The End of Elimination and Reintroduction.

It’s been quite some time since I last wrote a blog post about how I was getting on in the reintroduction phase and there are a lot of reasons for that, but from my bare notes the crux of today’s message is:

  • The elimination phase is hard.
  • The reintroduction phase will challenge you in ways you didn’t think of beforehand.
  • You will f**k up and possibly more than once.
  • But it’s definitely worth it in the long run.

Let me go into more depth.

I entered the elimination phase thinking that the only time I would need to dedicate to it would probably be a couple/few weeks before my gut had quietened down enough so that I could start the reintroduction phase. This was not the case. It took five weeks of elimination in total.

That’s five weeks of eating only very low FODMAP foods. Now don’t get me wrong, I created a lot of very delicious low FODMAP meals in that time and ate very well, but as a self-confessed ‘foodie’ I found myself missing a lot of higher FODMAP foods. However, I got through the elimination phase eventually (and was a low FODMAP saint the whole time) and began the reintroduction phase.

I have to say that by the time five weeks of elimination had passed I was like a kid in a sweet shop when reintroduction came around, so I struggled to decide between bread and dairy as my first re-challenge. (Although you’d normally only cut out lactose-containing products during elimination, I’d completely cut out dairy because I have a mild milk allergy and Lesley, the dietitian who was helping me through the process had suggested that I omit it from my diet so that we could eliminate it from my symptoms and help us to gain a more accurate result.)

Dairy won the coin toss, so I began week six challenging lactose. It went okay to start with and I wasn’t seeing any massive ill-effects, but it must have had a cumulative effect because I ended up having an IBS attack later that week. The lesson I took from that week was to stay on non-dairy milks (which I don’t mind because hemp milk’s delicious), but have the occasional piece of cheese when I fancy it, such as in a tomato, basil and mozzarella salad or a griddled halloumi burger or good brie on top of a cracker. You get the drift.

Week seven I chose to reintroduce bread. When it comes to reintroducing fructans you need to challenge each food that you want to reintroduce separately because the way the digestive system processes fructans differs for each food. In essence, you might find that you can tolerate some fructans, but not others.

So, you would follow a structure of:

  • Week 1: try reintroducing bread
  • Week 2: try reintroducing pasta
  • Week 3: try reintroducing cereal
  • Week 4: try reintroducing onion
  • Week 5: try reintroducing garlic.

I miss wheat bread a lot on the low FODMAP diet and don’t find gluten-free bread very tasty, so I was really excited, but nervous too, to try its reintroduction. I thoroughly enjoyed eating wheat bread again and I’m pleased to say that apart from a bit of bloating I had no real ill-effects, such as painful spasms. However, on Thursday that dramatically changed, but not because of the bread.

The Thursday of that week was my youngest step-son’s birthday, so we ordered a takeaway from his favourite Indian restaurant in Stirling. I love Indian food and this restaurant’s food is the best I’ve ever tasted, but’s also extremely heavy on the onion and garlic, so I’d resigned myself to having something low FODMAP from the fridge instead. This was not to be. When the food arrived it smelled out of this world and my little FODMAP-sensitive tummy (and brain) went out of the window. Let me tell you what I had:

  • Vegetable pakora (crisply fried on the outside and soft inside, filled with such vegetables as potato, ONION and CAULIFLOWER) that were dipped in ONION and GARLIC-laden pakora sauce.
  • Lamb dansac (a delicious slow cooked lamb curry that’s simmered in an ONION, GARLIC and LENTIL curry sauce).
  • Crispy poppadums (formed from CHICKPEA flour) that came with a delicious fresh ONION chutney.
  • And finally, Naan bread (made from WHEAT flour).

My mouth’s watering just typing this menu out, but in the early hours of the next morning it was watering for a very different reason as waves of nausea swept over me and I spent hours going back and forth to the bathroom. I felt like such a fool, but my dietitian, Lesley, was really understanding about it and just advised me at the time to eat entirely low FODMAP and allow my gut to completely quieten down before I tried re-challenging again. It took around five days for my gut to finally re-settle into normality.

Do I regret it? Yes, of course I do – I was in a great amount of discomfort. However, it also forced me to remind myself that I’m only human and it’s okay to f**k up with FODMAPs occasionally.

It’s now week ten of reintroduction and I’ve so far I’ve re-challenged polyols (fine), sorbitol (fine) and fructose (fine), but I’ve yet to try re-challenging galacto-oligosaccharides (GOS) and some fructans. I’ll get there eventually.

As you can see, the elimination and reintroduction phases are time-intensive and can be very taxing, but I would wholeheartedly recommend that anyone who has been officially diagnosed with IBS goes through them because it really does help you to identify your own personal FODMAP triggers and it may enable you to incorporate some higher FODMAP foods into your diet. Apart from enabling you to eat a bigger range of tasty food, this wider variety of foods will in turn also help support the growth of your good gut bacteria.

During this process I’ve built up a large collection of elimination phase-suitable recipes that I’m thinking of turning into a new cookbook and I would love to hear your thoughts on this, so please get in touch with your opinion.

I’d like to take this opportunity to wholeheartedly thank FODMAP-trained dietitian, Lesley Reid, for helping me through the elimination and reintroduction phases. Her support was incredible and she made the whole process achievable. Needless to say, if you’re looking for a FODMAP-trained dietitian to help take you through the experience I would highly recommend Lesley. (You can find her details below.)

And finally, I’d like to thank all of you who have followed my journey through the elimination and reintroduction phases. Your support and encouragement have been invaluable!

Lesley Reid, King’s College Professional FODMAP Qualified Dietitian

Lesley’s details are:

Telephone: 07777640035

Email: info@lesleyreiddietitian.co.uk

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Week 5: The End of the Elimination Phase

At the start of this process I honestly never envisioned that I would need to stay in elimination for more than two to three weeks in total, so I am astonished to see that my body has needed to go through five weeks of elimination in order to fully quieten my gut down enough to safely begin the reintroduction phase. There are a few points within that process that I’d like to share with you first though.

At the start of week four I’d taken a homemade gluten-free chicken mayo sandwich to work for lunch and I ended up eating it with a knife and fork because the gluten-free bread had crumbled to pieces to such an extent that it couldn’t be picked up and eaten. This will be nothing new to anyone who regularly eats gluten-free bread, such as myself, but the final straw was the horrible taste of the dairy-free margarine I’d used in the sandwich.

I love butter and although I happily drink non-dairy milk and use non-dairy cheese on a regular basis I find that I can’t do without the taste of real butter (normally of the spreadable variety). So it was a hardship to adopt the habit of eating dairy-free margarine during the elimination phase, but I did it regardless.

However, on that Monday morning at work when my sandwich had fallen apart I hit a wall and decided that enough was enough (PMS was heavily involved in this, by the way), so I messaged Lesley, the dietitian who’s taking me through this process, and I ‘informed her’ that I was coming off elimination because I felt fine and I missed butter. Why lie, right? Here’s our conversation for your viewing pleasure…

Now, I’m not going to lie, I wasn’t happy with Lesley’s response because I was just so sick of being on elimination and having to put up with eating really unsatisfying margarine, but again, PMS had a lot of involvement in that. However, I acknowledged to myself that she was the expert and I replied:

I’m a bit embarrassed to share that response with you because the very next day after I’d tried to control how long I was staying in elimination it turned out that Lesley was completely right and I had a full-blown spasm attack which lasted for 3 days. Here’s how that went:

I am so grateful that Lesley responded in the kind, understanding and professional manner she did because quite frankly no other response could have been as rough as I was being on myself anyway.

However, the main point, and I cannot stress this enough, is that this is exactly why IBS sufferers need to do this process under the tutelage of a FODMAP trained dietitian, such as Lesley.

I am an educated woman and I know a lot about FODMAPs and how the FODMAP diet works, but I would have made the completely wrong choice about when to come off elimination had I not been going through this process with Lesley. I don’t know better than she does. She’s trained in this stuff and I’m not and that’s why I had to listen to her.

And let me tell you, I’m so glad that I did because my gut is now completely quiet. It’s still. It’s not even making ‘whale noises’ during the night. And it’s been like that for five consecutive days now.

[Poo talk alert!] I’ve even had a solid stool the past two mornings in a row. That never happens!

[Period talk alert!] Even more surprising for me is that although I’m on day two of my period right now I’m still not having any gut symptoms or bowel issues at all when usually I would.

It’s astonishing and more than a little exciting too because I feel as though I’m in control of my symptoms for the first time in ages. For that reason I can understand why people would choose to stay in the elimination phase eating only very low FODMAP foods, but it’ll never be me because firstly, I miss tasty higher FODMAP foods too much to exclude them permanently from my diet and secondly, I know it’s bad for the gut microbiome long-term.

Lesley and I have a consultation scheduled for Friday in which we’ll discuss my progress and she’ll determine whether I’m ready to move on to the reintroduction phase and I’m more than happy to leave that decision in her hands because she’s the expert.

If you’re living with IBS and you can’t get it under control or if you’re stuck in elimination and you’d like the help of someone who is FODMAP-trained to take you into reintroduction I could not think of someone better than Lesley Reid. You’d be helping yourself towards a happier gut future. (Her details are at the bottom of this post.)

Low fodmap workshop

Lesley’s also running an ‘Introduction to the Low FODMAP Diet for IBS’ workshop on the 11th of May in Glasgow which is going to cover all of the important aspects of the low FODMAP diet. It’s a bespoke workshop which will cost £199 to attend (it’s normally £249) and this price includes a two course low FODMAP a la carte lunch in a top Glasgow restaurant.

The workshop will include:

  • Lesley will show you how you can improve your IBS symptoms.
  • You will learn the principles behind the low FODMAP diet and how to adapt recipes.
  • Understand what foods are allowed and what foods should be avoided.
  • How to decipher food labels.
  • All the information you will need to get started.
  • Advice on the Elimination and Rechallenge/Reintroduction stage.
  • Continued group support.
  • A freshly prepared 2 course A La Carte low FODMAP and gluten-free lunch at the first UK restaurant to offer a low FODMAP menu with a relaxed informal Q&A session during lunch with Lesley who will be happy to discuss general concerns you might have.
  • Plus you’ll get a Low FODMAP goody bag to take home with you!

I’m really excited to be going along to Lesley’s workshop because I love helping people to learn about how the low FODMAP diet works and how beneficial it can be in the treatment of IBS and I’m also really thrilled at having the opportunity to help people learn how to adapt recipes to become safely low FODMAP.

If you would like to book a space to attend the ‘Introduction to the Low FODMAP Diet for IBS’ workshop or if you have any questions you’d like to ask about the workshop then please contact Lesley by email at info@lesleyreiddietitian.co.uk

I think it’s going to be an excellent and very informative day and I’d be thrilled to see you there, but if you can’t make it then Lesley is also offering readers of The Fat Foodie 20% off the price of one-to-one individual consultations during April. Just email her at info@lesleyreiddietitian.co.uk to set up an appointment.

Lesley Reid, King’s College Professional FODMAP Qualified Dietitian

Here are the details for Lesley, the FODMAP Trained Dietitian, who is taking me through elimination:

Telephone:
07777640035

Email: info@lesleyreiddietitian.co.uk

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Project Elimination: Week 3

A lot has happened since I last updated you on my progress through the elimination phase, so this blog post is going to be more of a newsletter. As week 2 began to draw to a close I decided that my gut hadn’t quite calmed down enough to justify starting the reintroduction phase, so under the direction of my dietitian, Lesley, I continued into a third week of elimination.

This co-incided with me beginning to take Symprove liquid probiotics in an attempt to support my gut microbiome while in elimination. Studies have shown that the extremely low FODMAP foods we eat during elimination are low in prebiotic fibres (the ones that feed the bacteria in our guts) and, as a result, the elimination phase depletes the number of ‘good’ bacteria within the gut.

This isn’t ideal because our gut microbiome is an important factor in our overall health, so Lesley had suggested that I start taking a good quality probiotic to support my gut during the process. One of the probiotics that Lesley approves of is Symprove because it provides a shot of over 10 billion good bacteria in every daily dosage, so I contacted Symprove to see if they would be interested in allowing me to test it and I’d write about my experience on the blog as a result. Happily, they agreed and sent me a month’s worth of Symprove.

Symprove Liquid Probiotics

On the Sunday morning of week 3 of elimination I dutifully drank the 70ml recommended dosage of Symprove and awaited the results. (I had the Mango and Passion Fruit flavoured Symprove and it was palatable with the slightly tangy flavour you’d expect from a probiotic liquid.) Sunday passed without incident and I figured that my system was handling the Symprove well.

Unfortunately, at 2:10am on Monday morning I was proved wrong because I awoke with a very urgent need to go to the loo and, sparing you the details, by the time 7:45am rolled around I’d ‘went’ five times. At this point I had to take a couple of anti-diarrhoea tablets and I took one again after lunch, which calmed things down. Needless to say, my Monday was horrendous. It was a day spent wracked with intestinal spasms and cramps all day long. I had a hot bath after I got home from work and I was in bed for 7:30pm and asleep by 8pm. It was an exhausting day.

On a side note, does anyone else get extreme fatigue when they have an intestinal episode? I’m not kidding, at 11:30am I could have lain down on the carpet underneath my work desk and slept instantly!

When Tuesday morning came around I approached the Symprove bottle with caution, but conscious of my gut health, I decided to take it again. Thankfully I didn’t have a bowel reaction quite as violent as the day before, but I did have really bad gas all day long which was very uncomfortable. I had the same symptoms on Wednesday too after taking Symprove.

With this in mind I messaged Lesley and asked her whether she’d heard about people having this sort of reaction to Symprove and whether I should continue to take it, but as Wednesday progressed I decided that I would stop taking it because I felt too uncomfortable. This decision was partly motivated by the gut symptoms I was experiencing, but it was also influenced by a chat I’d had with an American friend who is very well-versed in the FODMAP diet.

In this chat, Hely advised me that Monash generally don’t advise taking probiotics during the elimination phase because it can skew the results, which makes a great deal of sense when you think about it. However, this is a double-edged sword because on the one hand you don’t want your gut microbiome to be depleted as a result of being in the extremely low FODMAP elimination phase (which has been evidenced in a number of scientific studies), but on the other hand you don’t want to warp the results of the elimination phase (and the reintroduction phase too, for that matter) by taking a very high strength probiotic which causes your gut to become symptomatic because how can you determine when your gut has calmed down enough on elimination to begin the reintroduction phase and, accordingly, start reintroducing higher FODMAP foods which contain good prebiotic fibres. You see the dichotomy here, don’t you?

I made the choice which I feel was best for my health and stopped taking Symprove, a decision Lesley fully supported, and the next day my gut issues had disappeared. Now, that’s not to say that I won’t try Symprove again in the future, perhaps after I’ve completed the reintroduction phase and my gut is on a more even keel, because I’ve heard a large number of success stories from people who’ve used it and have found it life-changing (Emma Hatcher has had positive results with it too), but at the moment I’m just going to focus on getting through the elimination phase successfully.

In other news!

(which I’m really excited to share!), Lesley’s asked me to join her at the ‘Introduction to the Low FODMAP Diet for IBS’ workshop she’s organising for the 11th of May this year in Glasgow which is going to cover all of the important aspects of the low FODMAP diet. It’s a bespoke workshop which will cost £199 to attend (it’s normally £249) and this price includes a two course low FODMAP a la carte lunch in a top Glasgow restaurant.

The workshop will include:

  • Lesley will show you how you can improve your IBS symptoms.
  • You will learn the principles behind the low FODMAP diet and how to adapt recipes.
  • Understand what foods are allowed and what foods should be avoided.
  • How to decipher food labels.
  • All the information you will need to get started.
  • Advice on the Elimination and Rechallenge/Reintroduction stage.
  • Continued group support.
  • A freshly prepared 2 course A La Carte low FODMAP and gluten-free lunch at the first UK restaurant to offer a low FODMAP menu with a relaxed informal Q&A session during lunch with Lesley who will be happy to discuss general concerns you might have.
  • Plus you’ll get a Low FODMAP goody bag to take home with you!

I’m really excited to be going along to Lesley’s workshop because I love helping people to learn about how the low FODMAP diet works and how beneficial it can be in the treatment of IBS and I’m also really thrilled at having the opportunity to help people learn how to adapt recipes to become safely low FODMAP.

If you would like to book a space to attend the ‘Introduction to the Low FODMAP Diet for IBS’ workshop or if you have any questions you’d like to ask about the workshop then please contact Lesley by email at info@lesleyreiddietitian.co.uk

I think it’s going to be an excellent and very informative day and I’d be thrilled to see you there, but if you can’t make it then Lesley is also offering readers of The Fat Foodie 20% off the price of one-to-one individual consultations during April. Just email her at info@lesleyreiddietitian.co.uk to set up an appointment.

Oh, one more thing. I’ve decided to do one more week of elimination just to be fully satisfied that my gut has calmed down before I start the reintroduction phase. As always, I’ll keep you updated on my progress.

Thanks for reading,

Jane (The Fat Foodie)  xxx

Lesley Reid, King’s College Professional FODMAP Qualified Dietitian

Here are the details for Lesley, the FODMAP Trained Dietitian, who is taking me through elimination:

Telephone:
07777640035

Email: info@lesleyreiddietitian.co.uk

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Project Elimination: Week 2 – I make a mistake!

On Sunday I went through to Edinburgh with my wife and we had a lovely day out, but I must confess that I made a big mistake when it came to lunch. Hunger got the better of me and we went to a Pizza Express that was nearby. I made a good choice by going for the gluten-free pizza base, but they’re not nearly as tasty as their standard bases and it certainly paled in comparison with the fantastic gluten-free pizza bases you can make with the Grass Roots gluten-free pizza base mix you can buy online from FODMarket.

Anyway, I ordered my pizza and when it came I made short work of it. I didn’t suffer any ill-effects immediately, but later that evening after dinner I started having painful intestinal spasms and bloating. After giving it some thought I realised that, for all that I’d chosen the gluten-free pizza base and vegan toppings, such as dairy-free cheese and low FODMAP vegetables, there was a high chance that the pizza sauce contained garlic and possibly even minced onion.

I think that’s where being prepared on the elimination phase of the low FODMAP diet comes in because I made a mistake by allowing myself to get too hungry which led to me making an impulsive decision about what I would eat. Sadly, I know that if I’d been at home I would have been able to prepare myself a suitably low FODMAP meal, but because I was outside I just went with whatever was handy nearby.

This experience has made me realise that I think this has wider implications for people who follow the low FODMAP diet, regardless of whether they’re on elimination, reintroduction or maintaining, and that is the cold hard fact that it is hard to eat out on the low FODMAP diet.

One thing I omitted from last week’s blog post was that I’d decided against visiting my step-daughter and her family overnight last Wednesday because I knew that I would have to bring my own food and prepare my own meals because they eat a largely vegetarian diet and it would most likely be very high FODMAP.

And do you know what? Aside from the hassle factor of cooking meals for myself (never mind the cost aspect too), the main reason I decided against going to visit was because I felt embarrassed. I was embarrassed and self-conscious that I was following an eating regime which set me apart from the family and meant that I had to eat differently from them. I was embarrassed that I would have to bring low FODMAP ingredients with me to make meals specific to my own requirements.

And that makes me sad.

It makes me sad to realise this because my family would never judge me for taking care of my own health and eating whichever way is best for me.

However, it’s sad that I should feel self-conscious about taking care of myself and eating the right foods during the elimination process in order to identify what doesn’t agree with my gut.

It’s Monday now and my gut is steadily quietening down thanks to a combination of medication and eating healthy low FODMAP food, but I have to say that I am glad I had my experience yesterday because it really brought home to me the importance of making the right food choices for myself.

I’ve enjoyed being fairly symptom free on the days I’ve eaten sensibly low FODMAP and I didn’t enjoy having them return after yesterday’s mistake. It’s made me even more determined to continue seeing through the elimination phase and, once that’s completed, start identifying the higher FODMAP foods I can successfully tolerate and the ones I can’t.

I think that the low FODMAP diet is still in its infancy, but I eagerly anticipate the day when our shops, supermarkets, cafes and restaurants are all FODMAP educated and there’s a plethora of low FODMAP foods available to us in the same way that we now have a much wider awareness of coeliac disease nowadays and the importance of coeliacs eating a gluten-free diet.

This post has been somewhat rambling and I apologise for that, but I hope the honesty of my words makes it clear to anyone else out there who struggles with IBS or is in elimination and makes a mistake or feels self-conscious about making food choices as a result of their own dietary needs, that it’s okay.

You can make whatever requests you need to make food suitable for you when eating out.

You can bring your own low FODMAP food with you to places if you need to.

And ultimately, you’re entitled to take care of your body in whichever way is best for it because it’s where you live and you deserve the very best.

With love,

Jane (The Fat Foodie) xxx

Lesley Reid, King’s College Professional FODMAP Qualified Dietitian

Here are the details for Lesley, the FODMAP Trained Dietitian, who is taking me through elimination:

Telephone: 07777640035

Email: info@lesleyreiddietitian.co.uk