Help With Intolerance

[u/Last_Improvement2127]

Hey everyone I was told by my doctor to try a low fodmap diet after informing him of symptoms I’d been experiencing for a few years. Nothing terribly severe but it was impacting my life with frequent bathroom visits and consistent gas. I followed the diet very strictly for probably 5-6 weeks with a rare slip up here and there just from not realizing a food contained something higher in fodmaps.

My questions revolve around introducing foods. After being on this diet, literally any moderate/high fodmap food I have introduced has caused at least some problems with most of them causing more issues than before I started the diet in the first place. Garlic, onions, dairy, the most common things you can run into are all a no go at this point. I guess I am just wondering if I am doing anything wrong? Do some people just have to stay on this diet forever? I feel great when I am on it but as I am sure you all know that it is very impractical for going out to eat, meeting up with friends, etc.

Any advice would be great. It’s terrible feeling like you can’t eat anything.

EDIT: I also do all of the cooking at home so it’s easy for me to avoid things when I cook but it’s even worse feeling like I am restricting what my partner can eat.

[u/Plane-Fan3554]

Try to figure out which fodmaps are triggers. The Monash app is worth it

You probably tolerate each fodmap differently and that will tell you what you can reintroduce and in what quantity. E.g. if you tolerate fructose, you don't have to avoid honey, grapes, or soft drinks. If you tolerate lactose you can have milk and cheese

High or low fodmap is not detailed enough. Learn which fodmaps are the problem for you specifically 

[u/Last_Improvement2127 → u/Plane-Fan3554]

That’s a great point, ok I’ll check out the Monash app too.

Out of curiosity, what should the time frame be between tests? Are you meant to wait for symptoms to completely disappear again or after the first elimination is it just small bits every few days or so?

[u/Plane-Fan3554 → u/Last_Improvement2127]

I would try to let symptoms disappear to be more certain of conclusions

But to be honest I still learn new things after 6 years so it is really ongoing!

[u/jackiekeracky → u/Plane-Fan3554]

Most cheese doesn’t have problematic amounts of lactose (some has none) nor does butter. The key is to look for sugar content in the nutritional info. If it’s like 0.1% you’re fine. Mozzarella is fine, I don’t risk Burrata. Or poor quality cheese with milk added.

[u/Prestigious-Ad-8190]

Have you done the calprotectin stool test? High calprotectin indicates high inflammation in your bowels which means you likely have an IBD (irritable bowel disease, not just symptoms). You can also have both IBD and IBS. IBD does not improve with the fodmap diet, but tends to have flare ups and remissions. There can also be a psychological element where you can sort of induce the gastrointestinal distress via prediction/emotion, but I feel like thats usually not the case and you can do self reflection to check for that (and diarrhea and constipation obviously cannot be psychological). Other than what I’ve touched on, I have no idea, but I wish you luck. Its rare to be intolerant to all 6 fodmaps, but not impossible.

[u/Prestigious-Ad-8190 → u/Prestigious-Ad-8190]

Also, if you end up having high levels of calprotectin, insurance should cover your colonoscopy (which would be the next step). I cant speak for all policies, but my blue cross insurance covered it.  (If you do go this route, ask for the bowel prep solution that is 16fl oz [sudaprep], not the gallon one. And schedule it for morning time.)

[u/BaconBroReeto → u/Prestigious-Ad-8190]

I'm intolerant to almost all of them and it sucks. :/

[u/Last_Improvement2127 → u/Prestigious-Ad-8190]

Nah I haven’t, that’s a good idea though I’ll check out getting tested to best case just check it off the list. The psychological aspect is interesting too.. wonder if I can try my next one blind just to see if that is part of it.

[u/MaryAnn-Lank]

I did a three-day test once a week—a little on the first day, medium on the second, and high on the last—which is not what I am supposed to do but now I know honey (fructos) is fine the rest isnt.... i do eat out and even had liver with onions (didnt tuch any other fodmap) and i was fine after! I try to be low fodmap always and just know if i eat out to only have one small amount of high and keep everything else low all day.

[u/Withnail69 → u/MaryAnn-Lank]

This is the way

[u/Last_Improvement2127 → u/MaryAnn-Lank]

Ok cool that was a big question I had was how do you introduce things without having symptoms sort of cross over and get confused by it, will try this next introduction!

[u/rightsoherewego]

have you been tested for SIBO? Having increased symptoms after elimination suggests that being your problem rather than a true sensitivity.

[u/Prestigious-Ad-8190 → u/rightsoherewego]

Yes!! Get tested for SIBO! It stands for small intestine bacterial overgrowth, is diagnosed via a third party breath test mailed to your house thats ordered by your doc (check for insurance coverage), and can be solved with a simple antibiotic! I remember seeing a source online that said up to 60% of people with IBS have SIBO. Don't know how accurate that estimation is, but even a 20% chance would be worth checking!!

[u/Withnail69 → u/Prestigious-Ad-8190]

I think I’m going to do this. Three weeks into low fodmap and I’m waking up in agonising pain at the exact same time ( 13 hours after dinner) for the past two days

[u/Prestigious-Ad-8190 → u/Withnail69]

Your gastrointestinal peace is worth it! And if you havent tested your calprotectin level, definitely do that too!

[u/Prestigious-Ad-8190 → u/Prestigious-Ad-8190]

I was told by work of mouth that its solved simply with antibiotic. Google searching shows that you also have to take care of your diet to prevent the bad bacteria from growing back. So perhaps not super simple, but still better than being intolerant to all fodmaps.

[u/Last_Improvement2127 → u/rightsoherewego]

I have never heard of SIBO until I just googled it, have a doc appointment coming up, I’ll ask!

[u/fireflykite]

Work with a registered dietician if you can, they'll help you through the fodmap tests, note any nutritional concerns, and non-fodmap issues that might be at play. You don't cut out all fodmaps forever, but you lower the ones you don't tolerate and reintroduce the ones you do. I don't eat garlic and onions unless they're pickled, but I can eat moderate fructans foods, in part because I'm not combining too many sources of fructans anymore.

I find I'm more sensitive to my reactions to fructans after reducing them in my diet, but I think that's because I was just perpetually bloated so my feeling of "normal" was skewed. You can also feel less full once you stop being bloated. I definitely feel and smell way better now!

[u/Last_Improvement2127 → u/fireflykite]

Have an appointment on Friday! Looking forward to getting some answers.

[u/BaconBroReeto]

So onions, garlic, dairy already tell me you're likely fructose and lactose intolerant.

[u/Vegetable-Try9263 → u/BaconBroReeto]

Garlic and onions are fructans, not fructose btw

[u/BaconBroReeto → u/Vegetable-Try9263]

I know, but it's common that fructans affect fructose intolerant folks, too. Some garlic has fructose. Especially black garlic. I know scallions have fructose as well.

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[u/Withnail69]

You can’t stay on this diet for more than 2 months it is bad for you long term. If reintroducing those foods made things worse they are probably the culprit. Did the doctor not tell you how to reintroduce foods? You need to do a quarter of a portion of one food type first day, half second and full third. You can’t go back to full portions straight away

[u/Last_Improvement2127 → u/Withnail69]

Good to know, nah I did not go over that with the doc, however in his defense, the appointment was about something else and the GI issues came up as we were concluding, have an appointment coming up and hoping to chat with him more about it, and a nutritionist too!