IBS-friendly low FODMAP high calorie ideas needed please

[longestlurkerever]

DH has what has so-far been diagnosed as severe post-viral IBS, though tests are ongoing. He's on a low-FODMAP diet which restricts pulses, certain nuts, gluten, apples, pears and stoned fruit, among other things and, through a process of trial and error, has also cut out caffeine, fatty foods, lactose (though low lactose hard cheese and lactofree products seem to be OK and he does tolerate a bit of butter) and eggs. He's mostly living on porridge made with water, low fat fish or meat with rice and mediterranean-style veg.

He's losing weight at a rather alarming rate and is having further tests to rule out anything more sinister (he's had a colonoscopy, stool samples, endless blood tests already). Assuming it's "just" IBS though, does anyone have any suggestions for snacks or lunch items we can make to get more calories into him? Sugar is OK in smallish quantities but high fat and dairy (except hard cheese and lacto-free products) make his IBS worse. I was going to attempt to make some brownies and flapjacks but the sugar and butter won't be brilliant for him. I think most nuts are OK but not his favourite cashews and pistachios.

Many thanks for any ideas. Is horrible to see him wasting away.

I'm on a similar diet and so is 1 DC.

It's hard but I think the way to go for him is more lean protein. You can buy gluten-free anything now so if he can eat gluten free bread, wraps and pitta bread then more sandwiches with chicken, egg, cold meats etc.

scones made with gluten free flour are good and low sugar. You could make savoury ones with cheese.

What about gluten free pasta salads with chicken, tinned tuna and permitted vegetables?

I've found that making brownies and reducing the sugar gives good results- reduced it by half to 100gms. But TBh this type of food is a 'treat' and not really nutritious.

I don't think you ought to bother with 'low fat' fish. He needs oily fish and there was some research a while back showing that IBS responds to high Omega 3 levels (found in oily fish.) So he should be able to eat salmon just not food cooked in fat- eg deep fried.

Most of the supermarkets now have gluten free products such as breads and cakes which aren't that high in sugar. And either Lidl or Aldi do a range as well.
Can he eat two slices of gluten free toast and jam along with his porridge in the morning. And increase his portion sizes of the things he can eat.
Can he have a soya or other alternative milk on his porridge instead of water, just to get more calories in there.
Can he have potatoes, like could he have a large baked potato for lunch with something in it.
Is sugar alone something he can tolerate? Like a fizzy drink that has had the fizz knocked out of it by stirring. They are basically sugar and water. Seems counter intuitive to a 'healthy' diet but calories is calories when you need more. Like 2 cans of 7up is around 300 calories.

Poor guy, that sounds really rough. What about chicken, tofu or fish curry with lots of coconut milk to add bulk and nourishment? If rice is OK for him perhaps try risotto which tends to be a bit more filling than just regualr rice, especially if he can stand a bit of butter or grated hard cheese added to it. Victorian-style kedgeree with boiled eggs, rice, fish can be much nicer than just plain rice and encourage him to eat more. If he can tolerate some nuts, I have a good pseudo-brownie/chocolate cupcakes recipe that is gluten free and pretty low sugar - uses dark chocolate, ground almonds or brazils or other nuts, eggs to bind it all together and a smidgeon of brown sugar. Or would that be too rich/too nutty?

Is he following the FODMAP with a dietitian? He ought to be. The basic FODMAP does not necessarily exclude dairy or gluten. These are introduced- or rather taken out- at a later stage if there is no improvement with the reduction in fruit, veg and pulses.

He could use lactose free milk- easily found in supermarkets - for porridge. Or he could try oat milk or almond milk. All would give him more protein. Lactose free cheese is available.

Nuts are a bit suspect IME- they do have a lot of fibre so although not high fodmap can be detrimental to anyone with an overactive bowel.

It's not clear from your post if you want ideas for packed lunches or lunches at home or in a work place where he can heat food etc.

DC takes things like gluten free pasta salads to work and heats in a microwave.

I know that cooking in deep fat or eating fat-laden foods like fish and chips, curries from take aways etc is different from eating food naturally high in fat.

Thanks for all the suggestions. We have only just discovered the lactofree range so are experimenting with that. He's never terribly well so it's hard to tell what triggers him but fingers crossed he's OK with it and we can make some creamier sauces and porridge. Jam unfortunately is out because of the fructose, as are eggs and soya, which are in a lot of gluten/dairy free recipes though it's possible egg white is OK and I will experiment a bit with this.

Coconut and almond milk are meant to be used sparingly so although he does eat these, I don't think we can just freely add coconut milk to dishes on a regular basis. Ditto cheese - it's OK fodmap-wise but in large quantities the fat and lactose become a problem.

I forgot to mention onions, garlic, pepper and chilli being restricted - makes curry not impossible but kind of tricky, ditto a lot of pasta sauces, though we do find things to make eg puttanesca or salmon and lactofree cream They're reasonably light meals though, especially when combined with malabsorption. I've been losing weight too, though can better afford to.

It's really annoying - we feel like we've got dinner more or less sorted but since we got his IBS better under control - mainly by reducing fat to almost none - other issues have cropped up like weight loss and kidney stones. It's so hard to get the balance right. The biggest problem is the fatigue that follows any IBS flare up.

He does have access to a microwave at work. I was also thinking snacks for between meals might be a good plan.

Both of us have a history of bowel cancer in our families and we're not entirely comfortable being so reliant on meat at every meal, but it's hard to see what else to do.

He does have a dietician though she tends just to say he's doing the right things. His GP takes his symptoms seriously and refers for lots of tests, for which we're grateful, but when they come back clear we tend to feel a bit like "well, you're not dying so what more do you want". He's waiting for a CT scan which I'm a bit nervous about and more blood/stool sample results though I think they'd have rung by now if they'd shown anything.

Is his dietician trained in FODMAPS though? That is an inadequate calorie intake from the sounds of it.

Posters are suggesting commercial products. Be really careful that he can tolerate preservatives and additives. They are really tricky for many FODMAPS people.

Can he tolerate avocado? Nuttelex is worth a trial to add calories. Maple syrup? Golden syrup?

Chocolate is not usually well tolerated--we use white chocolate sparingly.

Yes, I think so - she certainly knows about FODMAPs though he had already found out about them before his referral came through. She's an NHS dietician. They are "monitoring " his weight loss and said it would most likely level off but it doesn't seem to be - hence the CT scan referral. though that was also because of his potential kidney stone symptoms.

Yes, we do use gluten free pasta and some bread products but they have so many ingredients in that we are a bit cautious - he certainly doesn't have "free from" stuff every day - maybe a bready product less than once a week and the pasta more often. It's more or less just more rice though, isn't it, so not massively more nutritious?

Avocado is another "sparing" one - he tends to have it with sushi at work but in limited quantities. I've not heard of nuttelex - will look it up thank you - and I will try maple syrup. That's what I was going to use for the flapjacks.

He does eat chocolate. Perhaps he shouldn't. He is such a foodie though, it's hard to deny him everything!

Eggs are not restricted on FODMAP.

Why is he not eating them?

Not all NHS dietitians are trained in Fodmap- there is a rolling programme to train them at their request. (I've professional knowledge on this).

My personal view is that you need more information from the dietitian! Gluten free foods are not out of the question. Gluten free pasta is either all corn, all rice, or a mix of the two- nothing else in it.

You can make your own gluten free cakes etc with Doves Farm flour which is pretty safe-all the ingredients are on the label.

This website and the dietitian is very helpful- she's NHS and private and was one of the first people trained in Fodmap from Kings College where gastro consultant Peter Irving did the research and does the clinics at Guys and St Thomas', London. If your DH needs more info, she does appts by Skype and is very reasonable fee-wise.

www.wisediet.co.uk

This is from the website above- you can check if the person your DH sees is trained.

www.kcl.ac.uk/lsm/research/divisions/dns/projects/fodmaps/files/List-of-dietitians-for-website-December-2015.pdf

Has your husband had a blood test for coeliac? Sounds as though they have been thorough! I think my son developed it after a severe infection, though we will never know for sure.

sorry for the posts OP! But it seems as if your DH has 'other' digestive issues other than IBS and using the Fodmap- is that right?

I don't know the history but it sounds as if he needs a team effort between his GP, a gastro consultant with expertise in IBS and bowel issues and the dietitian. Is this all happening?

I'm just curious because eggs, cheese and fat are not excluded from the Fodmap.

what is missing from his diet are carbs, really. So instead of wheat he needs to get some carbs from oats, potatoes, tapioca, rice , quinoa, and corn.

If he has ENOUGH of these day to day, he ought not to lose weight so quickly.

There is a huge list of 'ok' fruit and veg in the Fodmap- starchy foods like parsnips and bananas for example- so he could have chunky veg soup (home made with homemade chicken stock) or take it to work.

Thank you - this is all helpful. Eggs he is restricting after he spotted an apparent correlation - there are personal intolerances in addition to the generally recognised FODMAPs - his dietician encourages a bit of experimentation. It's all trial, error and guesswork though, and his tolerances seem to vary depending on whether he has a cold or something. Weirdly when his IBS seems generally better controlled is when he seems particularly sensitive to lactose. He can sometimes "get away" with something that appears on paper to be bad, but too many of these occasions results in a flare up - putting all the pieces together can be tricky.

Is he doing the testing in a scientific way? I only ask because I've been on more elimination diets in my life than I care to remember for all kinds of things!

You basically eat about 6 foods then gradually introduce one at a time and wait a few days in between.

The 'challenge' is to eat a large amount of the food and no other suspect foods at all, then wait for a few days to see if there is a reaction.

TBH this ought to be done under supervision as it is if the Fodmap is followed with professional help.

If his intolerances vary so much day to day, I'd guess they are not intolerances at all- if that makes sense.

I think you need more professional help and if you can consider it think about someone trained in both IBS and food intolerances to help you both.

Also watch artificial sweeteners & egg replacements both can cause problems for IBS

I eat lots of root veg soup & bacon.....but gluten free stuff often has other things in (chemically stuff) which make me worse

You might want to check his sensitivity to soya too

If you really want to avoid processed gluten-free foods (I only buy the bread, nothing else) then you can find loads of recipes online such as from Dove's Farm, and make your own recipes including bread.

Don't apologise polly - i'm grateful for all input. It's ruining our lives, tbh.

We're really not sure. He has had sensitive digestion ever since he picked up a particularly nasty stomach bug in Sri Lanka years ago but it all went a bit haywire following a nasty gastro-virus a couple of years ago. He has seen a specialist who said it was "classic" post viral IBS and we did think he was on a general upward trajectory with the FODMAP plus other restrictions diet, but with significant dips if, for example, he caught a cold, when it becomes unmanageable again.

A couple of weeks ago he suddenly had a lot of pain that was either a kidney stone (the GP diagnosed kidney tenderness and he had pain on urinating - she referred for a CT scan but the date has not come through yet) or a stomach bug that triggered his IBS cramping (he was basically in agony all night) or some unfortunate combination of the two and since then I'm not so sure he is on an upward trajectory after all and the weight loss has continued/accellerated. Sorry for the TMI but he's quite concerned that the suplhuric burps that were a symptom of the original virus have returned. He's started hardcore probiotics (recommended by the specialist but not prescribed by the NHS) but they are not helping yet and may be making things worse. It's early days though and apparently there can be a short period of getting worse before progress is seen.

The gastro specialist we saw privately so it's not "joined up" exactly but the gp (some of them anyway - it's not always the same one) - have been good at referring for tests (inc coeliac, yes) and did refer to the dietician. I think he's going to try and make another appointment to bring all the strands together as soon as he gets the latest test results back. I thought the CT scan would be quicker though and am encouraging him to chase that up. We have a limited form of insurance that can bring things forward if the NHS waits are too long.

Thanks - not particularly scientifically I suppose, no, though he has been keeping food diaries and sharing them with the dietician, who says he's sticking to the FODMAP principles very well and only suggests a few tweaks whenever she sees him. The gastro specialist recommended the probiotics though he's only just started taking these after failing to get the GP to prescribe them.

PollyPerky getting good advise on the NHS is a nightmare - my FODMAP appt involved "this is the booklet - have a read and come back in 6 weeks to tell me how you are doing"

When I went back for more help - the training had involved Powerpoint slides of each page

katy Even privately (one DC went privately) you still have to follow the booklet for a number of weeks- that's the regime. Then you gradually add in more foods and see how you react. I'm not sure what other advice you felt was needed? the idea is to follow the very basic group of foods then gradually over several weeks, add foods that may cause a reaction. a private dietitian would do exactly the same, though you can of course ask then questions via additional appts at any time.

Trying to remind myself of our go-to meals for vegan/allergic friends. Polenta could be a good one, very simple but quite nutritious. Steamed fish, chicken, mince? A pilaf with brown rice and added bits of fish or lamb. Oat milk and almond milk in place of cream/milk. The problem is a lot of what we'd add to give protein/calories seems to be out of bounds for your DH at the moment eg coconut milk, ground almonds, cream, etc - are all oils and fats triggering for him, or just some? Eg could you saute veg for a soup in olive oil, coconut oil or sunflower oil OK? In which case maybe try to add more calories that way? Eg adding oil and lemon salad dressings? 'Creamy' squash or leek soup sauteed in oil with plenty of added oat milk or similar?

Sounds even harder than regular FODMAP, really feel for you.

OP tbh, anxiety is a huge factor in IBS. He might be caught up in a vicious circle, so something not linked to food may help- eg relaxation techniques, gentle exercise, yoga, mindfulness, meditation, body massage, etc. These physical therapies could really help him because the more anxious he gets about it all, the more that is likely to exacerbate the problem even if it weren't the original cause.

Probiotics sound like a very good idea. I know it's not in the same league at all but my DH got a nasty vomiting bug after travelling and didn't feel at all right afterwards - was recommended to try this by friends and helped so much: www.vsl3.co.uk/index.php

The fact that everything I ate caused a reaction even on the smallest amount

So I have been on it basically for nearly 18m

The consultant said I had a 'very fast transit time' & several significant intolerances which tbh is a description of my symptoms not a diagnosis

& then I get told to get on with it

By trial & error I have added in Vit D & B12, folic acid & zinc which have really helped (the zinc particularly) which are stabilising my ability to eat more selection

Thanks. Polenta is good and we've not had it much lately so I'll get some more. Oils I think we're going to have to try, though sparingly as if it ends up making his IBS worse it's counterproductive.

Those are the probiotics. I have high hopes and am stubbornly ignoring the fact they don't seem to be working yet!

Not heard about zinc, thank you . Will look into it.

I'll try and get him to relax. Is not always easy. He is going through a stressful time at work. I hope it'll be over soon. Baby dd2 is sleeping better at last and that seemed to coincide with an improvement

Spelt flour is acceptable under the fodmap plan. Treat it like plain flour and make something he would like. Fodmap typically doesn't cause weight loss as gluten free products are typically full of fat.