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 6: The Lactose Challenge

Last Friday Lesley and I had our final elimination phase consultation and she was happy for me to begin the reintroduction phase the following week because my gut had completely quietened down. After going through an extensive questionnaire which helped her to determine if it was safe for me to go forward onto the reintroduction phase we decided that I would try to challenge lactose the following week.

You don’t have to eliminate dairy during the elimination phase as long as you use lactose-free products instead, but I have a mild dairy allergy, so I had cut it out of my diet during elimination in order to make sure that any symptoms I was having as a result of the dairy allergy weren’t being confused with any FODMAP responses.

I’d also like to point out that during the reintroduction phase it’s important that you still eat the strictly low FODMAP foods you eat in the elimination phase, with the exception of the food that you’re testing on reintroduction. That way you know that if you have a reaction it’s due solely to the high FODMAP food you’re testing and not something else you’ve incorporated into your diet.

I was looking forward to this challenge because I’ve really missed having real butter on my toast and in sandwiches. I’d even missed cheese even though I’m not a big cheese eater, so I was keen to test my response to it.

During our consultation Lesley did a great job of explaining to me how the reintroduction phase works for each of the FODMAPs I’ll be testing, so I knew that on Monday I was to drink 125ml of normal milk, on Tuesday 250ml of milk and on Wednesday 375ml of milk. This was fairly easy for me to take because I just made myself decaf lattes every morning to test my reactions.

It’s funny because I thought I’d enjoy the taste of the lattes more than I actually did and I realised that I’d become so used to drinking non-dairy milks, such as hemp, rice and oat, that they’d became my new norm. As a result, I decided that regardless of the lactose response I had I’m definitely going to stick to drinking non-dairy milk.

Getting back to the lactose challenge, I was pleased to find that I had no ill-effects on the three days I drank the milk apart from nasal congestion which I attribute to my diagnosed milk allergy, so I thought I was doing well at tolerating the lactose, but on Wednesday evening I had a full-blown spasm attack which lasted all day Thursday too. Another weird effect of the lactose challenge is that whereas ordinarily I’m IBS-D the lactose had led to me having much more solid stools and having a bit of IBS-C which was very odd for me!

Lesley had stressed to me that I was to keep her informed about how each of the challenges went, so it was with disappointment that I messaged her on Wednesday evening and told her about my reaction. She reassured me that it could have been the cumulative effect of having lactose three days in a row which had led to my reaction, but she also said that I might be able to tolerate small amounts of lactose, but maybe not every day. Lesley then advised me to spend the rest of the week eating very low FODMAP again in order to re-settle my gut in preparation for testing a new FODMAP group next week.

Today is Friday and I now feel much better. My gut is once again calm and I’m confident that by Monday morning I’ll be able to start a fresh FODMAP challenge although I’ve yet to decide which one. I had planned on testing fructans, specifically bread, but I’m not sure if I’m ready to deal with another spasm attack quite so soon, so I suspect I might pick a group that I’m fairly sure I can tolerate well, such as sorbitol. I’ll decide when Monday comes around.

If there’s one thing that the lactose challenge has taught me it’s that reintroducing FODMAPs is not an exact science and it’s about finding out your different levels of tolerance. On that note, I think I’ll re-test lactose again in the future, but I’ll probably follow this method instead:

Sunday: 125 ml milk

Monday: Low FODMAP

Tuesday: 250ml milk

Wednesday: Low FODMAP

Thursday: 375ml milk

Friday: Low FODMAP

Saturday: Low FODMAP

By following this system I hope that I can monitor my body’s reaction to different quantities of lactose by seeing how it reacts the day after each ‘dose’ of lactose.

As always during this process I’ll keep you informed about how I get on with each of the challenges.

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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