Irritable Bowel Syndrome (IBS) Diet

Looking for information on Irritable Bowel Syndrome (IBS)?

Just got diagnosed with IBS? Go here.

If you’re interested in beginning an IBS Diet, click and learn about how a low-FODMAP IBS diet can help you, or continue reading to start with the basics.

If you have ever had irritable bowel syndrome, you know exactly how disruptive and chaotic it can be for your life. There are few words that are able to describe the stress, both physical and mental, that it typically causes in most sufferers’ lives. However, there are a few simple tweaks that you can make in your life that can actually have a huge effect on the severity of your IBS. Changing what you eat to match a well-researched IBS diet is one of the most effective and lowest cost treatments you can use in your battle against irritable bowel syndrome.

What is an IBS Diet?

It would stand to reason that the primary thing that any IBS diet would focus on is eating less of the foods that have been proven to irritate the gastrointestinal tract. This is exactly what is recommended under the FODMAPS diet, which is the premier diet based treatment for IBS. Adhering to this diet will reduce your IBS symptoms significantly, sometimes to the point where you don’t experience any of your old symptoms.

Now, before we get into the specifics, let’s break down exactly what FODMAPS means.

  • Fermentable
  • Oligosaccharides
  • Disaccharides
  • Monosaccharides
  • And
  • Polyols

With the exception of “fermentable”, all of these words probably don’t make much sense. But, there is a commonality between them all – the suffix saccharide. This is just a fancy word for carbohydrate – and carbohydrate is a fancy word for sugar.

To break down the words even further, let’s take a look at monosaccharides. Monosaccharides are the building blocks of all carbohydrates and are also known as simple sugars.

A disaccharide is just what it sounds like: a pair of monosaccharides, or two simple sugars.

An oligosaccharide is a clump of simple sugars that is greater than two. Basically, they are just a bunch of monosaccharides all lumped into one thing.

Lastly, the polyols. These are the artificial sweeteners or organic sweeteners that are not sugars, but taste like sugar. Things like Xylitol or Sorbitol fall into this category.

Why Sugar is Evil for Your IBS Diet

When you really look at it, the FODMAPS list essentially targets sugar in all forms as something to remove from your diet if you want to quell the symptoms of IBS. The question you might be asking yourself at this point is, “Why is sugar SO bad for me if I have irritable bowel syndrome?” It’s a very valid question and the answer isn’t immediately obvious, so let’s dig into it.

The most common IBS symptoms are primarily located in the large and small intestine, and are a result of poorly digested foods and their reaction with the bacteria in your intestinal tract. FODMAPS foods are foods that do not get digested well by your small intestine and make it to your large intestine relatively intact. There, they mix with the bacteria in your gut and react in a way that causes almost all of your intestinal IBS symptoms. That means bloating, water retention, farting, and other types of symptoms.

The Worst FODMAP

While there are a lot of FODMAPS foods, the worst of all are any foods that contain fructose – the fruit sugar. Fructose is especially troublesome for sufferers of IBS because of how prevalent it is in our modern diets. You can find it in all fruits and fruit-related products. It’s also used as a sweetener in literally thousands of products in the form of high-fructose corn syrup (HFCS). Everyone has heard of HFCS because it is simply in almost any packaged or processed food that you could purchase, no matter where you are in the world. This is what makes fructose the worst FODMAPS food – not because it is any worse for your intestinal tract, but simply because it is so common that it feels impossible to avoid.

Learn How to Avoid FODMAPS Foods

We will teach you exactly how to remove the FODMAPS foods from your diet safely and effectively. Within no time at all you’ll be moving towards the IBS diet that can help cure your IBS symptoms once and for all. It’s great that there are a lot of products out there to help you do this, but we feel that the natural approach to eating is going to yield the best results. Check out the rest of our resources on IBS diet strategies, plans, tips and tricks. Pretty soon you’ll be wondering why you didn’t do this years ago!

Interview with Patsy Catsos (MS, RD, LD)

Today I’m pleased to interview Patsy Catsos.

Patsy Catsos (MS, RD, LD)

Patsy Catsos (MS, RD, LD)

Patsy Catsos (MS, RD, LD) is a nutritionist/dietitian and one of the world’s leading IBS & FODMAPs specialists. She is also Past-President of the Maine Dietetic Association, author of IBS–Free at Last!, writer of www.ibsfree.net, and maintains a private practice in Portland, Maine.

Thanks for agreeing to this interview. How did you become involved in the world of FODMAPs and what is your area of expertise?

These are the questions you should always start with! I advise consumers to “consider the source” when evaluating internet information about IBS and FODMAPs, so it is only fair to offer a bit more about my point of view before answering the questions you have collected. First of all, I share your history of miserable GI symptoms (ulcerative colitis since 1985, IBS). When patients talk to me about the gory details of their problems, they are talking to someone who does not have to be convinced of what is at stake. Professionally, I am a registered dietitian with a bachelor’s and master’s degree in nutrition, job experience as a research dietitian and nutrient database manager at Tufts New England Medical Center, and currently working as a dietitian/nutritionist in private practice. I am essentially an expert at translating medical research and food composition data into usable tools for my patients and readers. I spend much of my time reading research papers related to IBS and FODMAPS and figuring out the most effective ways to interpret and communicate that information to my readers. I rely on internationally published scientific original sources for my data (much of it produced by researchers in Australia), but use my own ideas to create tools such as menus, label reading tips, recipes, shopping lists, and so on. I use my critical thinking skills and a lifetime of experience with food composition data to make educated guesses when accurate information is not available. I am located in the United States. As an active member of my professional association and as a writer, I have worked hard to get the word out to dietitians and physicians about the power of FODMAPs-restricted diets to help many IBS patients. Although I felt like a voice in the wilderness just a few years ago, the FODMAPs concept is becoming more mainstream.  A couple things I am not: I am not a member of an academic body that sets standards of care for IBS patients, nor am I personally engaged in producing nutrient data about the FODMAPs composition of foods.

One of our visitors asks: IBS diagnosis in the United States has improved by leaps and bounds, but other than Maine and a few other rare places, where can the majority of IBS sufferers get professional help with IBS? Patients country-wide are still often being told that “it’s in their heads” or are offered anti-depressant drugs.

Is there a network of IBS/FODMAPs specialists that patients ought to know about?

A dietitian (Registered Dietitian in the U.S., Accredited Practicing Dietitian in Australia, etc.) is by far your best bet for getting credible, effective help with food-related functional gut disorders. It is outside the scope of our practice to diagnose IBS, but when it comes to day-to-day management of any kind of medical diet, the right dietitian can help you immensely. As a service to both readers and colleagues, I have recently posted a link on my web site, www.ibsfree.net, to a directory of FODMAPs-knowledgeable registered dietitians who are accepting new clients. I hope this directory will grow and grow!

If you don’t see anyone in your area in my directory, go to www.eatright.org, click on “find a nutrition professional” and select the check box for “digestive disorders”. Or, ask your gastroenterologist for a referral to a registered dietitian in your area with a special interest in digestive disorders. Call the dietitian and ask whether s/he is familiar with FODMAPs. The basic concepts behind the FODMAPs diet are familiar to dietitians, however the specific food lists and strategy for the elimination diet may be new for many. Your dietitian will be more equipped to help you given the opportunity to gather resources before your visit. Professional materials about FODMAPs can be ordered from my web site. If you would like me to coach you, I am available via phone or skype. See the link in the sidebar of www.ibsfree.net.

Do you travel and do presentations for awareness? Does she have a lecture circuit? If so, sign me up!

I do not have a lecture circuit, but I do speak at professional events. I am experimenting with webinars for dietitians, and would consider doing a webinar for IBS patients if there seems to be interest in the idea. Actually, it would not be correct to call webinar attendees “patients” since I would not be collecting any personal health information or conducting any assessments on the attendees. The event would be purely educational in nature. If anyone would like to collect a few names for a pilot webinar, I would be game.

Another visitor (mcoffeesnob – “have and LUV her book”) asks: Since IBS as a conventional diagnosis is simply left at THAT and finding the causes and utilizing a specific diet are fairly new, have you received any backlash from (what I would call) the conventional medical field for your book and research? What about support?

There has been very little backlash from conventional medical practitioners for the material in my book (I don’t do original research in my practice setting). I think that is because anyone trained in the medical field can quickly recognize the inherent logic of the FODMAPs concept if they take even a few minutes to read through professional materials on the subject. One influential doctor in the field of functional gut disorders, William Chey, MD, University of Michigan, was heard to say publicly several years ago that FODMAPs was too complicated for patients to implement in a meaningful way. I sent him a letter and a copy of my book, and his most recent writings are very favorable toward the utility of the FODMAPs approach. Who can argue with success? Doctors who refer to me may not have heard of the FODMAPs approach at first, but they certainly hear it loud and clear when their patients tell them how much better they feel!

There are some potentially valid concerns about the diet that I share and address directly with readers of my book and blog: the diet is not right for everyone, many people need professional assistance from a trained dietitian to implement the diet, people should eat the widest and most liberal diet possible to get a wide range of nutrients, and so on. Please remember that information you read in a book or online is not a substitute for professional advice or individualized medical nutrition therapy.

(The following two questions are very similar, so I am giving a combined response, below)

We IBSers have the FODMAP diet, we have the Specific Carbohydrate Diet, we have the diet advocated by Heather Van Porous, the diet from Jini Patel Thompson – your FODMAP-elimination diet, of course, MRT/LEAP diet and no doubt others. How on earth does one decide which one is right for them?

Good question. As you know, I do not believe in one-size-fits-all diets for IBS, so there is no one right answer to this question! Altered gut function can be related to a number of adverse food reactions–some involve the immune system and others do not. First one must try to identify which type of adverse food reaction is occurring, then choose the diet approach that will address it. You should work with your doctor and dietitian to figure this out.

Clues that FODMAPs are the issue include the following statements from the patient:

  • My symptoms are primarily gas, bloating, abdominal pain, flatulence, diarrhea, urgency or constipation.
  • I have tested negative for celiac disease, parasites, Crohn’s disease, ulcerative colitis, microscopic/lymphocytic colitis, diverticulitis, cancer
  • I do have Crohn’s or colitis in remission, but I still have symptoms
  • I do not have fever or bloody stools associated with my symptoms
  • I’ve had a positive fructose or lactose malabsorption test
  • I might be lactose intolerant, can’t quite figure it out
  • Bread makes me feel bloated
  • I love fruit and eat loads of it
  • I eats lots and lots of fiber but my IBS doesn’t get any better, in fact it might be worse
  • I felt better when I tried a low-carb/paleo/Atkins/SCD diet
  • It’s gotten worse as I get older
  • I drink lots of sweetened carbonated beverages, candy, ketchup, BBQ sauce, honey
  • My mouth is dry, so eat a lot of sugar-free candy and gum
  • I’m a vegetarian and get most of my protein from soy foods and other legumes
  • I’m an athlete with very high calorie needs
  • The healthier I eat, the sicker I get–I just stay away from fruit, veg, and milk products

This next idea is critical: the effects of FODMAPs are primarily limited to the gastrointestinal tract, and the effects are usually over within hours or days after the offending sugars and fibers have been expelled from your body and you have recovered from the pain.

In my practice, if the patient has multiple health issues consistent with food-chemical or food sensitivities, such as migraine headaches, classic food allergies, aching body, hives, malaise, chronic sinus problems, other autoimmune or inflammatory conditions, etc, then I use mediator release testing to build a highly customized elimination diet based on the results of their blood test. (Food chemicals may be additives or naturally occurring. Examples are MSG, solanine, amines, salycilates, food dyes, nitrates, or caffeine.)

As for the other diets, I don’t doubt they may relieve symptoms for some people. I keep an open mind and will always be interested in new evidence for any approach that will help my patients. I am not intimately familiar with the details of other IBS diets, but I will offer some brief comments.

  • Specific Carbohydrate Diet (SCD): Elaine Gottschall was on the right track, but in my opinion this diet is outdated and too restrictive for patients with IBS if followed in its original form. I don’t agree with the degree of rigidity required by the diet–it just isn’t necessary for most people with IBS to never, ever have specific carbohydrates in any amount whatsoever. I take a much more experimental approach. We know now that a greater range of lactose-free milk products work well for many people with IBS, and that high fructose foods such a honey and apples, which were allowed on the SCD are problems for many IBS sufferers.
  • Heather Van Vorous/HelpforIBS.com: Heather has clearly helped many IBS sufferers by bringing attention to the whole issue of IBS and diet. Her approach may have been up-to-the minute in 2000, but now we know that “low-fat” and “no red meat” diets across the board for IBS are not necessary. A large part of her business is devoted to promoting fiber supplements for IBS, but the most recent studies have shown that fiber supplements help a minority of people, but fact, eight recent reviews have uniformly concluded that fiber has little or no benefit for most IBS patients. Results of a clinical trial published in the British Journal of Medicine in 2009 found that in order to yield one patient with adequate relief of abdominal pain or discomfort during the first  month of treatment, between four (psyllium) and thirty-three (bran) patients must be treated with fiber supplements! Though acacia fiber was not included in this trial, it is safe to say that fiber therapy in general does not have good odds of effectiveness v. theFODMAPS-restricted approach, which can help up to 75% patients with IBS get adequate relief.
  • Paleolithic Diet: Interesting concept! In doing a paleolithic diet, most FODMAPs are automatically eliminated, so it probably works pretty well to manage IBS for a lot of people. I especially appreciate that limited access to sweeteners throughout most of human history should probably guide current practice. But I think that humans are essentially opportunistic feeders and are meant to eat any food they can tolerate, so it doesn’t make sense to me that no one should eat potatoes or milk or any other category of food without consideration of individual tolerance.
  • Jini Patel Thompson: I’m sorry, I don’t know enough about this one to comment.

Are new formal classifications of IBS (beyond IBS-C and IBS-D — perhaps IBS-C/LI or IBS-D/FM) being discussed in professional circles in order to better help treat IBS with diet?

I’m not sure. I do know there is growing appreciation in professional circles of the role food plays in generation of IBS symptoms1.  I will have to leave it to physicians to debate the finer points of medical diagnosis. As a dietitian, I take a more functional approach. No matter what the medical diagnosis, we can improve symptoms and overall wellness by manipulating the diet.

Here is one hair I do think is worth splitting: the difference between a FODMAPS elimination diet and a FODMAPS-restricted diet. An “elimination diet” is a strict, temporary, learning diet that we do to learn what foods or food categories trigger symptoms. A FODMAPs-restricted (or controlled) diet is what we do going forward after we learn what our problem areas are, with the ultimate goal of the most liberal, varied diet possible. Please be clear with yourself which one you are doing. This will help you answer a lot of questions for yourself about whether is OK to eat foods that contain borderline amounts of FODMAPs. While it is not recommended to eat raisins or green beans during a FODMAPs elimination diet, for example, going forward you may find you are perfectly well able to tolerate small, controlled portions of these foods.

Another distinction that deserves more attention is the distinction between FM (fructose malabsorption) and FODMAPs intolerance. It is true that original research in the area of FODMAPs and IBS linked the two because subjects were qualified for the studies by having IBS and being positive for fructose malabsorption. Clearly,  fructose is one of the FODMAPs that can cause symptoms for patients with IBS.

But it is a mistake to overgeneralize that anyone with dietary fructose intolerance automatically (aka FM) cannot tolerate other FODMAPs, especially fructans. The fact that fructans consist of links of fructose doesn’t mean much at all. Fructose is poorly tolerated due to limited rate of fructose absorption in some people. Fructans never do get broken down to fructose because humans lack the enzyme for that; they are poorly tolerated due their own rapid fermentation and osmotic activity. While it is true that people with fructose malabsoprtion ALSO poorly tolerate fructans and other FODMAPs, they are not the same thing. Polyol (sorbito, mannitol) intolerance is actually more closely linked to fructose intolerance than fructans, because consuming it has the effect of worsening fructose absorption. Discovering these finer points in your own body is the purpose of the challenge phase of a FODMAPs elimination diet.

Lastly, it seems like many FMers see staying on top of the most recent food FODMAP data as a constant struggle – there is no centralized, updated, managed repository of FODMAP-centric utritional information and printed books are quickly deprecated. What do you see occurring to help solve this problem in the future – are you aware of any ongoing projects that aim to resolve this?

I suggest you direct this question to the Australian researchers who are producing the original nutrient composition data. I have been told that updated FODMAPs composition data is going to be published within the year.

I would counsel your readers to keep their eyes on the big picture. Most people with FODMAPs intolerance are not sick because green bell peppers/capsicum have .37 grams per 100 grams more sorbitol than red bell peppers/capsicum. They are sick because their bodies can’t handle large serving of milk, yogurt, ice cream, fruit, onions, garlic or beans and the modern diet contains too much bread, bagels, pasta, high fiber bars and cereals, artificial sweeteners, sugary beverages and juices. After experimenting with a FODMAPs elimination diet, they will usually find they can manage small portions of most foods and limiting the total FODMAPs load of the meal/day.

I do not say this in any way to disrespect those people who find that .37 grams of sorbitol DOES make a difference; I know many of them and it is a very real problem. I am very sympathetic to those who are sensitive to even the most minute amounts of FODMAPs, because even when better composition tables are available, FODMAPs composition of foods will continue to be a moving target. It will continue to be affected by analytical methods, processing, cooking, ripeness, botanical variety, growing conditions, storage, preparation methods and more.

Thank you for your time, Patsy.

  1. Eswaran, Tack and Chey, Food: The Forgotten Factor, Gastroenterol Clin N Am 40 (2011) 141–162 []

SIBO (Small Intestinal Bacterial Overgrowth Symptoms) Pain, Recurrence, and Treatment

Periodically we post excerpts from private discussion forums as valuable health information ought to be shared.
Recently, Trish asked,

My daughter has been having neverending pain for weeks now — she wakes up with it, it’s there all day, it gets worse when she eats and then declines but never ends. Her gastroenterologist thought she had pancreatitis, but thankfully all those tests are negative. So he wants to treat her for an SIBO and see if that clears up the pain.

I have a couple of questions about SIBO…
- Does it cause the unrelenting pain that Kaelin has been feeling?
- Does an SIBO tend to reoccur or once we’ve eradicated it, it’s gone?
- Are there some foods that are worse for an SIBO, something she should avoid that doesn’t necessarily affect an FMer?

A helpful user replied:

I have FM and have had SIBO. Since starting the fructose-friendly diet, I haven’t had any more flare-ups, so I sort of suspect the undiagnosed FM was contributing to it.

My understanding is that you want to limit sugars in general, since the bacteria can feed off of them, but you might want to check with her doc or a dietician on that. I definitely had the pains you mention, and I think that they’re pretty common. I also had a really foul smell on my breath at times.

If the test comes back positive, I highly recommend rifaximin, if you can swing it. It’s spendy, but does the trick with no side-effects.

Trish responded,

So is it stupid of me to consider treating it without doing the breath test? Her doctor doesn’t want to put her through another breath test — she felt the effects of the FM test for days — and I guardedly agree. I don’t want to give her unnecessary medication but, wow, she really suffered. If I agree to treating it, the doctor is going to prescribe rifaximin.

One more question: Every day Kaelin tells me that she’s “just so tired, not sleepy tired, just tired.” Is this another symptom of SIBO?

Good Samaritan:

Definitely. I would strongly suggest having her tested for vitamin deficiencies too, which can cause all sorts of symptoms, including fatigue. I found the SIBO breath test to be not nearly as hard on my system as the Fructose Malabsorption test (probably because the SIBO test is glucose, as opposed to fructose). I think it’s worth doing the test, just because you don’t want to be giving her antibiotics if she doesn’t need them. On the other hand, if she does have it, you should get it treated.

Trish:

So, um, “definitely” I’m stupid or “definitely” SIBO is fatiguing? :)

I mentioned how tired she’s been to her gastroenterologist and he did a bunch of blood, urine, and stool tests — I’m not sure of all the things he was looking for but so far “her numbers are within the range of normal”. (That just doesn’t sound quite as convincing as “everything looks good”)

I totally agree with not giving antibiotics unless necessary HOWEVER… Kaelin had diarrhea for a week or so after the hydrogen breath test and lost about 1.5 pounds, weight she could ill afford to lose. Her doctor is weighing one unnecessary treatment of antibiotic vs diarrhea from the testing. He’s much more worried about the potential weight loss than the potential misuse of antibiotics (because now that pancreatitis has been definitively ruled out, he’s reasonably certain it has to be SIBO causing the pain.)

Once the SIBO was treated, did the pain stop completely? Or did it still take some time for your gut to heal? It’s killing me that Kaelin is slowly eating less and less and at each doctor visit her weight has eeked ever downward.

Thanks for taking the time to answer my questions. It’s so hard trying to help Kaelin when I’ve never experienced anything she’s going through!

An expert/authority weighed in:

SIBO can cause high pain levels in some people. Those rotten little bacteria produce gas which distends the intestines and some people are ultra sensitive. My guess whould be that a young child is one of those people who has hightened response with a lower pain threshold to it. I can remember the pain I experienced from it was intense enough to make me groan and sweat profusely.

SIBO can re-occur, unfortunately :(
It’s usually treated with one of several different antibiotics; or a combination of them. Your doc & you will decide the best therapy. How good would it be if those mongrel bacteria would just foof off from the party, never to return. They like the free feeds too much.

I had another SIBO test about 10 days ago. The glucose used didn’t make me feel as bad as the fructose used to diagnose FM.
i.e. it didn’t give me the screaming trots!! LOL

Is Your Gluten-free Diet Not Quite Cutting It? Gluten-free, FODMAPs, and You

I’ve mentioned before on IBS Diet Plan that, when I first began experiencing symptoms, I went gluten-free for many months. A gluten-free diet did help me significantly – I’d estimate that it eliminated ~70% of my symptoms. That, however, wasn’t enough for me to live happily ever after.

Research shows that gluten intolerance – distinct from Celiac disease – is a very real condition1. However, if going gluten-free has significantly helped you, but hasn’t quite cured your IBS, it could be because you’ve eliminated all wheat from you diet and wheat not only contains gluten but also fructans (one of the fructose polymers that a low-FODMAPs diet attempts to avoid). In other words, it’s possible you have an issue not with the protein in wheat but with the carbohydrate2.

Alternatively, you may have an intolerance to both.

Part of the reason it took ~6 months for me to finally try a low-FODMAPs diet is that I was – on some level – quite pleased with the results I saw going gluten-free. On another level, I was depressed because I felt unfix-able, and destined to “suffer” – while less than previously – for the rest of my life. After all, what else can one try besides going gluten-free? The low-FODMAP diet is still highly unpublicized.

Luckily, you’ve read this. Give it a shot and see if it’s right for you.

  1. http://www.celiac.com/articles/22554/1/Gluten-Contributes-to-Irritable-Bowel-Syndrome-Even-in-Non-Celiacs/Page1.html []
  2. http://en.wikipedia.org/wiki/Fructan#Fructan_content_of_various_foods []

Low-FODMAP Diet vs. Standard Dietary Advice on Irritable Bowel Syndrome Symptoms

My primary motivation for launching IBS diet plan was to raise awareness of the low-FODMAP diet. The advice I was given after my diagnosis seemed psuedo-scientific and, frankly, baseless. Most importantly, it didn’t effectively treat my IBS symptoms.

The low-FODMAP diet did. And while the theory is still being tested for efficacy; today it held its own yet again.

A study conducted by H. M. Staudacher, K. Whelan, P. M. Irving, and M. C. E. Lomer aimed to determine whether a low-FODMAP diet is effective for IBS symptom control, and also how it stacked up against the standard dietary guidelines and conventional dietary treatment advice. Patients self-reported symptom severity, and the study concluded that 76% (three-quarters!) experienced great relief on a low-FODMAP diet as compared to 54% on a standard diet. General symptom response was also greatly improved – with the low-FODMAP group scoring 86% as compared to a standard of 49%.

More good news:

  • 82% of IBS patients on the low-FODMAP diet experienced a reduction in bloating
  • 85% of IBS patients on the low-FODMAP diet experienced a reduction in abdominal pain
  • 87% of IBS patients on the low-FODMAP diet experienced a reduction in flatulence.

Keep in mind that patients were simply instructed how to follow the diet – their ability to follow it precisely and accurately was untested. It seems likely that nearly everyone who suffers from IBS could see a reduction in symptoms on a properly executed low-FODMAP diet.

Clearly, a low-FODMAP dietary treatment is much more effective than standard dietary advice for controlling irritable bowel syndrome symptoms.1

  1. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-277X.2011.01162.x/abstract []

I’m Interviewing Cassandra Forsythe and Patsy Catsos (Author of IBS – Free at Last!); Any Questions?

I’ll ask anything you want (as long as it is appropriate).

Patsy Catsos (MS, RD, LD) is a nutritionist/dietician and true FODMAPs specialist.
She is also President of the Maine Dietetic Association, author of IBS–Free at Last!, writer of www.ibsfree.net, and a consultant for Nutrition Works, LLC.

Cassandra Forsythe is the author of two books and is a weight loss expert.

Ask away – either by email (to me – see the about page for contact information), or by commenting below. I recommend:

  • Questions about their books and publications
  • Questions regarding controversial issues
  • Questions about FODMAP with other diets
  • Questions about staying healthy on a restricted diet
  • Questions about losing weight while on a low-FODMAP diet

Free Low-FODMAP Diet Android App

Did you know that there exists a super-simple utility to help you quickly find what foods are suggested for a Low-FODMAP diet? Sufferers of Irritable Bowel Syndrome (IBS), Fructose Malabsorption, and other digestive or gastrointestinal issues (readers of this blog!) will certainly find this free app helpful.

The app features an interactive search interface which filters results as you type – much like Google Suggest.

In the words of app creator Sean Colombo,

Life is too short to waste time suffering because of your food… use this app to quickly determine whether a food is likely to cause you problems.

Here is the link.

Are You Claiming Your Gluten-Free Expenses as Tax Deductions Yet?

Note: The following post only applies to people who have been diagnosed with Celiac Disease. Gluten Intolerance does not currently appear to be exempted.

These guidelines are based on handouts from 2003. The current rules appear to be the same.

  1. You can claim only the additional cost of gluten-free products. As an example, pretend your local grocery sells wheat flour for $0.89/5 lbs and sells rice flour for $3.25/5 lbs (significant! that adds up!), the difference of $2.36 is a tax-deductible claim. You can also claim gas expenses if you have to shop at a health food store and it is further than your nearest grocery, as well as postage/shipping costs spent on mail/internet-order gluten-free products. Unfortuantely, you can not write-off the incremental time spent researching gluten-free products or shopping.
  2. Products that have no gluten-containing or otherwise ordinary counterpart or equal, such as xanthan gum, can also be claimed.
  3. Save your receipts! This is not normally important but could become necessary if your claimed cost differences are scrutinized.
  4. Include a letter from your doctor to your tax return. It is mandatory that this letter states you have Celiac Sprue/Coeliac/Celiac disease and that, consequently, you must adhere to a life-long gluten-free diet.
  5. List the total extra cost of your gluten-free products (non-itemized, as a single cost) under Medical Deductions.

That’s all! You now qualify for gluten-free medical deductions.

Similar appropriations are available in Canada. I am not familiar enough with foreign laws to elaborate, however.

8 Thoughts on Better Living with Dietary Restrictions

One year and eight months ago, I began to experience IBS-like symptoms. For a year, I tried to just pretend they weren’t happening. Of course, you can only ignore problems for so long, and so I eventually began a six month experiment in eating gluten-free and wheat-free (which lessened my issues) and then discovered the low-FODMAP diet which, several months ago, completely resolved all of my issues.

Well, all but one.

Now my issue is that I can buy every food I’m “allowed” to eat on a single trip to the grocery store.

Not really, of course. But don’t you sometimes feel that way? Then this post is for you.

If you have significant dietary restrictions due to one or more intolerances (gluten, fructose, etc), you’ve probably found that the most difficult aspects of abiding strictly by your diet are not strictly dietary challenges. Rather, they are mental, emotional, and social obstacles.

This post is a list of things I keep in mind to help me refrain from eating my personal poisons, and which help me see through the facade of monotony inherent in eating a restricted diet while living in a culture of overwhelming consumption and choice.

8. It’s Perfectly Normal

… which, coincidentally, is also the name of a wonderful children’s book.

For a country where the average citizen fills about twelve prescriptions a year1, we have a pretty big stigma on health issues. If that sounds like a lot, then hear this: 15% of us are on antidepressants2, which, by the way, is also the percentage of us who suffer from IBS.

Wait, really?

Yes, really. Your suffering is not at all uncommon. In Mexico – and this can’t say much for their drinking water – 45% of the population suffers from IBS. I’ve already written a bit about about widespread health problems and IBS prevalence here, but in short: You are normal.

And, if you ever don’t feel that way, you can just move to Mexico.

7. It’s Not That Restrictive! (call it a gastronomical adventure)

Of course you feel like your diet is insanely restrictive – you can’t eat what you’re used to eating. So stop eating what you’re used to eating!

Let’s say you’re on a gluten-free diet: you can’t eat wheat, and a few other plants and their derivatives. Oh no! You can’t eat a plant that never influenced much more than Europe.

But I have to eat rice all the time!
So do four billion Asians.

But I have to drink gluten-free sorghum beer!
You mean like they do in Africa, where they enjoy it?

That’s the key, by the way, learning to enjoy it. Consider it a gastronomical adventure and expose yourself daily to other cultures and cuisines that you previously never knew existed. When you find one you like, adopt it as your own.

I adopted south-east Asian. Thai food in particular is world-reknowned for its rich flavor – check out this list of 100 must-eat Thai foods and see how many you can safely eat. If you’re only gluten free, you can still eat almost all of them.

6. “I Can’t Eat Out”

Really, you’re allergic to this?

Of course, it’s not actually about eating out but about being able to have a lively social life. Don’t worry – you can eat out safely practically anywhere; you just can’t do it like you used to. Here are three tips:

Learn your staples. Guess what? Every restaurant (or restaurant genre, rather) serves quite a few safe and standard staple dishes that could never possibly by adulterated in an offensive way. One word: steak. Breakfast? with eggs. Dinner? with potatoes. Lunch? Pretend you still feel like having breakfast.

Become an expert on local restaurants. If you always know of a hot new place (and of course, for your benefit, its’ menu), then other people will let you pick the restaurant, giving you full control of the meal. Which reminds me…

Restaurants are generally flexible. Call ahead of time; explain your situation. Your dietary restrictions can (and will) be catered to discretely.

5. Cooking: Back to the Basics

If you love cooking, and especially if you’re currently on a low-FODMAP elimination diet, it can feel like you spent years honing your craft just to never be allowed to use it again.

Within time, you’ll be blending ingredients masterfully and care-free like the gold old days, but until then, I recommend you have a personal culinary rebirth. Have a love affair with minimalism; go back to the basics. You’ve probably been cooking elaborate dishes for so long that you’ve probably forgotten how good a perfectly poached egg can be. Or how good a perfectly grilled fish is.

Go crazy in the kitchen – experiment with sous vide or blowtorch cooking. Anything to stave off menu monotony.

4. Make it an Intellectual Endeavor

You’ve probably already learned more about nutrition than you ever hoped you’d need to. Why stop there?

Learn everything you can about food (especially your new adopted cuisine) and ingredients. Pretty soon, you’ll never have to ask what’s in a dish or worry for your safety. You’ll know which menu item has hidden breading (I’m looking at you meatballs) and which types of sugars are used in which deserts (Coconut ice cream sounds good if you’re dairy free but it might not be fructose friendly). You’ll be able to tell if noodles are made from rice or wheat from a single glance, or if french fries have been tossed in flour (yes, some restaurants do this).

And once you’ve developed your sixth sense for ingredients, life will be a lot easier. Which is good, because…

3. Your New Diet is Better for You

The most important reason to stick with your restricted diet is that it’s better for you. And soon, you’ll feel healthy and energetic. It’s not just better for you because you’re avoiding your personal poisons, but because it’s pretty hard to eat fast food or processed crap and still abide by your diet. The collateral benefit is reason enough.

Pretty soon, you’ll feel so much better that you’ll never second-guess choosing lasting relief over a temporary pleasure. Which reminds me, I just noticed I probably haven’t had a single piece of candy in the last few months.

2. Treat Yourself

You deserve comfort. Find your guilty pleasure – as long as it doesn’t break your diet – and indulge. Personally, I love the rich aromas and flavors of cocoa, coffee, and tea. I’m low-FODMAP, and these are my sweets.

1. Stop Thinking of it as a Choice

There is a dichotomy among practitioners of restricted diets. We are all, from time to time at social functions, asked “would you like a [insert poison here]?”

But that’s where the commonality ends. Because what we say in response separates us into two groups:

  • “No thanks, I’m not hungry” or “No thanks, I’m on a diet”
  • “No thanks, I can’t.

When you think about how good you feel when you stick to your diet, it’s not a choice – it’s a matter of health. A person with diabetes – or another ailment affected by diet – wouldn’t give in so easily to peer pressure. Never be embarrassed; your issues are out of your control and the person offering you the poison has an issue of their own.

Maybe you should start calling it poison too.

Do you have any tips for living with a restricted diet or thoughts on living well with dietary restrictions? Please leave a comment. Gluten-free, dairy-free, low-FODMAP food for thought ;)

  1. http://www.forbes.com/2009/08/17/most-medicated-states-lifestyle-health-prescription-drugs.html []
  2. I’m unable to find specific figures for total psychiatric medications, but “over 10%” are taking at least antidepressants according to http://www.time.com/time/health/article/0,8599,1914604,00.html []

IBS and Bad Breath – (Carbs, Ketosis, Ammonia, and Apples)

Recently, in a private fructose malabsorption support group, a member posted about how she had strugged with bad breath issues for years and had just recently found their source and resolved them.

A friend initially went to the doctor BECAUSE of her bad breath. Her family were complaining. I am not sure whether it was an ammonia smell though. She was sent for the fructose breath test and subsequently diagnosed with fructmal! So the doctor obviously believed it was a symptom.

She, (the poster), went on to explain a state called Ketosis1 , which is when ketone levels in the body are elevated. This occurs when the body (and brain) isn’t getting enough carbs, and thus occasionally occurs in practitioners of low-carb diets. A side effect of ketosis is ketosis breath or keto-breath – breath that smells somewhat like acetone and somewhat like rotten apples.

Yuck.

The fix? More carbs, obviously. Ketosis is not a diet – it is a physical state that should not be entered without expert medical guidance – and it’s not the intended goal of most low-carb diets. However, if you are going to maintain a state of ketosis, sleep easy knowing that many once keto-breath sufferers have reported that it went away within a few weeks without significant or intentional dietary change.

If you don’t want to wait weeks – and who would? – consider the following short-term breath tips:

  1. Drink more water.
  2. Mint, parsley, cloves, cinnamon, fennel seeds, cardamom and other natural breath fresheners will help mask the odor (like deodorant, but for your mouth).
  3. Good breath capsules, which are usually made from parsley oil (e.g. Mint Assure) are either a cure-all or snake oil, depending on whom you ask.
  4. Chew gum regularly.
  1. http://en.wikipedia.org/wiki/Ketosis []