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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Cucumber and Mint Salad (serves 4)

Cucumber and Mint Salad by The Fat Foodie

I’d say it’s fairly well known that I prefer my salads to be on the robust, substantial side, so it’ll not come as a surprise to you that this Cucumber and Mint Salad can be eaten either as a side dish to accompany a piece of grilled fish or chicken or on its own as a fresh lunch.

This Cucumber and Mint Salad in itself is very simple, comprising of just cucumber wedges, sliced bell pepper and cubes of salty feta cheese, but it’s elevated to something quite wonderful by the minty vinegarette it’s dressed in.

The standard vinegarette ingredients of white wine vinegar and olive oil are enhanced by the addition of dried mint and lime juice, creating a salad dressing which is tart, but herby at the same time. I’m not a big fan of salad dressings with a strong vinegar flavour, so I tend to make my vinegarette on the conservative side, but feel free to add more white wine vinegar or dried mint to yours, if you wish.

I make this Cucumber and Mint Salad a great deal because it’s perfect on the side of a piece of grilled salmon or chicken breast, but it also satisfies my appetite as a packed lunch at work. It’s just a great all-rounder salad choice.

Ingredients for the Salad Base:

1 cucumber (diced)

160g feta cheese (or non-dairy cheese)

1 red or yellow bell pepper

Ingredients for the Salad Dressing:

2 tbsps olive oil

1 tbsp white wine vinegar

1 tsp dried mint

The juice of 1 lime

1/2 tsp ground black pepper

1/2 tsp salt

Method:

Prepare the salad ingredients as directed and then place them in a large bowl.

Mix all of the salad dressing ingredients together and then toss it through the salad and serve.

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Project FODMAP Elimination Blog 1

Jane Cessford – The Fat Foodie

What the project is:

Last weekend I visited the Allergy and FreeFrom Show in Glasgow and I had the pleasure of meeting Lesley Reid, a registered dietitian who specializes in FODMAPs. Lesley was giving a talk at the show on recent developments in the FODMAP world and I’d arranged to have a chat with her afterwards.

Lesley’s talk was a brilliant whistle-stop tour through the basics of the FODMAP diet and I saw a lot of people taking photos of her slides and writing down notes of what foods were low/high FODMAP. However, another thing I noticed which made my heart sink was that when Lesley asked how many people were on or had tried the FODMAP diet and then asked how many had successfully gone through the reintroduction phase (I’m paraphrasing a little bit here, but it’s hard to remember the exact words), there were significantly fewer hands up for those who had reintroduced.

Now, this mirrors a concern I’ve had for quite some time now, that far too many people are going into the exclusion phase of the low FODMAP diet, feeling the benefits of cutting out high FODMAP foods, but aren’t going through the reintroduction phase to identify their own FODMAP tolerance levels.

As a blogger, I’m in a huge number of groups and channels on social media and I’ve noticed that a huge amount of people won’t try the reintroduction phase because they’re frightened that their IBS symptoms will come back.

I can sympathize with this, I really can, but the problem with staying in the exclusion phase is that it diminishes the number of foods people will eat which, as a result, has a detrimental effect on their gut bacteria and can lead to nutritional deficiencies in the long-term.

When I met Lesley I approached her with an idea I’d had for a while – that she, as a FODMAP trained dietitian, guide me through the elimination and reintroduction phases so that I can identify my new FODMAP tolerance levels while under the assistance of a trained dietitian, all the while documenting my experience of the whole project on my blog. Thankfully, Lesley empathizes with and understands my concerns about the number of people who won’t reintroduce and happily agreed to the project.

Why I’m doing it:

It’s been a couple of years since I put myself through the elimination and reintroduction phases and I’m noticing that foods I’d previously thought safe to eat are now sometimes causing me discomfort. Equally, there are foods I’d previously excluded from my diet in the belief that they were a FODMAP group I couldn’t tolerate, which I’m now able to eat. As a result, I think my gut microbiome has changed over time and I strongly believe that doing the elimination phase again, however difficult it might be, is the best way forward. Trust me, I’m not doing this lightly!

The other reason I’m doing this project is that when I first started the low FODMAP diet I did not consult a dietitian. This was for a number of reasons:

1.) I couldn’t afford to see a private dietitian.

2.) The waiting list to see a dietitian on the NHS is long and it would have taken a long time to get an appointment.

3.) I wanted to start ASAP because I was in so much discomfort.

4.) I’m a qualified researcher, so I knew I could educate myself in how the FODMAP diet in all of its phases worked before I began the diet.

The main reason I want to go through the elimination diet a second time under the tutelage of a FODMAP trained dietitian, such as Lesley, is so that I can live the experience and communicate to others the importance of going through the elimination and reintroduction phases.

Why I chose to do the elimination and reintroduction phases with Lesley:

Lesley Reid, King’s College Professional FODMAP Qualified Dietitian

I asked Lesley Reid if she would be open to doing the project with me because she trained in the Low FODMAP diet at King’s College London, so she’s entirely qualified as a dietitian to take someone through the intricacies of the FODMAP diet.

She’s also very passionate about the importance of the reintroduction phase of the low FODMAP diet and shares my concern about the number of people living in the exclusion phase.

She’s also local (I live in Stirling and she’s got two office locations in Glasgow), so it made sense to use someone close by.

What I aim to achieve:

I want to emphasise to everyone who follows the low FODMAP diet the importance of properly going through the elimination and reintroduction phases, so that a proper understanding of our own FODMAP tolerance levels can be understood with the long-term aim of being able to incorporate higher FODMAP foods within our diets to encourage good bacteria growth in the gut microbiome.

What’s happened so far:

This morning Lesley said that she’d be sending me documents to fill out, so that our project can proceed just like it usually would for any of her professional consultations and we’ll have our first telephone consultation on Friday.

I have to say, she’s so friendly and approachable that I already feel reassured that she’s going to be the dietitian taking me through this process.

The elimination phase is restrictive, so I’d be lying if I said I wasn’t nervous about going back through it, but I know that it’ll benefit me in the long run by informing me of my new tolerance levels and improving my gut health.

I’ll keep you posted!

Lesley’s details are:

Telephone: 07777640035

Email: info@lesleyreiddietitian.co.uk

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