Project FODMAP Elimination Blog 2 – First Dietitian Consultation

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.

Lesley Reid, King’s College Professional FODMAP Qualified Dietitian

Lesley’s details are:

Telephone: 07777640035

Email: info@lesleyreiddietitian.co.uk

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FODMAP Progress Update

The Fat Foodie

I’ve now been following the low FODMAP diet for a couple of months and I have to say that I’m feeling much better overall. I navigated the 6 to 8 week elimination phase without too many hiccups and have started to reintroduce some higher FODMAP foods back into my diet. Sadly, some foods remain difficult for me to process, a list that’s quite lengthy unfortunately, but the overall benefits of eating low FODMAP foods is reward in itself.

I think the FODMAP diet journey is an incredibly individual one and everyone will respond differently to it, just as they will respond differently to certain foods. I’ve had a few encounters online recently in which people have stated that particular foods shouldn’t be included in a low FODMAP recipe because they’re high FODMAP, even though they are actually a perfectly fine low FODMAP food if eaten at the correct serving size that’s recommended in the Monash app.

This has irritated me, to be honest, because I feel it is important to learn as much as possible about the health conditions which we suffer from. I’m all about educating myself to the best of my abilities as to what foods I can safely incorporate into my low FODMAP diet because it’s vital that we try to eat a wide variety of foods in our diet in order to get the best forms of nutrition our bodies require.

I’ve seen a lot of people online who are permanently living solely on the exclusion part of the low FODMAP diet and, as any good nutritionist will tell you, that’s not good at all because they are cutting out important nutritious dietary ingredients for no good reason. They’re also missing out on being able to eat delicious foods which would actually not cause them any digestive discomfort anyway!

Also, if there’s one thing that’s abundantly clear when it comes to the FODMAP diet it’s that everyone is different. That’s the whole freakin’ point of the FODMAP diet! Individuals will be able to tolerate or not tolerate a variety of foods differently. I don’t understand why people can’t just assess their own potential response to recipes or a meal and make suitable adjustments. For instance, if you know that you can handle a small amount of oats then have one small Anzac biscuit. If you can’t, then don’t eat them! It really doesn’t have to be hard.

Anzac Biscuits by The Fat Foodie

One thing that has been hard is that I miss bread a lot. I’ve tried a number of shop bought gluten-free loaves, but I find it difficult to get past their grainy texture and general lack of flavour. (I’ve found the £3 price point for a Genius loaf pretty hard to swallow too). I’ve also made my own gluten-free loaves. They’ve turned out okay and have been tasty enough, but they still don’t compare to a normal wheat loaf.

Wholemeal Seeded Gluten-Free Bread by The Fat Foodie

I recently tried sourdough bread, but I don’t think my system liked it. It’s quite an acquired taste at the best of times due to its sour aftertaste, but I suspect my body still isn’t that keen on processing either gluten or the fructans found in wheat. I’m in the process of getting a sourdough bread culture on the go which I intend to use to make a spelt sourdough loaf, so I’ll see what my body makes of that.

Sourdough Bread Starter by The Fat Foodie

As I said at the start of this post, it’s clear that the FODMAP diet is very much a personal endeavour and I think the journey’s very much about identifying what your own personal triggers are. All I can say with certainty is that I feel infinitely better as a result of finding out about the FODMAP diet and I’m happy to help spread the word to other IBS sufferers in order to help them too.

The Fat Foodie

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Dairy-Free Diet to Low FODMAP Diet

The Fat Foodie

The Fat Foodie

Hello there!

I thought I’d add a little blog post here to update you on the progress of my dairy-free diet, or lack of progress on the dairy-free diet, which would be a more accurate description really. I went onto a dairy-free diet at the beginning of January in an attempt to try to get my IBS symptoms under control. My GP confirmed (through blood tests) a long time ago that I am allergic to dairy, so I knew that continuing to consume it wasn’t doing me any good. I figured that the continuing problem with IBS was being caused by my dairy consumption so I cut it out. With the exception of the occasional thing that I haven’t realised had milk powder in it, I’ve been dairy-free for a long while now, but the IBS remains.

A while ago I made the mistake of eating a generous portion of onion rings and was up all night ill. I’ll spare you the grisly details, but I was in a lot of discomfort to say the least. I’ve known for ages that onions were a problem for me to eat, but I’ve never really taken it seriously and have continued to use them in my cooking. However, after being ill all night I returned to bed with a cup of peppermint tea and decided that I needed to find answers as to why my body was having this reaction so frequently. At around 4am that morning I discovered the low FODMAP diet.

Monash University researchers discovered that in the majority of cases, IBS was triggered by particular types of carbohydrates called FODMAPs:

Fermentable: (In which the bacteria in your gut breaks down undigested carbohydrates to create gas)

Oligosaccharides: (which include Fructo-oligosaccharides (FOS) which are found in wheat, rye, onions and garlic and Galacto-oligosaccharides (GOS) which are found in legumes/beans and pulses)

Disaccharides: (found in lactose products, such as milk, cheese and yoghurts)

Mono-saccharide: (which is fructose, a carbohydrate found in honey, apples, and high fructose corn syrups)

and Polyols: (Sugar polyols, such as sorbitol and mannitol, which are found in some fruit and vegetables and are used as artificial sweeteners).

Now, I know that’s quite a lot of science to digest (pardon the pun), but bear with me.

I’ve mentioned before that I work in a book shop and since the beginning of the year I’ve occasionally put FODMAP diet books out on the shelves or sold them to customers, but they’ve been in such low quantities that I didn’t really take much notice of what they were or what the FODMAP diet was. Let’s be honest, there are so many diet books out there it’s unlikely that I’m going to look in depth at them all.

However, when I started looking into the low FODMAP diet in the early hours of the morning I realised that there could be something in it. Also, by that stage I was willing to give anything a try that could possibly stop my abdomen feeling like an end of season battle scene from Game of Thrones.

Essentially there are low FODMAP foods and high FODMAP foods. The low FODMAP foods contain carbohydrates which are easy for the body to digest, whereas the high FODMAP food carbohydrates cannot be digested properly and will therefore create diarrhoea and gas. Monash University suggests that under the supervision of a nutritionist you should dedicate two months to only eating low FODMAP foods. After that time period, high FODMAP foods can start to be introduced into the diet in small quantities to see how well your body can tolerate them.

I’m not doing the low FODMAP diet under a nutritionist, but I’ve been using The Complete Low-FODMAP Diet book which has been invaluable, as has The Low-FODMAP Diet Cookbook because it’s helped me discover meals that are suitable for me to eat. I’m also going to treat myself to Emma Hatcher’s book The FODMAP Friendly Kitchen Cookbook which came out at the beginning of the year and contains some amazing low FODMAP recipes. She also has her own blog She Can’t Eat What?! which has great low FODMAP recipes on it.

Monash University also have a FODMAP app that you can download which contains a brilliant explanatory guide, a comprehensive list of low and high FODMAP foods, a collection of low FODMAP recipes and a shopping list creator. I’ve found it very useful indeed. I also found this website which lists low FODMAP foods and high FODMAP foods (both of which correspond with the Monash FODMAP app at the time of writing).

My friends, at the time of writing this I’ve been on the low FODMAP diet for a week and I feel ten times better already. My constantly bloated, rumbling, painful tummy is starting to disappear, as have the painful IBS spasms that I put up with for so long. On the third day of being on the low FODMAP diet my partner woke up and said “Wow! Your stomach wasn’t making whale song noises all night long!”, to which I replied a curt, “Thanks, I think!”.

I guess the point of this post is simply to let you all know that from now on my food will continue to be dairy-free (because that’s a definite in my life now), but it’ll also be incorporating gluten-free, low FODMAP diet food too. But you can bet your bottom dollar it’ll still be damn tasty!

See you in the next blog post!

Love, Jane  XXX

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