If GP recommends a FODMAP diet, should they refer you to dietician on NHS?

[Flecmac]

GP suggested this to me but said she can’t refer due to cutbacks, but in all internet info it says patients must be supervised by a dietician.

Thanks

[MaisieGray]

No, it isn't a "should" situation to my mind, there's plenty of readily-accessible information online. The NHS guidance is that a GP may be able to refer you to an NHS dietitian if general diet tips for IBS aren't helping; not that they will or should. It seems to me that the websites that urge professional advice if planning to carry out the FODMAP protocol are coincidentally those also offering said professional advice at a price ........

[Flecmac in reply to MaisieGray]

Thanks. Only problem is that there are conflicting ideas between sites, one says certain food OK another says not!! I need to be sure of what’s what.

[MaisieGray in reply to Flecmac]

I'm not sure that is a problem to be honest; and it probably mirrors the experience of everyone following a similar sort of exclusion/controlled inclusion sort of protocol, that not everyone is in absolute agreement on everything, and not everyone has the same experience as everyone else. But if you deconstruct the protocol, at its most basic, you exclude something, then reintroduce it gradually up to an amount that causes you IBS symptoms, then you know the level below which you can comfortably consume it. In that sense, it doesn't matter how that food is categorised, whether it is or isn't on someone's list. I think Kings College has a validated list but it may be available only to nutritionists if memory serves me correct. However, there are apps that can help. and I've read that the Monash University one is recommended (and reading the first review my eye landed upon, I read for instance "having been on the low FODMAP for several years under the guidance of my dietician, this is the only app I trust".)

[Kes8]

"The NICE guideline notes that excluding individual foods or complete food groups without appropriate supervision can lead to inadequate nutrient intake and ultimately potential malnutrition. In addition, symptoms often remain unresolved leading to further inappropriate dietary restriction. NICE therefore recommends that exclusion diets should only be undertaken by a specialist with dietary expertise, to ensure that the person's diet remains balanced and nutritious [NICE, 2017]."

cks.nice.org.uk/irritable-b...

Believe me I can't stand dieticians -I have never met a good one or one who isn't hideously arrogant (Worse than any arrogant thyroid ignorant doctor!)

But your GP shouldn't just through out unhelpful dietary advice without offering you any support.

[BadHare]

There’s lots of information available on the internet.

[Flecmac in reply to BadHare]

I know, it’s mine field!! Thanks xx

[humanbean]

If you are worried about conflicting advice on different sites, decide which one you feel has the most authority and stick to their recommendations. Try it for 6 - 8 weeks. That should be enough time to work out if its helping.

Then you could try slowly re-introducing any food that you eliminated to see if you can identify what was causing your problems.

If that doesn't get you any further you could then switch to some other website and follow their recommendations, or try a completely different diet. I've seen different people on thyroid forums mentioning that they got benefits from eliminating one (or more) of the following from their diets:

Gluten

Lactose

Casein (a protein found in animal milk products)

Nightshades

Fodmaps

Histamines

Sugar

and probably half a dozen other things I can't remember.

Personally I would never want to try more than one of these at a time. If I removed something from my diet and got no benefit from doing so I would want to start eating it again. I don't want to eliminate entire food groups from my diet if I can possibly avoid it.

I wouldn't rely on the NHS for dietary and nutritional advice. It was only when I gave up gluten under my own steam, having been told that I didn't suffer from coeliac disease, and got benefits from giving up gluten, that I realised the NHS really does have a total blind spot when it comes to diet.

[BadHare in reply to humanbean]

A lot of people have issues with phytates in grain, rather than gluten, so benefit from exclusion in the same way.

[humanbean in reply to BadHare]

I didn't know that, thanks for the info.

[Hidden]

I think probably in an ideal world you should have some supervison but I am inclined to think that in the NHS the supervison you might get would be worth the effort of attending the appointments. I have met one good dietician but most have been really unhelpful. There are some employees of the NHS that are a complete waste of time and NHS money. Dieticians, most psychological therepists and top of the list endocrinologists. It is best not to support these people by asking for refferals.

[BadHare]

These don't answer your query, but might be of some use:

healthunlocked.com/thyroidu...

kresserinstitute.com/ibs-gu... Lots on CK's website.

healthunlocked.com/thyroidu...

drhyman.com/blog/2018/04/13...

drhyman.com/blog/2018/04/20...

greenmedinfo.com/blog/lecti...

health.harvard.edu/staying-...

huffpost.com/entry/ask-jj-l...

independent.co.uk/life-styl...

Just trawled through past posts to find information on phytates that I posted on another forum, but it seems that & several other posts are missing. >

[Flecmac in reply to BadHare]

Thanks.

[MiniMum97]

I e been on the low FODMAP diet for way longer I should have done (due to other health issues) but as a result I know a lot about it 😊. My IBS-C was horrendous when I started and the diet was very effective. I have now managed to reintroduce most foods.

The best resource is the Monash University University low FODMAP app. They invented the diet and test lots of foods and they tell you whether they are high or low FODMAP via the app. There website also has lots of info. There is also a Kings college app which includes uk foods (the Monash one is Australian) but isn’t always accurate.

It is a complex diet and you are supposed to refered to a dietician if it is recommended to you, but I have learnt from talking to others who have seen dieticians that they often get given incorrect info by dieticians and little support so personally I would just give it a go yourself.

There is lots of duff info out there so cross reference with Monash if you are not sure. I will post a couple of links to some good websites below with good recipes and accurate info.

You will make mistakes initially so try not to worry about that and just keep going. You will get the hand of what you can and can’t eat in the end.

You should be on the diet for 6-8 weeks before reintroducing which you need to do following a particular system. You should only reintroduce when you are pretty much symptom free. I will post a link to a good reintroduction booklet if I can find it.

If you have any questions or need more info do let me know.

[Flecmac in reply to MiniMum97]

Thank you SO MUCH, you have been very helpful. I will look into this further. It’s good to know that it can work. I have tried many things to feel well but nothing seemed to help. It’s worth a try as mealtimes are difficult and eating out is a nightmare, just so stressful. Thanks again xx

[MiniMum97 in reply to Flecmac]

No problem! Let me know if you need any more info.

Why are you finding mealtimes difficult and eating out a nightmare? What are your symptoms?

[Flecmac in reply to MiniMum97]

Just get a lot of pain particularly in left side near hip. Morning particularly hard. I have constipation and never know what to eat. I had major op in April to remove tumour from nerve to spine. I also have scolicis of lower spine, Hashimoto’s and supposedly fibromyalgia.

Many thanks xx

[MiniMum97 in reply to Flecmac]

Is the pain after eating? Is it in the lower left part of your stomach?

If so, when you eat you set off your digestive system. Your gut will then start processing whatever it is in your gut which is usually what you ate 24-48 hours ago. If it was something you can’t digest very well this can can cause pain, bloating etc.

It could also be because your constipation is causing a blockage. It’s very common for everything to get stuck in the lower left part of your stomach. As your digestive system starts up this can then hurt.

Before trying a Low FODMAP diet, (if you haven’t done so already) you could try taking 350mg magnesium citrate (or you could try mag malate if you also have muscle pain) and 2 capsules twice a day of psyllium husk with lots of water. Vitamin c supplements are also good for constipation but have also been shown to reduce gut biodiversity so don’t take vitamin c long term.This may get things moving and reduce the pain.

Low FODMAP is good for wind, pain, bloating and diarrhoea but doesn’t usually treat the constipation as it tends to be low in fibre so if you try the above and you have normal stools but still have pain/bloating try Low FODMAP but you will probably need to continue with the magnesium/psyllium etc.

I would also recommend that you supplement with some good quality probiotics. And/or fermented foods such as kefir, sauerkraut, kombucha etc etc to improve your gut biodiversity. Eating a “rainbow” diet (ie lots of fruit and vegetables of lots of different colours) also helps with this.

From what you have said though I wonder whether the issue is related to your nerve op or scoliosis? If nerve function is impaired then this can affect gut motility j understand. Has this been checked out by your doctors? Have you tried an osteopath or chiropractor?

[Flecmac in reply to MiniMum97]

Not necessarily after eating, and yes left sided pain around hip area mainly at night and in morning, easing after opening bowel but never goes away, still have pain around hip. I never thought about the food eaten 48 hours previously causing problems! Always think of what last eaten. I use a hine made spray of magnesium flakes as struggle swallowing tablets and ingesting magnesium would cause diarrhoea. I avoid taking tablets because of choking. Always speaking to GP, she doesn’t know what to do or suggest anymore. I can’t sleep and feel very fatigued, I suffer from migraines which are very bad, can wipe me out for two days. The surgeon denies any correlation between my pain and the op. I was seeing Endo in Coventry (I’m in Notts) but some idiot has cancelled the appointment and booked me with someone else for this Saturday, which is useless, took 9 months to get that appointment!!! Really fed up.

Thanks x

[MiniMum97 in reply to MiniMum97]

katescarlata.com/lowfodmapd...

alittlebityummy.com

monashfodmap.com/ibs-centra...

monashfodmap.com/ibs-centra...

[MiniMum97 in reply to MiniMum97]

I only have the booklet as a pdf. If you are happy to PM me your email address, I’ll email it to you.

[Flecmac in reply to MiniMum97]

OK thanks x