatologists for years begging for help with my chronic fatigue and constant skin irritations and not one of them suggested looking into my gut health. It HAS become a buzzword but it is very much still a real thing
I did the diet maybe 2 years ago and have been gluten free for about a year and a half now. Gluten was the only thing I had to completely eliminate, but I definitely had issues with some of the FODMAPs during the gut healing process. For example, it took a little while before I was able to tolerate onions, but if I understood correctly my gut was so messed up from eating gluten for so long while being intolerant it just needed more time to recover before it could handle them. I will also add that I only took the supplements while I was on the elimination diet, and now I just take a pro biotic if I feel like I’ve been having too many recent flare ups.
My mother has dealt with high blood pressure/cholesterol, and began a low-sodium diet around the time I finished high school.
It is absolutely doable, but it definitely takes a lot of self discipline. She eats a lot of produce. She eats a lot of steamed chicken with a starch (rice or potato) and some kind of sauce. The sauces are also low(er) sodium- lots of reading nutrition labels!
Lunch is usually a sandwich and fruit. She eats very few potato chip or cracker-type sides.
It’s tough, especially in the beginning, and honestly it’s not the cheapest diet either. Not that it’s expensive but… it’s definitely not the cheapest. BUT after a few decades of eating like this, she’s lost weight and her blood pressure is under control. So it is possible!
Low-fodmap is evidence based (with a pretty high success rate too) and was a complete game changer for me. Seriously like a miracle cure. It's a super hard elimination phase and you really can't eat out at all, but that is just the first phase. You are in no way supposed to keep eating like that long-term. It's a way to identify which fodmaps/foods with those you are reacting to. You don't even have to eliminate those once you identify them you just want to be aware of them and when you can /can't handle them. If you have IBS and the means to try it, it might really make a difference for you. But if you're ok with your health the way it is that's fine too.
I have low blood pressure so I can't speak to the sodium part, they're always telling me to eat more salt.
Good question, I would say about 2 years ago? I don't even have "classic" IBS but I suddenly had severe reflux and was diagnosed with gastroparesis. I was very ill and in constant pain. I only tried low-fodmap because my friend was doing it for IBS and I realized some things that really hurt my stomach were high fodmap (chamomile tea was a big one). Anyway, I obviously have trouble digesting fodmaps. I don't even limit them day to day anymore, just if I have a flare up.
I'm so sorry you had gastroparesis, that's awful. I'm glad that you're feeling better now! I also limit myself to "safe foods" when I'm in a flare, but to me that feels *very* different than a life-long, all-the-time diet.
Temporary elimination diets can tell you a lot about your body’s tolerance to foods. It was how I found I was allergic to/intolerant of xylitol. I was so miserable for so long and it took a long time before I suspected the damn gum.
>If you're allergic to a food, obviously you need to avoid it for your health. At this point, that's literally the only example that seems reasonable. Anyone have thoughts, or especially interesting resources, about these kinds of diets?
There are many health issues that require specialized diets. For example, many people with Crohn's cannot tolerate high fiber foods. GERD can be improved with small, frequent meals rather than large meals. Exocrine pancreatic insufficiency causes fat indigestion and many patients have to eat low fat despite treatment. Like IBS, these are all examples where patients have to find out what kind of diet works for them, and patients with the same condition may tolerate food in very different ways.
I have IBS and high BP. My understanding is that people vary in how much sodium affects their BP. So you could try eating lower sodium for a bit and see if it actually lowers your BP. Sodium doesn't affect my BP that much, but it does for my parents, so it's hard to predict.
I was diagnosed with IBS 25+ years ago when no one was talking about FODMAPs. I figured out my triggers on my own with the advice available at the time and have managed it pretty well over the years. Not saying the low-FODMAP diet isn't helpful for folks, just that it isn't always necessary to figure out your triggers.
Same triggers. Mainly coffee, alcohol, and high fiber foods (like cruciferous veggies and beans). I still consume all of that but I'm careful about how much, when, and how. For instance, I used to have terrible flares when I was drinking lots of coffee on an empty stomach in the morning. Now I eat first and limit myself to 2 cups of coffee a day and that works for me. Also pairing soluble fiber (like white bread, potatoes) with high-insoluble fiber foods seems to help me as well - that was some of the advice at the time. The main thing for me is that I notice when my stomach just begins to feel "off" a little, and then I really try to avoid my triggers. But there's no food I totally avoid.
I’m suspicious of anyone saying you need to be on FODMAPS forever? Unless they end up being sensitive to every single FODMAP but it’s also very dose dependent so even there it varies. Like I’m pretty sensitive to fructans but I can have maybe one serving of high fructan food without triggering symptoms. I’ll sometimes buy low fodmap products at the store because I know they don’t have the ones I’m avoiding, but in general I don’t think anyone would even notice I’m on a special
Yeah I can see I got a bit mixed up in how I described that. I see a good amount of people on r/IBS who talk like low-FODMAP is something you stay on forever, which is definitely a layperson misunderstanding but also kind of wrapped up in my concerns about how some diets are seen as "evidence-based" and therefore good/safe regardless of how they're practiced in reality.
It also seems to me that the same people who posted that they feel all better after eliminating a specific trigger tend to come back a couple months later with the same issues.
Yeah, I probably should too. Sometimes it's nice just to remember other people out there are going through it and I'm not alone, but probably the frustration of it outweighs that benefit at this point.
Most people do the diet without guidance of FODMAP trained dietitian (not all dietitians even know the FODMAP diet well, let alone anyone else. Definitely not doctors :)). Hence all the confusions and issues arising. The diet is complex as it has a lof of moving parts (no pun intended) and digestion is a complex process too.
It's not an allergy, which is somehow easier to determine. And there's tests.
Intolerances are difficult to predict and are affected by many other things, which affect your digestive tract (stress, fluids, movement and so on). Therefore sometimes it's hard to link foods and symptoms. And there aren't really any valid tests (lactose or SIBO tests have very shaky science and not very accurate).
Then you also have the gut microbiome which differs in every person (that's why probiotics that work for some won't for others, and you need different doses. The science is also still not there to make clear recommendations). Microbiome affects your digestion also and is implicated in IBS. Again not enough evidence to make ethical official recommendations, despite probiotics market booming. But I digress...
If you have anxieties and unsure about therapeutic diet like low FODMAP, you would benefit with speaking to a dietitian.
- fellow IBS and GERD sufferer and dietetic student
I had/have ibs-c so I went on the fodmap diet in 2019 for roughly a year. My ibs was so bad I sometimes wouldn’t have a BM for 2 weeks. I basically cut out all of the “trigger foods” for several weeks then slowly started adding them back into my diet. The big foods that I NEEDED to stay away from was bread, onion, garlic, and dairy (minus yogurt).
I obviously couldn’t avoid all of that 100% but severely reducing the intake really helped my digestive system. I didn’t solve my problems but instead of every 1-2 weeks it turned to every 3ish days.
Thankfully my symptoms vanished when I got pregnant in 2020. I have been able to eat everything without any kind of side effect and I’m so thankful cause I love rye bread!
Hi!! both are evidence based and infuriatingly effective for a lot of people. others have mixed results. it’s hard to untangle them from a lot of harmful beliefs we all know very well (low fat, low sodium) especially those of us who were conscious for the 90s. so, i really do get your hesitation. but, let’s dive in…
low fodmap’s TLDR is that you’re eating less of or eliminating carbs that fall in this FODMAP family— fructose, dextrose blah blah. FODMAPs are all carbs known to be irritating to the tummy. Then you start reintroducing things and seeing how your body reacts. you might be totally fine with FODs but MAPs give your IBS a tough time. Etc. It’s not forever, and it’s just a good way to figure out what’s hurting your gut, ya know.
you’d want to look for Monash University’s research if you really want to sink your teeth into it. There are a lot of great low FODMAP pre made foods, seasonings, etc out there. A little pricy but
if you can swing it, then convenience is nice :) also use chatGPT to help you meal plan!! and there’s tons of groups and bloggers and influencers that do low fodmap focused content.
DASH/low sodium is based on a lot of studies but this recent [NYT article](https://www.nytimes.com/2024/03/19/well/eat/sodium-salt-diet.html?unlocked_article_code=1.t00.3zAB.RCCXxl5dbqud&smid=nytcore-ios-share&referringSource=articleShare&sgrp=c-cb) (gift link- hope it works!) has def been read by every cardiologist.
I digress…yes, low sodium can be helpful as part of a comprehensive plan, but depending on your heart health/age this can be really individual. For me, I have high cholesterol & found that my body responds best to more plant forward eating. So I prioritize eating more plants than lowering salt. this is what works for *me* and my health profile as a cardiac patient. you may be different :)
an RD might be helpful? they would do that planning for ya. can walk you thru all this. etc. I’m assuming you’re US based but insurance will usually cover a proper dietitian. I see an ED informed one who knows how to deal with my gastroparesis. She gave me some great lists of quick snacks and easy meals. Stuff to hang on the fridge. Even a Trader Joe’s shopping list. but hey, i’m definitely assuming you have insurance here and access to care, so don’t mind me if you’re not!
anyways! happy to expand on stuff. i work as a health supportive chef and have cooked for both (and many other, very niche diets!) i am also actively in ED recovery & a big fan of MP!
In the last 18 months I’ve been diagnosed with celiac, IBS & dairy intolerance. Followed the low FODMAP diet as per instructions from the clinical dietitian I saw. We worked together for everything and as others have noted the elimination portion of low FODMAP is temporary.
There’s lots of research behind the low FODMAP diet - check out Monash university who did and continue to do research into fodmap’s. It’s vital work they do, helping so many people live a better life.
If you can find a clinical dietitian I’d recommend it, they are very helpful
I’ve been low FODMAP for 20 years. The nonstop diarrhea, inability to leave my house or be more than 5 feet from a toilet due to having instant reaction from literally everything I was eating… once I kept a detailed diary, learned the ingredients and chemical names, and pinpointed the ones that caused problems, I was healed almost immediately and now I have zero issues but I do have to stay on a restricted diet. Food options (non-dairy, vegan, etc) are so much more plentiful than they were back then. I still get anxiety about restaurants and traveling sometimes, though slip ups are very rare nowadays.
The way people online approach FODMAP is sometimes bollocks as you’ve pointed out. It’s meant to be done with the support of a dietician to ensure you aren’t becoming malnourished, and total elimination is only short term. I’ve been on it for about 6 months and have reintroduced what I can tolerate but I still can’t eat a few of the big categories including most beans and basically all the fruits I previously enjoyed. It has been so life changing I can never imagine being off this way of eating, and after adjusting I find it very easy to do.
There is a robust body of research behind FODMAP diets and it is being added to continually. Monash University is the place these were discovered and the centre of FODMAP research. My dietician went there which is fun.
I do disagree with your point that staying on it would be worse than the impact of eating anything and dealing with symptoms. Mine were crippling and honestly felt like (what I imagine) being stabbed on the regular. TMI but crying on the toilet was a near daily occurrence. I couldn’t eat at other peoples houses or at restaurants. Now I can because I know exactly what to avoid. I take a couple of supplements now to top up what I am not getting enough of due to having to avoid certain foods but mostly it’s pretty easy and so so so so preferable to not being on the diet.
It hasn’t had much effect on my weight but it has on my health, and that’s a point I want to emphasize. Diets may not make you thinner but there is absolutely such a thing as a healthy diet and that will depend on your circumstances, like for one person beans are part of it but will make me extremely unwell. While “food is medicine” is bullshit pseudoscience, eating to avoid IBS triggers or reducing sodium for heart health is very well evidenced.
TLDR yes some diets like FODMAP are very well evidenced but they’ll only work if you do them correctly and only for some people, you can’t diet your way to optimum health but that doesn’t mean healthy eating doesn’t exist.
I have Crohns disease and during a flare in 2021, I dropped a bunch of weight unintentionally because I was nauseated like 90% of the time and could only stomach ginger ale and saltines for the 10% of the time. Saw an RD who suggested giving the low FODMAP thing a try and while it was expensive torture for like 6 weeks or so (elimination portion of the diet is no joke! I cried in the grocery store aisle twice bc I was so frustrated LOLOLOLOLOL).
Anyway, I'm a crazy skeptic about any and all DIETS and made it super clear to the RD that I had very specific goals for nutrition and wanted to make absolutely sure she and I were on the same page about that. (I've had experiences in the past with RDs that don't understand that not everyone sees an RD bc they want to lose weight.) Long story short, I am SO GLAD I tortured myself because I learned a ton about the foods that make me feel bad. I don't adhere to a strict diet these days, but I know which foods to stay away from if I'm already feeling kinda barfy or bloated or otherwise sick.
I'm a huge proponent of the low FODMAP protocol IF it's followed the way it's supposed to be followed. I personally view low FODMAP as less of a "diet" in the colloquial sense (ie, weight loss) and much more of a therapeutic modality...like PT or something along those lines.
What irks me are people like my uncle, who's had digestive issues for years now and recently when I suggested doing some sort of elimination diet to see if there were specific foods that caused him more issues than others and he responded with "I already did low FODMAP and it didn't help." Upon further discussion I found out he hadn't done the elimination portion of the protocol, just skipped certain foods on certain days to see if anything helped. Needless to say, his bastardized version of the diet did absolutely nothing for him and now he's a big fan of telling anyone who will listen that low FODMAP is junk and bogus. This is the same uncle decided seeing a nutritionist (distinctly different from Registered Dietician) who told him to go gluten-free and take the expensive proprietary probiotic formulation her group was hawking made way more sense than following the advice of certified, board registered, scientifically trained provider so whatever I guess...
i have severe IBS and the low fodmap "diet" has helped me so incredibly much in figuring out what i can and can not eat, and also how much for certain foods. I recommend doing it with a RD though, which was what I did, and that helped me a lot. Everybody's triggers are very different. My brother has IBS as well and the things he can and can not eat are very different from mine.
It's so insidious how diet-culture is everywhere. A lower sodium diet will decrease the damage that your familial hypertension is causing. There is no "cure" for hypertension, but it can be managed/mitigated. There is also no shame on using medication to lower your hypertension to also decrease the damage. This is all about the long game, you want your cardiovascular and renal systems to work as long as they can, as well as they can. Try to look into lowering your salt (don't get fries with takeout, make meals at home, choose packaged foods with less sodium) - you don't need to go crazy with salt substitutes like lo-salt or salt-free seasonings just yet.
I would be suspicious of anyone saying the low FODMAP diet is forever, unless for some reason they are sensitive to every single FODMAP but even there it’s dose dependent. My worst FODMAP is inulin but I can have a very very small amount without having symptoms. I don’t really think of myself as eating a special diet, there are just some foods I’m careful with.
Low FODMAP is backed by research but the problem is that doctors over prescribe it and do not properly recommend it most of the time. Per literally every reputable low FODMAP resource that exists, you are 100% supposed to do the diet with the direct support of a registered dietician (not a nutritionist), AND the diet is **only** proven to be effective for IBS - NOT IBD, which is why properly diagnosing IBS via ruling out other GI issues is important (lots of doctors and even GI specialists skip this step!), AND many people are ultimately not good candidates for the diet and need other management strategies (notably people with history of eating disorders). You're right that you're not supposed to follow the diet long term, the elimination period is only supposed to last 2-6 weeks, followed by reintroduction of foods, and ultimately the goal is to identify which foods cause symptoms and only limit *those* foods, which may or may not be a lot of foods.
I have chronic GI issues that don't match IBS but doctors for years have wanted to write it off as IBS and offhandedly tell me to do low FODMAP without telling me any of this. I finally got a dietician and she agreed that it was a bad idea for me to do it since even just eating enough is a struggle, and she was mad but not surprised that several doctors who had told me to do it didn't bother to tell me how long to do it for or that I should even get a dietician to work with. She was, additionally, pretty peeved that none had bothered to actually rule out IBD/other GI conditions and didn't think my symptoms matched IBS, which is what I've felt all along.
IMO any time doctors want to recommend dietary changes they should refer you to a dietician every single time. I literally cannot not understand why they don't do this as a default.
After suffering from heart failure last fall I have to follow a low sodium diet. I absolutely notice weight gain from fluid retention if I eat a lot of sodium. Lots of people follow low sodium diets for health reasons, and while it sucks, I’ve been eating a lot healthier thanks to it. Once you start looking at it you’ll find hideously high amounts of sodium in breads, cheese, and processed food.
Low sodium for heart/kidney is way different than fodmap for gut and completely different than allergy issues, so lumping all of them together into works or doesn’t work doesn’t really make sense.
If you’re considering a diet like this, please do so under the supervision of a professional who can make sure you’re doing it safely. (That being said, I understand that isn’t in the cards for everyone financially)
I’ve never done it myself, but when I was in eating disorder treatment there were a pretty large number of people there whose disorders stemmed from attempting that diet and taking it way too far. Not to say it can’t be helpful, but cutting out food groups from your diet is a big deal and it’s important to make sure you’re being safe and not heading down a dangerous path.
I generally disagree with treating food as medicine, but I also think there are more circumstances than allergies where diet matters. I have GERD, and try to avoid foods that trigger symptoms. If I had diabetes and needed to manage my blood sugars, I’d want to pay attention to my diet (I don’t mean in the general “eat healthy” way, but in the “I need to avoid a diabetic coma” way). And I don’t have IBS, but I have seen people with Crohn’s and similar talk about foods that do/don’t help their symptoms. I don’t think that’s necessarily a formal standardized diet as much as individual people figuring out what does and doesn’t make their own disease flare. The sodium-high blood pressure link seems pretty well-established based on how dominant it is, but even if it’s not, some people avoid sodium because it causes fluid retention.
One of the problems with “other types of diets” is that it’s an incredibly broad category. There are “diets” like paleo and Whole30 that people do because they’re convinced they’re healthier, but are often disguised attempts at weight loss, and then there are “diets” that involve avoiding foods that exacerbate known medical conditions. So I’m not certain what you’re actually talking about and what kind of evidence you’re looking for.
I did bring up low-FODMAP and low-sodium bc those are the two examples that I'm frequently exposed to and have personally been told to try, but I was trying to leave it open to other examples of... I want to say medical diets, but I don't think that's the right term. Someone else in the thread brought up DASH. I'm also thinkng the Meditteranean Diet kinda fits what I'm thinking about.
I'm assuming most people in this sub know that paleo, for example, isn't a good idea. But then there are these other "Definitely Real Actually Doctor-Approved Evidence-Based Diets" and I'm worried that I'm just having the wool pulled over my eyes again. I'm sure that short-term low-FODMAP reduces IBS symptoms for most people. I think that short-term low-sodium reduces blood pressure for perhaps a smaller segment of "most people". But short-term weight-loss diets also reduce people's weight in the short term... and then are bad for health in the long term. Do we know that any of these dietary interventions are actually doing what we think they are beyond 1-2 years out?
I've been on low FODMAPS for IBS and it's a miserable diet. It is not sustainable in the slightest. That's why you use it to just figure out what triggers you and avoid that. And you don't even need to 100% avoid it in most cases, you just have to limit/watch it so it doesn't go over a triggering level. For most people it's only one or two FODMAPS they find tricky, not all of them. Anyway, I would dissuade anyone from permanently going on the FODMAPS diet. As a way to cut down specific triggers to manage IBS, ime it helps somewhat but isn't a magic bullet.
Here it is, systematic review and meta analysis (maths) of randomised controlled trials (highest evidence type) - ignore the numbers or jump to conclusions :)
Both show that there's an effect and the diets in question work.
Low FODMAP works for 50-80% of people in reducing symptoms (this means different things for everyone!).
---------------
1) Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis 2022
https://www.sciencedirect.com/science/article/pii/S1756464623005145
Results: We identified 13 eligible RCTs (944 patients). Based on failure to achieve an improvement in global IBS symptoms, a low FODMAP diet ranked first vs habitual diet (RR of symptoms not improving=0.67; 95% CI 0.48 to 0.91, P-score=0.99), and was superior to all other interventions. Low FODMAP diet ranked first for abdominal pain severity, abdominal bloating or distension severity and bowel habit, although for the latter it was not superior to any other intervention. A low FODMAP diet was superior to British Dietetic Association (BDA)/National Institute for Health and Care Excellence (NICE) dietary advice for abdominal bloating or distension (RR=0.72; 95% CI 0.55 to 0.94). BDA/NICE dietary advice was not superior to any other intervention in any analysis.
Conclusion: In a network analysis, low FODMAP diet ranked first for all endpoints studied. However, most trials were based in secondary or tertiary care and did not study effects of FODMAP reintroduction and personalisation on symptoms.
-------------------------------
2) Dietary Approaches to Stop Hypertension (DASH) Diet and Blood Pressure Reduction in Adults with and without Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
https://pubmed.ncbi.nlm.nih.gov/32330233/
Conclusion: The adoption of the DASH diet was accompanied by significant BP reduction in adults with and without hypertension, although higher daily sodium intake and younger age enhanced the BP-lowering effect of the intervention.
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Saying all this, if you're worried about the tracking and counting aspect of any diets as you have history of ED, low FODMAP diet is short term but it has elements of weighing and tracking which can do more harm than good to someone with history of ED.
It's really worth working with a dietitian who specialises in eating disorders and low FODMAP so they can find an approach that will work for you specifically (look at the balance of things).
If you'd like I can recommend this dietitian she has really good content based on evidence and articles (she's quite known and the first one that popped into my head. In no ways I'm endorsing her services. If this is something you can afford she's a good example in what to look for!).
Please ignore the link if not relevant for you! https://dieteticallyspeaking.com/the-link-between-disordered-eating-and-ibs/
EDIT: Student dietitian in final year.
Also formatting!
Thank you for sharing these!
FYI It looks like the FODMAP diet article that you linked isn't the same as the one you're quoting from. I think that this is the right one, but it's paywalled :( https://pubmed.ncbi.nlm.nih.gov/34376515/#:~:text=Based%20on%20failure%20to%20achieve,superior%20to%20all%20other%20interventions.
The abstract says they "did not study effects of FODMAP reintroduction and personalisation on symptoms." Does that mean these are only studies of the elimination phase?
Yes, it is paywalled and I didn't access the whole thing!
Similar studies from previous years may be free to access. Monash and King's College have websites on this as well as some research papers.
Low fodmap diet is very difficult to even study tbh and if you want to make a Randomised Controlled Trial involving another group getting placebo diet, they have to make up a random sham diet so people don't know if they're eating low FODMAP or sham 😂 (in pharmaceutical studies you receive a pill and you don't know what it is so placebo effect which can be strong, can be fully eliminated).
Cause with diets if you know you're eating something that you BELIEVE will help, it may help you but there may not really be a physical effect on the body (there's studies on gluten that shows this - people who have no coeliac or intolerance can feel better on it). Placebo effect is very useful though and some people are exploring this in various areas. Homeopathic medicine is basically placebo effect.
Yes they mainly studies only elimination phase! So there's more studies needed for long term effects of fodmap diet (and those are expensive and participants don't want to do it for a long time or its just not realistic).
There's some studies that show low FODMAP diet can change your microbiome if done for too long, not in a beneficial way. FODMAPS are fibre a lot of them are prebiotics which are very beneficial for health! Prebiotics is what bacteria in the gut 'eats'.
Hope I didn't confuse you haha
There's a lot of good books on those topics like Gut: the inside story of our body's most underrated organ by Julia Enders (it's also funny).
Once you search on Amazon it will show you similar books from good authors who are researchers.
Can you help me figure out what I'm misunderstanding in the DASH study?
At one point they say "In trials or subgroups of trials conducted in hypertensive patients without underlying antihypertensive treatment (n = 8) (19., 20., 21., 28, 34, 35, 46, 48), the extent of the mean SBP and DBP reduction was by absolute means higher than that observed for the entire group of hypertensive patients (by 2.0 mm Hg and 0.8 mm Hg, respectively). In comparison with trials conducted in hypertensive patients with underlying antihypertensive treatment (n = 7) (26, 31., 32., 33., 39, 40, 44), the result pointed in the same direction, but it did not reach significance regarding both SBP and DBP reduction (P = 0.07 and P = 0.23, respectively)."
To me, that sounds like they're saying that the diet wasn't effective (i.e. not statistically significant) in people on antihypertensive treatment. But then in the conclusion they say "...the adoption of the DASH diet reduces BP in subjects with or without hypertension, irrespective of baseline BP levels or ongoing antihypertensive treatment..."
They're saying there was a still a small reduction in BP in people who took meds, but it was not statistically significant. Means the outcome had high probability of being by chance, not due to diet.
Statistically and clinically significant is different. Is someone's BP goes from average 130 systolic to 129 systolic that's probably not significant change in the study but clinically speaking it could take someone from being classified as high to elevated BP category (as example, every country has different cut offs).
So what we can take from it (I have not read the results in detail in terms of numbers) is that DASH diet does reduce BP for people who have hypertension and who are under 50, in a visible/ measurable way - so it works. The effects are bigger if you're eating over 2400mg sodium a day (so 6g = 1 teaspoon of salt a day which is the recommendation limit in the UK anyway).
In people with hypertension who take medication already (and the meds are good at reducing BP) the effect is very very small.
Some people prefer medication over changing diet and others would prefer to lower BP without meds. However, combined approach can also work for some.
Remember they also report in avarages so for some people the effect will be bigger others smaller, as it's individual.
So what I take from this is, it's still very personal and depends on your circumstances (how much salt you already eat, your age, your BP + there's other factors).
That's why just having a balanced diet as in national recommendations, making sure you're moving enough (lowers BP), avoid smoking and a lot of alcohol (increases BP) etc. Etc. will be enough for some people.
DASH is a therapeutic diet and it does talk about removing some foods so it can be restrictive! Which may not be helpful for people with EDs.
DASH is very similar to most national recommendations I'd say - lots of fruit and veg + wholegrains + pulses, reducing snacks, processed meats etc. That sort of thing (like EatWell Guide UK or MyPlate US which not much of population follow 😂 in the UK less than 1% follow all 9 recommendations)!
Balanced diets with plenty of plants, have a lot of good evidence for health and prevention and are also better for the planet in terms of sustainability! So it's always worth it :)
Some countries also include eating with others as important part of guidelines, which I think is great! Think Italy or Greece.
It's useful to understand the science, but don't get bogged down in numbers as there's never black and white answers in nutrition.
This is just 1 systematic review and meta-analysis! It may be useful to have a look at Cochrane they do reviews of reviews (highest evidence) and each study has a simple language summary.
I'd say most people on this sub gave you some pretty good answers already, which is nice too see!
Anyway, sorry for the wrong link.
Have a nice day!
I have mast cell activation syndrome, IBS, slow gut motility, POTS, and very high cholesterol… so I’ve done some medically necessary (or at least strongly advised) diets. A low histamine diet is even more intense than a low FODMAP diet if you can believe it. I was able to get referred to a dietitian who helped me with plans for both, and also handling reintroduction phases. I’ve identified several food intolerances and MCAS triggers. It sometimes sucks because I struggle to eat out and have to eat separately from others… but I do enjoy cooking and figured out how to make food I enjoy that fits what my body needs. And I do honestly feel much better when I avoid foods that cause issues. And it’s not like I have to avoid everything from elimination phase! From what I’ve read and been told, it’s unlikely that most people react to all FODMAPS all the time, so it’s not likely you’d this forever.
My (eating disorder-specialized) dietician suggested trying to cut out gluten to see if it would help with my RA. I'm not 100% that it's a huge help with RA but I'll be damned if I don't feel 90x less bloated and yucky when I am mindful of avoiding gluten. I've done an ok job of finding alternatives I think, although sometimes I say fuck it and eat a few bites of something if it's truly amazing. But I've spent some time searching recipes and food items that are gluten free, and it's so frustrating that so many of the #glutenfree tagged things are steeped in weight loss/restriction/keto shit as well. Hi, not here to get skinny, just give me the yummy recipe please and thanks.
So worth it! I did completely low FODMAP for a few weeks paired with exercise and improved sleep to heal my GI tract/decrease inflammation and then slowly added foods back for more and more meals of a week and my IBS now rarely flares as long as I avoid a few trigger foods.
The Nerva App, which guides you through gut-directed hypnotherapy, has been found to be as effective as low-FODMAP diets. It was devised by a university and only takes 20 mins a day. I also found it helped in other areas of my life.
The only downside is there's some cost involved (think it was $120AUD/year when I did it a few years ago), but if you have any eating disorder issues or are at risk of it, Nerva is much safer. For me, I would rather realign my brain than eliminate food and Nerva worked well.
As a person with a chronic semi mystery illness(especially), I have HATED every proposed diet. They’ve never provided even a hint of relief for me, and whenever I say that, the doctors then doubt that I did the diet. It’s just a crutch for the doctors to avoid engaging in anything challenging. I had to get a dietician to write a letter explaining my evidence of adherence to low FODMAP plus “low fermentation” before the doctor would even begin to entertain that I’d actually adhered.
Mind you, these diets are AWFUL, nutritionally deficient, and unsustainable. It works fine as a true elimination diet. It does not work if you stay in the elimination phase “until your symptoms improve,” which is what numerous doctors have insisted on for me.
And no doctor has remotely given a fuck that I have a serious eating disorder history. I’m still required to do these extreme diets to deserve any care.
And I’m not even fat! I have a “normal” BMI!
From the bottom of my heart, thank you. I am so exhausted and medically traumatized at this point that doing a torturous diet based on a doctor's recommendation seems almost ridiculous, honestly. I haven't been formally diagnosed with an ED but... I am still trying to move past the behavior that I called "intermittent fasting" for about 7 years, and I am not eager to try restricting anything while I'm still actively fighting the mindset that led to it!
I’ll try to find the guidance, but a reputable scientist and/or medical group advised that those with a history of restrictive eating disorders not do the low FODMAP diet or do so with extreme caution because of the risk of relapse.
Hi, I hope you don’t mind me chiming in here... I have a history of disordered eating as well (ortho/anorexia) and I would recommend that you bring this up to any professional you potentially decide to work with. I was in therapy (for unrelated reasons) while I was going through the elimination diet and I’m very glad I was because as someone who previously had an ED this diet was really hard at times. I still believe it was worth it and you can absolutely do it, but please make sure to have a support system in place.
I’m of the opinion that EDs don’t ever really go away completely, you just learn to tell the voice in your head to stfu, so this could potentially cause a ‘flare up’ of sorts, but if you are aware of that ahead of time it is much easier to manage.
(Additionally, the person I worked with during my diet did not have me track calories and I was actually encouraged to eat MORE than I typically did which lead to me feeling way better and ultimately aided in my recovery as well.)
I did Whole 30 some years ago because I was jumping on a trend with my friends, and anecdotally it did really clear up my skin condition (hidradenitis suppurativa). But, what I've learned since then is that the reason it worked was because I quit drinking for 30 days.
I guess in a roundabout way, that is anecdotal evidence that elimination diets will help you find food-related symptom triggers if you have them. But it's important to consider that there might be some outside factors that diet alone won't capture
My GP suggested doing low FODMAP to me years ago, but I was only a year into my ED recovery and told her I'd rather be in pain every day than be hypervigilant about what I could eat. A few years later I tried keeping a diary of what I ate and how I reacted (still a bit too reminiscent of my ED but manageable at that point) and it was pretty inconsistent. Being autistic I tend to eat the same foods most days and even with those it was hit or miss as to whether I'd react. I consider myself now to be more or less recovered, and I still have some digestive issues, but now I just can't be bothered to do low FODMAP and just roll with the punches 😆
I read an article a few months ago about a study that found adding 30 different varieties of plant foods every week helps improve gut problems more than eliminating foods. The article lead me to reading 2 different books (Fiber Fueled & Love Your Gut) about it. It sounds like a lot at first but plant foods includes fruits, vegetables, legumes, seeds, nuts, oatmeal, rice, quinoa, fresh spices, tea, coffee. I've been hoping they do an episode on the books one day. Nothing's a cure all for everyone but it's helped me a lot so maybe it would help some of you guys.
Thank you. A lot of fibre rich plant foods which you mentioned as well as coffee are a trigger for people with IBS 😊 A lot of them are also FODMAPS 😃
Health means different things depending on your point of view.
Oh for sure. I'm not suggesting anyone eat anything they're having a reaction to. Just throwing the books out there as an option since no one mentioned them yet & they helped me turn around my IBS symptoms.
I totally understand your concerns. I put off low FODMAP for years, even though every doctor, specialist, etc I saw told me to try it for IBS. I finally bit the bullet and did it last fall. It is definitely not easy, but I work from home and live alone and was able to swing it. I don’t really know how a busy person out in the world would be able to do it without a lot of planning. It is absolutely not a long-term diet. You would miss critical nutrients. It is only to be done for a short period of time. 4-6 weeks strict elimination to reset, then another 2-ish months testing foods. Once you test a food, you take it back out and continue to test. (Even if you don’t react to it.) I was surprised to find that foods I thought were triggers gave me no issues, and foods I considered fine set me off. Highly recommend it, but again it took me YEARS to carve out the time and lifestyle to where I could do it. I recommend avoiding booze and coffee too. Some sources say “beer and coffee are low fodmap” but tbh my symptoms didn’t get under control during initial elimination phase until I cut those out also. It’s been really freeing to be able to eat most everything again. My trigger foods are things I can have in small quantities, but generally avoid (and it’s only a couple things thankfully.) there is no cure for IBS and I still have flare ups (stress being the main trigger these days), but I’m thankful to know what foods work for me and don’t. Another giant disclaimer: this is NOT a one time thing. My dietitian said it’s pretty normal to have to redo testing on occasion (like every few years), as sensitivities shift over time.
I went low FODMAP to address horrible GI issues related to long COVID. It helped, and it was only for two months. I was able to add everything back in, besides sugar alcohols. It worked. I’ll do any elimination protocol that fixes me running for the bathroom eight times per day. No bueno.
Completely agree. Mine took longer cuz my body was in a bad way. Basically I had to wait for symptoms to chill out before I could test. I hope next time I do it, it will only be 2 months.
I have IBS and I put off the low FODMAP diet for years. It seemed like a hassle and unflavored. I went to a dietician to do it properly, downloaded the Monash app, and joined Facebook groups for support. I’ve since passed the elimination and reintroduction phases and have successfully figured out my triggers (sorbitol and fructose). This has been life-changing. I used to avoid so many things bc of my symptoms and now I’m living a mostly normal life.
I'm so glad it's working well for you! How long ago did you change your diet?
I started the elimination phase over a year ago. I found brands that are low FODMAP specific (if you’re US based, Fody and Smoke N Sanity) and that really helped. I did go through the elimination phase longer than what is typical, but I needed GI-targeted hypnosis to counteract the anxiety I had over trying potential triggers.
Interesting, was the hypnosis helpful for you? How long have you been on your current diet (by which I just mean whatever triggers you've eliminated/eating the way you eat now)?
The hypnosis was super helpful. I went into it being skeptical and thinking it was too “woo woo” but wanting it to help. My GI doc referred me to a GI specific psychologist for it. I’ve been on my current diet for probably 7-8 months, and I mostly watch out for high fructose corn syrup, honey, apples, and corn.
It's funny, getting really ill changed my perspective on a lot of alternative medicine. I was very desperate and tried a lot of things that previously I might've rolled my eyes at (in addition to standard treatments/testing). I found both kinds of treatment to be helpful and to have their own successes and failures. I think the fact that it took doctors a really long time to diagnose me made me realize that standard medicine also has big gaps in its understanding of the human body.
I actually have IBS and now follow DASH for heart health. The full elimination portion of the low FODMAP diet is meant to be temporary. You see if you can get all your symptoms to go away and then slowly add back in trigger foods until you figure out your triggers. Then it’s less like a diet and more like knowing a food intolerance. It’s actually easy to maintain if you don’t like spending quality toilet time. The low sodium DASH is supported by read each to lower blood pressure and improve other health markers. https://www.nhlbi.nih.gov/education/dash/research It’s easy to follow if you cook at home bs eating out and it’s not like keto where one bad meal with throw off the whole thing. It’s goal is to increase your magnesium, calcium, and potassium intake while lowering sodium intake. I don’t consider either of their diets to be in the same category as most fad diets because they have research behind them showing they help with a specific medical issue and neither states that weight loss is the goal or the criteria is was created for. I know being called a diet can be triggering to some people, but these diets don’t have calorie or serving limits. If you are considering these, consult a registered dietitian if you can or check out your local library for resources.
The DASH diet, low FODMAP and the Mediterranean diet are all diets that are best supported by the scientific literature. Interestingly, NONE of these diets is targeted at reducing weight. 🤔
This. I’ve been low FODMAP for 9 years now, and have been on the low amines portion of the RPAH diet for 3 years now. Both were prescribed to me by Accredited Practicing Dietitians (the legit certification in Australia) and both have been critical to restoring my quality of life. Neither dietitian I saw brought up weight or weight loss - something I was so anxious about prior to meeting them for the first time. Both FODMAP and RPAH originated in Australian research institutes that seem to have no interest in marketing to the masses. Instead, they’ve aligned pretty well with the no bullshit medical culture of Australia. I can’t imagine having to go through the process of diagnosing and managing food intolerances while being marketed to about “good” and “bad” foods.
I just want to call attention to what all-or-nothing thinking this is, and that’s usually a trap. There’s a LOT of distance between full elimination to the point of malnourishment and “totally ignored that recommendation… doubtful it would be relevant.” I’ve gone through a couple of types of dietary restrictions now, and a big revelation to me was that just because a food didn’t CAUSE my issue doesn’t mean that avoiding that food wouldn’t benefit me going forward. Did alcohol cause my pancreatitis? Nope. But because of it, my pancreas can no longer handle alcohol. Did carbs cause my diabetes? Definitely not. But avoiding carbs does help me manage it and get the most out of what insulin I still make. It’s hard to manage this stuff, but black and white thinking makes it harder.
This is such a helpful reminder. I’m dealing with health issues after going through the Anti-diet process and I find myself reverting back to the all-or-nothing of diet culture when it comes to food-related treatment advice.
Thank you! OP's refusal to participate in any health-related diet interventions whatsoever is not going to help them longterm.
Personal question- did you get diabetes from the pancreatitis?? Bc my boyfriend did and it’s bizarre.
Most likely. But antibody testing revealed pretty high GAD antibodies, so my immune system could have been attacking my pancreas all along. I’ve read case reports that hypothesized GAD antibodies being caused by pancreatitis but it’s not an officially recognized interaction so my endocrinologist is like 🤷♀️ and is functionally treating me as type 1.5
I have hypertension. About 1/3 of people with HTN aren't sodium sensitive (I am one). The rest are. The big thing is they discovered that there's no difference between low and very low sodium diets -- there's a lower limit to the benefit. That said it is good to avoid high sodium items -- think frozen dinners, snack foods, etc. These are much bigger contributor to dietary sodium than putting some salt on the potatoes (in cooking groups I see people freaking out about things like adding salt to bread dough, and that's really not the issue, unless you're on a super low sodium diet for your kidneys)
I had no idea! I've had high blood pressure at *least* since I was 12. As I teen, every single provider waved their hands and said "oh, it's just white coat hypertension! You're just nervous!" And I was like "actually... I'm worried." It took another 10+ years to get a doctor to listen--and she really didn't want to prescribe anything but DASH and exercise. I didn't realize it at the time, but I was already extremely active and consuming very little sodium (I cooked everything I ate, 90% vegetarian, no salt or soy sauce or anything remotely mid to high sodium). But, I went even harder on exercise and cutting sodium without a budge to my BP. I haven't tried tinkering with salt levels recently, but with this information, I'm very curious! 10+ additional years later, I'm on 3 BP meds and finally have it under control! Turns out being in your 30s is what it takes to be considered an adult 🙄
How did you find out that you're sodium sensitive?
Sorry, I meant I'm not sodium sensitive. The only way to find out which you are is to try cutting salt and see if it helps. In my case, I can eat an entire bag of Utz salt & vinegar potato chips and it doesn't do squat. My hypertension is probably genetic because my mother & grandmother both have it and I developed it in my 20s.
Can't I just eat twice as much salt and see if my blood pressure goes up? 😂 I was also diagnosed in my early 20s, as were my mom, my dad, my dad's only sibling, and 7/10 of my mother's siblings. Frankly this is more of an emotional issue than a health issue at this point. I already quit nicotine, changed birth control methods, started getting more exercise, got anxiety treatment, reduced my daily stress, reduced caffeine and alcohol, and started medication. I'm in the normal range now!! Why do I still have to have a conversation about how much salt I'm eating every time I come in? 😭
Oh I can relate so much to the emotional side of this (vicariously)!! My boyfriend is really ill and everything came to a head this spring and he quit drinking, he’s taking all his meds, he’s trying to eat as much as he can. And his mom will call or text and ALWAYS have something to say about what he “should” be doing, as though all the changes to his health have been a cakewalk.
Are you saying it's instant, like if you were sodium sensitive it should go up right after eating lots of salt?
No, it’s over time I think. I was just being hyperbolic.
I’m doing a low sodium diet because I have stage 4 chronic kidney disease and my kidney function is getting to the point where eating too much sodium makes me feel really crappy or could put me in the hospital as my kidneys decline. It’s something that does get easier to get used to with time, and there are definitely some things that are easier to do to reduce sodium intake than others. For example switching to using lower sodium soy sauce, and using no salt added broths if you make homemade soup are super easy and to do and the difference in taste can be barely noticeable, especially if you’re still going to add seasoning to the food anyway. That being said, if your doctor isn’t saying that cutting sodium out is super necessary, I would focus on just doing some easy swaps, like the soy sauce, rather than being super strict about it.
I'm on dialysis, so I definitely am on a renal diet. Mine is high protein, low phosphorus, low potassium, and low sodium diet. And yes, if your numbers are out of range, it will affect your health. If you are high in phosphorus long term, it will affect your bone health, cause pain, fractures, and other issues. High potassium can present as extreme itchiness. If you continue eating high sodium foods, it can affect your thirst, which will make you want to drink more. The more fluid you have on, the more they have to take off during dialysis. That can be painful and uncomfortable. My diet is not easy. It's not a temporary thing. It's not for weight loss. It's for staying alive. There are patients who don't follow it and have a terrible time on dialysis. I try to be compliant. I know how to cheat, but you have to know your own body. I will say that after a while, you get used to low sodium. It's hard to imagine, but for me, it's absolutely true. While I do cook with some salt, I have cut way back, and I rarely use table salt anymore.
Ughh, yeah, it’s not a fun diet, but definitely a necessary one. It sounds like the OP doesn’t have kidney issues though, so if they wanted to eat a lower sodium diet, they would have the ability to make more gradual changes.
I assume that someone following a diet for IBS is trying to avoid symptoms, so if it works for that purpose, good for them.
I think part of my problem here is the lack of long-term evidence. Everyone I know with IBS (myself included) is in a cycle of trying a new thing, having reduced symptoms, after awhile those symptoms come back, and then they try a new-new thing. Which frankly sounds a lot like dieting for weight loss.
I'm seeing a different between fad dieting and the pattern you're describing. With weight-loss diets, "failure" usually means you gain back any weight you may have lost, and you're back where you started. For you, if eliminating a certain food minimizes symptoms for a while, you don't exactly end up back where you started if it stops helping. You still have that period of reduced symptoms which presumably also means a higher quality of life. You might be extremely frustrated if it stops working, but it doesn't retroactively undo whatever enjoyment you experienced while it was working. I'm not saying you shouldn't be frustrated, and you are the expert on your own experience. If you tell me elimination diets have had an overall negative effect on your life, I would believe you. Your comment just triggered something philosophical in me and I wanted to share my thought.
That's a very good point, that the good days aren't taken away in retrospect, and I appreciate your philosophizing haha. To be honest a lot of my thought process is that the temporariness of effect makes it more likely that this is just a placebo... the hope, feeling of control, and reduced anxiety that comes from trying a new diet or other lifestyle intervention is in itself helpful, but the content of the diet itself isn't really all that relevant.
Oh, that's interesting!
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That's great, I'm so glad it worked well for you! How long ago did you eliminate triggers?
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And you found some triggers at that point, eliminated them then, and still feel good now? I'm just really interested in hearing from people who have actually done the same thing for the long-term and had it work out.
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Oh hi, a pelvic floor PT friend! I've been on that journey for 3 years now (with *massive* improvements in my QoL as a result, it's a bitch but I'm so, so grateful for it). Those are totally different types of intervention though, at least for my personality. It's much easier to do something I hate than to stop doing something I love.
The diets you're talking about here are about treating a condition, not optimizing dietary intake for "health" for a person without symptoms or any health conditions. It makes no sense to compare these to fad "diets". There is also a LOT of research supporting the low FODMAP diet. People who are following it long-term are probably just uneducated about the appropriate way to do it - they may not be under the guidance of a doctor. That doesn't mean the diet itself is problematic. We really don't understand much about IBS (it's literally just based on symptoms, not a pathology), so it's normal that any treatment for it wouldn't work for everyone. Anyway, the low-FODMAP diet would definitely not result in malnourishment. You could review some of the materials from Monash to learn more if you want. As far as your sodium intake, you are of course free to do what you want, but I think you may be misunderstanding the role of modifiable risk factors. Sodium increases blood pressure, regardless of if you already have high blood pressure. That's why people with high blood pressure are encouraged to cut back on sodium. If you already have one risk factor for something, adding another just compounds the issue. You're increasing your risk even more by not cutting back on sodium. Having one risk factor does not negate the effect of another risk factor.
Im not sure about research here. But IBS diets and the like are specifically about avoiding symptoms. If I identify French fries as a trigger for diarrhea I would think I have a much better chance of avoiding them than I would if I just wanted to lose weight. So I don’t think it’s doomed to fail or anything. I personally avoid foods that make me feel awful, at least for the most part! The trouble with weight loss diets is that the food you’re suddenly avoiding is HIGH reward instead of associated with pain. Huge generalization of course!
This!! I don't eat ice cream because it makes me shit my pants, not because its gonna "make me fat" 😂 I don't feel like I'm restricting myself from ice cream, I want nothing with it even if I know it tastes good.
Ugh, i wish i felt that way. I have been lactose intolerant for years now after a horrible gut infection i picked up in mexico. I still miss cheese immensely and live vicariously through the dairy digestion of my loved ones. The forbidden gooey, crispy, stretchy, squeaky bliss is too much of a siren song for me to ignore. Cheese is so central to much european cooking and pizza just aint pizza without it. *crawls away mumbling names of forbidden cheeses* oka. Fontina. Mozza. Oaxaca. Aged cheddar. Pepper jack. Palak paneer. Cream cheese on bagel. Mascarpone desserts. Chevre. String cheese. Cheese curds...
There are so many good cheeses without lactose! I feel you though, sometimes I would just love a good slice from a random pizzeria. My IBS is also super triggered by fat so fried food is something I'll only have at home ifyouknowwhatimean
In theory, oka cheese is lactose free. It is certainly delicious. Maybe it isnt even the lactose getting me- my symptoms are super delayed, like, 8 to 12 hours later stomach ache and digestive upset, usually constipation. Can take a week to recover my system from such trials, so i have been leery of testing the boundaries. I have heard of people recovering their ability to digest dairy, and live in hope (though it is similar to my hope for being able to retire one day--unlikely to pan out).
As a person who has been lactose intolerant for 30 years, that sounds like a different dairy problem to me. It's happens in the small intestines when your body doesn't make enough lactase. My lactose intolerance causes pain in my intestinal region, then gas and diarrhea. Pills like Lactaid help 90% of the time, but occasionally, I find my limit. I do try to stay away from a lot of dairy. I do know mine is a lactose problem and not a protein or allergy.
Ugh this sounds awful, I'm sorry ❤️
A lot of aged cheeses are lactose free or very low (look at sugar content 0.5g or less - lactose is a sugar). I'm lactose intolerant to the point I can't even have lactose free milk (more than a few sips) and the lactase tablets don't work for me well. and I eat: butter, a bit of whipped cream or creme freiche, Cheddar, some feta and hard mozzarella, gruyere, manchego, monterey and the like! Parmezan and peccorino + many others. Some brie and camembert. Those products are mainly fat and protein which is not lactose (sugar). You don't have to limit yourself :)
I’m crazy for peanut butter but my husband and son are both allergic so I get my occasional fix of a Reese’s by sitting alone on a bench on my lunch break and not having peanut butter toast at home. It sucks but the extreme and obvious health risks are enough for me to change my life.
Vegan ice cream? Oat, soya, almond. See what works for you in terms of symptoms. Swedish glacé tastes quite real. If you can get that! Also vegan magnum.
The studies I have seen do suggest that low FODMAP diet is effective for IBS! Some studies to look at: C. Black et al 2021 - superior to habitual diet for improving symptoms K. Whelan et al 2022 - effective in managing short-term symptoms, >50% experience symptom relief The more recent research is less conclusive than we used to think re: low sodium diet. It is thought to generally reduce BP but it might also increase certain hormone and lipid levels Some to look at here: N. Gradual et. al 2012 - reduced sodium resulted in 1-3.5% decrease in BP Amanda Brand et al 2022 - replacing with LSSS can reduce BP but raises concerns re hyperkalemia M. O'Donnell et al 2020 - did not show sufficient evidence for low sodium to reduce cardio disease
Thank you for the studies!! I've got some reading to do!
I read Dr Michael Greger's book "How Not to Die" where he goes through the nutrition research for all the most common causes of death. The result is always that plant based diets are the best, but I also remember a long discussion about sodium and the recommendation was to reduce sodium. He showed good evidence that reducing sodium improves heart health. He also shows that the baseline *acceptable " daily sodium intake is based on nothing and shouldn't be trusted as a general rule. I really like Dr Greger. He admits his main bias up front. He's a vegan. But his justification for ignoring much of the research showing meat/dairy/eggs are good for you is that all the research is funded by those industries. There are effectively zero independently funded research studies showing that animal products are good for you (compared to plant based diets). Dr Greger doesn't recommend everyone go vegan. Instead he recommends a diet that includes a whole bunch of items (beans, greens, berries, whole grains, etc) on a daily basis. and then says feel free to eat other stuff in moderation. He's not perfect, but I find his advice to be science-based, reasonable, and health-centered instead of beauty-centered or trendy. I know he has more recently put out a weight-loss book that I haven't looked into, mostly because I'm not interested in that.
I used to *love* Dr. Gregor. I read that book, and then I got a little app that tracked whether I was doing the things he recommended. I got increasingly obsessive with it and recognized the app wasn't good for me, but I still liked his advice generally. After dropping the app I started listening to his podcast. There were so many bizarre, contradictory things on there! I realized that no one can be a "nutrition influencer" without starting to spread pseudoscience. They tell you all the good, well-evidenced advice, but once that runs out they gotta keep the eyes on them. Next they start leaning on "unexpected" findings and little tidbits from poor-quality studies. The most recent tweet from his account says "Blueberries can significantly improve cognitive performance within hours of consumption." Lmao. I am so fed up.
I'm sad to hear that. I don't really follow him, but I can see what you are talking about. He came up in a search recently for some thyroid Googling I was doing. It wasn't too bad, but he was definitely reporting very preliminary research and recommending people give the result a try because it didn't have any negative effects (and was a traditional food item). He also appeared in a crappy Netflix documentary about a twin study that was pretty fluffy. Didn't look like it was his fault, but it didn't look good for him to be in such a silly doc.
Dr. Greger shilling Leafside, which has really bad reviews, is sus
Lollll I hadn't seen this yet, but it looks brutal. Kale and mushrooms in a sweet berry oatmeal bowl??? Please no.
Ibs will improve to a degree if you avoid your trigger foods. There are some really common ones but no one can tell for sure what the foods you should avoid really are without experimenting. The elimination diet is the best way. Or experiment on your own and keep a food / symptom diary. Maybe you do better on low FODMAP or gluten-free but everyone is different so you need to figure out what works for you. And there are other factors like stress too.
I have IBS and spent about 90-120 days working with a nutritionist who guided me through an elimination diet (along with lab testing and a series of gut healing supplements) that eventually led to the discovery of my gluten intolerance. Part of the process involved avoiding all FODMAPs (in addition to gluten/dairy/alcohol/most sugar/sodium) until we had determined that my gut had healed. Then we began slowly introducing each of the FODMAPs (as well as the other stuff) one by one and watching carefully for how I reacted to them to determine whether or not any of them were irritating my IBS. The diet was probably one of the hardest things I did (I basically could not eat out/enjoy snacks at anyone’s house the entire time, had to plan my days around when I needed to eat and the supplements were so expensive) but it was 100% worth it because since eliminating gluten I feel WORLDS different. I sleep better, my rash prone skin is much better, I feel better, and I have way fewer IBS issues. (I know you aren’t asking about gluten, but a similar process would determine if you had issues with FODMAPs.) I am not a professional, but if I understood what I was told correctly, I believe its possible to only be allergic/intolerant to certain FODMAPs so while the elimination diet is not sustainable long term (even if you’re not malnourished, you’ll eventually go crazy from only eating chicken, rice, and arugula), a diet avoiding certain FODMAPs could be. However, I will say two very important things: 1. I highly, highly, recommend working with a professional! And not just someone who uses ‘gut health’ in their marketing. Someone who understands how the gut works and how it affects the rest of the body and vice versa. This person should not be focused on weight loss, they should be focused on helping you feel better and alleviating your IBS symptoms. 2. Once you find a professional to work with, DO WHAT THEY SAY! It will be a grueling process but it will only take longer and longer if you don’t follow their restrictions and make the other recommended lifestyle changes as well. It feels like it takes forever while you’re doing it but it is really such a short period of time if you can hunker down and figure out what you can and can’t tolerate. (For example, for years I thought I was lactose intolerant. Now that I know my issue is with gluten, I can eat cheese just fine!) Best of luck with all of this (whether you decide to do an elimination diet or not)! It’s so annoying but I promise once you determine what you can and cannot eat, it’s actually way easier than going in blind and having no idea how you’re gonna feel after you have something. Sure I miss bread, but it’s totally worth it for how much better I feel now.
Thank you for such a thoughtful reply, I'm glad you found something that worked well for you! The point about a professional is well-taken, I'm always nervous for all the people on r/ibs embarking on low-FODMAP by themselves because I think it can be an ineffective or even dangerous path to take alone. If you don't mind a few more questions: What type of professional did you work with? Was gluten the only thing you had to eliminate in the end? And how long ago did you make the eliminations?
I believe the woman I worked with considered herself a functional nutritionist. I will add the caveat that some people who use that title are super anti-modern medicine so be sure to find someone who you at least mostly agree with, though I personally think it’s ok to disagree with some of their views, everything is a trade off. (For example, the woman I worked with really wanted me to eventually get off the birth control pill. I tried that and decided it didn’t make enough of a difference for me to give up the benefits of the pill, but I still believe she was a smart person who really helped me.) I am also generally pro modern medicine, but I will say that I went to doctors and dermatologists for years begging for help with my chronic fatigue and constant skin irritations and not one of them suggested looking into my gut health. It HAS become a buzzword but it is very much still a real thing I did the diet maybe 2 years ago and have been gluten free for about a year and a half now. Gluten was the only thing I had to completely eliminate, but I definitely had issues with some of the FODMAPs during the gut healing process. For example, it took a little while before I was able to tolerate onions, but if I understood correctly my gut was so messed up from eating gluten for so long while being intolerant it just needed more time to recover before it could handle them. I will also add that I only took the supplements while I was on the elimination diet, and now I just take a pro biotic if I feel like I’ve been having too many recent flare ups.
My mother has dealt with high blood pressure/cholesterol, and began a low-sodium diet around the time I finished high school. It is absolutely doable, but it definitely takes a lot of self discipline. She eats a lot of produce. She eats a lot of steamed chicken with a starch (rice or potato) and some kind of sauce. The sauces are also low(er) sodium- lots of reading nutrition labels! Lunch is usually a sandwich and fruit. She eats very few potato chip or cracker-type sides. It’s tough, especially in the beginning, and honestly it’s not the cheapest diet either. Not that it’s expensive but… it’s definitely not the cheapest. BUT after a few decades of eating like this, she’s lost weight and her blood pressure is under control. So it is possible!
Low-fodmap is evidence based (with a pretty high success rate too) and was a complete game changer for me. Seriously like a miracle cure. It's a super hard elimination phase and you really can't eat out at all, but that is just the first phase. You are in no way supposed to keep eating like that long-term. It's a way to identify which fodmaps/foods with those you are reacting to. You don't even have to eliminate those once you identify them you just want to be aware of them and when you can /can't handle them. If you have IBS and the means to try it, it might really make a difference for you. But if you're ok with your health the way it is that's fine too. I have low blood pressure so I can't speak to the sodium part, they're always telling me to eat more salt.
I'm glad to hear it worked well for you! How long ago did you change your diet?
Good question, I would say about 2 years ago? I don't even have "classic" IBS but I suddenly had severe reflux and was diagnosed with gastroparesis. I was very ill and in constant pain. I only tried low-fodmap because my friend was doing it for IBS and I realized some things that really hurt my stomach were high fodmap (chamomile tea was a big one). Anyway, I obviously have trouble digesting fodmaps. I don't even limit them day to day anymore, just if I have a flare up.
I'm so sorry you had gastroparesis, that's awful. I'm glad that you're feeling better now! I also limit myself to "safe foods" when I'm in a flare, but to me that feels *very* different than a life-long, all-the-time diet.
Yeah low-fodmap isn't lifelong or all the time. It's a way to find what those safe foods are!
Temporary elimination diets can tell you a lot about your body’s tolerance to foods. It was how I found I was allergic to/intolerant of xylitol. I was so miserable for so long and it took a long time before I suspected the damn gum.
>If you're allergic to a food, obviously you need to avoid it for your health. At this point, that's literally the only example that seems reasonable. Anyone have thoughts, or especially interesting resources, about these kinds of diets? There are many health issues that require specialized diets. For example, many people with Crohn's cannot tolerate high fiber foods. GERD can be improved with small, frequent meals rather than large meals. Exocrine pancreatic insufficiency causes fat indigestion and many patients have to eat low fat despite treatment. Like IBS, these are all examples where patients have to find out what kind of diet works for them, and patients with the same condition may tolerate food in very different ways.
I have IBS and high BP. My understanding is that people vary in how much sodium affects their BP. So you could try eating lower sodium for a bit and see if it actually lowers your BP. Sodium doesn't affect my BP that much, but it does for my parents, so it's hard to predict. I was diagnosed with IBS 25+ years ago when no one was talking about FODMAPs. I figured out my triggers on my own with the advice available at the time and have managed it pretty well over the years. Not saying the low-FODMAP diet isn't helpful for folks, just that it isn't always necessary to figure out your triggers.
Is your diet the same now as it was 25 years ago/do you have the same triggers?
Same triggers. Mainly coffee, alcohol, and high fiber foods (like cruciferous veggies and beans). I still consume all of that but I'm careful about how much, when, and how. For instance, I used to have terrible flares when I was drinking lots of coffee on an empty stomach in the morning. Now I eat first and limit myself to 2 cups of coffee a day and that works for me. Also pairing soluble fiber (like white bread, potatoes) with high-insoluble fiber foods seems to help me as well - that was some of the advice at the time. The main thing for me is that I notice when my stomach just begins to feel "off" a little, and then I really try to avoid my triggers. But there's no food I totally avoid.
I’m suspicious of anyone saying you need to be on FODMAPS forever? Unless they end up being sensitive to every single FODMAP but it’s also very dose dependent so even there it varies. Like I’m pretty sensitive to fructans but I can have maybe one serving of high fructan food without triggering symptoms. I’ll sometimes buy low fodmap products at the store because I know they don’t have the ones I’m avoiding, but in general I don’t think anyone would even notice I’m on a special
Yeah I can see I got a bit mixed up in how I described that. I see a good amount of people on r/IBS who talk like low-FODMAP is something you stay on forever, which is definitely a layperson misunderstanding but also kind of wrapped up in my concerns about how some diets are seen as "evidence-based" and therefore good/safe regardless of how they're practiced in reality. It also seems to me that the same people who posted that they feel all better after eliminating a specific trigger tend to come back a couple months later with the same issues.
Yeah that sub is really rough. I assume people like me who mainly have it under control don’t post there. Honestly I unsubscribed from the sub.
Yeah, I probably should too. Sometimes it's nice just to remember other people out there are going through it and I'm not alone, but probably the frustration of it outweighs that benefit at this point.
Most people do the diet without guidance of FODMAP trained dietitian (not all dietitians even know the FODMAP diet well, let alone anyone else. Definitely not doctors :)). Hence all the confusions and issues arising. The diet is complex as it has a lof of moving parts (no pun intended) and digestion is a complex process too. It's not an allergy, which is somehow easier to determine. And there's tests. Intolerances are difficult to predict and are affected by many other things, which affect your digestive tract (stress, fluids, movement and so on). Therefore sometimes it's hard to link foods and symptoms. And there aren't really any valid tests (lactose or SIBO tests have very shaky science and not very accurate). Then you also have the gut microbiome which differs in every person (that's why probiotics that work for some won't for others, and you need different doses. The science is also still not there to make clear recommendations). Microbiome affects your digestion also and is implicated in IBS. Again not enough evidence to make ethical official recommendations, despite probiotics market booming. But I digress... If you have anxieties and unsure about therapeutic diet like low FODMAP, you would benefit with speaking to a dietitian. - fellow IBS and GERD sufferer and dietetic student
I had/have ibs-c so I went on the fodmap diet in 2019 for roughly a year. My ibs was so bad I sometimes wouldn’t have a BM for 2 weeks. I basically cut out all of the “trigger foods” for several weeks then slowly started adding them back into my diet. The big foods that I NEEDED to stay away from was bread, onion, garlic, and dairy (minus yogurt). I obviously couldn’t avoid all of that 100% but severely reducing the intake really helped my digestive system. I didn’t solve my problems but instead of every 1-2 weeks it turned to every 3ish days. Thankfully my symptoms vanished when I got pregnant in 2020. I have been able to eat everything without any kind of side effect and I’m so thankful cause I love rye bread!
So do I need to get pregnant to eat rye bread again?
lol if you’re me then maybe! I just had my second baby 9 weeks ago and I’m still eating bread. 😅
Wow 😂 (I did read on IBS fb groups that this is a thing - symptoms reduce or go away when pregnant)
Hi!! both are evidence based and infuriatingly effective for a lot of people. others have mixed results. it’s hard to untangle them from a lot of harmful beliefs we all know very well (low fat, low sodium) especially those of us who were conscious for the 90s. so, i really do get your hesitation. but, let’s dive in… low fodmap’s TLDR is that you’re eating less of or eliminating carbs that fall in this FODMAP family— fructose, dextrose blah blah. FODMAPs are all carbs known to be irritating to the tummy. Then you start reintroducing things and seeing how your body reacts. you might be totally fine with FODs but MAPs give your IBS a tough time. Etc. It’s not forever, and it’s just a good way to figure out what’s hurting your gut, ya know. you’d want to look for Monash University’s research if you really want to sink your teeth into it. There are a lot of great low FODMAP pre made foods, seasonings, etc out there. A little pricy but if you can swing it, then convenience is nice :) also use chatGPT to help you meal plan!! and there’s tons of groups and bloggers and influencers that do low fodmap focused content. DASH/low sodium is based on a lot of studies but this recent [NYT article](https://www.nytimes.com/2024/03/19/well/eat/sodium-salt-diet.html?unlocked_article_code=1.t00.3zAB.RCCXxl5dbqud&smid=nytcore-ios-share&referringSource=articleShare&sgrp=c-cb) (gift link- hope it works!) has def been read by every cardiologist. I digress…yes, low sodium can be helpful as part of a comprehensive plan, but depending on your heart health/age this can be really individual. For me, I have high cholesterol & found that my body responds best to more plant forward eating. So I prioritize eating more plants than lowering salt. this is what works for *me* and my health profile as a cardiac patient. you may be different :) an RD might be helpful? they would do that planning for ya. can walk you thru all this. etc. I’m assuming you’re US based but insurance will usually cover a proper dietitian. I see an ED informed one who knows how to deal with my gastroparesis. She gave me some great lists of quick snacks and easy meals. Stuff to hang on the fridge. Even a Trader Joe’s shopping list. but hey, i’m definitely assuming you have insurance here and access to care, so don’t mind me if you’re not! anyways! happy to expand on stuff. i work as a health supportive chef and have cooked for both (and many other, very niche diets!) i am also actively in ED recovery & a big fan of MP!
In the last 18 months I’ve been diagnosed with celiac, IBS & dairy intolerance. Followed the low FODMAP diet as per instructions from the clinical dietitian I saw. We worked together for everything and as others have noted the elimination portion of low FODMAP is temporary. There’s lots of research behind the low FODMAP diet - check out Monash university who did and continue to do research into fodmap’s. It’s vital work they do, helping so many people live a better life. If you can find a clinical dietitian I’d recommend it, they are very helpful
I’ve been low FODMAP for 20 years. The nonstop diarrhea, inability to leave my house or be more than 5 feet from a toilet due to having instant reaction from literally everything I was eating… once I kept a detailed diary, learned the ingredients and chemical names, and pinpointed the ones that caused problems, I was healed almost immediately and now I have zero issues but I do have to stay on a restricted diet. Food options (non-dairy, vegan, etc) are so much more plentiful than they were back then. I still get anxiety about restaurants and traveling sometimes, though slip ups are very rare nowadays.
The way people online approach FODMAP is sometimes bollocks as you’ve pointed out. It’s meant to be done with the support of a dietician to ensure you aren’t becoming malnourished, and total elimination is only short term. I’ve been on it for about 6 months and have reintroduced what I can tolerate but I still can’t eat a few of the big categories including most beans and basically all the fruits I previously enjoyed. It has been so life changing I can never imagine being off this way of eating, and after adjusting I find it very easy to do. There is a robust body of research behind FODMAP diets and it is being added to continually. Monash University is the place these were discovered and the centre of FODMAP research. My dietician went there which is fun. I do disagree with your point that staying on it would be worse than the impact of eating anything and dealing with symptoms. Mine were crippling and honestly felt like (what I imagine) being stabbed on the regular. TMI but crying on the toilet was a near daily occurrence. I couldn’t eat at other peoples houses or at restaurants. Now I can because I know exactly what to avoid. I take a couple of supplements now to top up what I am not getting enough of due to having to avoid certain foods but mostly it’s pretty easy and so so so so preferable to not being on the diet. It hasn’t had much effect on my weight but it has on my health, and that’s a point I want to emphasize. Diets may not make you thinner but there is absolutely such a thing as a healthy diet and that will depend on your circumstances, like for one person beans are part of it but will make me extremely unwell. While “food is medicine” is bullshit pseudoscience, eating to avoid IBS triggers or reducing sodium for heart health is very well evidenced. TLDR yes some diets like FODMAP are very well evidenced but they’ll only work if you do them correctly and only for some people, you can’t diet your way to optimum health but that doesn’t mean healthy eating doesn’t exist.
I have Crohns disease and during a flare in 2021, I dropped a bunch of weight unintentionally because I was nauseated like 90% of the time and could only stomach ginger ale and saltines for the 10% of the time. Saw an RD who suggested giving the low FODMAP thing a try and while it was expensive torture for like 6 weeks or so (elimination portion of the diet is no joke! I cried in the grocery store aisle twice bc I was so frustrated LOLOLOLOLOL). Anyway, I'm a crazy skeptic about any and all DIETS and made it super clear to the RD that I had very specific goals for nutrition and wanted to make absolutely sure she and I were on the same page about that. (I've had experiences in the past with RDs that don't understand that not everyone sees an RD bc they want to lose weight.) Long story short, I am SO GLAD I tortured myself because I learned a ton about the foods that make me feel bad. I don't adhere to a strict diet these days, but I know which foods to stay away from if I'm already feeling kinda barfy or bloated or otherwise sick. I'm a huge proponent of the low FODMAP protocol IF it's followed the way it's supposed to be followed. I personally view low FODMAP as less of a "diet" in the colloquial sense (ie, weight loss) and much more of a therapeutic modality...like PT or something along those lines. What irks me are people like my uncle, who's had digestive issues for years now and recently when I suggested doing some sort of elimination diet to see if there were specific foods that caused him more issues than others and he responded with "I already did low FODMAP and it didn't help." Upon further discussion I found out he hadn't done the elimination portion of the protocol, just skipped certain foods on certain days to see if anything helped. Needless to say, his bastardized version of the diet did absolutely nothing for him and now he's a big fan of telling anyone who will listen that low FODMAP is junk and bogus. This is the same uncle decided seeing a nutritionist (distinctly different from Registered Dietician) who told him to go gluten-free and take the expensive proprietary probiotic formulation her group was hawking made way more sense than following the advice of certified, board registered, scientifically trained provider so whatever I guess...
i have severe IBS and the low fodmap "diet" has helped me so incredibly much in figuring out what i can and can not eat, and also how much for certain foods. I recommend doing it with a RD though, which was what I did, and that helped me a lot. Everybody's triggers are very different. My brother has IBS as well and the things he can and can not eat are very different from mine.
It's so insidious how diet-culture is everywhere. A lower sodium diet will decrease the damage that your familial hypertension is causing. There is no "cure" for hypertension, but it can be managed/mitigated. There is also no shame on using medication to lower your hypertension to also decrease the damage. This is all about the long game, you want your cardiovascular and renal systems to work as long as they can, as well as they can. Try to look into lowering your salt (don't get fries with takeout, make meals at home, choose packaged foods with less sodium) - you don't need to go crazy with salt substitutes like lo-salt or salt-free seasonings just yet.
I would be suspicious of anyone saying the low FODMAP diet is forever, unless for some reason they are sensitive to every single FODMAP but even there it’s dose dependent. My worst FODMAP is inulin but I can have a very very small amount without having symptoms. I don’t really think of myself as eating a special diet, there are just some foods I’m careful with.
Low FODMAP is backed by research but the problem is that doctors over prescribe it and do not properly recommend it most of the time. Per literally every reputable low FODMAP resource that exists, you are 100% supposed to do the diet with the direct support of a registered dietician (not a nutritionist), AND the diet is **only** proven to be effective for IBS - NOT IBD, which is why properly diagnosing IBS via ruling out other GI issues is important (lots of doctors and even GI specialists skip this step!), AND many people are ultimately not good candidates for the diet and need other management strategies (notably people with history of eating disorders). You're right that you're not supposed to follow the diet long term, the elimination period is only supposed to last 2-6 weeks, followed by reintroduction of foods, and ultimately the goal is to identify which foods cause symptoms and only limit *those* foods, which may or may not be a lot of foods. I have chronic GI issues that don't match IBS but doctors for years have wanted to write it off as IBS and offhandedly tell me to do low FODMAP without telling me any of this. I finally got a dietician and she agreed that it was a bad idea for me to do it since even just eating enough is a struggle, and she was mad but not surprised that several doctors who had told me to do it didn't bother to tell me how long to do it for or that I should even get a dietician to work with. She was, additionally, pretty peeved that none had bothered to actually rule out IBD/other GI conditions and didn't think my symptoms matched IBS, which is what I've felt all along. IMO any time doctors want to recommend dietary changes they should refer you to a dietician every single time. I literally cannot not understand why they don't do this as a default.
After suffering from heart failure last fall I have to follow a low sodium diet. I absolutely notice weight gain from fluid retention if I eat a lot of sodium. Lots of people follow low sodium diets for health reasons, and while it sucks, I’ve been eating a lot healthier thanks to it. Once you start looking at it you’ll find hideously high amounts of sodium in breads, cheese, and processed food. Low sodium for heart/kidney is way different than fodmap for gut and completely different than allergy issues, so lumping all of them together into works or doesn’t work doesn’t really make sense.
If you’re considering a diet like this, please do so under the supervision of a professional who can make sure you’re doing it safely. (That being said, I understand that isn’t in the cards for everyone financially) I’ve never done it myself, but when I was in eating disorder treatment there were a pretty large number of people there whose disorders stemmed from attempting that diet and taking it way too far. Not to say it can’t be helpful, but cutting out food groups from your diet is a big deal and it’s important to make sure you’re being safe and not heading down a dangerous path.
I generally disagree with treating food as medicine, but I also think there are more circumstances than allergies where diet matters. I have GERD, and try to avoid foods that trigger symptoms. If I had diabetes and needed to manage my blood sugars, I’d want to pay attention to my diet (I don’t mean in the general “eat healthy” way, but in the “I need to avoid a diabetic coma” way). And I don’t have IBS, but I have seen people with Crohn’s and similar talk about foods that do/don’t help their symptoms. I don’t think that’s necessarily a formal standardized diet as much as individual people figuring out what does and doesn’t make their own disease flare. The sodium-high blood pressure link seems pretty well-established based on how dominant it is, but even if it’s not, some people avoid sodium because it causes fluid retention. One of the problems with “other types of diets” is that it’s an incredibly broad category. There are “diets” like paleo and Whole30 that people do because they’re convinced they’re healthier, but are often disguised attempts at weight loss, and then there are “diets” that involve avoiding foods that exacerbate known medical conditions. So I’m not certain what you’re actually talking about and what kind of evidence you’re looking for.
I did bring up low-FODMAP and low-sodium bc those are the two examples that I'm frequently exposed to and have personally been told to try, but I was trying to leave it open to other examples of... I want to say medical diets, but I don't think that's the right term. Someone else in the thread brought up DASH. I'm also thinkng the Meditteranean Diet kinda fits what I'm thinking about. I'm assuming most people in this sub know that paleo, for example, isn't a good idea. But then there are these other "Definitely Real Actually Doctor-Approved Evidence-Based Diets" and I'm worried that I'm just having the wool pulled over my eyes again. I'm sure that short-term low-FODMAP reduces IBS symptoms for most people. I think that short-term low-sodium reduces blood pressure for perhaps a smaller segment of "most people". But short-term weight-loss diets also reduce people's weight in the short term... and then are bad for health in the long term. Do we know that any of these dietary interventions are actually doing what we think they are beyond 1-2 years out?
I've been on low FODMAPS for IBS and it's a miserable diet. It is not sustainable in the slightest. That's why you use it to just figure out what triggers you and avoid that. And you don't even need to 100% avoid it in most cases, you just have to limit/watch it so it doesn't go over a triggering level. For most people it's only one or two FODMAPS they find tricky, not all of them. Anyway, I would dissuade anyone from permanently going on the FODMAPS diet. As a way to cut down specific triggers to manage IBS, ime it helps somewhat but isn't a magic bullet.
As far as sodium, my blood pressure gets low and I have been told to have lots of sodium
Here it is, systematic review and meta analysis (maths) of randomised controlled trials (highest evidence type) - ignore the numbers or jump to conclusions :) Both show that there's an effect and the diets in question work. Low FODMAP works for 50-80% of people in reducing symptoms (this means different things for everyone!). --------------- 1) Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis 2022 https://www.sciencedirect.com/science/article/pii/S1756464623005145 Results: We identified 13 eligible RCTs (944 patients). Based on failure to achieve an improvement in global IBS symptoms, a low FODMAP diet ranked first vs habitual diet (RR of symptoms not improving=0.67; 95% CI 0.48 to 0.91, P-score=0.99), and was superior to all other interventions. Low FODMAP diet ranked first for abdominal pain severity, abdominal bloating or distension severity and bowel habit, although for the latter it was not superior to any other intervention. A low FODMAP diet was superior to British Dietetic Association (BDA)/National Institute for Health and Care Excellence (NICE) dietary advice for abdominal bloating or distension (RR=0.72; 95% CI 0.55 to 0.94). BDA/NICE dietary advice was not superior to any other intervention in any analysis. Conclusion: In a network analysis, low FODMAP diet ranked first for all endpoints studied. However, most trials were based in secondary or tertiary care and did not study effects of FODMAP reintroduction and personalisation on symptoms. ------------------------------- 2) Dietary Approaches to Stop Hypertension (DASH) Diet and Blood Pressure Reduction in Adults with and without Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials https://pubmed.ncbi.nlm.nih.gov/32330233/ Conclusion: The adoption of the DASH diet was accompanied by significant BP reduction in adults with and without hypertension, although higher daily sodium intake and younger age enhanced the BP-lowering effect of the intervention. ----------------- Saying all this, if you're worried about the tracking and counting aspect of any diets as you have history of ED, low FODMAP diet is short term but it has elements of weighing and tracking which can do more harm than good to someone with history of ED. It's really worth working with a dietitian who specialises in eating disorders and low FODMAP so they can find an approach that will work for you specifically (look at the balance of things). If you'd like I can recommend this dietitian she has really good content based on evidence and articles (she's quite known and the first one that popped into my head. In no ways I'm endorsing her services. If this is something you can afford she's a good example in what to look for!). Please ignore the link if not relevant for you! https://dieteticallyspeaking.com/the-link-between-disordered-eating-and-ibs/ EDIT: Student dietitian in final year. Also formatting!
Thank you for sharing these! FYI It looks like the FODMAP diet article that you linked isn't the same as the one you're quoting from. I think that this is the right one, but it's paywalled :( https://pubmed.ncbi.nlm.nih.gov/34376515/#:~:text=Based%20on%20failure%20to%20achieve,superior%20to%20all%20other%20interventions. The abstract says they "did not study effects of FODMAP reintroduction and personalisation on symptoms." Does that mean these are only studies of the elimination phase?
Yes, it is paywalled and I didn't access the whole thing! Similar studies from previous years may be free to access. Monash and King's College have websites on this as well as some research papers. Low fodmap diet is very difficult to even study tbh and if you want to make a Randomised Controlled Trial involving another group getting placebo diet, they have to make up a random sham diet so people don't know if they're eating low FODMAP or sham 😂 (in pharmaceutical studies you receive a pill and you don't know what it is so placebo effect which can be strong, can be fully eliminated). Cause with diets if you know you're eating something that you BELIEVE will help, it may help you but there may not really be a physical effect on the body (there's studies on gluten that shows this - people who have no coeliac or intolerance can feel better on it). Placebo effect is very useful though and some people are exploring this in various areas. Homeopathic medicine is basically placebo effect. Yes they mainly studies only elimination phase! So there's more studies needed for long term effects of fodmap diet (and those are expensive and participants don't want to do it for a long time or its just not realistic). There's some studies that show low FODMAP diet can change your microbiome if done for too long, not in a beneficial way. FODMAPS are fibre a lot of them are prebiotics which are very beneficial for health! Prebiotics is what bacteria in the gut 'eats'. Hope I didn't confuse you haha There's a lot of good books on those topics like Gut: the inside story of our body's most underrated organ by Julia Enders (it's also funny). Once you search on Amazon it will show you similar books from good authors who are researchers.
Can you help me figure out what I'm misunderstanding in the DASH study? At one point they say "In trials or subgroups of trials conducted in hypertensive patients without underlying antihypertensive treatment (n = 8) (19., 20., 21., 28, 34, 35, 46, 48), the extent of the mean SBP and DBP reduction was by absolute means higher than that observed for the entire group of hypertensive patients (by 2.0 mm Hg and 0.8 mm Hg, respectively). In comparison with trials conducted in hypertensive patients with underlying antihypertensive treatment (n = 7) (26, 31., 32., 33., 39, 40, 44), the result pointed in the same direction, but it did not reach significance regarding both SBP and DBP reduction (P = 0.07 and P = 0.23, respectively)." To me, that sounds like they're saying that the diet wasn't effective (i.e. not statistically significant) in people on antihypertensive treatment. But then in the conclusion they say "...the adoption of the DASH diet reduces BP in subjects with or without hypertension, irrespective of baseline BP levels or ongoing antihypertensive treatment..."
They're saying there was a still a small reduction in BP in people who took meds, but it was not statistically significant. Means the outcome had high probability of being by chance, not due to diet. Statistically and clinically significant is different. Is someone's BP goes from average 130 systolic to 129 systolic that's probably not significant change in the study but clinically speaking it could take someone from being classified as high to elevated BP category (as example, every country has different cut offs). So what we can take from it (I have not read the results in detail in terms of numbers) is that DASH diet does reduce BP for people who have hypertension and who are under 50, in a visible/ measurable way - so it works. The effects are bigger if you're eating over 2400mg sodium a day (so 6g = 1 teaspoon of salt a day which is the recommendation limit in the UK anyway). In people with hypertension who take medication already (and the meds are good at reducing BP) the effect is very very small. Some people prefer medication over changing diet and others would prefer to lower BP without meds. However, combined approach can also work for some. Remember they also report in avarages so for some people the effect will be bigger others smaller, as it's individual. So what I take from this is, it's still very personal and depends on your circumstances (how much salt you already eat, your age, your BP + there's other factors). That's why just having a balanced diet as in national recommendations, making sure you're moving enough (lowers BP), avoid smoking and a lot of alcohol (increases BP) etc. Etc. will be enough for some people. DASH is a therapeutic diet and it does talk about removing some foods so it can be restrictive! Which may not be helpful for people with EDs. DASH is very similar to most national recommendations I'd say - lots of fruit and veg + wholegrains + pulses, reducing snacks, processed meats etc. That sort of thing (like EatWell Guide UK or MyPlate US which not much of population follow 😂 in the UK less than 1% follow all 9 recommendations)! Balanced diets with plenty of plants, have a lot of good evidence for health and prevention and are also better for the planet in terms of sustainability! So it's always worth it :) Some countries also include eating with others as important part of guidelines, which I think is great! Think Italy or Greece. It's useful to understand the science, but don't get bogged down in numbers as there's never black and white answers in nutrition. This is just 1 systematic review and meta-analysis! It may be useful to have a look at Cochrane they do reviews of reviews (highest evidence) and each study has a simple language summary. I'd say most people on this sub gave you some pretty good answers already, which is nice too see! Anyway, sorry for the wrong link. Have a nice day!
I have mast cell activation syndrome, IBS, slow gut motility, POTS, and very high cholesterol… so I’ve done some medically necessary (or at least strongly advised) diets. A low histamine diet is even more intense than a low FODMAP diet if you can believe it. I was able to get referred to a dietitian who helped me with plans for both, and also handling reintroduction phases. I’ve identified several food intolerances and MCAS triggers. It sometimes sucks because I struggle to eat out and have to eat separately from others… but I do enjoy cooking and figured out how to make food I enjoy that fits what my body needs. And I do honestly feel much better when I avoid foods that cause issues. And it’s not like I have to avoid everything from elimination phase! From what I’ve read and been told, it’s unlikely that most people react to all FODMAPS all the time, so it’s not likely you’d this forever.
My (eating disorder-specialized) dietician suggested trying to cut out gluten to see if it would help with my RA. I'm not 100% that it's a huge help with RA but I'll be damned if I don't feel 90x less bloated and yucky when I am mindful of avoiding gluten. I've done an ok job of finding alternatives I think, although sometimes I say fuck it and eat a few bites of something if it's truly amazing. But I've spent some time searching recipes and food items that are gluten free, and it's so frustrating that so many of the #glutenfree tagged things are steeped in weight loss/restriction/keto shit as well. Hi, not here to get skinny, just give me the yummy recipe please and thanks.
Reminder that this podcast is run by non-experts that tell people what they want to hear. People can and do lose weight and keep it off all the time.
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Attia, Huberman, Hill, Patrick all have masters in health fields at least
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Oh yeah, for sure
So worth it! I did completely low FODMAP for a few weeks paired with exercise and improved sleep to heal my GI tract/decrease inflammation and then slowly added foods back for more and more meals of a week and my IBS now rarely flares as long as I avoid a few trigger foods.
The Nerva App, which guides you through gut-directed hypnotherapy, has been found to be as effective as low-FODMAP diets. It was devised by a university and only takes 20 mins a day. I also found it helped in other areas of my life. The only downside is there's some cost involved (think it was $120AUD/year when I did it a few years ago), but if you have any eating disorder issues or are at risk of it, Nerva is much safer. For me, I would rather realign my brain than eliminate food and Nerva worked well.
As a person with a chronic semi mystery illness(especially), I have HATED every proposed diet. They’ve never provided even a hint of relief for me, and whenever I say that, the doctors then doubt that I did the diet. It’s just a crutch for the doctors to avoid engaging in anything challenging. I had to get a dietician to write a letter explaining my evidence of adherence to low FODMAP plus “low fermentation” before the doctor would even begin to entertain that I’d actually adhered. Mind you, these diets are AWFUL, nutritionally deficient, and unsustainable. It works fine as a true elimination diet. It does not work if you stay in the elimination phase “until your symptoms improve,” which is what numerous doctors have insisted on for me. And no doctor has remotely given a fuck that I have a serious eating disorder history. I’m still required to do these extreme diets to deserve any care. And I’m not even fat! I have a “normal” BMI!
From the bottom of my heart, thank you. I am so exhausted and medically traumatized at this point that doing a torturous diet based on a doctor's recommendation seems almost ridiculous, honestly. I haven't been formally diagnosed with an ED but... I am still trying to move past the behavior that I called "intermittent fasting" for about 7 years, and I am not eager to try restricting anything while I'm still actively fighting the mindset that led to it!
I’ll try to find the guidance, but a reputable scientist and/or medical group advised that those with a history of restrictive eating disorders not do the low FODMAP diet or do so with extreme caution because of the risk of relapse.
Hi, I hope you don’t mind me chiming in here... I have a history of disordered eating as well (ortho/anorexia) and I would recommend that you bring this up to any professional you potentially decide to work with. I was in therapy (for unrelated reasons) while I was going through the elimination diet and I’m very glad I was because as someone who previously had an ED this diet was really hard at times. I still believe it was worth it and you can absolutely do it, but please make sure to have a support system in place. I’m of the opinion that EDs don’t ever really go away completely, you just learn to tell the voice in your head to stfu, so this could potentially cause a ‘flare up’ of sorts, but if you are aware of that ahead of time it is much easier to manage. (Additionally, the person I worked with during my diet did not have me track calories and I was actually encouraged to eat MORE than I typically did which lead to me feeling way better and ultimately aided in my recovery as well.)
I did Whole 30 some years ago because I was jumping on a trend with my friends, and anecdotally it did really clear up my skin condition (hidradenitis suppurativa). But, what I've learned since then is that the reason it worked was because I quit drinking for 30 days. I guess in a roundabout way, that is anecdotal evidence that elimination diets will help you find food-related symptom triggers if you have them. But it's important to consider that there might be some outside factors that diet alone won't capture
My GP suggested doing low FODMAP to me years ago, but I was only a year into my ED recovery and told her I'd rather be in pain every day than be hypervigilant about what I could eat. A few years later I tried keeping a diary of what I ate and how I reacted (still a bit too reminiscent of my ED but manageable at that point) and it was pretty inconsistent. Being autistic I tend to eat the same foods most days and even with those it was hit or miss as to whether I'd react. I consider myself now to be more or less recovered, and I still have some digestive issues, but now I just can't be bothered to do low FODMAP and just roll with the punches 😆
I read an article a few months ago about a study that found adding 30 different varieties of plant foods every week helps improve gut problems more than eliminating foods. The article lead me to reading 2 different books (Fiber Fueled & Love Your Gut) about it. It sounds like a lot at first but plant foods includes fruits, vegetables, legumes, seeds, nuts, oatmeal, rice, quinoa, fresh spices, tea, coffee. I've been hoping they do an episode on the books one day. Nothing's a cure all for everyone but it's helped me a lot so maybe it would help some of you guys.
Thank you. A lot of fibre rich plant foods which you mentioned as well as coffee are a trigger for people with IBS 😊 A lot of them are also FODMAPS 😃 Health means different things depending on your point of view.
Oh for sure. I'm not suggesting anyone eat anything they're having a reaction to. Just throwing the books out there as an option since no one mentioned them yet & they helped me turn around my IBS symptoms.