Low fodmap diet and indigestion

[Bluemon76]

Hello there,

Has anyone with IBS-C and acid reflux followed the low fodmap diet? I've been looking into it but lots of things in the diet safe for IBS are not safe for acid reflux. Anyone have any experience on it?

Thanks for reading

[Catatvet05]

How is your reflux? Is it constant? The FODMAP is okay, sometimes is works and it doesn’t. Dairy and gluten is a no, although very little is okay. For me, at the start was try and error and making sure I don’t eat it again. Fried food is a no, no although I love good chips! Definitely nothing acidic. It’s taken me over 2 years to get to a point where I’m eating not a lot. Meat and fish gives me acid, pretty much a lot does including rice! Quinoas is good though and so is a little of buckwheat. Salad with celery seems to be good with just a little olive oil.

[Bluemon76 in reply to Catatvet05]

Thanks for your reply, my reflux is usually bad 3-4 times a week, I try to eat acid free foods (at least the ones I know they are acidic) and I don't eat much either, I've lost 10 kg in a year because the only thing really works for me is not eating! So I'm 45 kg now and don't want to go below that. I have to go and see a dietician because it is true that the whole thing is really complex...

Many thanks

[Catatvet05 in reply to Bluemon76]

My gp and consultant won’t send me to see a dietitian! Mine is 24/7. I wish it was 3-4 times a week. I’m constantly burping, acid in mouth etc. Apparently it’s related to anxiety and not gerd or what ever reflux there is. I also lost weight so I feel for you. It’s frustrating for sure! Gp don’t realise how depressing it is

[Bluemon76 in reply to Catatvet05]

I Understand you because my GP is the same as yours, so I'm thinking to see another one or even change gp practice... It is indeed very frustrating....

[Catatvet05 in reply to Bluemon76]

They seem all the same in my local practice. What also frustrates me is they ask me what I want to do next but if it’s referral I have to get tests done. You need someone who has very good grasp of Your treatment and is empathetic. Or unless it’s just the system which I expect partial is the problem?

[Bluemon76 in reply to Catatvet05]

Which type of tests if you don't mind me asking? Ogd, celiac disease, etc? Don't you want to get tests done to rule out other things?

[FRreedman]

The idea with the fodmap diet is to get yourself referred to a dietician so they can go through it with you and make a personal diet just for you. You have to remember that the diet caters for IBD(c), with and without GERD or reflux and also IBD(d) with and without GERD and reflux, so is a very complex and sometimes complicated item to understand. Good luck and stay safe.

[xjrs]

I have IBS-C and have suffered from reflux in the past and did find that some Low FODMAP foods caused me problems due to their acidity - for instance tomatoes.

IBS-C and acid reflux tend to go hand in hand. Just wondering if you've tried any probiotics such as Alflorex to see if they make you more tolerant of foods? Here is some information about IBS that I have shared with others in this group that will explain things further (some of which you will know already):

IBS can be due to a number or combination of factors - these can be stress (including stress from early life experiences) which impacts the communication between the brain and the digestive system. There are lots of free webinars online at the moment regarding mindfulness meditation which might help. Plus you can ask to be referred for CBT or something similar to reduce your anxiety - I would have thought online appointments are available. Exercise can play a major role in IBS in terms of reducing stress, helping your gut microbiome and regulating bowel movements.

There is also not absorbing certain types of carbohydrates called FODMAPs very well, the residue ending up in the colon and bacteria feeding off them causing symptoms. Ordinarily feeding gut bacteria is a really good thing - when you feed good gut bacteria these produce by-products that have great health effects in the gut and throughout the body. However, in some people with IBS bad bugs might have the upper hand over good - these bad bugs may cause symptoms such as pain or disordered bowel movements. There is an interesting infographic on this here:

gutmicrobiotaforhealth.com/....

This is why it’s worth trying probiotics such as Alflorex (which has been scientifically studied for IBS) or Symprove to crowd out the bad bugs and make their numbers die down. If that doesn't work you can try the FODMAP elimination and reintroduction diet. This is normally under the guidance of a nutritionist via GP referral - this may not be possible at the moment so you can read about it online. If you download the Monash University FODMAP app it will tell you which foods contain FODMAPs and in what quantities. You can eliminate all FODMAPs for 2 weeks and then introduce each type of FODMAP one at a time starting in small quantities, increasing over a 3 day period and wait up to 4 days for symptoms. I go much slower than this - only introducing a small amount (1/4 to 1/3 of a normal portion size) of the same food for 3 days and then increase if tolerable or no symptoms and cut back to the previous amount if symptoms for longer and then try to increment again . I've read your microbiome can adapt to handling a new food if introduced very slowly and your bad bugs are under control with a good probiotic. Ideally you want to eat as many FODMAPs as you can since they are good for your health. Many people with IBS don't have diverse gut bacteria - it has been found that people who lack a diverse microbiome are more prone to diseases in general. In the long run, if you can get your symptoms under control, the ideal situation is to have a very varied diet - lots of different coloured fruits and vegetables, a variety of protein and carbohydrate sources including cereal fibres. This may seem a long way off, but with the right treatment all of this is possible. Last year all I could consume to control my IBS was white rice, protein and limited low fodmap veg. Using the approach above (particularly introducing Alflorex) I am now able to consume far more foods - more than I've ever dreamed of including wholewheat bread which is unheard of for me.

If you are also suffering from pain, you may be suffering from visceral hypersensitivity (functional abdominal pain) - there is info about it here:

iffgd.org/lower-gi-disorder...

It is where the brain interprets the normal activity of the bowel as pain - this is due to a wearing down of neurons in pain control centres of the brain which can be caused by PTSD, neglect or abuse in childhood, extreme stressful events etc. The first line treatment is nerve pain agents such as low dose amitriptyline. There is a theory that being on something like amitriptyline for 6-12 months can help the pain control centre neurons to regenerate. Note that amitriptyline can cause constipation, but this can be helpful in people who are diarrhea dominant. Unfortunately I couldn't tolerate these. Linaclotide (for IBS-C only) & Alflorex have helped me with this intestinal pain.

You may also find assistance with anti-spasmodic medication such as mebeverine (Colofac) or enteric coated peppermint.

You can find some info on self management here:

theibsnetwork.org/the-self-...

[Bluemon76]

Thank you so much for your very informative reply. I've tried alflorex for a month and didn't find any difference. I suppose having both things, IBS + Gord, makes things more complicated, as you said, some low fodmap foods can be really acidic for GORD, like tomatoes or pineapple... And being vegetarian doesn't help either....

Thanks again

[Djv01 in reply to Bluemon76]

Hi! How are you doing now? I have everything in common with you. I have IBS-C, acid reflux, and I’m a vegetarian, as well. Have you found anything that helps you?

[pgiese]

I have IBS-C and acid reflux. I've found the FODMAP has been helpful for me, but just because something is in the FODMAP guidelines doesn't mean that it will be harmonious with your body. I take lansoprazole for my acid-reflux, but I still needed to keep a food diary to manage both conditions. Personally, I've found that my acid-reflux has nothing to do with the acidity of foods and more to do with the preservatives, additives, and quickeners. Anything with sulphites is a recipe for a night of pain and anguish! I've found sticking to whole foods where I can control the ingredients is the best option. FODMAP is tricky for vegetarians, since it almost requires veganism. I've found macrobiotic food recipes to be real safe. You need to trust your own experience and intuition. Find a grain (rice) and veg like carrots and start stir-frying (or boiling) from there and add on. I also had no luck with probiotics. Managing stress is also crucial and it aggrevates both conditions.

[Bluemon76 in reply to pgiese]

Thank you for your reply pgiese, I agree that preservatives and additives give acidity, I found that also...