When you have tummy bloating, wind, looseness and discomfort, even pain, it can be very distressing. You will have had medical care to make sure there is nothing very worrying needing further treatment. People with these symptoms often have IBS – irritable bowel syndrome. IBS can interfere greatly in how you run your life. You may be worried about being out of your house for extended time, or realise that whenever you eat out you often seem to have gut problems as a result.
FODMAPS is the name given to various small carbohydrate molecules, including fructose. If the intake of these is greater than the person can absorb at the time they ferment in the gut and can be one of the reasons for these annoying symptoms.
A diet low in these compounds can be a very useful treatment where diagnosis of fructose intolerance has been made. And in some with IBS it will reduce the discomfort of bloating and the other symptoms. The fructose overload is often described as “fructose intolerance”, and now described by some as “food intolerance”.
However the FODMAPS diet is not the full story of food intolerance and IBS. It is ‘the new kid on the block’ where diet and IBS is concerned.
Many people already know their IBS symptoms are worse after rich meals, which restaurant meals often are, or after meals with herbs or spices, Asian meals, or particular foods such as tomato, capsicum, or peppermint. This is more likely to be food chemical intolerance than FODMAPS intolerance.
Since the 1980s a diet low in additive colours, flavours and preservatives as well as natural chemicals, such as amines, salicylates and glutamates, has been used for IBS with good results when people suspected food sensitivity. When the FODMAPS diet is used it also reduces many of these chemicals. The low chemical diet has also been shown to be useful for many other symptoms that food sensitive people have such as migraine or eczema. The symptoms that respond to a low chemical diet may improve symptoms in many parts of the body, not just the gut. In IBS it is reported to reduce the crampy pain, and gut urgency which may be accompanied by the range of discomfort through to pain.
When FODMAPS was first suggested for IBS symptoms it was a specified diet based on the gut function. Now those working with IBS are commenting on supersensitivity to pain with gut change especially bloating distension, particularly related to the gut brain connection. They also now talk of individual variation in tolerance. These ideas have been useful for a long time in those working with the food sensitive people who have a variety of symptoms not just IBS.
There is a need for more research into which reactions are due to FODMAPS and which are due to food chemical intolerance. If you fill out a Family Sensitivity History which shows all the suspect food sensitivities the three generations in your family you can see whether food chemical intolerance is more likely or not. See Are You Food Sensitive? for details.
Whether we begin with a food chemical elimination diet or a low FODMAPS diet we have reduced many of the foods likely to cause reactions. It is by doing challenges or trialling foods one at a time that we can see what may be causing the reactions. If reactions to fruit occur we would not know if it is fructose or salicylates but if the reaction is to pears which are very low in salicylates fructose is the likely culprit. If reactions are to herbs or spices, capsicum, or tea, added to either diet the reaction is to salicylates. APDs can advise on high FODMAPS foods to also trial.
If you are sensitive to FODMAPS foods you will still have your own pattern of foods containing FODMAPS. Another confusing aspect is that food intolerant people can react to particular whole foods such as eggs, that are not high in suspect chemicals, or FODMAPS, nor come up as positive with allergy tests. Other suspect foods are dairy and wheat. But the reaction to dairy may not just be lactose intolerance, nor the wheat one to the FODMAPS fractions. Attending to different types of fibre or using probiotics or prebiotics are other factors that may need attention. For all these reasons, and because FODMAPS intolerance and food chemical intolerance can occur together, it is a good idea to give yourself the help of an Accredited Practicing Dietitian.
So the idea of doing what I call diet detective work is still the best way to gradually understand what is happening. A key idea understood as part of the Diet Detective Process is that of individual variation in tolerance. If you are food sensitive you will find that you have your own particular tolerances. See Are You Food Sensitive? for more information on understanding how to find the foods you personally tolerate.
i have reread and reread your reply as it gives me some hope i asked if your diet for your ibs can be bought as a paperback or hardback as i use the computers at my local library and would like to have a book at home to refer to you do such amazing work
i am on a salicylate free diet but i also have ibs and low salicylate fruit and vef which i have been consuming a great deal has greatly increased my ibs severe bloating pain discomfort so what do i do i am desperatcan you advise me i have severe reactions to amines and salicylates mouth ulcers violent sickness cracked lips
Dear Dawn,
Having a IBS at the same time as the Low Chemical diet is the worst combination!! But you are not alone and I have been working on this increasingly for the last 40 years, but in detail for the last 15 years. It gets complicated as you have to decide where on earth to begin, and then how to gradually get a manageable group of foods to eat. So I wrote the book just for people like you.
The book is Your Diet for Your IBS using all my experience, combined with that of my very bright dietitian colleague, Ashleigh Jones. You need what we have designed: the Combined Low Chemical, Low FODMAPs Diet. We have even provided 10 options as the starting point including the one you probably want to begin with: Option 7: The Combined Diet which is low Chemical and Low FODMAPs. You may gradually look for detain on amines in option 10: the Amine Sensitive Diet.
You will just love it as the whole book is written so you get a step-by-step guide so you really feel that we understand the pain and complexity of IBS. With each option you are given lists of allowed foods with the important information of just how much of each food you can have and how often, at the beginning while you run your four-week trial. And we also give you a detailed meal plan for that option. While you are dealing with so much pain you might be extra careful with the amounts of foods allowed and how fresh they are.
Don’t feel disheartened! We have detail on how to test very low risk foods after four weeks to expand your diet over weeks and months. It does take the four weeks to get to some starting point. Your Diet for Your IBS also gives detail on how to manage if you have a loose gut, or if you have to manage constipation.
We really cover much in the book but you will manage better with the help of an experienced dietitian at the same time as reading the book. See if you can find one near you. I am fully retired now. (I do write articles every two weeks on this site.) You can also Google Ashleigh Jones as she does on-line appointments with Zoom. Mouth ulcers make everything so much worse. You may be one of those who need to cook all fruit and veggies at first as the raw acidity, especially of the pear can be a big problem. You may even have to cook white, bland celery. (Notice how fussy I am about words when choosing foods. It is not just is it allowed or not allowed.) And you will learn to have the cooked pear spread over the day in 4 to 6 teaspoonfuls so you minimise the bloating, but still have some pear.
Your violent sickness and the very cracked lips worry me. Do make sure you are referred to a real gastroenterologist so you can tell him or her your story – particularly after reading Your Diet for Your IBS – so you know what to say is happening to you, knowing Ashleigh and I have seen it in others.
I am delighted that I can suggest information which you can have to download in five minutes after reading this. See http://foodintolerancepro.com/product/your-diet-for-your-ibs-ebook/ Note that you can the e-book. Another way to go is to get a complimentary PDF to read any time, if you are the sort of person who likes a hard copy of the book to put your own notes and highlighting through the book. Or you can go to AmazonKindle. I am so pleased this book is now available for people like you. All the best! Joan
Thank you very much for this. I have only just cottoned on to the importance of avoiding onion and garlic – and am feeling much more confident about my chances with the FODMAP diet now – but I know I have some other sensitivities going on as well – and that’s what’s so hard for some to understand. Thank you again.
I am so pleased to have read this as I was about to have an appointment with a dietician specializing in FODMAP work. Since I started my own experiments again, I have realized that my problem is that I can only eat very very small amounts of anything at one time so as to avoid pain. eg 1 ryvita or 1/2 ryvita with small amount of topping. Trapped wind is what I am finding to be the culprit so I am eager to find out why the chemistry or physicallity of my body does not allow me to eat as others do without this build up of gas. I have found doing my experiments most helpful. When I see other people enjoying a meal and never complaining of pain, I really wonder what on earth is wrong with me so I am thinking I am on track with some answers now. Kind Regards to Joan and readers.
Dear Wendie, Yes you are right to experiment with food. As part of diet investigation you can try to identify whether the gas is high in your stomach area or if it is down lower. I presume you have discussed your symptoms with your doctor to check if there are medical investigations that should be done. These will clarify whether or not there is some other medical problem present. Many food sensitive people do note that size of the meal matters. Another factor that makes a difference in some is just how dense a food is. A plain biscuit may be tolerated but a more dense one [such as a shortbread] cause gut pain. Your dietitian is also likely to suggest sips of water with all bites of food to make sure that the food is well mixed with the gut enzymes and gut bacterial flora, so that food progresses through the gut as it should. There are other factors that we could call “The Layer Underneath” to attend to. These include foods that cause wind in some people and not in others, and foods that affect the amount of pain you get. Your dietitian is likely to ask you to fill out a Family Sensitivity History which shows what food sensitive symptoms you have and those your immediate family have, as well as all the foods, and environmental factors, that they suspect are causing symptoms. It is worth having the help of a dietitian as diet investigation can seem complex but it can be managed. You will be so relieved when you have investigated diet and found what is causing you such upsetting symptoms. I wish you well in your “diet detective work”. Joan
This is very interesting. I’m struggling with IBS (C) now and it’s so frustrating! I try to stick to a Low FODMAP diet but still seem to react and have continuing symptoms. I will try to find an experienced dietitian in Sydney. Can you recommend anyone?
Don’t forget to also try eliminating high Salicylate and Amine foods too.
Thanks Elle, You are adding to the emphasis that the article was making. Nowadays dietitians can get information on managing the combined diet where bloating and wind are present, as well as cramping pain, urgency and discomfort when passing a bowel motion, not to mention other symptoms. See the comment on the Articles section of my site under IBS Are you FODMAPS or food chemical intolerant from your type of pain”
https://foodintolerancepro.com/category/irritable-bowel-syndrome/are-you-fodmaps-or-food-chemical-intolerant/” IBS is complex but diet is helpful. Joan
This is amazing and very helpful
Dear Gail, thank you for your awareness that IBS is complex and that each person needs to work towards their own diet. Joan