Since my last blog post about my Irritable Bowel Syndrome and my attempts to solve it, I’ve properly learned what FODMAPs are (which I didn’t know then), and tried a low-FODMAP diet. The FODMAP app I’m using recommended I see a dietician to help me implement the diet properly, so I did. It was somewhat helpful – although not as much as I’d hoped – and I’m still following it.
So in this post, I want to review my hypotheses about what foods are causing or “triggering” (or indeed “irritating”) my condition, cross off the ones I’ve rejected, and record my newest hypotheses. I’m pretty excited because I think I’m getting closer to understanding my condition, and if my understanding helps some other people who have the same problem as me, that will be of benefit not just to me, but potentially to all those other people as well. However, I should stress that, right now, these are all just hypotheses. Hopefully in the future I’ll be able to get a better understanding of what’s going on, by reading and doing further experiments (i.e. experiments on myself).
- Gluten. Many people start to believe that gluten is making them ill, “cut out gluten” from their diet, feel better, and stop there. But why stop there? What if it was not gluten that was causing their problems at all? I have tried substituting gluten-free bread for ordinary bread, and keeping everything else the same in my diet, and this didn’t seem to help much – or at all. Also, I later had a blood test for coeliac disease done, which came back negative. So it seems that I am neither coeliac, nor do I have “gluten intolerance” (which probably doesn’t exist anyway).
- FODMAPs. These – there are 4 main types of FODMAP – are clearly part of the picture. Let’s look at the 4 types of FODMAPs in turn:
- Fructose: Yes, definitely. For example, apples give me abdominal cramps. How I could have gone through the majority of my life without realising this fairly straightforward cause-effect relationship is a mystery to me, but there you go. I suppose it’s possible that something, perhaps some antibiotics, triggered this particular food intolerance in me at some stage in my life, and previously I didn’t have it. But I don’t remember ever being free from IBS symptoms for long periods of time – so probably not.
- Lactose: I’m sure that I have lactose intolerance, and this was so obvious that I realised it (though I did not know exactly what it was, nor the name for it) when I developed it at around age 11, as many people around the world do. Arguably this is not really a “medical condition” because the majority of the world population has it. It’s more like people who can digest lactose (which includes most white people, but does not include adult-me, even though I’m white) have some kind of superpower. Taking lactase pills really does seem to help – and taking 2 or more of those pills spaced out through a meal, instead of the recommended one pill just before a meal, seems to help even more in some cases.
- Polyols: I am indeed, it turns out, extremely intolerant to even small amounts of polyols – as I found out when I tried to take a small caffeine pill that also contained sorbitol, a polyol. I won’t make that mistake again! (Of course, it’s theoretically possible that I’m actually intolerant to caffeine, but I have other evidence that I’m intolerant to polyols.)
- Oligos (oligos-fructans): Am I also intolerant to oligos-fructans, thus rendering my condition a complete – and rather unusual and dangerous, I understand – “all-FODMAP intolerant”? Well, according to the very useful and inexpensive Low FODMAP diet helper app that I use, 2 slices of certain brands of “ordinary” gluten-free bread are low in all types of FODMAPs, whereas some normal, non-gluten-free breads are high in both oligos-fructans and fructose. The problem with this hypothesis is twofold: eating gluten-free bread didn’t seem to help me, and eating Warburton’s 400g Toastie bread, even though it isn’t gluten-free, did. But I suppose it’s possible that the particular brands of gluten-free bread I tried weren’t low-FODMAP (unfortunately it seems no UK food producer has heard of FODMAPs, so food labels are no use for determining this) and it’s possible that for some reason, Toastie bread is low-FODMAP while more ordinary breads aren’t. It just doesn’t seem very plausible to me.
I don’t fully understand what makes food high or low FODMAP – I think in some cases it’s not just ingredients, but also food preparation methods. A very good example is sun-dried tomatoes – the very same ingredient – a tomato – is harmless if eaten raw, but becomes high FODMAP if left out in the sun to dry, amazingly enough!
The only way to really know for sure if a food is low FODMAP is to rely on the Monash University testing centre and their FODMAPs mobile app (see above), which connects to the Monash FODMAP test database that is regularly updated with new foods. This means that if people want a food that’s not sold in Australia to be tested, it needs to be shipped over there to them. In principle, even if it’s the same type of food as something that’s already in their database, if it’s a food with multiple ingredients and it’s a different brand, it might be very different from a FODMAP perspective! Maybe I’ll suggest to them that they test the Toastie bread (and the gluten-free breads that I tried).
So anyway, score a big fat zilch for gluten, and 3 out of 4 for FODMAPs, with the remaining 4th FODMAP – oligos-fructans – being unproven.
But I don’t think that FODMAPs can be the whole story for me, because I also have problems from eating most types of crisps (which are called “potato chips” in American English), which the Monash FODMAP app says are low-FODMAP. This is weird because crisps are essentially nothing but potatoes, salt and oil – and I don’t seem to have problems with potatoes, salt or oils per se. Chips (which are called “French fries” in American English) don’t give me problems. Weird!
- Time of day. I’m inclined to reject this idea out of hand as just silly. How could the time of the day that I eat something, per se, affect my digestive system? I’ve never heard of that happening. But empirically, I haven’t yet ruled it out.
- Annoyingly, IBS symptoms can last for up to 24 hours after eating trigger foods, so the actual trigger might be something else that I tend to eat earlier – on the previous days – and it’s just coincidence that making it’s looking like the different types of bread make a difference. I consider this hypothesis extremely statistically improbable already, but it should be easy to rule out.
- mandubianhotep on Twitter – somewhat predictably for a Frenchman – suggests “quality and quantity of ingredients” (of the bread). This is frustratingly vague compared to most of the other hypotheses, which makes it more difficult to assess, so I’m inclined to ignore it for now and come back to it later if I run out of ideas. Well, actually he did tweet me very specific instructions to follow – but from a “scientific” perspective I would like to discover what is really going on here, not just find something that works and then stick with it. That’s the same mistake that the gluten-free people who aren’t actually gluten-intolerant make.
- Comparing the ingredients of one of the problematic types of “ordinary” bread, and the “magical” Toastie bread, there doesn’t actually seem to be all that much difference. The “ordinary” bread has palm fat which the Toastie bread doesn’t, so it might be that. This is saturated fat produced by fractionation.
- The Toastie bread has an agent added to prevent mould, and the “ordinary” bread doesn’t, so perhaps I’m extremely sensitive to invisible quantities of mould at levels that don’t affect most people. That would be very weird and disturbing, so I’m going to assume it’s not true. ;)
- The Toastie bread does have a substantially different consistency – it’s thicker – so perhaps it’s due to the use of less yeast. However, I can eat a whole loaf of it with few ill-effects, and yet have major ill-effects from a few slices of normal bread, so that doesn’t seem plausible.
So I’m going to go with palm fat, and test that hypothesis some more. And is this somehow connected with my “crisp intolerance”?
Stay tuned for the next exciting episode in this saga…