# IBS Threshold - working towards a symptom cure



## tummyrumbles (Aug 14, 2005)

The FODMAP theory introduced the concept of a "personal threshold" to FODMAPs, meaning a point at which IBS symptoms began. The FODMAP diet is based on the principle of excluding all FODMAPs for 2 months then gradually reintroducing one FODMAP at a time to test tolerance. The FODMAP theory accepts that we need to eat some FODMAPs for a healthy diet but individual tolerance levels to particular FODMAPs vary. Some might react badly to wheat for instance, whereas others are fine with it.

http://www.medicinetoday.com.au/cpd/files/articles/201103/MT2011-03-029-HALMOS.pdf

We should extend the "threshold" to include all factors that affect IBS, not just diet. Other equally important points to consider are: digestion time, sleep, transit time and bowel evacuation time.

Bowel evacuation time may not be directly linked to overall transit time. Some people go regularly once a day, but have a sluggish colon. For many of these people incomplete evacuation leads to their main IBS complaint, gas, and gas in turn can cause constipation. A regular 24 hour bowel evacuation doesn't mean that all food is eliminated every 24 hours. A potentially problem food like bread could still be causing symptoms days afterwards.

This makes "complete evacuation" difficult to pinpoint. At what stage is evacuation considered to be complete if stool is segmented throughout a sluggish colon? Can diet and other factors lead to a more efficient and quick digestion and bowel evacuation? And can a low flatulence diet reduce gas symptoms even if you are still constipated?

Reducing fermentable carbohydrates (FODMAPs and resistant starch) will reduce the short chain fatty acids that produce gas and constipation. Soluble fibre also can feed bacteria, however a longer cooking time and pureeing can reduce fibre content. Complete chewing aids digestion of carbohydrates.

Alcohol causes gas as well as damage to the intestinal tract.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2614138/

Alcohol has its own threshold limit as a small amount can be beneficial for some people. The dose determines whether it is a safe or unsafe food.

Sleep has an affect on IBS. Serotonin is a neurotransmitter that regulates intestinal motility. A lack of sleep can affect serotonin levels.

http://www.ncbi.nlm.nih.gov/pubmed/16408408

Certain sugars such as lactose in milk and raffinose in baked beans can be highly indigestible for some people. Other FODMAPs and resistant starches may be more easily digested and it would be easier to maintain your dietary threshold by excluding these two sugars as much as possible. Plant foods and cheese can be higher in calcium than milk, and hard cheese is an acceptable low FODMAP. Hard cheese and yoghurt generally has very little lactose.

All of these factors have a cumulative effect on IBS and together, a low FODMAP low starch diet, careful chewing, and a good night's sleep will aid digestion and efficient peristalsis. Quite often there is some leeway where a less than ideal diet could be compensated by extra digestion or sleep time, and vise versa. What we lack in one area we can gain in the other.


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