#013 What Else To Try If The Low FODMAP Diet Does Not Help Your IBS Symptoms

Accredited Practising Dietitian Vivienne Pither explains that there could be a different possibility to help your digestive issues, if the low FODMAP does not help your symptoms completely.

In this episode Vivienne Pither APD discusses how various symptoms, including IBS symptoms may be due to  food chemicals and not only, or not necessarily, due to high FODMAPs.

In this episode, you’ll learn:

  • The symptoms Vivienne’s daughter presented.
  • How Vivienne was able to find a solution for these symptoms.
  • What are motor and vocal tics all about?
  • Possible causes for ADHD and ODD symptoms.
  • What are natural food chemicals?
  • In which food can these chemicals be found?
  • How can food chemicals trigger IBS symptoms?
  • What are the main symptoms of food intolerance?
  • What are the three main food chemicals?
  • What medications contain these chemicals?
  • What is the RPAH elimination diet?
  • How to do the RPAH elimination diet.
  • Why is important to be followed by a health expert before attempting the RPAH elimination diet?
  • and a lot of other information…


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Can’t listen to this episode right now? Read the transcript below!

LARAH: Welcome to the Low FODMAP Diet and IBS Podcast.

My guest Vivienne Pither, is an Accredited Practising Dietitian (APD), who specialises in food intolerances. She helps children who are struggling with behavioural issues such as ADHD and ODD (oppositional defiance disorder), anxiety, OCD tendencies, tic disorders and those diagnosed with Tourette Syndrome. She also helps adults with chronic fatigue syndrome, fibromyalgia, anxiety, depression as well as Irritable Bowel Syndrome (IBS).

Vivienne’s goal is to help as many families as possible discover the NUTRITIONAL LINK to what is causing adverse reactions in their children’s and their own body and brain. We are all different and often our genetic predisposition strongly influences the food our bodies can metabolise.

Vivienne’s motto is: Life experiences are invaluable

VIVIENNE: Absolutely.

LARAH: That’s the only advantage of getting older. It’s our life experiences.

VIVIENNE: Yes, as long as we recognise them. That’s important as well.

LARAH: So welcome to the podcast. I have to confess that Viv is also my dietician.

VIVIENNE: We’ve spent some time together, haven’t we?

LARAH: Yes, since January this year. It’s been pretty much almost eight months that Viv has been following me throughout my journey of weight loss and getting healthy and fit. And I have to say, she’s done a fantastic job because there you go, eight months later, I’m sixteen kilos lighter than I was and I feel like a brand new person.

VIVIENNE: Wonderful, and you look fantastic too.

LARAH: Thank you, Viv. So let’s start with the first question. I know a little bit of your story and especially your daughter’s story is quite incredible.  Would you be able to share it with our listeners, as I believe that a lot of people will find it very useful?

VIVIENNE: Yes, sure, absolutely. When my daughter was about six years old, she started displaying some involuntary movements, which are called motor tics and vocal tics. So basically, she was making noises that she had no control of and also her body was jerking. This came on quite suddenly, after we had just spent two months in Australia on holiday, we were actually living in Japan at that time. We actually didn’t know what was going on with her, so we quickly did some dr. Google search, as you do, and found that she had these tics. And basically, just watching her whole body just out of her control, I was absolutely desperate, as any mother would be, to try and find a cure for her.  And then, when I researched more into it, all of the information that was coming back to me was that she had a tic disorder that if diagnosed for a year, basically meant she had Tourette Syndrome and there was nothing that we could do for it, except possibly try some different drugs.

On the back of that diagnosis, we also realised that she had ADHD, which was confirmed by a paediatrician, and she had what’s called ODD, which is called Oppositional Defiance Disorder. She was a child that always said no and she would get angry; she would often hit her brother, she would yell at us for no reason, and you’d actually ask her why she was upset and she couldn’t explain why. She was just angry and she always woke up in a bad mood. So when we started to link all these things together, we realised that she wasn’t well at all.  So I started doing my research, as you know, into how to help her, and I came across a website called The Food Intolerance Network, which is run by a wonderful couple called Sue and Howard Dengate. They basically went through something similar with their daughter years ago and they took her to what is called the RPAH (the Royal Prince Alfred Hospital) allergy unit, where they conducted an elimination diet. I thought, “Okay, well, I’m actually studying to be a dietitian at the moment, by correspondence, and if I can help my daughter through diet, then I believe that that is the best way to help her.”  So I thought, “Okay, I’m going to try this.”

In the first three days after removing not only artificial chemicals, but some natural chemicals found in food, which shall I explain later, I said to my daughter, “Hey Charlotte!” And for the first time ever, she turned around and said “Yes, Mum,” and I nearly fell over. I was like, “Oh my goodness, this is working.” So she’d suffered from what is called “foggy brain” as well, which basically means that many of the chemicals in the food were affecting the messages being transmitted in her brain so she couldn’t actually process what was going on.  Anyway, basically, from then, we started doing this diet and her tics started to subside; her behaviour improved; her handwriting went from a scrawl to neat; she stopped getting terrors at night where she would wake up sweating and screaming her head off and you couldn’t console her. You couldn’t even touch her. She stopped wetting the bed; she started being very pleasant to be around and most of all, she was happy — just a really happy, content child. So for us, this was such a profound change that we knew we were on the right track.

I made some mistakes along the way. When we came back to Australia I was giving her certain food, which I actually thought was okay, and then I found that there was like a nasty chemical in that food — one particularly called synthetic antioxidant 319, which is put into oil to keep it from going rancid. She was having a savoury biscuit that had that in it and her tics started to come back; her anxiety came back; her ODD came back and she was just becoming really unsettled and really unhappy.  So I went through everything all over again and found two items that were likely causing an issue. I removed them, and within three days she was again back to normal.

So from the day that we started this diet, it’s been eight years and she’s now fourteen, she is thriving academically, she’s thriving socially, she doesn’t display any of the symptoms which her body was once riddled with, but mind you, if we do make a mistake, her symptoms can return.  So this is not a cure as such, but this is a management of her symptoms.  This is how we manage them and it is hard work because she is on a strict diet and she can’t go into any party and eat all of the junk food. We can’t go to any restaurant and just eat their food, but it’s absolutely worth every bit of effort that it takes.

So in that time we also had two other children. We had her little brother, who is four years younger, when we also found out that he had dairy intolerance. He couldn’t tolerate, not lactose so much, but actually the cow’s milk protein called casein. And then we had another child who has pretty much grown up on this diet and she’s also dairy intolerant and food chemical intolerant as well, to a degree, but she’s the most balanced, gorgeous child that you could possibly have. We feel that she’s such a godsend because she’s so easy to manage. It’s effortless to parent her.Practising Dietitian Vivienne Pither with her kids

Yeah, that’s pretty much our story at the moment. And yes, it’s interesting to watch the children progress and watch their struggles as well, with not being able to eat a lot of foods out there, but I can say that they do have, not a perfect diet, but it’s a very healthy diet, which is helping them to grow physically, but also to be mentally in a good place, which is so important these days because there are so many mental health issues out there, that could simply be improved just through making better food choices.

LARAH: Yeah, this is great, what you said. And who knows, maybe your third child is also the way she is because of the diet she had since she was a baby. And as you’ve seen in your first daughter, she had presented those symptoms because of the food and because of the allergies and intolerance that she had.

VIVIENNE: Yes, yes. So she actually didn’t have any allergies as such. An allergy is an allergic reaction, an immunological response. She actually wasn’t having that kind of reaction, which is sometimes easier to identify, because someone might get hives or a rash or start sneezing or coughing. Those symptoms come on really quickly, but with food intolerance, some symptoms can take three days to present. So say, for example, you might eat something on Monday but not react until Thursday. Or, you may have a build-up over three days and that will cause a large reaction.  So food intolerance is really, really hard for people to self-diagnose as such. They may know that there’s something wrong with them because they’re not feeling well, and they’ll often think, “Oh, you know, I had bananas the other day, but they were fine. I didn’t react. And then the next day I had an orange, and I was okay; and then, I may have had some pawpaw and was also okay; and then I had some chocolate and I reacted. Well, it must be the chocolate.”  Well, actually, it’s probably a build-up of natural chemicals — which I’ll, again, explain later — that has contributed to that overall effect.  So everybody has a threshold, or we could call our cup full, and if that cup overflows, that’s when we see a reaction. So if we only have a little bit, we might be all right, but if we have a lot in one go, we will fill that cup and we will overflow. Or say, for example, we have a build-up of over say five to seven days, and then our cup overflows, we will then react.

So my job as a dietitian is actually, once we’ve worked out what chemicals or food chemicals are affecting the person, is then to work out, “Okay, how do we manage this, so that we do get some food chemicals back in?”  I actually think it might be a really good idea, or a good time, at the moment, to explain what these food chemicals are because, Larah, as I’ve explained to you before, these can actually be found in healthy foods like spinach, tomatoes, avocado, seaweed, mushrooms… and that’s what takes a little bit more understanding and acceptance for some people because they think, “Oh no, that’s all I’ve been eating….”

LARAH:  Yeah, absolutely.

VIVIENNE: “…and they’re supposed to be healthy.”

LARAH:  Yes, and I discovered that when I was told that I had IBS, it’s exactly that. I always thought, there is junk food; there is processed food; there is fatty food and there is healthy food, and never would I have thought that healthy food can make you sick. So in my case, it’s merely FODMAPs, but of course now, you’re going to talk about the natural food chemicals which some people might think “Ah, really?”.  We’re not just talking about the highly processed junk food or food that has been heavily sprayed with chemicals, but normal food that we are feeding our family and we’re thinking we’re doing a good thing…but not for everybody.  So let’s go into that now about these natural food chemicals and which foods they’re found in.

VIVIENNE:  Okay, so all of our foods are made up of three main chemicals called: salicylates, amines and glutamates. Salicylates are basically the natural pesticide found in all fruit and vegetables, that the fruit and vegetable have inside, or mostly on the outside actually, to prevent insects from attacking it. So if we think about it like that, actually those foods, that are sprayed with pesticides, those fruits and vegetables, they actually don’t have to produce as many salicylates, whereas organic food, which isn’t sprayed, has to produce a lot of salicylates to protect itself.

Now these salicylates are found in, when I say fruits and vegetables or anything that’s plant based, we have to think outside of what we just see in the vegetable market, so we think of things like nuts, herbs, spices, jams, honey, yeast extracts… even tea is extremely high in salicylates. Coffee, juices, beer, wine — wine’s made from grapes. Anything that smells is perfumed because that also comes from plants. So things like lavender, eucalyptus oil, tea tree oil, water fragrances, washing powders, fragranced toilet paper, the sprays inside the house to make them smell nice, fabric softener, deodorant, moisturiser, soaps, and the list goes on and on and on.  So they can actually contribute to your salicylate load as well. But the interesting thing with salicylates, or how they actually found out about salicylates causing reactions, was when they started elderly people on aspirin to thin their blood and there was a percentage of them that reacted. And what they found was that they were sensitive to salicylic acid, which is basically salicylates. So it’s interesting that even then medications like aspirin, ibuprofen or non-steroidal anti-inflammatories, herbal medications, nurofen, liquid paracetamol that’s flavoured, all the kiddies’ medicines basically in chewable supplements, like vitamin supplements, are actually very high in salicylates. For a lot of people, salicylates do actually cause a problem. Salicylates cause the most symptoms out of any food chemical.

The next natural food chemical is called amines. Dietary amines basically come from the protein breakdown of a food. So if you think of the structure of something — so you look at something like a tomato — a just ripe tomato is nice and firm, but as that tomato ages, it actually softens inside so that chemical structure, which is a protein structure, actually starts to break down and that fruit then becomes softer and softer and starts to fall apart and the skin starts to split and break easily, and then it starts to smell. It gets a stronger smell and a stronger taste, and that strong smell and taste is attributed to the dietary amines in there that are released from that protein breakdown.

Other foods that also we need to consider is anything that’s aged. So when we think about things that age, we actually think of things like cheese, tasty cheese, brie, camembert, blue cheese… Fish, as well, breaks down really quickly. That’s why it goes off. That protein breaks down really quickly. It releases amines and that’s when it starts to ferment and that’s what causes that smelly fishy smell.

We also get it with meat, because it’s pure protein breakdown as well. So chicken goes off really quickly, as we know, but things we have to be more careful of, are actually things like red meat and lamb that has been vacuumed packed, okay? So those meats are vacuum packed. They sit on the shelf, not frozen, but just in that pack for sometimes up to three months. Then, what that is doing is, as the protein inside the structure actually starts to break down, it releases amines. It makes the meat taste nicer, but also, it’s a lot more tender.  So that’s how a lot of people like to eat their meat.  When we actually follow a low amine diet, we actually have to buy meat fresh off the carcass.  So we go to a local butcher, who we’re actually seeing chop it off the carcass, and that’s the meat we want. And when you think about it — or when I think about it — that’s actually how we should be eating our food — fresh, either picked off the tree, dug out of the ground or fresh off the carcass, not something that’s been sitting in a packet or a plastic seal for up to three months.

LARAH: Disgusting.

VIVIENNE: When you think about it like that, it is disgusting. Other things like ham and salami which are being hung for months or sometimes a year are extremely high in amines. But I actually should say that amines are also found in a lot of fruit and vegetables. So some things have both amines and salicylates. Things like bananas, tomato, avocado, olives, spinach, again, and broccoli, these all contain amines, as well as like brown chocolate, not white chocolate. but brown chocolate — it’s really high in amines from the cocoa or cacao. In juices, because oranges and all the citrus fruits contain amines as well. All nuts contain amines and anything fermented, so beer, wine, any yeast extracts and, more commonly now, any of the fermented vegetables contain amines. So if you’re on a Paleo diet or GAPS diet or one of these new age diets, those diets are actually really high in amines, salicylates and glutamates. And I do actually get quite a few clients who come to me who have tried those diets, who end up suffering more than before they started the diet, even though they had started what they thought was a healthy diet.

And that now brings me to the final food chemical called glutamate.  Now glutamate is an amino acid building block of all proteins and is found naturally in most foods. It is what makes foods taste delicious. I basically call them concentrated amines to give you an idea of how strong they are. They are found naturally in a lot of very tasty food such as tomato, mushrooms, stock cubes, soy sauce… It’s been fermented for a long time. Meat extracts, yeast extracts. And if we think about it, what do most Asian restaurants and sushi chefs, what do they actually flavour their food with? MSG.

LARAH: Yeah.

VIVIENNE: And MSG, it’s monosodium glutamate which is a synthetic form. There are over a hundred thirty terms for MSG, which could be another discussion of another podcast. But MSG — basically anything with the word extract mixed to it is another form of MSG whether it’s natural or artificial. HVP, which is hydrolysed vegetable protein, actually sounds healthy. It’s basically, say for example, corn and soybeans that have been boiled in hydrochloric acid and then dried and made into a powder. It’s crazy to think about the foods that we’re eating.

So, yes, those are the three foods. We’ve got salicylates, amines and glutamates and they’re present in all natural foods, but then they’re present in varying amounts.  So, for example, some foods like tomatoes contain all three — salicylates, amines and glutamates — and so do things like broccoli.  So when you’ve got kids that crave broccoli you’ve actually got to think that there’s something going on here.

LARAH:  So if they crave it, they might be actually having an intolerance to it, to the food chemical in it?

VIVIENNE:  Yes, so what these chemicals do in some kids and adults is actually feed the high. It gives them a chemical high like a drug does. So say for example, that having something like LSD, which makes them feel really good and gives them that high, that’s exactly what food can be doing — the food chemicals because foods break down to a chemical level and then they all move through into the brain. So when we are looking at this in kids and adults, kids actually show their symptoms a lot more quickly and often you’ll get the ADHD kid turning into a depressive adult and a highly anxious adult as well. So these are the things that we need to look at. These foods basically break down and travel through our system and affect our nervous system. These kids will actually sit down and eat a bowl of broccoli without any complaints. They’ll love their cherry tomatoes in their lunch boxes and they’ll eat a whole punnet of strawberries. They love their dried fruits, which is also tainted with metabisulfite which is a preservative. They’ll love their grapes; they’ll sit down and eat a kilo of grapes.  Again, they contain salicylates, amines and glutamates. They’re extremely tasty and they’re also coated in metabisulfite to preserve them. That’s why we can get them all year around.

LARAH: The more you’re talking, the more I’m thinking now about my daughter, because some of things you were discussing in the beginning, like waking up in a bad mood and just constantly being unhappy for no reason. I have to say that she likes junk food. She’s ten years old and, for her, if it doesn’t come out of a packet, it’s not food. She is completely different from me and the rest of the family, but I have to say that, yes, she does love broccoli and strawberries.

VIVIENNE: …and spinach?

LARAH: Yes, she likes spinach — not massively, but that really makes me think that that’s something I should really look into for her. But then, can we say, what is there that does not contain these? And does it mean if someone is intolerant to one of the chemicals, let’s say salicylates, is this person necessarily also intolerant to the other two or could it be just one of them?

LARAH: Yeah, good question. Actually, no. So what that means is that they can be intolerant to one, or they could even be intolerant to two or three. And we actually also can see the food proteins as well, such as cow’s milk protein, which is called casein, can also have an effect. Gluten, which we know is the latest fad — to cut out gluten. Soy protein, as well, can be an issue.  So basically, what we do with an elimination diet is, I conduct a really thorough family history.  So I look at not only the client, but I look at their siblings, their parents, their grandparents and their aunties and uncles.  And when you start to look from both sides of the family really deeply, you start to see what that person, your client, is most likely sensitive to. From that is where I then work out, “Okay, what should we take out first and to what degree?” Not everybody has to go on a very, very strict diet.

So to explain that, all of these chemicals have a level as such. Either they are low chemical, moderate chemical, high or very high. Some people think that to do this diet properly, you have to start on a low chemical diet, but I don’t do that. If, when I look at the family history and all the symptoms and the degree of severity of symptoms, I then decide, “Okay, do we start with high salicylates, low amines and low glutamates because there is a strong history of moody people or those who are estranged from their family or there’s a long history of depression?”  And I think, “Okay, they’re likely sensitive to amines. Salicylates tend to be okay and more tolerated.” I’m going to leave them in there initially but take out the very high ones, and then we’ll stop. If, after a couple weeks the client hasn’t had enough of a profound moment to say, “Wow, this has really helped me,” I will then look at reducing the level of salicylates.

Everybody’s so different and I would not encourage anybody to this on their own, because I actually end up finding that a lot of people who do try it on their own, end up eliminating a lot of really healthy foods because they don’t know what’s contributing to their symptoms. They’re getting worse, but they’re following the diet, but they may have just left one thing in there that wasn’t right. Or, they’re not actually including other factors, which I definitely take into consideration, which can contribute to their cup being full. And those other factors are environmental factors. So we touched on perfumes before, and anything that smells. Even filling up the car with petrol, can set someone off, from inhaling the fumes.

I also look at stress. So in the initial something, I discussed very closely with you, Larah, about how stress can really affect us. Many people who have tried a low FODMAP diet, also know that stress can really affect the gut and know it can contribute to their symptoms, whether it’s bloating or diarrhoea, or pain in general. And what’s really important with both the low FODMAP diet and the low chemical elimination diet, is that we don’t want to blame food unnecessarily. So if we’re going through a really stressful week, whether it’s work or kids have exams or it’s the last week of term and these kids are exhausted, and then suddenly little Johnny can’t tolerate a food that he’s been tolerating really well. We don’t want to take that food out; we actually want to go, “You know what? He’s just had a really stressful week. That stress is probably to blame. Let’s leave that food in there for the moment and then wait until that stress has passed.”

So we’ve got stress; we’ve got environmental factors, which are like the perfumes, the fumes, pollution… wind, some people are sensitive to. If it’s a windy day, pollen in the air and seasonal changes as well. That’s when most people get sick, is during change of season. And then the third thing that we really have to take into consideration is hormones. So hormones kick in. For little boys, it’s from birth; they get boosts of testosterone every so often or throughout their lives. For girls, it’s more so when they hit puberty and then when they start menstruating. And then every month when they’re premenstrual, they become more sensitive, because the cup is filling up with hormones and it leaves less room for food chemicals. So when we take all of those other three factors into consideration, we then look at, “Okay, is food that actually causing it because I ate a banana yesterday and I‘m reacting. Is it the banana or is it actually because I’m stressed, premenstrual and it’s a really windy day outside?”

LARAH: Well, it is so hard to determine, isn’t it?

VIVIENNE: So that’s really hard for someone who isn’t experienced in this diet.  It is really hard for them to factor all that in. All of my clients basically have an online interactive diary that factors all of those things into the equation. So I ask them how their stress levels are. I ask them how their bowel movements are, which is another important factor, and I also ask if they’ve been exposed to any environmental stimulants that day and what their stress levels are like and if they are hormonal.  That’s not even looking at food at that point. Food comes into it, of course, but yes, I am really big on not blaming food unnecessarily and teaching people to be able to identify, “Oh yeah. I’m actually stressed today.” It’s good, because if someone can identify that they are stressed, they can then manage it.

LARAH: It’s very interesting. So pretty much, we’re saying that there isn’t a specific test that can be done, like a blood test or a breath test or anything. It is just really going through your diet and eliminating some food and determining if that was the real cause of the symptoms. Is that the only way to determine?

VIVIENNE: Yes, okay, and that’s another really good point. So if you go and Google food intolerance, what you’ll find will come up on your computer is a whole lot of ads for a test that will identify all of your food intolerances and allergies apparently. So those tests which are very costly, they’re usually about $300. Even if they are $150, it’s still a waste of money.  Those food intolerance tests aren’t reliable whatsoever. So in regards to the tests that pop up on your website — the food intolerance test, which tests for IGG sensitivity apparently. Now the Australasian Society of Clinical Immunology and Allergy have a statement on their website that IGG food antibody testing and other techniques are basically not credible. There is no credible evidence that measuring IGG antibodies is useful for diagnosing food allergy or intolerance, nor that the IGG antibodies can cause symptoms. So on their website they actually state that IGG antibodies are proteins produced by the immune system in response to exposure to external triggers like pollens, foods or insect venoms. Their presence reflects exposure to these triggers, not disease that results from exposure. And IGG antibodies to food are commonly detectable in healthy adult patients and children whether food related symptoms are present or not.  So what these tests actually do, is they give you a huge list that is printed out for you and tell you to avoid all of these foods…and then that’s it. They say, “That’s it. Just don’t go and have them ever again.”

LARAH: Hmmm… So they’re not asking you to try them again in the future, when certain conditions have changed? They just say don’t have them ever.

VIVIENNE: No, because there’s no service that accompanies it. Basically these tests are saying go and avoid these foods and that’s it. Whereas with the RPAH elimination diet, we take out the foods that we feel are most likely to contribute to your symptoms based on the food chemical or the food protein. We take those out. We allow about four weeks until that somebody has five symptom free days. In some people, it does take longer. It also takes under consideration if there are a lot of mistakes made during that time which is my job to try and prevent. I encourage everybody to really stick to the diet so that we can get through it quickly. And then what we do is we challenge each of those chemicals, okay? So with these other tests, they basically say take it out, but if you leave one food in there that that test hasn’t supposedly detected… If you leave one food in there that is going to cause symptoms, that person will continue to react.

LARAH: eah, yeah.

VIVIENNE: Right? So one food can cause terrible symptoms in somebody. When we’re going back to what we do, we challenge people. So I will challenge first, let’s say for example, salicylates, and I’ll bombard them if they’re a resilient person and their symptoms aren’t too extreme. If they have some mental health issues and self-harm, or are potentially suicidal, then I will go a lot more carefully. But if the kid is hyperactive and not concentrating in school and then suddenly little Johnny’s come home with an award for the week for being the most focused kid in class, because he’s been on the elimination diet — which has happened twice this week with my clients — it’s just so good for the parents to get that feedback from the school. And these kids are so proud and it reassures them that they’re on the right track and that all they have sacrificed is worth it. So they get those external rewards. Then we pump them with salicylates — first step — no amines and no glutamates whatsoever yet.  And then we see how they react. And say, for example, the salicylates may kick in and it causes little Johnny to be a bit more restless in class. He can’t sit still; he’s a bit hyperactive; he’s being a bit silly making silly noises, a little bit more distracted, but basically just jumping out of his seat. So then, we take the salicylates back out, we get Johnny back to his baseline where he’s good little Johnny again, and then we put in the amines.

Now the amines, he seems to be going okay really well for the first three days, and then he’s out in the playground and he hurts somebody, but he didn’t mean it. He actually didn’t mean it, he just couldn’t stop himself from hurting somebody. Or he’s in a really angry mood at home and he’s just not right, but that hasn’t kicked in for three days because with amines, it can take three days for that symptom to present itself.

So what we’ve got: Okay, salicylates are making Johnny silly and hyperactive, but the amines are making him really angry and out of control. And then, basically, if little Johnny has reacted to the amines, we don’t even bother with the glutamates. We know that they’re going to cause even more trouble with him. Say initially, if we’ve also taken dairy out of this little Johnny’s diet because he also has a history of constipation, where he wouldn’t go to the toilet sometimes for up to five days.  So dairy is often related to constipation in kids and it’s a very, very common issue. Then we put the dairy back in with little Johnny, not only does that constipation start, he stops going to the toilet and he’s been going every day since he’s been on the diet. Then he stops listening. He can’t even hear mum when she asks him a question; he’s daydreaming in class again. He sometimes has what’s called ‘sneaky poos’, so he’s constipated and he’s not going to the toilet. A little bit comes out, and then, a little stool comes out but he’s sucks it back in and he’s leaving skid marks on his undies and he smells because he’s sat in his undies all day. This sounds really gross, but this is actually quite a common thing.


So he starts whistling and humming in class. He doesn’t realise he’s doing it. He’s getting really annoyed because suddenly everybody in the class is being too noisy and he wishes everybody would be quiet. And, “Mum, can you turn down the television because I can’t stand the noise?” but he’s speaking in a really loud voice.  So then we see what dairy has done to him.

Going back, when we take out all the food chemicals, it’s really important that we challenge each one so that Mum and Dad can really see how each chemical is affecting that child so that later on in life, as we start to introduce foods or Johnny goes to a party and has something, we actually know what he’s had. And we know he’s had something that’s either amines, because he’s in a bad mood, or something that’s maybe he’s had some coloured lollies, because he’s off his tree and he’s running around like crazy.  So he’s had something with salicylates which is also flavourings in lollies, for example, or he’s had something that’s got dairy in it. That part of the process is really important.

So little Johnny — that doesn’t mean he has to be on a low-chemical dairy-free elimination diet for the rest of his life, okay? We’ve worked out how much he’s sensitive to each chemical.  Say, for example, the salicylates. It took him five days to react. Well, that means he probably can actually tolerate some of them and that’s where we learn to work out his tolerance. We give him either a little bit every day, but if that builds up after some time, we might go, “Okay, he’s having too much. He can’t actually tolerate having it every day, so we’ll start him every second day. If that’s too much, we’ll do it every third day.”


VIVIENNE:  What I do then is to work out what is the level of tolerance and I also teach the parent who is managing this diet. I teach them how to monitor his symptoms and learn to manage it, so that we can not only make sure that little Johnny is getting some of those healthy foods back in, but he’s getting them to the point where it’s also decreasing his sensitivity a little bit each time as well. So we don’t want him to go into a full blown reaction. We don’t want to go out and give him a whole Granny Smith apple on day one. We want to give him a small sector of that apple that’s been peeled on day one, and then possibly every second day and see if he manages that. If he manages that, then we either increase the days he’s having it, so the frequency, or we increase the amount on every second day. So it comes down to a real fine turning and it does take a long time. As I said, I teach the parents how to do that so that they’re not having to come back and see me weekly.

LARAH: Thank you.  And that’s very important because it’s a little bit like the low FODMAP diet; it’s not meant to be a diet for life. You’re meant to find your balance — the right threshold that allows you to still have some of that food that, at the end, is still natural and healthy. It’s just not as healthy for someone, who has these kind of issues.

So bringing it back to the low FODMAP diet, as this the low FODMAP diet and IBS podcast. By the way, this information is so useful and I’ve taken a lot of that on board, especially with my youngest daughter, so we’ll definitely look into it. But bringing it back to the low FODMAP diet, for our IBS sufferers that have tried the low FODMAP diet, they’re saying, “You know, it’s not really working for me because although I’m eliminating this food, I’m still having symptoms.” And again, not being a dietitian and not knowing what they actually eliminated and in what quantities, it’s very difficult even to understand why the low FODMAP diet is not working for them. But now that I’ve talked to you about these food chemicals, then it makes me think that on top of the low FODMAP diet, maybe they need to do an elimination for food chemicals. How do you see that?

VIVIENNE: So for somebody who has undergone a low FODMAP diet and has seen some improvement, but they’re still suffer from some gut issues, then I would actually look at conducting the RPAH elimination diet because things like salicylates, amines and glutamates can definitely cause similar symptoms, especially glutamates, which actually can cause more stomach irritation than any of the high FODMAP foods. So I’m seeing it even in my own daughter when she has eaten something with too many glutamates in it, having to rush off to the toilet within half an hour and evacuate everything because her stomach just hasn’t been able to tolerate it. She’s had that really strong urgency to go to the toilet and, you know, the sweats come on and her body’s shaking and she’s just having that full blown reaction, and she’s not FODMAPs sensitive at all.

LARAH:  So can you just give a couple of the most common food that contain glutamates?

VIVIENNE: Okay, yes sure, absolutely. So glutamates, apart from MSG…so going to a Chinese restaurant and eating something from their other foods that contain very high glutamates are tomatoes, grapes and the broccoli, of course. Other foods that contain them are green peas — not snow peas, but actually green peas along with grapes, sultanas and raisins as well. A lot of jams and jellies contain them. Other things are corn. It’s high in glutamates. Sauerkraut, seaweeds, spinach, a lot of the low FODMAP foods are in there, as you know. So yeah, basically, just out of the fruits and vegetables, those are your main ones.


VIVIENNE: For somebody who has undergone a low FODMAP diet and had some success with improving their gut health as in their stomach has settled down; they don’t have the bloating or the flatulence anymore; their toileting regime is perfect every day; they’re doing a tight formal sausage stool that passes easily, which is so important to know that everything’s working. But if they’re suffering from other symptoms, that would indicate that they have some food chemical sensitivity.

Now those symptoms — there’s about a hundred symptoms that are related to food chemical sensitivity. Usually, if somebody has one and it’s not debilitating, then don’t really worry about it, but if they have actually quite a few symptoms, then that’s where they’re more likely to seek some help. So what kind of symptoms would we be looking for? Things that I actually look for, is if the person has pale skin and dark circles under their eyes. That’s showing that their body is inflamed and they‘re under stress. You see it often with kids where they’re really, really pale and have these dark circles. Another thing is their history of eczema, skin rashes and hives, cradle cap as a baby or a newborn that is restless and they’re suffering from colic — basically, trying to put them down and they’re screaming the whole time. Food chemicals can affect our airways through asthma, hay-fever, sinusitis or allergic rhinitis, frequent tonsillitis, chronic throat clearing, frequent ear infections…

LARAH: That’s incredible. So much.

VIVIENNE: And that’s only a few, Larah. I’ve got recurring mouth ulcers, indigestion, other things like reflux, the nervous system, headaches, migraines, the tic disorders of course, dizziness, vertigo, chronic fatigue, unexplained tiredness, confusion, sound sensitivity, irritability. I’ve already touched on the oppositional defiance, where the kids that is uncooperative or argumentative, loses tempers, over reacts to small incidents, is in a bad mood, breaks rules, blames others, deliberately annoys others, has difficulty in making friends, is easily bored or distracted, unreasonable… We then look at those with an impaired concentration so they’re vague or have a foggy brain. They don’t finish their tasks in school, they disorganised, easily distracted, difficulty reading and writing, those with speech impairment, stuttering, make repetitive noises or silly noises, speak in a really loud voice or hum or whistle constantly. And then those kids, who constantly wet the bed, has growing pains which aren’t actually growing pains. They’re actually related to food intolerances, especially in the lower legs. Joint pains in adults. They blame arthritis, but what is causing that arthritis? What is causing that inflammation? And lastly, anxiety and depression, and anxiety is rife through children at the moment. They’re all seeing child psychologists to try and work out, “Why is my child is so anxious?” and, it is basically a basket case every time something little happens or is not coping with school or friendships. Kids have panic attacks and teenagers are self-harming and having suicidal thoughts, and adults with depression. So all of those symptoms, when you look at it all of one piece of paper, how many boxes has that person actually ticked? That’s where, okay, yes they may have fixed their bowels, but other suffering.  Do they continue to suffer in other ways that is debilitating in their lives?

LARAH: That’s eye opening, really, because sometimes we just go for the diagnosis. We’ve got IBS and we look for one solution, or a couple of solutions like managing stress and, of course, the diet, but we don’t think that there could be a lot more. We’re not aware, really.

VIVIENNE: No, we’re not aware and, you know, I haven’t even touched on the nasty food additives.  I haven’t talked about the artificial additives that they’re putting in all of our food. It’s not every additive; it’s a list of additives that we actually label as nasty additives. So you just have to Google that and it will lead you to the FedUp website which is run by Sue Dengate. That has that list of specific additives which are preservatives, colours, flavourings, flavour enhancers. That list of chemicals can have a profound effect on these kids. They’re even often more damaging than the natural food chemicals as well.  So for everybody, I would actually recommend taking out those nasty additives to live a good healthy life and to look after their nervous system. We’re not concerned solely on the cardiovascular system here and our weight and such; so my job is to look after somebody’s nervous system, calm them down, make them more balanced in life, and happy.

LARAH: Yes, there is so much to consider, really. I think we will have to do another episode and talk more about those additives because, yes, we’ve concentrated on the food that is considered healthy, but there is so much more that is already unhealthy and is damaging us so much more, so we have to leave it to another episode. This is the longest episode I have recorded. I’m not sure how much I’m going to be able to cut, because every single sentence is so full of important information.

VIVIENNE: And we haven’t even touched on the supplements as well. A lot of food intolerant people are also deficient in some very common nutrients and vitamins and this includes vitamin D. When we look at supplementation, it is not something that we discuss openly without a consultation, but it is something that I definitely look into with each client to make sure that we’re covering all bases and trying to improve their tolerance levels, so that we can expand their diet as much as possible.

LARAH: Yes, so we will definitely have another episode. Maybe we can let the listeners ask some questions, so if anyone has got any specific questions for Viv, please email me, send me a message on Facebook and let me know what you would like Viv to discuss in the next episode.

VIVIENNE: Perfect, it sounds great. I have really enjoyed today and thank you for allowing me to share my story with you, Larah.

LARAH: Thank you.

VIVIENNE: It’s been really nice to be able to do that and share it with your listeners. I hope it helps… or helps even just one person out there.

LARAH: I’m sure there will be more than one person. You’ve already helped me, so I’m sure they’ll be someone else that has been helped today.

VIVIENNE: Wonderful, thank you.

LARAH: Okay, so just to finish if off, if people want to get in touch with you…?

VIVIENNE: Yeah sure. Well, I encourage everybody to really go and have a look at my website to start with. It’s ViviennePitherDietician. You can probably just Google Viv Pither dietician and it will come up, just so they can have a look and say, “You know, is this really what is affecting me or my child or my husband or even my parents?” And then, through that website, you’ll be able to either email or call me. My email address is on there and my phone number. I’m available through phone or Skype consults. I actually consult worldwide via Skype and it works really well. And yes, we can arrange a time to discuss your individual needs. So yes, I encourage everyone to come and have a look at my website.

LARAH: Thank you, Vivienne and I will put the link to your website on my show notes so that it will be easy to find.  Well, thank you again, and thank you so much for all the information you’ve given us. That was wonderful.

VIVIENNE:  My pleasure, Larah. Thanks for today. I really appreciate it.

LARAH:  Thank you for listening to this episode with Vivienne Pither, a very experienced dietitian and an expert on food intolerance. I know this episode was longer than the usual ones, but Viv has so much useful information to share with us, that it was just too difficult to cut some of the content out to make it shorter. I really hope you find it as useful and informative as I did. The reason why I really thought it was a good idea to present this information on this podcast which is a Low FODMAP diet and IBS podcast is that in some cases, people who suffer from IBS do not seem to be improving completely, even by adopting a low FODMAP diet, and I really wanted to give you some food for thought.  So if this is the case for you, it could be that there are low FODMAP foods that you cannot tolerate because of some of the food chemicals within those foods. And again, we are not just talking about artificial chemicals, but also natural food chemicals as we have heard from Viv — chemicals that are present in normally, very healthy low FODMAP food. But, unfortunately, some of us do not agree with those food chemicals. Viv also talked about the RAPH elimination diet which explained how intolerance to food and environmental chemicals can have an effect on people, and especially on hypersensitive children. So, if this is the case, this may be just another thing you could ask your health professional to help you find out.

Well, this is all for now, but don’t forget to subscribe to the podcast, so you won’t miss any of the episodes. As usual, all the links for this episode can be found in the show notes on my website. Until next time, I wish you all the very, very best with your life and your health, of course. Goodbye.

Links and resources mentioned in this episode:





About Larah

I have been suffering from Irritable Bowel Syndrome for many years, but it took a longtime to get a diagnosis, since then I have been following a low FODMAP diet, which has changed my life for the better. This is my story and experience with IBS and the low FODMAP diet.