In the 90’s Dr. Sue Shepherd developed a form of fructose malabsorption diet. Subsequently a team at Monash University, led by Professor Peter Gibson and including Dr. Shepherd and others, developed the low-FODMAP diet. Since then, various books, apps and blogs have been published to help people navigate the diet and also update all on new research pertaining to FODMAPs. If you are already a part of the FODMAP community then you know different findings and discrepancies exist from the U.S. to the U.K. Doctors, researchers and registered dietitians from all over have slightly different points of view. The best thing you can do is to work with a FODMAP expert that you trust and like – the same way in which you would choose a doctor for any other need. An expert will help you to navigate the diet based on research and facts and will take into consideration how your own body reacts to food, stress, environmental pollution, etc. We (those suffering from IBS, IBD, GERD, gastroparesis, Celiac and other digestive/inflammatory issues) are all very different – so what works for you, might not work for another person.
Fodmap Life Expert: Patsy Catsos, RD
Question: Personally, I have a question – as I’m two days in: If I slip up and have something bad, does my FODMAP 6 week start all over again (like it does with Whole30?) Meaning, if I’m good for a week, but eat an avocado on day 7, am I starting all over or will I just potentially feel uncomfortable and that’s that?
Answer: The FODMAP elimination diet is a learning diet, not an exercise in following rules. Here is what I tell my patients: You will learn more the closer you stick to eating the foods on the elimination phase of the diet, but the whole project is not ruined if you make a mistake.A “mistake” would be realizing you just ate a sliver of avocado in your sushi, not eating a whole avocado because you feel like taking a break from the low FODMAP diet. Or accepting a sliver of cake at your daughter’s wedding, not deciding to eat a bagel for breakfast. Make your best effort and you will lower the FODMAP load in your diet enough to learn something.
You’re an adult. Its your call. If you choose to make a lot of big, deliberate exceptions, accept that you won’t learn as much about whether changing the types of sugar and fiber in your diet can help you manage your symptoms. “Starting over” is not likely to add much to the learning process at that point.After you’ve figured out which types of FODMAPs are problems for you, you can make all the exceptions you can stand!
I want people to have less anxiety and stress around food and IBS, not more.
Unlike a 100% gluten-free diet, cross-contamination is not an issue when it comes to FODMAPs.
Bio: Patsy Catsos is a registered dietitian, medical nutrition therapist, and author of IBS—Free at Last! Change your Carbs, Change your Life and the Flavor without FODMAPs Cookbook. In her Portland, Maine practice, she helps patients with gluten-related disorders, IBS, and other gastrointestinal problems manage their symptoms and experience a better quality of life. Patsy is a frequent speaker at community and professional events. She is active on a variety of social media platforms including www.ibsfree.net, where she blogs about low-FODMAP living.Patsy completed her undergraduate studies at Cornell University and earned a Master’s degree in Nutrition at Boston University. She interned at Boston’s Beth Israel Hospital. She is a professional member of the Crohns and Colitis Foundation of American, the Celiac Sprue Association, the North American Society for the Study of Celiac Disease and the Academy of Nutrition and Dietetics.
Fodmap Life Expert: Emma Carder, RDN
Question 1: What can one use in place of onions in recipes?
Answer: This has to be one of the most common questions that I get asked by my clients along with what can I have in place of garlic! In terms of buying foods like ready meals, sauces, condiments, soups, gravies etc…it can be very tricky to find anything onion /garlic free. If you are able to make your own meals though then there are some great alternatives out there to use. These are the main swaps that I would recommend;
Garlic, basil or chilli infused oils, finely sliced (green part) spring onions, finely sliced green leek leaves, chives (dried or fresh) or asafoetida powder ‘hing’ (an Indian spice) are all suitable for getting a lovely onion/garlic flavour without the FODMAPS. Asafoetida powder can sometimes contain traces of wheat so for anyone of a completely gluten free diet it’s vital to read the ingredients on this spice. It is also VERY pungent …a little goes a long way!
Question 2: I love zucchini! And I thought they were low fodmap.. but now I read that they are high fodmap… are they?
Answer: Zucchini or courgettes as we call them in the UK are FODMAP friendly. Monash indicate that 1 serve (1/2 a cup or 66g) is low in fodmaps. A serving > 100g does contain oligo fructans though and may not be tolerated by everyone
Bio: Emma is a friendly & highly motivated Registered Dietitian & Nutritionist with over 19 years of post graduate experience. Emma graduated from Queen Margaret University Edinburgh in 1995 and has since gained dietetic experience in both the NHS and private freelance sector. Throughout her 15 year NHS career Emma specialised in a number of key clinical areas including nephrology, gastroenterology, upper GI Cancer surgery, bariatrics, critical care, neurology and elderly care.
Fodmap Life Expert: Tamara Duker
I recently had the pleasure of interviewing Tamara Duker, a Registered Dietitian (RD) with a master’s degree in Clinical Nutrition. She knows a thing or two when it comes to food and nutrition, cooking and eating, recipes and healthy living. She is a cake lover challenged with gluten intolerance (like so many other ladies!). Her practice is based in New York City and she has expertise in helping people with:
- Soft diets for dysphagia
- Gluten-free diets
- Low-FODMAP diets for IBS and SIBO
- Lactose-free or low-fructose diet for digestive intolerances
- Medically-supervised elimination diets for Eosinophilic Esophagitis
Here is Part One of our interview – please read and then check back next week for Part Two:
Question 1 – What would you say is the average age of people coming to see you for the first time? Are they a mix of male and female or mostly female? Do you find that they’ve come to see you because someone else has recommended they see an RD, or do you find you’re receiving more e-patients?
TD – While I see patients of all ages– from 11 at youngest to 80-somethings at the higher end, my “typical” patient is a woman in her 20s-40s. Commonly she reports having had a “sensitive stomach” or “stomachaches” since childhood that has recently gotten worse, but in other cases I hear she was totally fine until one time she got sick when traveling, and then her bowels have never been the same since. They come to see me out of desperation– either they find me via google (my name comes up a lot when you google “bloating” or FODMAP-related search terms, as I write extensively on these topics for US News), or their gastroenterologist referred them to me.
Question 2 – What are the lactose-based products they are most unhappiest to part with?
TD – My lactose intolerant patients are unhappiest to part with pizza, ice cream and yogurt. Often, they part with the yogurt and then suffer through the pizza and ice cream. The problem with pizza/ice cream is that often its the high fat content that triggers IBS symptoms rather than the lactose per se–so even if they take a lactase supplement, they still may not tolerate these foods well. They are beyond ecstatic to learn that there is a lactose-free, low fat real dairy yogurt available, as soy yogurt tastes awful, coconut milk yogurt is a FODMAP bomb and almond milk yogurt is a sugary, carb bomb. Healthy snacking is much more convenient when yogurt is an option.
Question 3 – Can you please describe Medical Nutrition Therapy?
TD – Medical nutrition therapy is different from nutrition counseling or education in that diet is a prescription to treat or improve a medical condition. Some examples of this would be: gluten-free diet for celiac disease, using soluble fiber therapy to improve IBS-D, using the low FODMAP diet to manage symptoms of chronic bloating in IBS, etc. Medical nutrition therapy, importantly, is evidence-based and employed by credentialed clinicians, often in close collaboration with a medical doctor.
Question 4 – Can you provide other tips for the lactose intolerant crowd/FODMAP fans?
- Watch out for protein powders, drinks or bars that use whey protein concentrate or milk protein concentrate. These can be very high in lactose.
- If you use lactase supplements to help digest conventional dairy, use chewables, not tablets. Chewables are much more effective.Take with the first bite. Take additional dose mid-way through the meal/snack if there’s a lot of lactose.
- Green Valley Lactose Free yogurts are the most FODMAP-friendly yogurts I have ever encountered. If Green Valley Organics yogurt is not available in your market, look for Redwood Hill Farm goat’s milk yogurt instead– its about 40% lower in lactose than conventional yogurt, which is comparable to your typical Greek yogurt. To reduce its lactose content even further, you can strain it for 2 hours in a paper-towel lined seive/strainer over a pot, which yields a thicker greek-style texture (lactose is water soluble, so it leaches out with the excess liquid). I have a recipe for “Goat’s Milk Labne” here which I absolutely love.