# Should high FODMAPs ever be reintroduced?



## tummyrumbles (Aug 14, 2005)

I've been on the FODMAP diet since 2013, but not all that strictly. It was just the last 4 or 5 months that I've been on the Paleo Autoimmune diet as well and have been totally grain free. I eat animal protein and low FODMAP vegetables and seem to get away with one banana a day. If I stick to this strictly I don't get IBS symptoms the next day, because evacuation is usually complete.

The only problem is I don't really feel that I'm gaining much tolerance, to either starches or high FODMAPs. When I do experiment by introducing corn for example or more than 1 piece of fruit, I get an abundance of gas, and this always affects evacuation the next day. If I malabsorb just one small thing it's as though I've been eating pizza all day because the whole diet comes undone. It seems I'm locked in to this very restrictive diet which is basically eggs, seafood, meat, low FODMAP vegetables including salads. Any departure from this and the symptoms return. It's not really so much a healing diet as a diet that just doesn't feed bacteria; so these are two very different concepts.

There's a very strong belief among IBS commentators that prebiotics, the soluble fibre high FODMAPs and resistant starch that feed bacteria, are selectively fermented and only feed beneficial bacteria. (Soluble fibre which isn't prebiotic is believed to feed all bacteria, including the bad ones). We're told for gut health that we need to reintroduce high FODMAPs as soon as we can tolerate them but what if we can't ever tolerate them?

There's no doubt that prebiotics and their byproducts, short chain fatty acids are very healthy for the colon, generally speaking. These acids keep the colon acidic, which favours beneficial bacteria. But the assumption here is that carbohydrates are mostly digested and presumably there won't actually be all that much fermentable matter in the colon, which is true for a healthy person. This is why people who don't have IBS can eat baked beans without symptoms. They don't digest legumes all that well either, but they don't produce the voluminous gasses that we do. The short chain fatty acids produced when a person malabsorbs carbohydrate, as in the case of IBS, will naturally be a lot higher. The general rule with IBS seems to be everything in moderation. We can tolerate SOME fructose. We can tolerate certain FODMAPs, but not too many of them. And we can tolerate short chain fatty acids in the colon, but not an abundance of them or we make the inflammation worse.

Some researchers, such as Sue Shepherd, have found that prebiotics can further inflame an already damaged intestine and that extra gas from malabsorption can cause Crohn's Disease. Instinctively this is what I agree with. Ultimately we have to trust our instincts and I feel that there is nothing healthy in an overabundance of gas, whether it's from prebiotics or not. It just doesn't feel right and actually feels inflammatory.

Why does everyone say that the low FODMAP diet is only temporary? A great many of the sugars in FODMAPs are either fructose or fructans (chains of fructose). Fructose is a highly toxic sugar, when it isn't accompanied by glucose, as in natural fruit. The underlying reason for fructose intolerance is believed to be a problem with Glut5 transportation into the intestine's cells. And one of the main reasons for Glut5 disorder, apart from genetics, is believed to be inflammation. So if we want to digest fructose and fructans again we would need to heal the Glut5 transporters. But we can't heal inflammation by creating more inflammation. So if we want to heal the gut we have to stop eating the fibres that are highly fermentable, and these tend to be high FODMAPs. But if we stop eating the high FODMAPs then that seriously reduces the short chain fatty acids which are needed for gut health. It can do your head in.

One way around this problem could be in bananas. These are a low FODMAP fruit and also low in fructose. Bananas have inulin, a prebiotic fibre, but at a lot lower level than the inulins in high FODMAPs - garlic, artichokes, onions etc. Kale is believed to be another low FODMAP prebiotic.

A lot of experts are now recommending things like potato starch as a source of resistant starch to heal the gut. The theory is that resistant starch, being a polysaccharide (and not a short chained carbohydrate like FODMAPs) is too long to be broken down in the small intestine and moves along the colon undigested, until it arrives in the descending colon where is feeds beneficial bacteria only. (FODMAPs - the shorter chain carbohydrates, on the other hand, are believed to be digested in the ascending colon.) Where are the studies that prove that harmful bacteria doesn't also eat resistant starch? How does this theory fit in with SIBO, where bacteria of all kinds are able to access carbs in the small intestine before we can digest them?

Many believe that the reason why we all got IBS in the first place was through damage to our gut lining from alcohol, excess starches, sugars, trans fats, lectins, phytates and saponins from grains, legumes and nuts.

It doesn't instinctively sound right to me that the way to heal the gut is to ingest a lot of one of the toxins that led to this condition in the first place.

Something that is not intrinsically inflammatory is insoluble fibre. That doesn't mean that insoluble fibre isn't going to make things worse if you have an inflamed colon. But I've found that I tolerate it very well however I don't eat constipating foods like grains & legumes anymore, so there's no push and pull effect with one food trying to move out while the other food wants to stay put. Insoluble fibre creates bulk and helps to put pressure on the bowel wall to stimulate a bowel movement and I can promise that this is exactly what happens with me.

Something to be aware of whenever you're introducing fibre, is that soluble fibre is fermented by bacteria in the colon, which produce enzymes to help degrade the fibre for consumption. So we actually do digest some calories from soluble fibre, just not a lot of them. It could be that if you don't gradually add fibre in very small doses at the start, then there will be too much fibre in the colon not being digested. This is because the microbiome adapts according to diet - and sometimes this can take anywhere from a few hours to a few days. If you mainly eat starches and meats, you could have a different microbiome to someone who eats a lot of vegetables every day.

If you suddenly start eating a fibre that you've never eaten before - or haven't eaten much of it - then you mightn't have the bacteria, and their enzymes, to digest it in the colon. (Remember this is soluble fibre which is only digested in the colon). The food residue then exerts an osmotic effect in the colon, leading to diarrhea, or for some of us who are IBS-C, very loose, mushy stool.

This could be why so many people here have trouble with insoluble fibre. No fibre is either completely soluble or insoluble. All fibre is a mix of both. So it's important not to take in too much too soon of any fibre. Introduce it very gradually and give the bacteria that eats it time to grow.

(I'd really appreciate if anyone has more information on the topic of bacterial enzymes and fibre tolerance as I've been looking for quite a while).


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## Denis (Feb 10, 2012)

The theory for the various diets that starve bacteria seems to be that once your overgrowth is more controlled (through bacteria starving from your diet) you can can add more FODMAPS/harder to digest food because there wont be too much bacteria to feed on them. I know people on the Fast Tract Diet including that author have fkund that they can tolerate a higher "Fermentation Potential" of foods eventually but it takes a while to do. Even then if they eat too many hard to digest foods for too long their symptoms return.

Dr Siebecker mentions on her website that a SIBO diet can take 1.5 to 2 years to fully work so it can take a signifcant amount of time. As you know being low FODMAP is not enough if you are still eating high starch or sugar foods.

I remember reading the people behind the low FODMAP diet changed it to being "temporary" bevause they found it starved gut bacteria and altered the microbiome. Still research into gut bacteria is very new and logically I do not see the benefit of going out of my way to feed gut bacteria. I also do not see how prebiotics only feed good bacteria especially since a certain amount of a type of bacteria can be good but too much is bad. Furthermore all bacteria feed on undigested carbs from my understanding.

It is possible that if we heal our guts and starve the bacteria we can tolerate a higher FODMAP level. As with anything it seems good to try reintroductions a d see if you get symptoms. At the end of the day however tolerated is not optimal as we see from how the average american eats. Just because their diet does not lead to IBS does not mean it isnt responsible for other lifestyle illnesses that have been popping up. Again peple on gut healing diets are able to tolerate more food eventually but it is a long process.


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