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Low Fodmap diet information

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BubbleandSqueak

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I am just starting on the Low Fodmap diet the second time around. I have not been diagnosed as a diabetic, but I have been diagnosed with Crohns for several years now and more recently (couple of years ago now) the hydrogen breath tests showed that I was both lactose and glucose intolerant. There was some suspicion of SIBO but a couple of courses of antibiotics didn't really change things so I was referred to a dietitian. Things have been somewhat up in the air since. I was put on the Low Fodmap diet a year ago and it didn't work out. This might have been at least in part because I was to some extent "winging it" and maybe ate an unbalanced diet. I kept to it strictly and managed around 10 weeks but didn't quite make to 3 months which is when the re-introduction phase begins (at least currently under the NHS). A year later and under the supervision of the NHS dietitian, I have just started the Low Fodmap diet again and would like to get it right this time, however I am rather frustrated by the lack of information. I do have a list of things I can and cannot eat and an app that provides the same when I go shopping, but I would like to find some practical recipe ideas and would appreciate it if someone could point me to a forum that can provide some useful practical information and support. I have yet to find a forum that deals with the Low Fodmap online.

In addition, I can't help wondering whether my condition might be a pre-cursor to diabetes, or whether it is an entirely separate issue? I (and apparently the Gastroenterology clinic) don't know what to make of the fact that I had tested with BOTH lactose and glucose intolerance, which the nurse at the time said was rather unusual - its usually one of the other but both is very rare. Whatever the cause, since apparently its not an IBD issue it is apparently not the responsibility of the Gastroenterology clinic which I am under, nor apparently the function of the dietitian service, which appears to be ridiculously understaffed, to deal with medical issues and provide a diagnosis. I therefore seem to be in something of a no mans land - not fitting into any particular category - with no answers which is deeply frustrating in itself. I would appreciate any insight into why I might have registered an intolerance to BOTH sugars.

(As an aside, I was given an information sheet regarding Lactose intolerance, but was given no advice regarding glucose. Yet, I have noticed that quite a lot of foods have glucose syrup as an ingredient - sweet as well as savoury - and I have observed a correlation between these and my symptoms so I now try to avoid both. I was so sensitive to Lactose that prednisone tablets - which are quite small but do contain it - left me in agony and made me feel extremely ill. I had previously tolerated them without any problem as a treatment for Sarcoidosis for several weeks. I have reason to believe that Dextrose also causes my symptoms. Over the last two years since my intolerance to Lactose and Glucose was discovered, my symptoms have not changed, although doing my best to avoid both sugars where listed as ingredients has made them more tolerable).

Sorry, lots of information here, but any insights greatly appreciated.
 
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Often terms get bandied about with no explanation thus causing confusion.
Glucose intolerance is a term used to describe metabolic conditions that result in higher than normal blood sugar levels. Conditions that fall under the umbrella of glucose intolerance include type 2 diabetes, prediabetes, impaired fasting glucose (IFG), and impaired glucose tolerance (IGT).
This is not that you are intolerant of actually ingesting glucose as such but does imply that your body has problems tolerating carbohydrates which convert to glucose.

People with lactose intolerance are unable to fully digest the sugar (lactose) in milk. As a result, they have diarrhoea, gas and bloating after eating or drinking dairy products. The condition, which is also called lactose malabsorption, is usually harmless, but its symptoms can be uncomfortable. This is different to milk or dairy allergy as it id the proteins in those products which cause problems.
Lactose intolerance is when you can't digest lactose, the sugar found in dairy products. You'll often get symptoms like stomach pain, gas, and diarrhoea. With a milk allergy, the symptoms affect more than just your digestive tract.

You should be able to get lactose free products and be careful of carbohydrate intake.
It would be worth asking for an HbA1C test which is a test to diagnose diabetes and then you would know exactly what they meant by saying you were 'glucose intolerant'.
It maybe that if you are diabetic or 'at risk' then the FODMAP diet may not be the best for you.
Do you take any medication for your Crohn's? My OH has been diagnosed as having largely asymptomatic Crohn's (doesn't actually believe it is that) what he eats has no impact and he takes Pentasa.
You appear to fall between two areas of medical expertise.
PS the prednisone if you are still taking then are steroids which are well known to increase blood glucose levels
 
Leadinglights said:
Often terms get bandied about with no explanation thus causing confusion.
Glucose intolerance is a term used to describe metabolic conditions that result in higher than normal blood sugar levels. Conditions that fall under the umbrella of glucose intolerance include type 2 diabetes, prediabetes, impaired fasting glucose (IFG), and impaired glucose tolerance (IGT).
This is not that you are intolerant of actually ingesting glucose as such but does imply that your body has problems tolerating carbohydrates which convert to glucose.

People with lactose intolerance are unable to fully digest the sugar (lactose) in milk. As a result, they have diarrhoea, gas and bloating after eating or drinking dairy products. The condition, which is also called lactose malabsorption, is usually harmless, but its symptoms can be uncomfortable. This is different to milk or dairy allergy as it id the proteins in those products which cause problems.
Lactose intolerance is when you can't digest lactose, the sugar found in dairy products. You'll often get symptoms like stomach pain, gas, and diarrhoea. With a milk allergy, the symptoms affect more than just your digestive tract.

You should be able to get lactose free products and be careful of carbohydrate intake.
It would be worth asking for an HbA1C test which is a test to diagnose diabetes and then you would know exactly what they meant by saying you were 'glucose intolerant'.
It maybe that if you are diabetic or 'at risk' then the FODMAP diet may not be the best for you.
Do you take any medication for your Crohn's? My OH has been diagnosed as having largely asymptomatic Crohn's (doesn't actually believe it is that) what he eats has no impact and he takes Pentasa.
You appear to fall between two areas of medical expertise.
Click to expand...
Over 20 years ago the term Impaired Glucose Tolerance was now what is classed as Pre Diabetes.
 
In addition, I can't help wondering whether my condition might be a pre-cursor to diabetes, or whether it is an entirely separate issue? I (and apparently the Gastroenterology clinic) don't know what to make of the fact that I had tested with BOTH lactose and glucose intolerance, which the nurse at the time said was rather unusual - its usually one of the other but both is very rare. Whatever the cause, since apparently its not an IBD issue it is apparently not the responsibility of the Gastroenterology clinic which I am under, nor apparently the function of the dietitian service, which appears to be ridiculously understaffed, to deal with medical issues and provide a diagnosis. I therefore seem to be in something of a no mans land - not fitting into any particular category - with no answers which is deeply frustrating in itself. I would appreciate any insight into why I might have registered an intolerance to BOTH sugars.

Welcome @BubbleandSqueak 🙂 There seems to be some confusion about the use of the phrase “glucose intolerance”. On this and other diabetes forums that would be just an older term for pre-diabetes. However, I think you’re using it in a different way and saying your digestive system is not able to tolerate glucose due possible SIBO or some disruption or intolerance within it.

I don’t know for sure but I can’t see how that kind of ‘glucose intolerance’ would be related to diabetes at all. Not being able to digest glucose wouldn’t mean you’re diabetic. If you want to rule out diabetes for sure, ask your GP for an HbA1C blood test. That’s the diagnostic test for diabetes.

People with diabetes don’t have an intolerance to glucose (which is why I dislike that phrase being used here). People with Type 1 diabetes like me have an auto-immune condition where the insulin-producing cells in the pancreas have been destroyed. People with Type 2 often have insulin resistance where they make enough insulin but their cells can’t use it properly due to resistance.

With regard to your Low Fodmap diet and digestive issues, you’ll probably get more help on a Crohn’s forum such as this:

https://crohnsforum.com/

.
 
I used to take Azathioprine for the Crohns, but have been off it for 3-4 years now.

To clarify the glucose thing, I had hydrogen breath tests for both Lactose and Glucose. Both registered very high levels of hydrogen in the breath. My blood sugar level was normal. My understanding of the result of the hydrogen breath test is that it shows that I am not able to digest either of these sugars, which are then left over in the gut for bacteria "to feast on" which leads to the bloating, discomfort, cramp and pain that result. The information leaflet regarding lactose explained where lactose can be found (milk and some of its byproducts), so I have been able to avoid products that contain lactose for the last year and although it has not eliminated symptoms, it does seems to have been helpful. However, with regards to the outcome of the glucose test, I was given a leaflet on SIBO. The nurse at the time said that this did not mean that I had diabetes but the diagnosis was down to the Gastroenterology clinic who would probably perform some further tests to establish the cause.

Over time Gastroenterology gave me two courses of a specific antibiotic which had little effect, from which they conclude that my problem is not down to SIBO, hence the referral to the dietitian.

grovesy, I find it interesting that over 20 years, Impaired Glucose Tolerance was classed as Pre-Diabetes. Although I am aware of individuals that have been informed by their GP that they have pre-diabetes, such terms have not been mentioned to me at any time. Since I am in my sixties, I am probably in right age group to be getting the onset of such problems...

My concern is that if this is a pre-cursor to diabetes, can/should I be doing more in the way of preventative measures to manage my intake of sugars? Other than the advice on managing my Lactose intake, I have been given to advise on sugar intake in general.
 
@BubbleandSqueak See my reply above. Not being able to digest sugars is not the same as being diabetic. I can digest sugars perfectly well - yet I’m diabetic because my pancreas can’t make the insulin I need. The two things are different.

You say your blood sugar level was normal. It’s the blood sugar (HbA1C) that diagnoses someone as diabetic not whether they can digest glucose/fructose/lactose or whatever. A normal HbA1C means you don’t have diabetes. I have read nothing that suggests an inability to adequately digest certain sugars means you’re more likely to go on to develop diabetes.

As long as your HbA1C is normal, you don’t have diabetes. I hope that reassures you.
 
Inka, sorry, our posts crossed. Thank you for the clarification and I take you point. Since my blood sugar levels have been normal throughout, my problem is not about insulin production and regulating blood sugar levels, which I understand distinguishes diabetes. It seems clear that I am dealing with mal-absorption and the word "intolerance" is probably meant to describe that condition. The test was described as a "tolerance" test but the comments here probably explain why one of the dietitians I spoke with stated that I do not have glucose intolerance despite the positive test. It is probably down to differing interpretations of the word "intolerance".

Ok, so now that is clear and you state that there is nothing to suggest that the inability to digest certain suggests can lead to diabetes, that provides some reassurance. However, the question remains, why have I developed such a problem? How do I deal with it, other than the obvious course to eliminate Lactose (and possibly other sugars) from the diet?

One possible explanation, I suppose, is damage to the intestines caused by Crohn's, but nothing of the sort has ever been mentioned or explained to me. An endoscopy some 3-4 years ago did show somewhat flattened villi but Coeliiac was ruled out with a test. Again, I see no connection between this and mal-apsorption of sugars.

If I can manage the Low Fodmap diet this time, then the re-introduction phase might determine what foods I will need to avoid and I would not be at all surprised if these contain the sugars in question. Evidently the diabetes forum is not the proper place so the question for me now is, where do I go to get further information on this condition?

BTW, Inka, I will try the Crohn's forum, although since the consultant said that we are not dealing with a Crohn's flareup and this is not an IBD issue, I have reservations, but I will try. Thanks.
 
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Since I am under the Gastroenterology clinic, the GP does not really want to discuss the matter as it is the responsibility of the clinic. The clinic do not see it as a medical matter so are not exactly pro-actively involved regarding this issue, although I am still having yearly follow-ups for Crohn's. Since my Crohn's is in remission, I do understand that they need to focus on patients who have more urgent IBD needs.

The diet sheet is the one I already have and I have found it useful. The crohnsandcolitis.org.uk link is very helpful. I will give them a call. Thank you.
 
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