Expert Advice

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.

With that said, I have decided to start taking some of your questions from our Facebook page and asking some of my favorite FODMAPs experts from the U.S. and abroad.  If you have a question you would like answered, please post it to our wall and I will do my best to get it answered.  Thank you FODMAP Life fans!

 

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.FODMAPs Expert: Patsy Catsos

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.

 

Expert: Emma Carder, RDNemma carder fodmap life

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.

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22 thoughts on “Expert Advice”

  1. Hi,
    I am a crohns/vegan sufferer ! recently put on a fodmap strict diet for 4 months, became very ill and lost a lot of weight.
    Seem to have gone off my food, feel very tired and so low, with my dexa scan for osteoporosis with a T score at -3.0
    Have had a flare up since mid December. Been off work for almost two months.
    Please advise

  2. Colleen,
    what is a Hydrogen Breath test?? I am going soon for the lactose test and fructose breath test. is that the same as Hydrogen?? Curious…?? I asked for one because of all my symptoms I am PETRIFIED to eat now ALWAYS in pain Bloated feel pregnant when I am not… Pressure Cannot take this anymore even trying the fodmaps diet!! UGHHH! Thanks,
    Jen

      1. Hi There,
        I am so sorry that I could not reply earlier, I am still suffering, and off work, its now been one year and three months, since I last mailed to you, just feel so weak, is it because I am a vegan!

      2. Hi Urmi,
        No problem. Perhaps I can help you with nutritional consulting? Being vegan there are a few things you need to do on the low-FODMAP diet in order to make sure you are getting the nutrients you need.

  3. Thank you so much for sharing your knowledge with so many. I have two questions:
    1. Is there a diet tracker (such as the one on Fitness Pal) that includes FODMAPs, to make it easier to add up the troublesome carbs in a meal? If not, can we look into getting one made?
    2. I have GERD as well as IBS, which means I have a very small list of things I should eat. (e.g., I can’t do citrus fruit or tomatoes because of GERD.) Do you know of anyone who has written about this particular combination of issues? I have almost no symptoms because, thanks to books about the low FODMAP diet I have figured out what works. I eat exactly the same foods every day, but I’d like to try branching out a little and could use some guidance.
    Thank you!
    Martha Coleman

  4. If you add something to your diet that you have eliminated and are now trying, how long does it take to get a negative reaction to it? Hours? Days? Also, I am suspecting that I might have SiBO but I can’t be tested for 2 more weeks. If I eat strictly by the SCD (and feel pretty good by the way) is it possible that I will not test positively to the breath test in 2 weeks but still have SIBO? In other words, can the test still be accurate? Or might I cure myself? I went to a dietician and have lots of information but I don’t plan to go back until the test is done. Life was complicated with a UTI and the need to reschedule the test. Otherwise, it would be done already.

  5. Even though I’m following my low fodmap diet while on vacation, I’m so bloated and constipated. Elevation seems to make me worse and we are in high elevation. Anything I can take or do to help with this pressure and pain?

  6. Any chance I could still get a reply to this question above? I wrote it over 2 months ago and never heard back. BTW, the nutritionist started me on L-glutamine 3times a day. Seems to be helping. Do you have any thoughts on that?

    1. Hi Leslie, Thanks for writing me again. I had my baby on 5/21 so I’ve been busy! A negative reaction can take minutes to hours or a day or two. I cannot answer this question “If I eat strictly by the SCD (and feel pretty good by the way) is it possible that I will not test positively to the breath test in 2 weeks but still have SIBO?” but I would like to look into it for you.
      L-glutamine is most often recommended for patients who are more diarrhea prone and I’ve heard many positive reviews for how it’s helped people with IBS-D. Did she tell you about GABA, to take 750 mg 1–3 times per day as needed?

  7. Hi! I’m just starting the FODMAP diet. I’m also gluten intolerant and following a gluten free diet but still have symptoms like bloating, gas, and constipation. I’m wondering if it’s beneficial to eliminate all fruits for a couple weeks to determine which fruits cause problems? I think that some of the low FODMAP fruits still cause me to become bloated and gassy. For example bananas seem to cause me trouble even tho they are in the OK fruits to eat.
    Thanks for your time!
    Trischa Wass

    1. Hi Trischa,
      Not everyone is the same, so yes some people have trouble with low-FODMAP foods. Are there any other fruits that cause you trouble? Have you had an Hydrogen Breath Test to see if you malabsorb fructose? That could be a great place to start. Consider following the low-FODMAP and negate the fruits/foods you know to cause you symptoms. Use a Food & Symptom Diary to keep a detailed report of every single thing you eat and drink everyday: http://www.boncalme.com/booksresources-low-fodmap-digestive-disorder-books/food-symptom-diary/

      1. Colleen,
        Thanks for the reply back! I haven’t had any type of breath tests done. I’m not sure where to go to have the tests done? I just talked with my regular doctor about the GI troubles I’ve been having even after following a gluten free diet. I do notice that dairy gives me gas as well so I try to stay dairy free as well. My doctor suggested I try the FODMAP diet after I told him I got bloated and cramps/ gas after having fruits. He seemed to be more in favor of having me try the diet before having the tests done. I’m thinking it would help me narrow down the diet a bit more if I had the testing done.
        Would you be able to help me find out where to go for testing?
        I live in Vancouver, Wa. I have started a food journal for everything I eat.
        Thanks again for your help!
        Trischa

      2. Hi, FODMAP experts agree that an HBTest can help if it’s done before you start the diet, but if you’ve already started the diet, don;t worry. The test looks to see if you malabsorb fructose, lactose and polyols. It’s administered by a gastroenterologist. Ask them to rule out SIBO and also have blood tests for celiac disease too. Have a great Saturday!

  8. Hi, I am in need of some help, I am on 4 different diets.
    Gluten-free
    Dairy free lactose free
    Fodmap diet
    I.C. diet for my bladder flares frequency
    I feel like I have hit a wall I cant seem to make all these diets work.
    I have had a heart attach and arteries stented in the past, I am currntly on zyfaxin for the 3rd time in 6 months.
    Please any help would be greatly appreciated.

    1. Hi Donna, Are you seeing a doctor and a dietitian? I cannot comment in this case as there are a couple health ailments at play. Let me know if you need help finding a dietitian.

  9. Hi, I am in need of some help, I am on 4 different diets.
    Gluten-free
    Dairy free lactose free
    Fodmap diet
    I.C. diet for my bladder flares frequency
    I feel like I have hit a wall I cant seem to make all these diets work.
    I have had a heart attach and arteries stented in the past, I am currntly on zyfaxin for the 3rd time in 6 months.
    Please any help would be greatly appreciated. Please email me , I do not know how to find your answer, hope you get this!

    1. Hi Donna, I’d like to make sure you are put in touch with an appropriate health professional who can assist you on these diets. Please send an email to: info @ boncalme . com

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