Last Friday I had my first telephone consultation with Lesley Reid, the FODMAP trained dietitian I’m working with while going back through the elimination and reintroduction phases of the FODMAP diet.
I’d prepared a few notes in advance which listed some of the FODMAP groups I found were most problematic to my gut, as well as some questions I wanted to ask her, but I was really impressed with everything she covered that I hadn’t thought to discuss.
Lesley began by taking me through an intensive questionnaire which identified important health questions. These questions included whether my IBS had actually been diagnosed by a doctor in the past (it has), my gynaecological history, and they also ruled out a number of other potential factors, such as coeliac, gastritis etc. She then asked me to tell me about my symptoms and give her a run-down of my IBS history which covered when it had begun, whether I could identify if there was anything in particular that started it, and how I manage it now (medications etc.). She also asked me about my general health which incorporated any medications I’m taking, if I have any allergies, how much exercise I take and how well hydrated I am.
After we’d discussed in great depth the ‘medical’ part of the consultation Lesley then moved on to discuss the elimination phase she had planned for me. I was prepared for her to advise me to go into the elimination phase for the standard 2-6 weeks of eating solely low FODMAP foods, but Lesley informed me that the gut microbiome is negatively affected by being on the very low FODMAP elimination phase, so it’s best not to stay in elimination for too long. Also, Lesley said that because I’ve already been through the elimination phase once before and I’m quite informed as to what triggers my gut, I should initially go into elimination for two weeks and see if my gut is symptom free at the end of it. If not, we’ll do another week and then decide whether to begin the reintroduction phase at that point.
I have to be honest, I was thrilled to hear that I might only have to do two to three weeks of elimination because it was quite daunting to consider being on it for longer, but Lesley’s positive and encouraging manner left me feeling confident that I could do it. She’d also posted two King’s College London low FODMAP diet booklets to me in advance which covered what the low FODMAP diet was and what products were suitable for the low FODMAP diet, which were handy to have on hand. Unfortunately, the King’s College booklets are only available to registered dietitians, but I’ll always prefer the Monash app anyway.
Lesley advised that I should omit dairy from my diet during the elimination phase due to my diagnosed low level cow’s milk allergy, so that we could remove it from the equation and prevent our results being skewed. She also recommended that I begin to take a probiotic supplement, so that my gut microbiome can be supported (and hopefully improved) while in the elimination phase.
One of the questions I had for Lesley was whether I could incorporate Monash app recommended low levels of some higher FODMAP foods within my diet during elimination, but Lesley said that it was better to stick to a diet which is as low FODMAP as possible. She explained that this is so that all potential FODMAP triggers are removed from the diet in order to calm the gut down during the elimination phase in preparation for the reintroduction phase.
After I came off the phone to Lesley and was processing our conversation it struck me that I hadn’t realized the number of behaviours I’d been doing that were possibly affecting my gut: wine, coffee, dairy, and even over-indulging on certain high FODMAP foods because I’ve been working on a vegan cookbook! For all that I thought I was quite educated in my own low FODMAP diet it turned out that I’d actually been quite blinkered to how I’d been eating and it took a conversation with an actual dietitian to highlight where I’d been going wrong.
Another thing I’d love to share with you all is that I’d said to Lesley that I assumed she wanted me to keep a food/symptom diary, but she actually recommended that I download an app called MySymptoms which enables you to record your food, liquid, medication, supplements, stress levels, exercise, environment, symptoms, bowel movements, energy levels and sleep quality for every day and the times they occur. This enables the app to correlate your ‘intake’ with your symptoms. It’s also a great tool because you can generate a PDF to send to your dietitian at the end of the week. (I’d actually forgotten to ask Lesley of she wanted me to send her my PDFs daily or at the end of each week, so I messaged her and got a really quick and friendly reply saying weekly was fine.)
I genuinely can’t stress enough how beneficial it has been to start this process with a FODMAP trained dietitian. Aside from the fact that Lesley is fully aware of all of the health aspects which are involved in an IBS patient, she’s also really opened my eyes to how important my own diet decisions are when it comes to managing my IBS and FODMAP intake. If you’re thinking of beginning the low FODMAP diet or even if you’ve never consulted a dietitian before and are just eating low FODMAP, I’d highly recommend consulting a FODMAP trained dietitian, such as Lesley.
Before I began the elimination phase I put a lot of work into generating a list of very low FODMAP foods for myself, so that when it came to making breakfasts, lunches, dinners and snacks it’d be easier than having to think off the top of my head. I also started writing a book of recipe ideas for myself which were all suitable for the elimination phase, so that I always had a recipe at hand that I could quickly make without the danger of accidentally eating high FODMAPs.
I’m not going to lie, it was much harder to create recipes which were suitable for the elimination phase as opposed to my usual maintaining phase low FODMAP recipes, so as a result, I’ve decided that I’m going to write an elimination phase cookbook which will include all of the recipes I’ve used during the elimination process.
In a sense, I suspect that the reintroduction phase is going to be tougher because I’m going to have to stay fairly low FODMAP until I’ve identified my new FODMAP triggers, but I’m committed to following the process through in its entirety because it’s going to be worth it in the long run.