Should you take a probiotic alongside a low FODMAP diet?

This question comes up in my clinics all the time and I thought I'd share my thoughts on this here...It is not yet known whether it is better to take a probiotic alongside a low FODMAP diet or not. In 2016, Staudacher and colleagues published a randomised controlled trial looking at the effects on IBS symptom improvement and faecal bacteria with a low FODMAP diet and probiotics (VSL#3) versus a low FODMAP diet alone. IBS symptoms improved to the same extent in both groups, suggesting that VSL#3 did not add any further benefit. However, VSL#3 in combination with low a FODMAP prevented the decline in the numbers of bifidobacteria (beneficial bacteria) that is usually seen in those following a low FODMAP diet. We do not yet know whether the beneficial bacteria comes back with the reintroduction of high FODMAP foods at the later stages of the diet or whether this can only be achieved by adding in a probiotic...

 


Let’s talk about caffeine (& enjoy our morning coffee)

Caffeine is often unfairly criticised by some, but this is not justified when the evidence from research studies on moderate intakes is considered.In fact, moderate caffeine intake has been associated* with a reduced risk of heart disease in adults. Caffeine also has desirable short-term effects, such as improved alertness, concentration, and reduced perception of fatigue and pain.

Safe upper levels for caffeine consumption for healthy adults (report by EFSA**) have been defined as no more than 200mg as a single dose, and no more than 400mg as a daily dose.

Caffeine content of common drinks (per serving):

  •  espresso: 140mg
  •  filter coffee: 90mg
  •  black tea (teabag): 50mg
  •  decaff coffee: 15mg

Based on the above, up to 8 cups of tea or 2 cups of espresso, can be safely consumed as part of a balanced diet. However, what caffeine should not be used for, is to compensate for inadequate food intake or lack or sleep. Although it may feel like it's helping short-term, it may mess up your hunger signals, make you feel anxious and further disrupt your sleep..

*association studies do not suggest cause & effect, but merely a link, therefore, evidence from these studies need to be taken with a pinch of salt.

**(EFSA) European Food Safety Authority


Do you suspect a food intolerance?

If you suspect you have any other food intolerances, you should see a dietitian who will be able to support you in identifying the culprit for your symptoms. A dietitian’s role is to carefully assess your diet, eating patterns and other potential factors that may impacting on your symptoms and propose dietary/ lifestyle manipulations.
If you are likely to have food intolerance, you may be offered to complete an elimination diet. They require dedication and time, but if done properly, can be invaluable in helping you to find out whether you have any particular food intolerances and how to best cope with these. your digestive symptoms may arise from years of dieting, in which case elimination diets may make things worse, not better. Make sure you see a dietitian with experience in gastroenterology and disordered eating to receive the support that you need.


What are probiotics?

Defined by the World Health Organisation as “Live microorganisms that when administered in adequate amounts, confer a health benefit on the host”. Probiotics are described first by genus, then species and then by strain (i.e. Bifidobacterium infantis 35624).

There are significant differences in their functions even at the strain level; therefore, for example, only because this specific strain (Bifidobacterium infantis 35624) was shown to benefit people with IBS (human trials), it does not mean that all other Bifidobacterium strains will have the same effect!