The Low FODMAP Diet 101 (what you should know)

If you’ve been hanging around with me for a little while now, either through my blog, email letters, or over on social media, you may have noticed I’ve been dropping the F-word quite a bit.

No, not that F-word. (I’m much classier than that ;))

I’m talking about FODMAPs.

Don’t worry…if you’re not sure what that word means you’re most definitely not alone.

In this post I’m giving you a brief overview of the Low FODMAP Diet, what exactly it is and how it works, and what you should know before you begin one.

But first…

What the heck is a FODMAP?

FODMAP is actually an acronym for a group of short-chained carbohydrates (certain sugars and fibres) that are poorly digested and absorbed in the small intestine, and as a result, lead to unpleasant digestive symptoms in some individuals who have a sensitive gut – typically associated with Irritable Bowel Syndrome (IBS) and other gut-related conditions, such as Small Intestinal Overgrowth (SIBO).

These poorly absorbed FODMAPS travel to the colon largely intact where they become food for the microbes (healthy or otherwise) that naturally reside there. As a by-product of this “break-down” or fermentation process, these microbes produce gases that can contribute to bloating, abdominal distension, pain, and cramping.

Furthermore, these undigested FODMAPs also have an osmotic effect, meaning they draw water into the intestines – which can contribute to further bloating and distention. And if you’re somebody who already has fast motility to begin with, this can equate to loose stools and diarrhea.

Overall, this lovely little combo of gas and water can lead to altered and unpredictable bowel motility – both constipation and loose stools.

Enter…

The Low FODMAP Diet as a Tool for IBS Sufferers

The Low FODMAP diet is a dietary regimen that was designed by researchers at Monash University in Australia to help minimize the GI (Gastrointestinal) symptoms associated with IBS.

Research has shown that up to 75% of IBS sufferers experience relief when following a low FODMAP diet.

With up to 15% of the world population suffering from this functional gut disorder and its associated symptoms of bloating, abdominal pain, distension, excess gas, and altered bowel motility (constipation and/or diarrhea), the ramifications of these findings is quite significant.

Although each person’s experience of IBS can greatly differ within the known range of symptoms, for many people it’s a debilitating condition that can severely affect their quality of life.

 

FODMAP stands for:

Fermentable (carbohydrates easily broken down by gut bacteria)

Oligosaccharides (Fructans and Galacto-oligosacchardies aka GOS)

Disaccharides (Lactose)

Monosaccharides (excess fructose)

And

Polyols (sugar alcohols such as sorbitol and mannitol)

As you can see it’s quite a mouthful, so let’s just stick with the acronym, shall we?

 

High FODMAP Foods

Here’s a brief sampling of some high FODMAP foods by their respective categories. It’s important to note that foods can contain more than one group of FODMAPs.

Fructans: wheat, barley, rye, onions, garlic, nectarines, dried figs, inulin (added to many packaged goods)

GOS: legumes, cashews, pistachios

Lactose: milk, yogurt, cottage cheese, ice cream

Excess Fructose: apples, pears, mangos, asparagus, honey, agave nectar, high-fructose corn syrup

Polyols: apples, apricots, blackberries, mushrooms, cauliflower, snow peas, sweeteners like xylitol, sorbitol, and mannitol

 

Low FODMAP Foods

This is by no means a complete list, but some of the foods considered to be low FODMAP include:

Grapes, oranges, blueberries, strawberries, bell peppers, bok choy, carrots, eggplant, most leafy greens, cucumbers, brown and white rice, quinoa, polenta, almond milk, goat cheese, feta, cheddar, lactose-free yogurt, chia seeds, hazelnuts, pumpkin seeds, walnuts, beef, chicken, eggs, fish, firm tofu, tempeh, butter, olive oil, coconut oil, apple cider vinegar, soy sauce, peanut butter, maple syrup, dark chocolate, stevia (w/out inulin, FOS, or chicory root), most spices (except onion and garlic powder), black, green, and white tea, peppermint tea, coffee.

Keep in mind that FODMAPs are a type of carbohydrate, so if the food contains no carbohydrates, such as the case with many animal proteins and pure fats (i.e. oils), it’s safe to assume that it wouldn’t contain any naturally occurring FODMAPs.

 

Size Matters (BIG TIME)

When following this diet it’s not enough to just eat from a list of low FODMAP foods and avoid lists of high FODMAP foods, because in many cases the portion size matters.

Some foods that are considered low FODMAP can quickly become high FODMAP when eaten in larger quantities, just as some foods that are considered high FODMAP can be considered low FODMAP (and enjoyed) in a smaller portion size (i.e. 1 tbsp. vs ½ a cup).

A great reference guide for portion sizes is the Monash University Low FODMAP Diet app that can be downloaded to your smartphone. I highly recommend it as it’s continually being updated with the latest FODMAP research. (see resources below).

 

How the Diet Works (3 Stages)

1) Elimination Phase. For 2 – 6 weeks all high FODMAP foods are restricted. The point of the elimination period is to get GI symptoms under control and to assess whether or not these foods might be contributing to your symptoms.

2) Reintroduction/Re-challenge Phase. Each group and subgroup of high FODMAP foods are methodically tested one at a time and in varying portion sizes to see which ones might be potential culprits. You may discover that you can handle a small serving size of some foods, but a larger quantity triggers symptoms. And it’s not uncommon to find that only 1 or 2 categories of FODMAPs are problematic for you.

3) Personalization Phase. Based on your findings you can customize your diet to your unique needs and preferences. Once you know which foods trigger your symptoms, you can continue to either limit them or modify the portion size to suit yourself. Since FODMAPs have a cumulative effect, you may be able to eat small amounts of your “trigger foods” as long as your total overall FODMAP load is low.

 

What You Should Know Before You Begin

Before jumping into the diet here are some important considerations to be aware of:

It’s a Temporary Diet. After you complete the Elimination phase of the diet, the goal is to only avoid (or reduce) those foods that trigger your symptoms while adding back in all of the others foods that don’t and that you enjoy. It’s not about eliminating all high FODMAP foods forever.

Don’t Equate FODMAPs with Unhealthy. As you likely noticed from the food lists above, many foods high in FODMAPS are actually quite nutritious and considered part of a sustainable healthy diet. Remember, the idea is to find out which foods trigger your symptoms (and in what quantities) and then introduce them back into your diet in a way that you can enjoy them without suffering and having to police every bite.

(Of course there are some that you can ditch for good if you please. I’m *looking* at you high-fructose corn syrup.)

It’s One Piece of the Digestive Health Puzzle. While some people experience a significant reduction in their symptoms when following this diet, there may still be other factors that need to be considered alongside a low FODMAP diet such as overall diet quality, eating behaviours, hydration, stress, intestinal infections, and other potential non-FODMAP food sensitivities.

It’s NOT the First Place to Start. As you’ve likely gathered by now, this diet can be quite restrictive. While a little sacrifice upfront in the short-term can mean long-term freedom and empowerment if you can pinpoint food culprits, there are still many other factors that should be addressed first (i.e. diet, eating habits) that can potentially provide a significant relief in symptoms without having to be so restrictive from the get-go.

Seek Guidance. If you’re seriously considering following this diet fully (as in ALL in), at the very least download the Monash University app as mentioned above. Better yet though, consider working with a Certified Nutritionist or natural health practitioner who is well-versed with this diet and can guide you through each phase while keeping you accountable. 

 

Final Thoughts: Is a Low FODMAP Diet Right for You?

If you suffer from IBS, or another functional gut disorder, and the associated symptoms of abdominal pain, constipation, diarrhea/loose stools, bloating, and/or distention, then it’s definitely worth considering. Although to reiterate the point mentioned above under the list of considerations, it’s definitely not the first place to start.

It also goes without saying that it’s always important to see your medical practitioner first to rule out more serious GI diseases (i.e. Celiac Disease, Inflammatory Bowel Disease) and some gynecological conditions, which can have similar symptoms to IBS.

With that said, individuals with Inflammatory Bowel Disease (i.e. Crohn’s) or Celiac Disease can have IBS-like symptoms occur at the same time, so in conjunction with the standard treatments for these conditions (i.e. a gluten-free diet for Celiac Disease), a low FODMAP diet may provide further relief.

 

Sources/Resources

Monash Low FODMAP Diet app: https://www.monash.edu/medicine/ccs/gastroenterology/fodmap/education/iphone-app

https://aboutibs.org/facts-about-ibs

http://fodmapmonash.blogspot.ca/

 

The 3 Steps to an Effective Elimination Diet (and do you even need to do one?)

These days it seems almost the norm to be eating a “free from” something diet, whether it be dairy, gluten, sugar, or something else.

It seems everywhere you turn someone is promoting their detox program or sugar-free challenge, and while these types of programs definitely have a place, this isn’t quite what I’m talking about here today.

Don’t get me wrong, giving your body a break from less than ideal foods is a great step for igniting new healthy eating habits and patterns, and helps us develop a greater awareness of our food choices – not to mention the side benefits of perhaps feeling lighter, more energized, more clear-headed, and just overall healthier.

Here I’m referring to an Elimination Diet as a therapeutic tool to help you uncover specific food culprits or sensitivities that might be contributing to unpleasant symptoms such as bloating, digestive upset, constipation, loose stools, cramps, IBS, skin problems, and any other imaginable symptom you may be experiencing.

When it comes to food sensitivities it can sometimes be challenging pinpointing exactly what’s causing the issue, because unlike an allergic reaction where the effect is often immediate, sensitivity symptoms can take a bit longer to show up as the culprit travels through the full length of your digestive tract, and only when it reaches a certain point may symptoms appear. This can be highly dependent on your transit time as well, aka how long it takes for food to travel through your digestive tract from chewing it all the way to eliminating it.

An Elimination Diet, in the sense I’m talking about here, is:

  • An opportunity to gather information about foods that might be triggering your symptoms.
  • Short-term: generally anywhere from 2 to 6 weeks depending on the symptoms and the food being eliminated (but it can be shorter or longer).
  • A period to alleviate symptoms and determine food triggers.
  • 3 Steps (discussed in detail below), including a Reintroduction phase and a Personalization Phase, in addition to the Elimination Phase.

But first…

Do You Even Need to Do an Elimination Diet?

It can be really easy to get overly rigid and dogmatic around the idea of elimination diets, and some people take the whole concept a little bit too far.

In fact, just the idea of going on an elimination diet can lead to obsessive thinking about food and feelings of deprivation in some people.

When I work with the women in my programs, the last thing I want to do is impose unnecessary restrictions on their diet. In fact, I want them to be able to enjoy the most varied diet possible while simultaneously being free of nagging and uncomfortable symptoms.

That’s the sweet spot!

But getting to that intersection may require a little short-term restriction in the form of “investigative work” to get to freedom over the long-term.

The good news?

When it comes to food it’s rarely ever so black and white, unless you have a severe food intolerance (i.e. gluten in the case of Celiac Disease) or a severe food allergy that cause reactions in even minute amounts.

What’s Your Starting Point?

For many people, including many of the women that I work with, doing an elimination diet is NOT the first line of defense.

In fact, there are a lot of other changes that can often be made first with respect to diet and eating patterns/habits before taking that route.

For example, when working with women who suffer with IBS, I can help them upgrade their diet significantly and get relief from symptoms without having to go on a full Low-FODMAP diet (which can be quite restrictive).

For many people, it’s a question of quantity and/or quality of the food being eaten.

This can be summarized perfectly by the Bucket Analogy.

For example, if somebody who eats a lot of foods made from wheat (i.e. flour products, bread, cereals) rather than eliminate wheat entirely I may recommend higher quality products such as those made from sourdough or sprouted grain (or even wheat-free options) which can be easier to digest.

Or in the case of somebody who consumes a lot of milk and milk products – perhaps it’s giving up drinking milk as a beverage and instead focusing on quality dairy products like organic kefir, unsweetened yogurt, goat’s cheese, and butter in tolerable amounts.

Believe it or not, some people may even benefit with an elimination period of eliminating foods in general (wrap your head around that one!) because it’s cause for crazy-making and can lead to disordered eating behaviours and obsessive thoughts around food, interfering with other aspects of their life. Obviously this is very individual, but worth mentioning.

Types of Elimination Diets

You might give up one or more of the following, depending on your specific symptoms:

– Foods High in FODMAPs (certain short-chained carbohydrates that are poorly digested/absorbed in the small intestine contributing to IBS symptoms in some people)

– Gluten

– Sugar

– Dairy (Lactose)

– Nightshade Family

– Allergenic Foods (i.e. Seafood, Eggs, Wheat, Cow’s Milk, Soy)

– Gastric Irritants (Coffee, Alcohol)

– Processed Foods/Refined Sugar

Note: The last category is difficult to re-challenge because it can encompass any and all different types of foods. If you eat a lot of wheat, sugar, and dairy, particularly in their processed-form, you’re likely going to notice a significant difference in how you feel if you were to give all of these things up for a period of time – obviously a good enough reason to do it but you won’t necessarily be able to pinpoint the exact culprit (if there’s even one).

It many cases it really is just a question of quantity. The Bucket Analogy (mentioned earlier) is the perfect example of this – when your bucket becomes too full, your symptoms spill out all over place. Lighten your overall load and they start to disappear.

3 Steps to an Effective Elimination Diet

#1 Elimination Phase – After choosing what you’re going to eliminate, you refrain from consuming that food for a set period of time. I usually recommend a period of 2 -6 weeks depending on the food/substance.

Usually we know if there are certain foods or substances that we overconsume in our diets, and we may even suspect a certain food (or food type) is contributing to our symptoms. This is usually a good place to start.

#2 Re-introduction/Re-challenge Phase – This phase can actually be harder than the first step because it requires a bit of strategy. The more foods (or categories of foods) that you gave up, the longer this period will take.

The key here is to be systematic and methodical in your reintroduction.

If you give up a bunch of foods for 30 days and feel great afterwards, but then start reintroducing them all at once, you won’t know which one(s) was causing the issue for you.

You want to test one eliminated food (or family of food) at a time and in varying amounts over a few days to see if you notice any symptoms.

Sidenote: The Low-FODMAP diet is bit trickier in this regard, and I recommend working with a nutritionist who is experienced in this area. Keep in mind though that it’s often not the first place to start for most people.

#3 Personalization Phase  Based on your findings you can customize your diet to your unique needs and preferences. Once you know which foods trigger your symptoms, you can continue to either limit them or modify the portion size to suit yourself. Since food sensitivities usually have a cumulative effect, you may be able to eat small amounts of your “trigger foods” as long as your total overall load is low (i.e. refer back to the Bucket Analogy).

There you have it!

Have any questions?

Put them in the comments below and I’ll do my best to answer them!

The Bucket Analogy

A few days ago I ate a piece of cake.

I know. Ground breaking.

I do have a point though so please bear with me.

As I watched the cake being sliced and passed around, it would have been all too easy for me to decline.

But the truth is, it looked really good. So in the spirit of celebration and sharing in the special milestone, I ate the cake.

And I felt fine.

No energy crash, no digestive discomfort, no desire for more sugar later on in the day (or the next), and no noticeable symptoms in my body (i.e. digestion, skin) the days following. Most importantly though – no drama or guilt associated with eating the cake.

I boil much of this down to having a relatively empty bucket.

If you’re wondering what the heck I’m talking about, allow me to explain.

Enter: The Bucket Analogy (in all its fine glory)

I learned this little gem many years back when I was first studying nutrition and holistic health, and if you’ve ever worked with me in my private coaching practice you’ve likely heard me reference it at some point or another because it serves as a beautiful illustration (in my opinion, anyways).

Okay, stay with me.

Your body is like a bucket…

To start, visualize a bucket with an out spout or “drain” at the bottom.

This one kind of works, but imagine a larger out spout at the bottom, or multiple out spouts.

Now imagine pouring water into this bucket.

As the bucket starts to fill up, the water naturally drains out the bottom of the bucket through the out spout.

It’s really quite a nifty little system actually, because in this case we’re not looking to accumulate water because we don’t want our buckets to become too heavy for us to carry around, nor do we want our buckets to overflow and spill all over the place.

From the day we are born and as we progress through life interfacing with the world around us, we continue to fill up our imaginary bucket with this imaginary water.

What is this imaginary water actually made up of?

So glad you asked ;)

The Contents of the Bucket (in a nutshell)

  • Allergens/Sensitivities (food, environmental)
  • Various Toxins (pollution, industrial, water, food)
  • Diet/Lifestyle choices
  • Infections (bacterial, viral, fungal, parasitic)
  • Stress (physical/emotional)
  • Trauma (past/present)
  • Genetics

So in other words, basically anything and everything that comes into our life experience can ultimately contribute to the content (and weight) of our bucket.

When we’re born, we enter this world with a relatively light load and then we start to fill’er up as we go about living our life (by the way we all have different size buckets – no two buckets are exactly alike!).

You would think babies are born with empty buckets, but according to the Environmental Working Group this isn’t quite the case. In one study there was an average of 200 industrial chemicals and pollutants found in the umbilical cord blood of newborn babies.

I know, frightening.

Don’t worry though, it’s not all doom and gloom.

This is where the 2nd part of the bucket analogy equation comes into effect.

Next up: The Out Spout, aka the Drainage System

Naturally we want to have an efficient and well-functioning drainage system in place so that our buckets can keep up with the demands of our world.

This “drainage system” is actually our body’s detoxification system and it’s comprised of all of the organs involved with processing and eliminating. This includes our lungs, skin, lymph, liver, kidneys, bowel and digestive system as a whole.

We eliminate through our breath, sweat, urine, and bowel movements (I know, sexy talk).

So what happens if our bucket starts to fill too rapidly and the drainage system can’t keep up?

We’ll have an overflow of course, or perhaps a flood in more extreme cases!

This spillage = your symptoms

The bucket (actually your body) literally can’t handle anymore and your symptoms start to spill out everywhere.

Speaking from a dietary perspective, this is why you might be able to handle varying amounts of “sensitive” foods throughout different periods in your life.

For example, maybe you can handle a little bit of wheat here and there without any noticeable symptoms, but as soon as you start eating it at breakfast, lunch and dinner, you may start noticing that you’re not feeling so hot.

Or you eat the cake, but then you go on to eat the ice cream and the doughnuts too. And drink all the wine. Oh, and you’re also dealing with some pretty heavy stuff in your life, and all of a sudden (or so it seems) you’ve gone and spilled your bucket all over the floor and no amount of mopping will stop the flood of symptoms.

This is of course a more obvious example but it demonstrates a great point: diet is rarely black or white.

Sometimes it’s not a question of having to eliminate a food completely from our lives, but just a matter of not overeating it (not rocket science, I know).

So as you can see there’s actually two critical parts of this bucket analogy that we need to address:

1) Those things that fill up our bucket (aka our bucket-fillers)

2) Making sure we have an efficient, and smooth-running drainage system that will ultimately keep up with what we’re throwing in

I know of course it’s not quite as straightforward and simple as I describe above.

Sure, there are those obvious bucket-fillers (i.e. cigarette smoke, alcohol, pollution), but there also inconspicuous ones too – like sneaky chemicals in our food, personal care products, and household cleaners, or even toxins our bodies produce internally. Even so-called healthy foods can create unpleasant symptoms based on the microbes in our gut, and until our gut health gets sorted out, we may have to limit certain foods that once gave us no issues at all.

Enter my role as a nutritionist.

Not only do I guide you in pinpointing and limiting all of those things that fill-up your bucket too rapidly, but maybe more importantly, I also help to ensure your “drainage system” is well-functioning, because I know that you’re not living in a hermetically sealed bubble closed off from the real world.

This is where diet, supplementation, fine-tuned digestion, and other lifestyle habits and practices come into play.

Because at the end of the day?

I’d love for you to be able to enjoy a piece of cake from time to time too without your whole world going up in flames.

I know, I know, a little bit dramatic, but it helps drive my point home.

When you’re really able to tune into your body and learn its language, you usually know when things are running smoothly, or when the bucket is fuller than ideal (relatively speaking, of course) and some changes need to be made in your life.

You can really only gauge the water-line based on how you’re feeling in this moment, on your lifestyle and dietary choices you’ve been consistently making, and by reading the language of your body.

Sometimes eating the cake might not be the best choice, there’s no arguing with that.

Other times it just feels right (Hint: if it is, you likely won’t have any feelings of guilt about it).

And on this particular day, for me, it did.

So I fully enjoyed it, and all is well in my world :)

 

Upgrade Your Eating Habits in 5 Steps

Originally published on www.bell-wellness.com

Want to feel healthier? Lose weight? Improve your digestion?

While upgrading your food choices is naturally a great place to start, in reality, it’s only half of the healthy eating equation.

Have you ever stopped to examine “how” you eat? In other words, playing close attention to your eating habits.

You see, changing your diet and upgrading your food choices is typically the easier part.

Your eating habits on the other hand, now they can run deep.

Implement the following steps below and reap the benefits of better digestion, increased energy, and a flatter stomach!

1. Avoid (Too Much) Liquid with Meals. Drinking liquids with meals dilutes the digestive secretions needed for breaking down our food. Small sips are okay, but definitely avoid gulping large amounts of liquids. It’s actually best to drink most of our liquid (ideally water) on an empty stomach between meals so that you’re already hydrated when you sit down to eat. Speaking of which…

2. Sit Down and Relax. Enjoy your meals distraction-free. Rushing, stress, worry, and anxiousness are all antithetical to good digestion and are a recipe for bloating, gas, heartburn, and stomach aches. When our sympathetic nervous system is activated, aka, “fight or flight” mode, our ability to digest and assimilate our food is greatly reduced. It’s important we get into parasympathetic “rest and digest” mode in order to give our bodies a fighting chance to digest the food we’re feeding it. If necessary take 5-10 minutes to relax before eating, and if the option is to hurriedly eat to make a meeting, you’re better off skipping the meal, eating something light, or waiting until later.

3. Chew Your Food Well. Keep in mind that your stomach doesn’t have teeth! Chewing well breaks down food into smaller more manageable particles, easing the digestive burden on our stomach and intestines. Smaller food particles also allow for easier absorption of nutrients and negates the likelihood of opportunistic bacteria to ferment larger undigested food particles, which can increase symptoms of gas and bloating.

4. Don’t Graze. Many people never experience the feeling of true hunger because they’re constantly nibbling throughout the day. If you’re constantly grazing or snacking consider transitioning back to a 3 meal per day approach to enjoy the benefits of optimized digestion and fat burning, freed up mental space that’s otherwise preoccupied with food, increased energy that’s otherwise thwarted towards digestion, and getting back in touch with true hunger and satiety signals.

5. Avoiding Eating Heavily Within 2-3 Hours of Bedtime. When we go to bed with a stomach full of food not only is it a recipe for disrupted sleep and indigestion, but it also impedes the process of healing, detoxification, and cellular regeneration that would normally occur during this time of nightly slumber (because energy is diverted towards digestion). The idea here is to be done your main meal within 2-3 hours of lying horizontal. You can still eat within this time frame if necessary, but ideally it will be a lighter meal (i.e. soup or salad) or small snack.

While it may not be possible or easy to transform your eating habits overnight, the first step in effecting change is just becoming more aware of your eating habits in the first place, and noting where they could perhaps use a little upgrade!