# Need help: Low-FODMAP vs. SCD diet, more fiber vs. less fiber



## sf_tallguy (May 8, 2013)

I'm a 44-year-old male who is otherwise healthy other than having had IBS-D for nearly 20 years and mild lactose intolerance most of my adult life. Recently, my symptoms seem to be getting a bit worse and I've decided to finally try some diet interventions to see what might work. I'm a bit confused by the different diet options and looking for some help. It seems a few routes contradict each other, so I'm having trouble deciding how to proceed.

As for my IBS background, over the years, I've had a range of tests (colonoscopy, sigmoidoscopy, upper endoscopy) which all came back normal. IgA and IgB were both normal. I did have giardia once (resolved with antibiotics) and at various points stool samples have been positive for the so-called "harmless" fellow travelers: Entamoeba Hartmanni, Endolimax Nana, and Blastycystis Hominis. My doctor didn't suggest treatment for those (the last stool sample was six years ago now, so I don't know if those are still present, but presumably they are).

My symptoms are flatulence, especially in the evening and at night, and soft/loose and foul-smelling stools. Once in a while I have watery stools, and sometimes even semi-firm (at least consolidated) stools. I generally have 1-2 BMs per day, usually a relatively urgent one in the morning after coffee and breakfast and sometimes I experience constipation in the evening (specifically, a feeling of needing to void, but unable to do so). On a bad day, though, I might have 4-5 loose or watery BMs and sometimes experience tenesmus (feeling that I'm unable to fully void without serious straining). Currently, I have an anal fissure probably from excess straining. I don't normally have pain or cramping. I manage fairly well with my symptoms and after so many years I've actually just become so used to it that it doesn't even strike me as abnormal anymore.

I've been taking nortriptyline nightly for years and sometimes also Imodium in the morning and they seem to help a bit, but it really varies. I'm an omnivore and eat a relatively varied and healthy diet with lots of fruits, vegetables and whole grains and I don't actively limit any particular food groups other than milk. I do eat a range of cheeses and ice cream regularly with lactase pills as a supplement, and take beano when eating beans, brussels sprouts, etc. I very rarely eat processed foods, and never eat artificial sweeteners, but I do probably eat more sweets than I should (usually home-made baked goods, dark chocolate, caramels, ice cream, etc.).

So I'd like to try either a low-FODMAP diet or a Specific Carbohydrate Diet (SCD) and possibly take some fiber supplements. But the low-FODMAP and SCD diets overlap on some points and contradict each other on others (brown rice, oats, quinoa are okay on the low-FODMAP diet, but forbidden on the SCD diet, and apples, peaches and mangos are fine for SCD and ruled out for low-FODMAP). Likewise, it seems that for IBS-D, some people report more fiber makes symptoms worse, while others swear by it.

Thoughts on how I might proceed, or questions I can or should ask to help decide which dietary path to consider? Something else entirely, other than what I proposed, above? I've got a doctor suggesting I try Bentyl. But I'm wanting to test out dietary interventions, first. Or is Bentyl worth it (seems to be mostly for people with pain and cramping, which isn't me)?

Thanks for any advice!


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## Kathleen M. (Nov 16, 1999)

Low Fodmap was designed more for IBS. SCD was for inflammatory bowel diseases, so they aren't going to agree, they start from different assumptions.

I might tend to the low fodmap as it is more for reducing the amount of gas the bacteria in the gut can produce.

Fiber is very individual, I don't know how to predict who it will help and who it won't. If you do try a fiber supplement (or adding high fiber foods) start small and increase slowly.

It would be nice if there was a one size fits all answer, but there isn't.


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## sf_tallguy (May 8, 2013)

Thanks, Kathleen. That is helpful. I was not aware of that distinction, so it does sound like low FODMAP would be a better place for me to start. I've got the "IBS - Free at Last" book and found some great FODMAP resources online. And with fiber, again, thanks for the advice.


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## Wanting2BWell (May 8, 2013)

Hi,

I read your post, and my daily condition is similar to yours. I have been trying the FODMAP restrictions with pretty good results. In the past few months I have also stayed virtually gluten and dairy free, with the occasional "cheat". It has made a big difference in my symptoms...and when I do cheat......I REALLY have a problem....sometimes lasting for 2-3 days.

If you are certain you are dealing with IBS, I think the FODMAP is definitely worth a try....and find a nutritionist who can guide you through it. It is an elimination diet, so not everything is given up forever..... Good luck!


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## Wanting2BWell (May 8, 2013)

Sorry....duplicate post


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## Brownish72 (Aug 26, 2012)

Each diet needs to be tailored to the individual.

Currently, for example, i do a combination of the low-fodmap diet + SCD. Meaning I eat only SCD legal foods (so no grains / no starch) , and I limit the fermentablity of my foods via the low-fodmap diet.

The biggest mistake on these diets is adding new foods. Its a slow process. I hate it, and I'm still doing it. You add a little bit, you wait.. then you try more than you did last time, and do this over a period of 2-4 days. Its like with a newborn. You add a new food, and you look for a reaction over the next few days. Eventually you will hopefully build a list of foods that are "safe" foods that you know you can turn to.

I mention this each time in most of my posts, because I do feel bacteria are the root cause of IBS for those who do not have any other well known conditions, such as celiacs, IBD etc. If you have not been tested for Small Intestine Bacterial Overgrowth, aka SIBO, it is worth investigating. Its a simple test, non-invasive, and your profile of symptoms fits the condition. On the other hand, the 'profile' that fits SIBO is quite large. But its an easy test, and that could also help you choose which diet to do. If you have SIBO, a SCD would be more 'effective' theoretically because of the types of carbohyrdrates allowed on the diet. But if you do not have SIBO, fodmap would be awesome. Or you do a combination of the two, start tomorrow, and regardless of what you do; diet seems to REALLY make IBSer's feel better 

Good luck


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## Dr. Dani (Jan 18, 2013)

When it comes to IBS-d, often it's true that too much fibre can make symptoms worse, especially if you are using only food appraoches alone to control your symptoms. Stress plays a huge role and causes physical changes in the gut, leading to the predominance of the parasympathetic nervous system, which can lead to diarrhea in IBS. That being said, insoluble fibre for IBS-d is best kept at a minumum, so for example, brain fibre. Soluble fibre sources can also cause lots of bloating in some people, esp. with IBS-d. So taking a fibre suppplement even something like PHGG is not recommended if you suffer lots of bloating and IBS-d

Hope this is helpful for you!


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## RainboGirl (May 1, 2013)

Hi, I am currently doing the FODMAP diet with a dietitian and she recommended to eat at least 3 pieces of fruit ( the safe ones) if constipation was a problem.


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## sf_tallguy (May 8, 2013)

Brownish72 - I don't think I was ever tested for SIBO. I will talk with my doctor about doing that. Probably best to do it before starting a full elimination diet phase. Thanks for the suggestion.


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## Brownish72 (Aug 26, 2012)

Good luck. But starting a diet like SCD or Low Fodmap is a very easy intervention to see what happens, whether you get tested or not, it seems like most IBS patients get relief from low carb diets. Once again, a reason why I feel SIBO / Bacteria is the root cause of this condition.

If you do a diet; I recommend really not cheating to get the full benefits. And this is quite difficult at first. But once you get passed this part, it becomes easier. Best of luck


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## Tonya Hildreth Stevens (Jun 18, 2014)

Brownish72 - your journey sounds very similar to mine. Do you have an update on your condition? Here is my SIBO treatment to date and test numbers and dates in case it helps you.


Flagyl for 5 days in June 2012 (June 12th ish for 5 days) for presumed giardia
Seemed mild improvement during the course but no resolution of gut symptoms or brain fog or sleep issues

Toxoplasmosis meds (Sulfadiazine and pyrimethamine) starting 9/27/12 - 10/12/12 for ~2 weeks
Seemed to resolve brain fog and need for so much extra sleep but was not resolving gut symptoms. I told OHSU infectious disease doc that I thought the meds were working on the brain infection and sleep issues but not the gut and asked if it could work on any other infectious disease and he said "no" and you don't have toxo so you must stop taking these meds and since my gut issues did not seem to be resolving (now know it was SIBO / 2 issues going on because of this Malaysia thing) and because he insisted he was the expert in this and the negative toxo PCR blood test, I stopped the meds even though I knew they were working and had cleared my brain fog and sleep issues.

Mebendazole deworming pill filled on 11/3/12 but not taken until a week or two later
Did not seem to do much

45 days of Xiafaxan (Rifaxan) and Metronidazole (Flagyl) started evening of 11/27/12 at 3 per day until ~12/20 when I went down to 2 a day until 12/28 down to 1 pill per day until 1/2/13, none on 1/3 but had to take on 1/4/13 due to stomach hurting then nothing 1/5 or 1/6/13 and started again the evening of Monday 1/7/13 due to still positive for SIBO finding.
Seemed to resolve the gut issues within 3 days of taking and never felt better since before Malaysia trip

7 days of Alinia - starting Dec 6th
Seemed to help additional sluggishness of gut but nothing really significant

3 days of Albenza at 200 mg twice a day starting Saturday 1/12/13 through Monday 1/14/13
Did not seem to do much

Started Rifaxin again 1 or 2 pills a day starting the week of 1/9/13 and then 3 times a day starting 1/16/13
Seemed to start helping again

1/16/13 started neomyacin as well with Xifaxan
Mixed results as gut seemed okay, other than norovirus issues but head and brain fog issues coming back the whole month of January

2/2/13 started toxo meds again (on my own since I had the rest of the 6 week prescription that I only took 2 weeks of earlier)
Brain fog/ infection feeling pretty much gone by 2/5/13 but was very sick to my stomach on 2/4/13 and mind-blowing headache, just like the first couple days on it last time but now fine
Once off xifaxan, my gut starts to hurt again within a day or two and feels like SIBO is back but brain infection is better with toxo meds
I was having illness/ sick feeling after starting the antibiotics or taking them. As such, on 2/7/13, started taking 1 sulfa every 3 hours for 5 - 6 times per day instead of 2 every 6 or 7 hours, 3 times a day as the heavy dose seems to have more of a negative impact on how sick I feel and headaches then keeping a standard level every 3 or so hours.
Still taking the daraprim 25 mg once a day



2/12/13 - I started Erythromycin 50mg prokinetic taken once a day at bedtime. I checked with Dr. Rose that the low level antibiotic prokinetic would not be bad to take while on toxo meds (1 of the 25 mg Daraprim and 6 of the 500 mg sulfadiazine daily) 
3/7/13 - 3/15/13 Started back on SIBO meds - Xifaxan and herbal antibiotics (Allimed and Berberine Complex) on 3/7/13 after seeing SIBO expert Dr. Seibecker. Stopping around mid-March 2013 in preparation for push endoscopy.
4/1/13 - 4/15/13 - Started back on SIBO prescriptions of Xifaxan and Allimed and Berberine Complex.
4/15/13 to 4/30/13 - Continued to take Allimed and Berberine
5/1/13 to 5/10/13 - started on doxycycline (2 per day) and Folic Acid (suspected Tropical Sprue but more as a preventative to the post lumbar puncture infection)
5/12/13, took 3rd SIBO test with 45 ppm hydrogen and only 3 ppm methane - started Reselor prokinetic 1 mg. Went up to 2mg on Monday 5/20/13 and back down to 1 mg after that but on 5/23/13, Dr. Seibecker said since still SIBO positive now at 45 ppm, c/an go to 2 mg Reselor, back on Xifaxan, Neem and Propolis.
5/23/13 - Xifaxan started again after 3rd positive SIBO 45 ppm (took Xifaxan, Allimed and Berberine today, awaiting Neem & Propolis to arrive). 
6/25/13 - Still on 3 Xifaxan 550 mg per day for me and 3 of the 200 mg per day for Brianna, taking 4th SIBO test on Sunday, June 23rd and awaiting results. Also take 2 - 3 of the Neem and Propolis per day and 1 - 3 of the Berberine per day in addition to Xifaxan for me, but Brianna will only take Xifaxan. Connor only takes Berberine 3 times per day.
6/26/13 to 8/25/13 - added back in Metronidazole for evening dosing of Xifaxan pairing and morning 6/27/13 - huge positive movement by 9am Thursday 6/27/13. Maybe metronidazole was the key and was the reason my SIBO levels cut in half from Nov 2012 to Dec 2012 SIBO test. Brianna and I both on Metronidazole and Xifaxan pairing from 6/26/13 - 7/15/13. We both did not taking any antibiotics on 7/16/13 to prepare for the 7/17/13 SIBO breath test and will not take any more until we get the results of the test. 8/25/13 took my last antibiotics and Reselor given feeling pretty good, minimal SIBO improvement and to give my body a break.
August 2013 - starting Bactrum/Septra - good study of about 99% success rate on children in brazil 6 - 10 years old for SIBO improvement
8/27/13 - started on probiotics and back on Reselor after 8/29/13 Dr. Siebecker appointment. Still on the same prokinetic and probiotic as of 9/5/13 but no other antibiotics.
9/15/13 to 10/01/13 - After SIBO test, started Sulfamethox - TMP DS 800-160 Tab twice per day, metronidazole 250mg 3 times per day and after 9/17/13, added Nitazoxanide/Alinia in addition. Started prokinetic Reselor again on 9/16/13 evening but stopped all probiotics (just made my stomach bloat and hurt more and never seemed to help much). Plus, seems that probiotic converted from positive hydrogen results to positive methane results
10/06/13 to 10/15/13 Xifaxan just twice per day after lunch and after dinner as mornings seemed fine
10/15/13 to 10/24/13 Bactrim & metronidazole pairing, Allimed and Candidstat added since 10/21/13. Stopped Bactrim and metronidazole on 10/25/13 due to raging yeast infection
Xifaxan from 10/25/13 - 10/29/13
Elemental diet from 11/7/13 - 11/15/13
Allimed & Berberine and Reselor sporadically from November through February 2014
Elemental diet from 2/15/14 - 2/25/14
Reselor, Allimed and Berberine daily 2/27/14 to present 3/10/14, then just Reselor until 4/8/14
Off Reselor for Triple therapy Alinia, Sulfamethox and metronidazole from 4/8/14 (Brianna didn't start until 4/10/14) to 4/20/14 (4/22/14 for Brianna)
Reselor starting 4/20/14 for Tonya & 4/22/14 for Brianna (1/2 of the 2 mg pill in morning, other half at night and ¼ in morning and ¼ at night for Brianna). Even though Methane was lower on 5/18//14, acne, weight gain, dizziness, more tired again, pain in left side small intestine area significantly increased with Hyrdrogen numbers as I predicted test result with those worsening symptoms before getting 5/18/14 test back. 
5/28/14 Tonya and Brianna back on Xifaxan 3 times per day plus Reselor in morning and night
6/3/14 Tonya and Brianna added metronidazole to Xifaxan because Tonya's stomach hurting so badly, getting super tired, needing more sleep, etc. 6/4/14 - had to leave work to come home and nap after going to bed 2 hrs early night before, plus diarrhea/ soft stool but stomach pain subsiding after soft stool and maybe because of adding metronidazole? Acne continued to get worse and stomach pain and dizziness and sleep need increased until meds stopped on Wed 6/11/14 prior to starting elemental and clear antibiotics are not working/ still getting worse - see if test on 6/14/14 confirms this with higher or lower numbers than 5/18/14 test.
Started elemental via ng tube for Brianna and orally for Tonya on 6/13/14. By 6/17/14, dizziness is subsiding a bit and stomach pain almost gone but making significant noise all night 6/16/14 but some lower abdomen - like some organ in pelvic region, is hurting and same with Brianna so maybe kidneys processing elemental but different than SIBO gut pain, so elemental diet may be killing bacteria

*SIBO Test Results Tonya = mostly all double peaks*

Date:  Hydrogen Methane Double Peak Times

11/16/12 154 ppm 37 ppm 120 mins single peak at 191 ppm combined

12/21/12 85 ppm 21 ppm 80, 120 & 160 mins triple peak

5/12/13 45 ppm 4 ppm 100 and 140 mins hydrogen

6/23/13 65 ppm 5 ppm 100 and 140 mins hydrogen

7/17/13 45 ppm 5 ppm 100 and 160 mins hydrogen

8/17/13 39 ppm 4 ppm 100 and 160 mins hydrogen

9/15/13 24 ppm 30 ppm 80 and 180 mins peak methane

9/25/13 86 ppm 1 ppm 120 and 160 mins hydrogen

10/6/13 90 ppm 2 ppm 80 and 180 mins hydrogen

11/8/13 11 ppm 0 ppm 60 and 120 mins hydrogen

11/14/13 3 ppm 3 ppm

2/17/14 68 ppm 9 ppm 120 mins and 160 mins

2/24/14 13/12 ppm 4/5ppm 120 mins at 13/4 and then 180 mins 12/5

4/4/14 16 ppm 5 ppm 80, 120 & 160 mins almost same

5/18/14  49 ppm 1 ppm 80 min & 180 min double smaller 21 peak


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