Low fodmap, how to add foods back in?

[Myrtle81]

Hello,

Am having good success with the low fodmaps diet, and low sugar as well. But every time I try and add foods back in I get trouble again. Has anyone got any advice on this please?

Thanks

[patientj]

Hi Myrtle,

My re-introduction of FODMAPs was very unscientific and a case of trial and error, because my symptoms never stabilised on the diet. However, this link might be some help - rmdietetic.com/2015/12/07/r... - and I recently saw this link on Twitter written by the same person - nicerfoods.com/top-tips-get....

Best of luck.

[Myrtle81 in reply to patientj]

Did it work for you? Where is your journey now?

[patientj in reply to Myrtle81]

I keep meaning to write a blog post about it but never do. Maybe soon...

I've been on a modified low FODMAP diet for about two years now. It hasn't eradicated my symptoms completely, but now I've got my anxiety under more control, things are more stable and predictable. That has allowed me to work out what my food triggers are, and also predict when I can and can't get away with eating higher FODMAP foods.

There have been some surprises along the way. When I first went on to the diet, I accidentally-on-purpose had a small helping of baked beans and was farting for a week. I thought I'd never touch them again, but I've now discovered I can eat small amounts without problem (or at least no more a problem than the general public).

Another surprise was broccoli. I used to eat this a lot but cut it out on the diet. I've since discovered that I can usually tolerate it, but if I ever have it with tomatoes, for whatever reason it disagrees with me. We're all different.

I still use lactose-free milk just to keep things under control, but have no problems with normal milk in my tea, or even on my cereal if away for a couple of days. I've been eating cheeses and yoghurt for a while now with little issue.

The main thing for me has been cutting out wheat. That made the biggest difference overnight. However, I don't (and we shouldn't) abstain completely. I won't have sandwiches but if someone is serving bacon sarnies the morning after the night before I'll insist on a single slice of white bread. I have gluten-free pasta and some other gluten-free products (e.g. Domino's GF pizza base is actually better than their normal base in my opinion) but I will sometimes treat myself to a Gü dessert which, on a one-off occasion, doesn't seem to be a problem, and is also good for my morale.

I also feel that soy products may contribute to my IBS so I've been managing that in a similar way. Cutting them out where I can, not eating on consecutive days but not stopping me from treating myself when I need to. I was excited to discover that After Eight mints are soy-free. I think my dentist would be less-impressed!

Everyone's different, and will have different tolerances. Like me, you may find there are foods you can't stomach now, but that you might be able to in a few months' time. Let us know how you get on.

[Myrtle81 in reply to patientj]

Hey, it sounds like our triggers are the same, I am the same as you with broccoli, soy, tomatoes etc etc. I have, however found sour dough bread to be amazing!!, I have a couple of slices in the morning and it seems to bind things together a bit more.

I am also lactose intollerent after gastric flu, I have tried to reintrduce slowly.

The blog you sent over, says you eat your trigger for three days and have three days wash out, is that what you have been doing? How does it help to reintrduce? 

Am pretty strict on the fodmaps at he moment and when I had that first solid bm, it was like nothing else, a wow moment, but now am needing to get some foods back in.

Please keep me posted, so interested in this. 

Xx

[patientj in reply to Myrtle81]

I've not had the confidence to try sourdough yet. I did make some spelt bread a couple of years ago. It tasted great but the side effects were noxious and I'm very glad no one could work out it was me!

I've not done the whole reintroduction process properly. As my symptoms were never stable I would never have been able to tell if what I had eaten caused the symptoms or something else. Instead, one day I just decided I'd try a little of something I hadn't eaten in a while and see what the consequences were.

You should probably try and do it properly, though; especially if you have some control over your symptoms. The washout phase is important because sometimes IBS symptoms can take a couple of days to manifest themselves so if you don't leave this window, when you try the next dietary trigger, the symptoms you experience may be a result of the previous test FODMAP rather than the current one.

Hope that makes sense!

[Myrtle81 in reply to patientj]

You should try the sour dough, I am really fine with it and butter on it too, try a small piece. I had spelt bread and that was awful with me too.

Ok, I think I will try the process, I am still not sure how trying something for three days will cure you of that food! I presume they mean little bits at a time, the wash out, then next food, wash out, then next food, repeat...?

Shame you can not get your symptoms stable, mine are 'if' and a big if, I stick to fodmaps with no cheating, which is super hard, with cakes and treats about. Although I am baking my own dairy free treats now.

[patientj in reply to Myrtle81]

Good luck!

One clarification: the three-day trial of each FODMAP isn't to cure you of it, but to see if that FODMAP triggers symptoms. I think the advice is to try increasing portion sizes and see if anything happens. If you don't get any symptoms as a result, then it's probably safe to reintroduce those foods back into your diet (but only *after* you've finished the other tests). Or you may find you can tolerate a little, but not lots.

I'll try and give the sour dough a go, then. I presume you found the normal wheat-based sour dough no problem?

[Myrtle81 in reply to patientj]

Right I see, so the new forth you can avoid said triggers, presumable you can keep going on the repeat till you can tolerate it smaller amounts?

The sour dough I brought from tesco, White sour dough bloomer, hope that helps. Very tasty. So I guess it is wheat based, but white bread.  I am really missing my brown breads with nuts and seeds, but that does not work well for me at the moment, sadly. I am missing vegtables I like also, inc broccoli.

[patientj in reply to Myrtle81]

People find that there are some FODMAPs they simply cannot eat. If you get symptoms from eating some, there's nothing to stop you from trying it again in the future. However, I don't think constantly trying the same FODMAP builds up your tolerance to it.

The modified FODMAP diet is basically the diet you live with - low FODMAP diet plus whatever FODMAPs you can tolerate at whatever amount. Also, there's nothing to stop you eating the things you can't tolerate once in a while - at least this way you can plan and know what and when to expect things to go wrong!

[Myrtle81 in reply to patientj]

Hello...

I presumed, with my non infinite wisdom! There was a stage where * you have ibs, mine is after a short illness along with lactose intolerance, you have a crap time, you work out your triggers...

* You live on the diet you can tolerate avoiding your triggers, eg,  so at the moment I am having hard bm, and things are good, presumable at this stage your gut heals??? Presumably (?) at this stage, your body can rid its self of bad bacteria, and start to re build, take a probiotic too...

Do this for a month, longer perhaps, then, start to reintrduce foods? 

Is that possible? Does that happen or work?

Many thanks 

[patientj in reply to Myrtle81]

Some people's IBS does disappear. I don't think we really know why.

As no one is completely sure what causes IBS (and there will be multiple causes) it's very hard to answer your question, both in general, and specifically for you.

You talked about your gut healing. There is a school of thought that says IBS is caused by a leaky gut (the tight barriers between cells are loosened and allow food and other compounds thought), possibly following an infection. That is beyond my area of knowledge so I wouldn't like to comment on how true that might be or what the prognosis is/can the gut heal itself in that way.

As for the bacteria, I know a bit more about that! The low FODMAP diet does alter the bacterial composition in your gut. It may be that by removing some FODMAPs from your diet, you starve some bacteria of their primary food source and these colonies dwindle, allowing other bacteria to take their place. The problem is that bacteria can be remarkably resourceful and work out ways to process different foods, so these 'evil' colonies may survive in low numbers just waiting for the right FODMAP to be served up to them at which point they will capitalise on that food source better than any other bacteria and the colony will grow again.

The added complication is that we don't know whether the IBS symptoms are caused by a microbial imbalance, or an individual's inability to tolerate the bacterial by-products of digestion (or both!). It could be that for whatever reason, some IBS sufferers' guts are more sensitive to pain (in fact there's even some scientific evidence suggesting this) and so the same bacterial colonies could have vastly different consequences for different people.

So, in short, IBS can be short-lived and people do recover. However, for many patients it's a question of managing your IBS in the long-term and perhaps along the way stumbling across something that helps more.

Does that answer you question? Quite happy to explain more is you're still unsure.

[Myrtle81 in reply to patientj]

That is a brilliant reply, thank you so much, really in depth. Yeah I totally get it, all what you are saying. 

Since having 'ibs' I have read and read loads, also tried lots of things to work out what is going on, we are all like guineapigs really I guess, testing and re testing.

And yep the bacteria can be super sneaky, I am hoping to trick my mine with the above solution!!! 

Yeah I get everyone is different, it seems like a nightmare to treat, so glad I found this forum and and so glad we can chat about what works and what does not. There are also some great blogs about I have read, from people suffering to people who have cured, through various methods.

Thanks again for your reply, yeah that does help, as I suspected, all different inside and out, and doctors have no clue really!!

Have you been down the doctors route? With any success?

Many thanks

[Myrtle81 in reply to Myrtle81]

My ibs was from gastric flu, with a time of stress thrown in as well, I also got lactose intollerent from it as well. 

Previous I could eat anything no problems. Am suspecting mine is a bacterial over growth now.

[gilesy94]

I don't know whether this is some help or not but I have had IBS for two years now and I have been taking some pro biotic tablets every day for the past 4 months. Now, If I have something what I deem 'bad for me' or 'naughty for my tummy' I'm not that bad. I still have a loose bowel or slight tummy ache but near as not as bad as what I would have been a year ago! After taking these, I feel I am getting stronger and stronger everyday and if I do have something which I shouldn't. So no I haven't as such introduced anything properly back into my diet but it may benefit you to take some pro-biotics first to build up your immune system. It's just a thought. Good luck.

[Myrtle81 in reply to gilesy94]

Thank you so much, I am at this stage you said, I have a diet that is solid now, which is great, so am now taking good probiotics, great minds and all. Thanks for your help. Hopefully slowly we will both get more healed guts. Xx