My low FODMAP + Whole Food Journey.
As a dietitian and a long time IBS sufferer my intentions were to heal my guts not just keep symptoms at bay with the low FODMAP diet. IBS is not a curable disorder and SIBO is also likely to reoccur despite treatment. Let me reveal my hypothesis as to how my IBS came about. As a child I remember being able to eat anything. During my teenage years my eating habits greatly changed as do many with a little more control over food choices and less parental guidance. This was also when the USDA changed the food guide pyramid encouraging everyone to eat more grains and starches and very little fat. A cumulative effect of a unhealthy relationship with a boy, poor self image, and waif type models in the magazine fueled the fire for my eating disorder. Limiting my calorie and fat consumption was a high priority. My obsession with being thin and staying thin took over a good part of my late teens and early 20s. I suffered from bulimia for many years and flirted with anorexia. Not only was my diet devoid of most fats it was also highly contaminated with a variety of artificial sweeteners. My weight fluctuated as do many with bulimia and my lowest was probably in the low 100s for my 5'5" frame. Fortunately with the help of family and therapy my disordered eating improved however it has lingered for years. Only after moving to Bend Oregon and engaging in endurance sports with my now husband did I shift my thoughts on food as fuel. Up until the past few months fat was not my friend and this stemmed from the low fat craze of the 90s. Making the decision to focus on just whole foods broke me free of my fat phobia .My obsession with nutrition early in life helped me decide on my career choice at age 16 which has brought me so much joy over the years.
Looking back I have had IBS since age 20 or maybe sooner. Over the years many food triggers were identified and eliminated from my diet such as sugar free gum, sugar free candy, low carb bars, and lactose. Even one piece of sugar free gum causes bloating and gas due to the sugar alcohols. A low carb, high protein bar can cause me to leave work sick with debilitating stomach cramps. No thank you!! There had been no real effective diet or treatment for IBS not until the wonderful people over at Monash University discovered the low FODMAP diet. About 75% of IBS sufferers have relief with this diet. Once the low FODMAP diet was mainstream I bought Patsy Catsos's book Free at Last and it was life changing. Finally my belly was happy and I felt free and finally in control of my GI symptoms. It took me a long time to do the full elimination diet,. but when I finally embraced this diet it was like night and day. The reintroduction phase was scary and took several months but it was a great leaning experience. Unfortunately my belly was intolerant to all FODMAP groups to a degrees. However this taught me my safe thresholds and how to live on a modified low FODMAP diet. For example I can tolerate 1/4 of an avocado, a slice or 2 of an apple, and a condiment with a little garlic powder in it without my belly going bad. My goal is to keep my FODMAP bucket low, a great visual from Patsy Catsos. The low FODMAP diet a great place to start for anyone with IBS. I teach this diet on a regular basis as a outpatient dietitian and see amazing results.
The low FODMAP diet helped me greatly for about a year but I got to a point where my symptoms started to return to a lesser degree and my FODMAP thresholds were lowered. No longer did I feel light on my feet and my clothes were not fitting as well as before. Constipation started to become more problematic in addition to low grade abdominal pain and mild bloating. IBS is a crazy disorder and often difficult to pinpoint triggers since other factors such as stress, inactivity, and eating too much at one sitting can all contribute. The stars had to be in align for me to have a good day. It was time to get help, I opted to meet with both a naturopath and GI physician to compare notes from both eastern and western medicine regarding this topic. Both has suspected SIBO which was also in my radar. The home lactulose breath test showed positive however my results were not typical. My hydrogen levels started off at 56 and climbed to 156 by the end of the 2 hour breath test. A rise of 20ppm in hydrogen indicates SIBO. This test may have been stopped if I was in a clinic setting since baseline should be < 10ppm. My elevated baseline may be in itself a positive result. To read more about SIBO breath tests click here. Next step included a round of Rifaxamin which worked wonderfully and got me back to baselinefor months. During this time my FODMAPs were kept low and I had a calm belly for ~ 6 months. This did not last forever, symptoms returned and I feared my SIBO was back. GI recommended a another round of Rifaxamin plus better compliance with a probiotic VLS-3. This combination did help but over time my bad belly days started to out number my good belly days again so it was time to move into a different direction.
I decided that there must be some other culprit contributing to my digestive issues. Grains, dairy, sugar, and legumes can all lead to inflammation and altered gut bacteria so out they went for a short while. After several months into this diet adventure my belly was happy. My FODMAP threshold has increased greatly and bad belly days are few and far between. Crossing my fingers that this is the missing link and just maybe on the right path to curing IBS.
This brings me to back to my hypotheses as to why I battle with SIBO and IBS, my low fat, high intake of artificial sweeteners and possibly bulimia caused dysbiosis and wrecked havoc on my gut bacteria. It is time to heal those guts once and for all! Thanks for listening.