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.

FODMAP? What’s a FODMAP and Why do I Care?

Cherries

 

“Ugh. What did I eat this time? But I ate that the other day and was fine. Why didn’t my body like it this time?” This is a conversation I’ve had with myself a lot over the past few months. I was diagnosed with IBS a few years ago, given a high fiber diet and told to figure out the foods that set off my symptoms. Well, the high fiber diet didn’t really work, and I couldn’t figure out the foods that did it because the symptoms seemed so random. Sometimes I could have a bowl of cherries and be OK, other days cherries would make me sick. What’s up with that? Talk about frustrating.

A couple of months ago, I decided to try the FODMAP diet. What’s a FODMAP? FODMAP stands for fermentable oligo-, di-, mono- and polyols. These are all types of sugars that some of us may have problems digesting. If you think of your gut like a bucket, you can eat FODMAPs until the bucket fills and then you get symptoms. Each person has a different size bucket and reacts differently do the different FODMAPS. I had gotten Patsy Castos’s book IBS Free at Last! and read through it. The plan seemed solid. However, I just didn’t want to give up all those yummy foods that contained FODMAPs. That was until I had a bad couple of weeks that landed me on the couch and feeling horrible just about every day. I’d reached my limit. I started the elimination diet after reading through all of the materials again. Within two days, I felt better than I had in a long time! It was amazing!

After following the plan for a couple of weeks, I started the challenge phase. Honestly, this was and still is hard. It was hard to eat food that I thought might make me feel bad when I’d begun feeling so good. The challenge phase is a necessary evil though. If you don’t challenge yourself you can’t find out how much of the different FODMAP foods you can tolerate. I’m still working on challenging myself with different foods. At least I’ve found that I can have small amounts of fruits and gluten-containing products. Dairy and I still don’t get along well, though.

If you have ongoing stomach or gastro-intestinal problems, or have been handed a diagnosis of IBS without follow-through other than a high fiber diet, FODMAPS may be a good fit for you. I’d highly recommend Patsy’s book. She also has an excellent website. If your not sure if FODMAPS is right for you, she discusses that here. Either way, if you have ongoing GI issues keep looking for answers. Your days don’t have to be filled with pain and the stress of not knowing if or how your body is going to react to food. If you want more information feel free to email me or post in the comments section below.

FOD-what?

Do you have gastro-intestinal (GI) issues? Frequent gas, bloating, constipation, diarrhea, etc.? Does it seem like the symptoms do not make sense? Have you been diagnosed with IBS and found that the high fiber diet hasn’t helped? Do sometimes you eat a food and you’re OK and the next time you eat it and you end up in pain? Or, do you have ongoing GI issues? Then, I have two resources for you.

The first is FODMAPs. FODMAPs are a group of fermentable carbohydrates. When you eat them, the bacteria in your gut digests them quickly which causes fluid to be pulled into your gut which can cause gas, bloating, etc. The reaction usually occurs a couple to a few hours after you’ve eaten the food. And, the reaction depends on the amount of FODMAPs you’ve eaten – not necessarily a specific one.

All of this may sound complicated, but it really isn’t. Patsy Castos is an expert on FODMAPs and has an excellent book that walks you through the elimination diet and challenge phase – IBS Free at Last! Patsy also has an excellent website on FODMAPs, IBS, and other GI issues.

GI issues can have other causes, too. Niki Strealy is an expert in GI issues of all sorts. In fact, she’s the “Diarrhea Dietitian.” Ok, you can stop laughing. I know. You’ll never forget that now will you? Niki has a book called “The Diarrhea Dietitian” that goes into FODMAPs and other reasons you may be experiencing GI issues. Niki has a lot of personal experience in the area. You can read more about her on her website. Niki presents information on GI issues in practical terms with a good sense of humor. Her book is a valuable resource for those with GI issues.

My overall point is – if you or someone you know is having GI issues that occur frequently, there are great resources out there to help. This isn’t a topic most people want to talk about so issues often go undiagnosed and people are left suffering. This isn’t necessary – particularly with Niki and Patsy’s resources.

And, if you want more information, Niki will be joining me on my July Monthly Interactive Nutrition call on Wednesday, July 16th at Noon central time. The call is scheduled for 30 minutes, but we may go longer. If you want more information, you can go to my facebook page for all the details.