Hi, I'm new to this community. I'm not having much luck with the FODMAP diet, at least so far. My IBS symptoms are milder than many I've seen - I experience regular constipation, bloating, and abdominal discomfort. I started experiencing the abdominal symptoms in April of 2020, completely out of the blue. I've always had issues with constipation and heartburn. I have taken daily heartburn medication for over a decade now. My gastrointestinal doctor put me on a daily dose of Restoralax nearly a year ago now, which has helped a lot with keeping me more regular, but has not helped with bloating or discomfort.
I've been trying the FODMAP diet now for a month, which I believe I've stuck to quite well. I've made the odd mistake here and there, but not anything major. My dietician suggested giving it another week, and if things still aren't improving, I might as well give it up. In fact, so far, I'd say my symptoms might actually be a little bit worse.
Do you have any suggestions? Could there be something else labelled as low FODMAP that causes other people issues? How long would you go at this before giving it up?
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farmer854
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I have predominantly IBS-D with rare bouts of constipation. I stuck strictly to the low Fodmap diet for 8 weeks, and found it didn't work 100% for me either. There were many foods on that low list that made my symptoms worse. Oddly there were some high Fodmap foods which didn't, and I could eat happily (tested after the 8th week)
For instance, I don't do very well with fruits. I can just about handle a dessertspoon of blueberries, and about 15 peeled grapes, but if I eat grape skins it's trouble. Same with potato skins, and sometimes even the peeled ones don't suit me. Same with bananas, oranges etc. Some of the veggies don't suit me but some high Fodmap veggies do!
But one thing I did find are a few staple foods on the low list which were gut friendly for me, and I still eat those now. You will just have to feel your way through the foods, and try very small amounts at first, finding your tolerance level. Likewise you could feel your way through certain high Fodmap foods, and see if any of those are OK.
Some foods are low Fodmap in small amounts, and high in bigger amounts (such as broccoli etc)
Things are so different with IBS D and IBS with constipation. For me, it was mainly fibre or insoluble fibre which was the problem..
It sounds like you have been giving FODMAP elimination and reintroduction a fair try. People's IBS can be due to a number of factors, one of them being a gut bacterial imbalance. This is why FODMAP elimination works for some people since it reduces feed for your microbiome, meaning that bad bugs are fed less, reducing symptoms, but it also means that the good bugs are fed less too, which in the long run isn't so good for your health. Another factor can be stress or having experienced highly stressful events recently or even back to childhood, including childhood neglect. This impacts the gut/brain axis which upsets the signals between the brain and the gut, so gut mechanisms don't work properly. In your shoes I would:
1) Give it another week as your dietician suggests
2) Try Alflorex which has been scientifically studied for IBS and is good at fighting off any dominance of bad bugs in your gut. Give that a 3 month trial. This is better than doing FODMAP elimination and reintroduction since it protects your microbiome, might make you more tolerant to foods. The wider the diet you can eat, the better your microbiome, a good microbiome helps guard against IBS symptoms.
3) Alongside the above, try the Nerva gut directed hypnotherapy app. It helps to improve the signals between the brain and the gut and relax abdominal muscles. This helps to reduce stress associated IBS.
Also if you are more on the constipated side, this can trigger heartburn, since food gets backed up, creating more pressure in the system, putting pressure on the valve that sits between the stomach and the throat, allowing acid to flow back from your stomach. It could be that being low FODMAP might be making your constipation worse since it reduces the amount of fibre in your diet. Have you tried increasing fibre? Alflorex might help you to be more tolerant to it. It did help me in that way. If you can clear out regularly, you might find that your bloating, discomfort and heartburn reduce significantly.
Here are some tips on increasing fibre - you may find that you don't need the constipation meds if your diet is adjusted to include more fibre.
To improve constipation in the short term you can try ground flaxseed on your breakfast, starting at 1 teaspoon and increasing at 1 teaspoon every 2-3 days - you'll need to consume extra water with it.
These foods are also high fibre:
8-9 Prunes
2 tablespoon chia seeds (soaked for 10-15 mins in milk or non dairy milk with cereal or water)
Shredded wheat (or if GF: Nutribrex)
60g Quinoa
Wholewheat bread (note Alflorex may be necessary to make you more tolerant to this)
75g Whole grain pastas (if GF: Buckwheat)
2 Hard pears
5 Dried apricots
90g Raspberries
1 orange (contain a natural laxative)
2 kiwi.
I find that I need to have 1 orange a day and then another high fibre fruit later in the day to help with BMs.
If all else fails, try Optifibre - reading the label regarding working up the dose.
Exercise can help with BMs. The government recommends 150 mins of moderate exercise (e.g. walking as if you are late for an appointment) or 75 of intense exercise (e.g. jogging) per week. I also have a bit of a walk around straight after breakfast to get things moving.
You need to ensure that you are drinking enough fluids (2 litres of fluid per day).
There is some good advice about constipation here:
There are also medications that help IBS-C (constipation dominant IBS). I suffer from IBS-C and have been prescribed Linaclotide for it. Alongside the Alflorex it has also helped me with the IBS pain since it calms intestinal nerves.
Some people are more prone to constipation due to their intestinal anatomy. Through colonoscopies I have been told that I have a long loopy (redundant) colon. This means that food takes longer to pass through and in the mean time the intestines have more time to suck out water from the stool, drying them out and causing constipation. I have found that I need to consume much more fibre than other people to have regular BMs.
I have also found useful having most of my food at meal times, leaving 4-5 hours of not eating between meals, eating my fruit snack before a meal. This means that your digestive system has time to process each meal. It also allows something called the MMC (migrating motor complex) to run which sweeps food waste from your small intestine into your large intestine. This only happens when you have an empty stomach. When people snack regularly, it prevents the MMC from working properly. I also find the larger meals help to push things along better than drip feeding through snacking.
Thank you for such a detailed response. I've seen Alflorex mentioned before and I think I will give that a go. I'll take a look at the Nerva app as well.
I've tried increasing fibre, both through Metamucil and through high-fibre foods, but I've just found it makes the bloating and discomfort worse without really changing the constipation. Maybe as you suggested, the Alflorex could help there.
After a year of quite severe IBS symptoms and load of tests to rule out all the nasties, I was suggested the FODMAP diet. I followed it for about 6-8 weeks. I did see some improvement, but not completely. When I started the reintroduction phase, I did find that some foods (the usual culprits like wheat and the onion family) did make my symptoms worse. Now, I try to avoid all except small amounts of these, if I can. But I never really got to the bottom of the problem. When eating out, I just try to minimise, the high FODMAP foods. This was over 4 years ago. Some people are lucky enough to find their trigger foods and are able to eat everything else. Most things seem to upset me somewhat. Sometimes I have a flare up and I've eaten nothing high FODMAP all week. Now, I'd say I am "managing" it (with Loperimide occasionally).
I have been doing low-FODMAP for exactly a year now. It helped tremendously almost immediately--up to a point. And never went beyond that! I started taking in a lot more fiber--seeds and nuts ground into smoothies, and lots of spinach salads and other leafy green veggies. This, in the last month or so, has helped tremendously!
Now I am diabetic, type 2, so I already low-carb for that. I have the Celiac genetic code and a family history of it, so I avoid wheat, rye, etc., completely (no grains except small amounts of white rice and organic corn in tortilla form). And I have food allergies and sensitivities-- like a potentially-fatal reaction to sulfiting agents, and an apparent intolerance of glyphosated foods. So while a year seems a long time, getting my IBS-D better is a big deal!
Is your heartburn medication a proton pump inhibitor? If so, that could be the culprit. Common side effects include digestive upset, including constipation. They also are very hard on your kidneys. You might want to bring these concerns up with your doctor. You might want to consider a different medication (famotidine) plus lifestyle changes for your heartburn. If you’ve been on a PPI for ten years, getting off of them will take time and patience, as many people get rebound reflux.
I thought Fodmap was not working until I avoided fructans. Fructans in wheat bread and some veges were the culprit. And no, I cannot eat everything on Fodmap diet; use it as a guide, a starting point, adding and subtracting foods that are bothersome.
Could it be a gluten intolerance?I say this because I had such a bad stomach for years, then my friend suggested an intolerance test as she suffered the same, and was gluten intolerant.
I did the test , and amongst other things, gluten was one of them. 😳 no matter what I ate, my stomach would be so bad, bloated like I was pregnant, painful, excessive wind, diahorra and or constipation, and all because my stomach was 'raw' from the gluten.
I've given gluten up now , and my stomach is back to normal. It's a bit tedious at times, but I'd rather do detective work finding out the culprit before I eat than to suffer all that again.
The intolerance test showed I had intolerance to a number of things , kiwis, which I loved, brown bread, white bread [ anything with gluten in it) molasses, ( I used brown sugar in my coffee) ect...also bee stings. It said although I wasn't allergic to them, I'd probably suffer more than someone else. So well worth my money. Tbh, I'm so glad I did it now as all tests came back ok from my doctor.
It's well worth looking into just to be able to live a normal life again.
You could try just cutting gluten out, without having a test done, my celiac test came back normal from my doctor, but I do have an intolerance to it.
Thanks for the feedback. The FODMAP diet basically completely removes gluten, so I would say I've given that a good test and haven't seen results. I have been tested for Celiac as well. I'm glad it worked for you though!
Ohhh I'm sorry to hear that.I'm not that familiar with that diet, was going to give it a go myself if the removing gluten didn't work for me, I don't know much about it tbh.
It's a minefield isn't it, an absolute nightmare, but I'm sure with looking at and eliminating some of your foods, you'll find the answer. Stay positive.
farmer854, go back through the foods you are now using from the Fodmap and check them for their possible lectin and oxalate content, both are irritating and can cause antinutrient overload. Take time to become familiar with both and how they may be neutralized. Also research the functions activated thiamine has in your gut health regarding IBS. Thiamine (vitamin B1) requires adequate magnesium to become activated. Also check into the antithiamine factors that diminish or destroy thiamine. Always consult your health care professional before using any supplement.
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