IBS and Amitriptyline

[Fmkhan]

I have started taking Amitriptyline 10mg a day for Post infectious IBS-D.

The whole week was ok with no symptoms but since yesterday, it started again while I ate some food out of my diet routine.

My question is do I need to stick to low FODMAP diet while taking medicine or can I eat any food?

Also how do I know if certain food has caused the symptoms/ flare up? How long does the food take to show symptoms so that I avoid that food in future?

Kindly share your experience.

[Trinity7]

Hi fmkhan yes still keep to fodmap diet especially if it has been working before. As this gets to main causes meds support. Our bodies are very unique the response to food can sometimes be as quixk as 30mins in my own experiences and can also happen day after or two days after.

[Fmkhan in reply to Trinity7]

Thank you.

FODMAP diet helps with my symptoms while taking medicine. It feels like I don’t have any issue. But as soon I eat any high FODMAP then it starts

[xjrs]

You can tell what is affecting you by keeping a food diary. I keep mine on a spreadsheet. Change only 1 thing at a time about your normal diet (that you are OK with) and wait up to 4 days for symptoms. Each person's turnaround time is different. I know that mine is 2 days, so I wait 2 days for symptoms.

Being very low FODMAP can help in the short term, but in the long term it can be counterproductive, since it reduces feed for the microbiome. Often with IBS , there are some bad bugs hanging around in the gut dominating. By being low FODMAP you aren't feeding those bugs, which reduces symptoms, but you also aren't feeding the good bugs either. These are needed to keep the bad bugs under control.

Have you tried good probiotic on a 3 month trial? Alflorex worked best for me and has been scientifically studied for IBS. Others get on well with Symprove.

These should help to keep the bad bugs under control. The bacteria in Alflorex also helps to digest complex carbs. I found I could eat a wider variety of foods on this, though I still have some food intolerances. The best diet for the microbiome, once you are able to eat more is the Mediterranean diet.

[Fmkhan]

Thank you so much for such helpful detailed explanation.

Currently I am taking BIOGLAN ULTIMATE FLORA probiotic for a month. I have been taking Amitriptyline 10mg for a week now.

I will follow your advice as still I have no idea about when my body show symptoms to certain high FODMAP food.

[xjrs in reply to Fmkhan]

I know my turnaround time, since once emptied from a colonoscopy prep or when I've had diarrhoea in the past, it takes 48 hours from eating again for me to have a BM. Usually any food related symptoms occur for me in this window.

[Fmkhan in reply to xjrs]

Thank you so much for sharing such valuable information.

Can you suggest any Mediterranean food/s that is ok with ibs?

[xjrs in reply to Fmkhan]

Here is a useful diagram in relation to the Mediterranean diet:

researchgate.net/figure/The...

By the way there is a slightly different recommendation in the UK regarding the consumption of fish:

nhs.uk/live-well/eat-well/f...

In terms of Mediterranean foods that are OK for IBS, the issue is that everyone's food intolerances are different. There is a general guide about being low FODMAP, but this has inherent problems (described above) and different people are tolerant to different types of FODMAPS, which is why an elimination and reintroduction diet is necessary to tailor the diet.

My recommendation is to at first get the system into as stable a position as possible through probiotics that work well for you (assuming a gut bacterial imbalance) and medications as necessary. There are also stress management techniques such as the Nerva gut directed hypnotherapy app or any form of mindfulness or meditation (there are lots of guided meditations online). Once things are a bit more settled, then try to introduce foods one at a time and keep a food diary. For example, the Mediterranean diet speaks heavily of pulses, nuts and seeds. In terms of pulses, if you use the canned variety and rinse these thoroughly, since most of the FODMAPS leach into the water, with rinsing, this is a good place to start.

With nuts, it might be worthwhile grinding them in a coffee grinder to make them easier to digest.

With anything new, always start with 1/4 to 1/3 of a normal portion size, try that for 2-3 days and if OK increment by another 1/4 to 1/3 and so on. If you experience symptoms cut back to the previous amount for longer and try to increment again. The microbiome can adapt to handling new foods when introduced slowly over a period of time (although sometimes it is still necessary to eliminate certain foods).

It doesn't matter if you can only consume a part portion of the food. The importance is diet variety. This increases bacterial diversity in the gut and bacterial diversity helps guard against IBS.

[Fmkhan in reply to xjrs]

Thanks a lot I will have a look at it