Hello. I’ve just read the book with interest, but I have a question on the theory.

I know for pretty sure that the foods that give me the biggest problem are onion and garlic, especially raw. Garlic-infused oil seems to be OK. This fits well with FODMAP theory, which I was familiar with before reading the book. However I still get IBS-like symptoms (bloating mainly, especially in the early hours of the morning), with reduced severity and frequency, even when avoiding those and lactose.

The question I have is that the theory presented in Clever Guts seems in some ways contradictory to FODMAP theory. It seems to suggest that those substances feed the healthy gut biota – they are prebiotics. Whereas FODMAP theory seems to suggest the organisms that eat FODMAPs are bad (because they produce gas), and we would be better off without them, but while they’re there, just avoid feeding them FODMAPs.

Do the theories contradict or am I on the wrong track with the above?

I want to give Clever Guts’ protocols a go starting with R&R, but I have two questions, one related to the above and one not

1) I assume I should keep eliminating onion and garlic during R&R even though the book doesn’t say to do this?

2) Is lactose-free dairy OK for R&R? I am very fond of my usual breakfast of home-made muesli with home-made yoghurt, which I make using lactose-free milk. (Yes it does work, somewhat paradoxically.)

Its complex! FODMAP is pretty restrictive and the more you restrict your variety of foods, the more your restrict the diversity of your microbiota; the less diverse your microbiota, the less resilient the “tropical rain forest” in your gut. So this move towards cutting out more and more foods can do more harm than good. A bit like serial dieting. It doesn’t work.

It all depends on your baseline diet and your symptoms. Have you kept a detailed food diary and mapped what you eat against your symptoms? If not then that is the place to start. If you can be clear about which foods/food groups cause your problems, they are the ones to eliminate initially. If your symptoms then resolve your probably have cause and effect. Give it a month and if you remain symptom free, cautiously add back the omitted foods one by one (small quantities to start) and see how you get on. Make small and incremental changes step-by-step

1) So in answer to your first question YES! (assuming these foods are problematic for you)

2) Yes -and maybe try some Kefir

I agree with GrahamPhillips. What food types or individual foods you reduce, avoid, introduce or reintroduce at any given point in your Clever Guts journey depends on the analysis of your detailed food and symptom diary (p.187 + p.266-267).

Do note how varied the sample meal planners and recipes are, and the encouragement throughout the book to eat a *really wide variety* of wholefoods each day and each week. ideally have a different breakfast each day: switch up the live/ fermented dairy product or have organiceggs, switch up the low sugar fruits, switch up the grains/ pseudograins/ seeds/ nuts in the muesli.

Coming to FODMAPs … You mention “IBS-like symptoms” and avoiding lactose, but have you been medically diagnosed with lactose intolerance or with irritable bowel syndrome?

Yes FODMAPs are prebiotics, they can be fermented before eating or after eating by various microbes (bacteria/ yeasts). The by products of fermentation are acids, alcohols or gases. Your reaction to FODMAPs and other prebiotics depends upon how much you eat, the health of your gut microbiome and how reactive/ easily irritated your gut itself is. Some gas production/ acid production/ bloating/ gut muscle contraction is completely normal or healthy. Excessive gas, painful spasms, constipation or diarrhoea is obviously not.

Many with IBS and/ or lactose intolerance can tolerate some prebiotic rich foods, within a *properly balanced and very varied* wholefood diet. Generally those with a reactive or sensitive gut need to make changes to their diet very slowly one at a time. What you add or increase is as important as what you reduce or eliminate. Good nutrition may calm irritation/ inflammation in the gut itself.

Thanks for the replies.

Have I been diagnosed? No. My symptoms aren’t very severe; the worst of it is waking at night due to discomfort/pressure. Usually cooling down and having a wee to make space for the bloating helps enough to get back to sleep. I will go to a Dr if this R&R effort doesn’t work. The hassle for me is the expectation of wasting time trying various Drs who don’t give a fig and take minor gut issues to be hypochondria.

After I posted this, I got to thinking maybe it works like this: something (not FODMAPs) causes the gut irritation, and that irritation is aggravated by the products (especially gas) of fermentation, which will be produced in greater quantity when FODMAPs are consumed. If that’s the case (and your replies seem to say the same thing – ?) then eliminating FODMAPs might work (but is very restrictive) but a better solution would be to eliminate the source of irritation. Which would be … ? I’m guessing gluten, “refined grains” (I wish the book would be more specific about that), readily available carbs in general (sugar, starch -> GI). Either these things directly or the microorganisms they feed (although I’m still confused how there can be such microorganisms when sugar/starch is absorbed higher up than the large intestine). Sorry, I know I overthink things!

I used to eat a lot of white bread and sugary chocolate bars. They’re both gone now, so hopefully that will be the main help. Mostly replaced with fats and protein (avocado, oily fish, olive oil, eggs, nuts, olives, ripened/aged cheese… kefir grains are in the mail!) and some buckwheat-flour-based items. Plus a heap more lettuce, spinach and vegetables than I was eating – both quantity and variety. I am still eating white rice … I suppose that has to go, too?

I did switch up the breakfast and had chia/tinned coconut milk pots for a couple of days. And then got explosive watery diarrhoea. Guessing it was either the chia or the big mound of broccoli and cauliflower the night before so both are gone for now…

I am keeping a food diary but I was too keen make a change to bring myself to keep eating my old diet for a week. It can be tricky, especially when I am trying for variety, to relate symptoms to foods. An example is in the last paragraph … or was it the smoked eel, or the Australian Salmon with dry coconut sambal (incl fish sauce & soy sauce), all new? A fair bit of guesswork involved…

Taking control of our own health through diet and lifestyle modification can be very powerful. It is great how enthusiastic and inquisitive you are.

Medical conditions can be mild, moderate or severe: diagnosis is based upon clusters of signs, symptoms and test results not simply severity. If your symptoms are waking you at night that is not hypochondria!

The detailed food and symptom diary is a *factual record* that “helps identify any pattern in relation to diet and other factors [and] will help you be systematic and focussed in your approach.” (p.187-188). A thorough diary is an invaluable diagnostic tool for a doctor or dietician. The longer it is maintained, the easier it is to identify trigger foods, nutritional imbalances or gaps. But stop short of self diagnosing specific allergies, intolerances or medical conditions.

Do note that Dr Mosley and co “don’t recommend removing too many foods at one time, so it might be helpful to do R&R in several stages. You can always repeat the process … at a later date.” (p.190) Dr Mosley further advises we “introduce foods one at a time with a gap of at least three days between each one … To try and identify the foods that are causing you problems.” (p.193) Going slowly and carefully reduces or eliminates guesswork.