Trust the process?

Trust the Process

I have the message above in my office. It frequently reminds me to slow down and trust the process. There are so many processes in life. And, for things to go smoothly trusting the process is necessary. When working with clients who have digestive issues, there is a process I follow. FODMAPs are a part of the process.

If you haven’t read the last post, FODMAPs are types of sugars that many people don’t digest. This leads to all sorts of digestive drama and distress. In order to figure out if FODMAPs are an issue, and if so which ones and in what amounts a specific process needs to be followed. (If you want to read the last post, you can do so here.) Here is the basic outline of the process I use with clients.

Phase 1: Elimination

The goal of the Elimination Phase is to get you feeling better. Fast. Most people feel better within three to five days. In the Elimination Phase you eliminate all high and medium FODMAP foods for a period of time. Foods that contain FODMAPs are: milk and milk products, honey, most fruits, high-fructose corn syrup, wheat and rye-containing foods, certain vegetables, inulin, chicory root, some vegetables, some sugar-free foods, dried peas and beans. This phase can last anywhere from one to four weeks. I recommend two weeks or until having seven days of no or minimal symptoms. Although the list of foods to eliminate may seem daunting, there are a lot of foods that you can have.

Phase 2: Challenge

The goal of the Challenge Phase is to determine which FODMAPs don’t get along with your body. It could be one or more. And, it could be the “dose” of the food. During the Challenge Phase you stick with the elimination diet and add in a food that contains on FODMAP in three dose sizes – small, medium, and large. If you have symptoms from any of the doses you can decide whether to try the next dose up or stop and move into a washout period. The washout period is usually three days and allows your body to return to a symptom-free state. Then, you can move on to the next FODMAP-containing food. If you don’t experience symptoms with the large dose, you can move onto the next FODMAP-containing food without the washout period.

Phase 3: Personalization

The goal of the Personalization Phase is to determine how much of combined FODMAPs you can have without causing symptoms. In the Challenge Phase you tried foods with one FODMAP. In the Personalization Phase you try foods with multiple FODMAPs to see how much total FODMAPs you can have without having symptoms.

The whole FODMAP Protocol can take 8 to 12 weeks. While this may seem like a lot of time, is it really that much time to invest to start feeling better? To have a list of foods and amounts of foods that you know you can eat without symptoms?

If you want to know more, you can always contact me using the Contact link at the top of the page. Click on the link to get the FODMAP Resources I use with my clients.

Tired of trying to figure out where to start? Confused about all the information out there? This can help!

Fruit.

Fruit.

Where to start? What works? When you’ve been having stomach issues for a while, figuring out where to start can be confusing. So much so, that it can be easier just to go along with the symptoms rather than spending the energy to figure out where to start.

It seems simple, right? Figure out what foods are causing the problems. But, it can be really complicated. Think about what you ate yesterday. All of it. How many foods did you eat? What about things that you drank? Usually, the plethora of things we put in our mouth makes figuring it out too confusing.

You may also have a hard time figuring it out because you’ll eat something one day and be fine. You’ll eat it the next day and end up having problems. It makes no sense! Trust me, I’ve been there.

You research on the internet and find all sorts of conflicting information. You don’t have the time or energy to search through all of the information out there to figure out what to do. You’ve been to a GI Doc who didn’t help either.

After personally dealing with everything talked about above, I’ve started using a FODMAP protocol as the starting point for my clients who have digestive issues. The FODMAP diet was developed by Monash University in Australia. They still continue the program today by testing foods and giving them FODMAP ratings. And, the FODMAP diet has been studied by universities and shown to help relieve digestive issues and symptoms.

What are FODMAPs anyway? FODMAPs are types of sugars that a lot of people have problems digesting. When these sugars reach the small intestine, fluid is drawn in to dilute them and you feel bloated and uncomfortable. Then, the sugars and fluid move into the large intestine where some of the bacteria of your microbiome eat the sugars. Then, the microbes produce gas. Now, you’ve got gas and extra fluid in your large intestine which leads to you feeling more bloated and uncomfortable.

The FODMAP protocol eliminated foods that are have FODMAPs in them for a period of time then challenges your body with the different FODMAP foods.

Next week we’ll dive into the FODMAP protocol and how it works.

I’m so confused! Where do I start?

When you’re dealing with digestive issues, figuring out where to start to get your symptoms under control can be overwhelming. There are so many choices and approaches. So much information on the web. A lot of it conflicting. What works for one person may not work for you. All you want is to get well. To get your symptoms under control so you can get your life back.

I’ve been there. As a Registered Dietitian with a PhD in Kinesiology I was so frustrated! Understanding how the body works and how food works in the body is my job! My area of expertise. And, I couldn’t figure out my own symptoms. Once I’d finally had enough, I became obsessed with getting my symptoms under control and my life back.

In my research and training specific to digestive issues I learned about the “5 Rs of Gut Restoration”. The 5 Rs are:

  • Remove
  • Replace
  • Repair
  • Reinoculate
  • Rebalance

The 5Rs have become an integral part of my practice when working with clients who have digestive issues. (If you want more details about the 5Rs, I’ve done a series of blog posts. You can start here with an overview of them). I also created a graphic you can download to get more information about each “R” and how they fit together.

When I use the 5 Rs in my practice I start with the first one – Remove. Why? There is usually one or more foods that are causing problems. And, I want my clients to start getting better NOW! I know when I was dealing with digestive issues, I wanted to feel better NOW.

In the Remove step, there are three basic ways to figure out what needs to be removed:

  1. Food sensitivity testing
  2. Basic elimination diet
  3. Structured elimination diet

All are great places to start. And, they can be used in combination.

Food Sensitivity Testing

Food sensitivity starts when decide which testing to use and send in a blood sample. Let lab analyzes your sample and sends the results to your practitioner. Then, you meet, develop a plan and start on your elimination diet. The main downsides:

  • There’s no gold standard for food sensitivity testing. I use both ALCAT and LEAP in my practice. Food sensitivity testing, regardless of the test used, is not fool-proof. It is a starting place though.
  • It takes time – usually 2 to 4 weeks – before you can start on the plan.
  • It can be expensive. Depending on the type and amount of testing and amount of counseling needed food sensitivity testing can run from a few hundred to a few thousand dollars.

Basic Elimination Diet

When using a basic elimination diet, you choose what food and drinks to eliminate and how long to eliminate them. You could eliminate diary, gluten, eggs, soy, nuts, peanuts alcohol, and other foods you believe may be causing problems for anywhere from a week to a month. Then, you introduce the foods one-by-one to determine which is causing the problems.

  • A basic elimination diet can also be a good place to start. Some of the downsides are:
  • It can be very restrictive and hard to stick to. Depending on what you choose to eliminate it can be difficult, if not impossible, to eat out or at other people’s homes.
  • You may or may not get the foods that are causing the issues eliminated. I’ve known people who did an elimination diet down to, basically, chicken and rice only to find out later that rice is a food that triggers their symptoms.
  • The reintroduction period can be hard. If you’ve been on a strict elimination diet for a couple of weeks to a month, when you get into the challenge/reintroduction phase it’s really easy to go wild and eat everything you’ve been denying yourself.

FODMAPs

Finally, you can use a structured elimination diet like FODMAPs. I’m going to talk specifically about FODMAPs because it was developed by a university (Monash University in Australia) and has been the subject of at least 100 research studies. FODMAPs has been shown to help reduce the symptoms of people with Irritable Bowel Syndrome. In my practice, I’ve found that it helps those who have a broad range of digestive issues.

FODMAPs removes certain sugars from your diet. Specifically, FODMAPs stands for Fermentable Oligo-, Di-, Mono-saccharides And Polyols. These are types of sugars that some people have problems digesting. When doing the FODMAPs diet, you go through an elimination period (one week to a month) of following a diet with little to no FODMAPs. Then, you go through a Challenge Phase where you test out each type of FODMAP in various amounts. This is critical because you may be able to digest one FODMAP but not another, or you may be able to digest a small amount but not a lot. This program allows you to figure out how much of each type of FODMAP you can tolerate without causing symptoms. The Challenge Phase can take 5 to 8 weeks or more, depending on how you choose to do it.

As with any of these approaches, the FODMAP elimination diet has some downsides. These are:

  • Figuring out which protocol to follow. There are a lot of FODMAP resources out on the web. This is good and bad. It’s great to have a lot of information. And, it can also be overwhelming.
  • Finding information that is up-to-date can be a challenge. Given the plethora of information on the web about what is and isn’t FODMAP-safe, a lot of it is out-of-date and requires you double check it with the latest information put out by Monsh University.
  • As with the basic elimination diet, the challenge period can be hard. You need to continue following the FODMAP elimination diet during the challenge phase.
  • It’s common to eat everything you’ve been restricting when you finish the elimination phase and not finish the program. Then, you’re right back where you started.

Where To Start?

With any of these approaches, you should assess how you feel before you start and then several times through the process. If you’d like the form I use with my clients, you can get it here.

In my practice, I usually use a combination of approaches. Typically, I’ll use the FODMAP plan to get people started. Then, we’ll decide whether to do food sensitivity testing. I use this approach because most people with digestive issues who follow the FODMAP plan start feeling better within a few days. And, I’ll use food sensitivity testing to refine the foods they can and can’t have. We can always do food sensitivity testing after we see how they respond to the FODMAP diet.

The difference between food sensitivity testing and FODMAPs is that food sensitivity testing identifies foods that are causing an immune reaction. Food sensitivities cause an immune reaction that isn’t as severe as an anaphylactic reaction, but is still causing your immune system to react. It can be important to get these foods out of your diet in order to reduce inflammation as well as other symptoms including digestive issues, migraines, arthritis, joint aches, muscle aches, etc.

FODMAPs on the other hand are sugars that your body has a hard time digesting. They don’t cause an immune reaction. They can cause digestive issues including gas, bloating, constipation and diarrhea. This is because when they pass into the small intestine they aren’t broken down, usually due to a lack of the enzymes that are needed to break them down. This causes additional fluid to be pulled into the small intestine to dilute these sugars. Then, when the sugars pass into the large intestine (or colon) some of the microbes in your microbiome love to eat them, and eat them quickly. Then, the microbes release gas into your intestines which causes further discomfort. It could be one or more FODMAPs that don’t get along with you. A well designed FODMAP program will help you figure out if it’s one or more FODMAPs that don’t get along well with you and the amounts of the ones you do get along with that you can eat without causing symptoms.

If you’re having digestive issues and are ready to take control of your symptoms, the best place to start is by figuring out what you need to remove. Then, you can move into the other Rs from there.

If you’d like to get started with a FODMAP protocol, here are the FODMAP Resources I use with my clients.

Meditation and Rebalance

woman meditating

Is it just me or is meditation everywhere? Every time I turn around someone is talking about it. Writing books about it. Discovering it. Or, finding a new way to do it. Is meditation magic? Is it “woo woo” stuff?

I’ll say the answers, in my opinion are, “yes” and “maybe” depending on your perspective. What I will say definitively is that meditation plays a huge role in Rebalancing our digestive tracts.

Meditation has been shown to reduce stress, lower blood pressure, and help modulate our immune systems. How meditation does these things isn’t clear. What is known is that meditation help you learn to focus your mind, still your thoughts, and relax. Over time, the more you meditate consistently the more you respond to stress differently. I started meditating last year. I’ve found that when something stresses me I am able to respond – act in a thoughtful way – rather than react – fly off the handle. I’ve found that I’m less prone to letting my mind run amok.

Why is this important? For many people with digestive issues, stress plays a role in when and how their symptoms show up. A stressful time means that their symptoms will show up or get worse. If we can control how we respond to stress, the appearance or worsening of the symptoms can be stopped or minimized. Pretty cool, right?

Meditation doesn’t have to be “woo woo”. You don’t have to put on “weird” music and sit with your legs in funny positions. I promise. You can meditate sitting in a chair, on the floor, walking, cooking, eating, running. And, you don’t have to do it hours on end. Whenever you can take a few minutes is when you can meditate.

If you want to try meditating, I suggest starting small – 5 to 15 minutes at a time. I find first thing in the morning is the best time to meditate. You can use apps to help, guided meditations where someone gives you cues through the process, or just set a timer and focus on your breath. Whenever a thought come in to your mind, don’t run away with it. Thank it, or notice it, then bring your mind back to your breath.

Below are some resources to help you get started, and keep, meditating. One of my favorites is the Headspace app. If you want a fun read to help you understand meditation better, I’d highly recommend Dan Harris’s book 10% Happier: How I Tamed the Voice in My Head, Reduced Stress without Losing My Edge, and Found Self-Help that Actually Works—A True Story. Dan Harris is an anchor on Nightline and Good Morning America weekends. The story about how he got on the road to meditation is worth the read.

Do you meditate? If so, what have you noticed?

Meditation resources:

Headspace website and/or App

10% Happier website and App (Apple only)

Calm app

10% Happier: How I Tamed the Voice in My Head, Reduced Stress without Losing My Edge, and Found Self-Help that Actually Works—A True Story by Dan Harris

Re-balance? That presumes I had balance at some point.

Relaxation.

Relaxation.

The last of the 5Rs of Gut Restoration is “Rebalance”. Although balance is a concept that we often spend time, effort, and energy chasing (and feeling like we fail at achieving it) the components of “balance” are critical not to just our gut health but also our overall health.

Rebalance includes: stress management, sleep, exercise, mindfulness, and other lifestyle factors that help you feel more “in the zone” or like your life is “clicking”. Why are these things important? Three words – parasympathetic nervous system.

The parasympathetic nervous system controls organs such as the heart, lungs, liver, and gastrointestinal tract all the way from the stomach to the large intestine. The Vagus nerve diretly connects our brain to our digestive tract. Yes, your brain and your gut are linked. About 80% of the nerves go from your gut to your brain (I always thought it was the other way around).

Stress management is the first key of Rebalance. When we are stressed the sympathetic nervous system (the fight-or-flight response) can take over and override the parasympathetic nervous system. This means that, for one thing, your digestive tract receives less blood and slows down when we are under stress. This makes sense because if we are having to run from a bear, we want the blood going to our legs and arms, not digesting the lunch we recently had. However, when our stress levels are raised over time, this can impact our digestive tracts in the long term. That’s when we need to step back, re-assess and help get the parasympathetic system back in the game. Because, even if you’re doing all of the other Rs, you won’t get the results you want without including the fifth – Rebalance – and stress management. Some of the other pieces of Rebalance are intertwined with stress management. We’ll touch on it more in this post and next week’s post.

Sleep is critical to our body’s ability to repair. When you workout you are damaging your muscles and body. That’s the point of working out. It’s when you sleep that your body repairs the damage you’ve done in the workout. When we sleep our body releases hormones that help keep us healthy. Our minds get to process the events of the day. Quality sleep helps you learn because that is when the neural pathways are built. If you want to get to the “top”, whatever the “top” means to you, do as Arianna Huffington says, “Sleep your way to the top.”

Next week, I’ll continue on the “Rebalance” theme.

I’d like to hear from  you about what comes to mind when you hear the word “balance”.  How do you get and/or maintain balance? Do you think it’s even achievable?