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Monday, January 11th, 2016 08:26 pm
 So, you have irritable bowel syndrome?

Yep, since about 2000. My symptoms are mostly low-grade diarrhoea, flatulence, bloating and fatigue, but occasionally I get abdominal pain, or rumbling noises in my abdomen (for which I recently learned the delightful technical medical term “borborygmi”).

Sounds annoying, but not life-changingly awful.

That’s about right. Also embarrassing, and frequently unpleasant for anyone downwind of me.

And you’re on a new diet for your IBS?

Yep, the "low-FODMAP" diet.

Never heard of it. What’s the teal deer?

I have to cut out gluten, dairy, pulses, onions and garlic.

Huh?

And some other things like mushrooms, most fruit, cauliflower, pistachios, cashews and artichokes. And I’m meant to limit my intake of butternut squash, but not other squashes. There are a whole bunch of rules.

You said you have to cut out onions and garlic - how about leek?

Yep. And shallots. And the white parts of spring onions, but the green parts are OK.

And you’re not allowed dairy?

Yep - no milk, cream or ice cream for me. But I’m allowed hard cheese. And Brie and Camembert.

OK, I call shenanigans. You’re making this up.

I’m really, really not. I was told to follow this diet by my doctor.

Oh, your “doctor”, eh? Are they a doctor of crystal Reiki homeopathy? Because this is some “astral quantum chakra”-level enterobollocks.

No, he’s a medical doctor, in a perfectly ordinary NHS surgery. Though he did tell me that he didn’t know much about FODMAPs before handing me a printout and sending me on my way.

OK, supposing - just supposing - you’re not making this up, what the hell are FODMAPs?

Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols.

Say what?

Short-chain carbohydrates which are poorly absorbed by the small intestine, but which make the bacteria in my large intestine go OM NOM NOM DELICIOUS CARBS, causing my enteric nervous system to go “Oh dear! I appear to be full of nasty fermentation products. Better get rid of them quickly!”, and in turn causing me to go “Bloody hell, tummy, I’ve already been six times today and I have a meeting in five minutes, do we really have to do this right n- OK, I guess we do. Dammit, I’d just washed those trousers.”

But gluten is a protein.

Well spotted. The problem is actually with wheat, which has high levels of fructans (one of the two classes of oligosaccharides under the FODMAP label; the other class is galacto-oligosaccarides, which are common in pulses). However, supermarkets and restaurants have “gluten-free” labelling, not “low-fructan” labelling.

Is there any evidence for the FODMAP theory?

Yes! There are peer-reviewed publications demonstrating both the mechanism described above and the benefits of a low-FODMAP diet for patients with IBS.

Is this a revolutionary new treatment, discovered by a mom, that doctors hate?

As previously mentioned, I was told to follow it by my doctor, and AIUI the mechanism described above was already the established one for lactose intolerance (lactose being the disaccharide in the acronym). The FODMAP concept appears to have been devised by Dr Sue Shepherd, a dietician and academic. I don’t know if she has any children.

Is it helping?

It seems to be, yes! I’ve been on the diet for about a month now, and my symptoms are definitely reduced - my bad days now are about as bad as my average days before, and my good days are almost normal. And lapses from the diet seem to be followed by a couple of bad days.

And you think that this may be connected to your utter failure at vegetarianism a few years ago?

Possibly. When I cut out animal protein from my diet, I started eating a lot more pulse-based dishes to compensate, and most of those also contained onion and/or garlic. When I restored meat to my diet, my intake of pulses and alliums went down. That could explain some of the horrible fatigue, lethargy and brain-fog I experienced for those two years, and the dramatic improvement I experienced when I started eating meat again. This theory predicts that my symptoms will be triggered by either fructans or galacto-oligosaccharides, and I'll find that out soonish.

When I saw you last you said you could/couldn’t eat Foodstuff X, but now you’ve changed your mind! What gives?

It’s possible that I was wrong the first time - this is a complicated diet with a lot of rules, I don't always remember them all, and it’s not always obvious what chemicals are in a given food. For instance, lots of surprising foods contain onion powder, which is a major no-no. Or it’s possible that I’ve moved onto a different phase of the diet - in the first two months I’m meant to eliminate all FODMAPs as far as possible, and then over the next few months I’m meant to slowly re-introduce the different FODMAP classes one at a time to see which ones actually cause me problems. Anyway, I realise that this diet makes me a major pain to feed, so thank you for making the effort!

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Tuesday, January 12th, 2016 08:00 am (UTC)
Same here. Although not so far back. And yeah, it's a major pain - there are several foods I miss very much.
Tuesday, January 12th, 2016 09:32 pm (UTC)
Oh yes, they're great. Takes my reaction from explosive to slightly grumbly.

(And you inspired me to write a post.)