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

Digiprove sealCopyright protected by Digiprove © 2019

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

Digiprove sealCopyright protected by Digiprove © 2019

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

Digiprove sealCopyright protected by Digiprove © 2019