When FODMAPs doesn’t work

“I’m contemplating doing the RPAH elimination diet after little success with low FODMAPs” wrote a woman in her mid 50s with a 13 year history of IBS. 

FODMAPs vs the RPAH Elimination Diet

A dietitian who specializes in IBS tells us that she usually finds that food chemicals are the main issue in IBS, and the RPAH diet is the one she uses most.

If your only symptoms are IBS (e.g. bloating, reflux, stomach cramps, wind and diarrhoea) your dietitian may recommend a trial of the FODMAPs diet but if there are any other food intolerance symptoms – in you or your family - then it may be best to do the 3 week strict RPAH Elimination diet, perhaps with gluten and dairy free options - and no mistakes.

My GP said “… most people would react if eliminating and then introducing a dose of something” and she’s concerned I will make myself more sensitive.

I am disappointed that your GP didn't refer you to an RPAH trained dietitian (see our list below). We recommend the diet with a dietitian’s supervision because there are 3 important stages:

  • elimination (no more than 3 weeks)
  • challenges (exactly as written down by RPAH)
  • reintroduction

That way you will find out exactly what affects you, and reintroduce everything else in a timely manner - as recommended by dietitian Joy Anderson in the letter below:

Why see a dietitian? - an answer for your GP
A letter from Joy Anderson (a retired WA dietitian from our list who was made a Member of the Order of Australia for her significant contribution to community health especially through the Australian Breastfeeding Association)

"As a dietitian who uses the RPAH Allergy Unit Elimination Diet in my everyday practice, I can assure you that it does work brilliantly in the majority of cases, in infants (via mother's breastmilk), in children and in adults as well. However, it needs to be done properly ... The diet should be supervised by an Accredited Practising Dietitian with experience in food-chemical intolerances and conducted as a test diet, for a limited period of time - usually only 3-4 weeks in duration. Occasionally it may go longer, but the dietitian ensures that nutrients are adequately compensated for. The challenges are then performed in a timely manner and the diet refined to be liberalised as much as possible, while only avoiding the problem foods long term. I have many, many satisfied clients who were fobbed off by other health professionals in the past, because they didn't 'believe' in food-chemical intolerance” – Joy’s  letter appeared in the June 2013 issue of the Medical Journal of Australia InSight

Have you seen much success treating IBS?

Absolutely!!!!  There are reports from people like you for whom FODMAPs didn't work or made them worse, who then did well on the RPAH diet. Or some people need to combine both.

"I was diagnosed with IBS about 2 years ago and told to follow the FODMAP diet to reduce symptoms. The last few months my symptoms flared right up again … and  have now been told to cut out salicylates and amines (at least initially) as that is likely to be my problem. After one week on the elimination diet I have noticed a huge improvement, apart from the fact I am missing all my usual fare like spinach, coconut, berries, tomato and the list goes on! I am so grateful though for the relief, I actually feel normal again. Thanks!" –  Lisa, story [1214]

“I was on the Fodmap diet and it wasn't working - now I am going low Salicylate foods and I'm improving a lot “– Karen, story [1465]

“I have been suffering from various IBS-like symptoms for several years… A couple of months ago I saw a dietitian and tried a FODMAP elimination diet for a month. Although there was improvement in some areas there was a decline in others. I became VERY forgetful and suffered stomach cramps when eating what turned out to be foods high in salicylates“ – Sharon, story [1122]

See more stories in our new story collections about IBS and FODMAPs

More information

IBS factsheet

Introduction to food intolerance

List of experienced and supportive dietitians

Support - people say our facebook group is friendly and supportive


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