BLOG on Irritable Bowel Syndrome and the Low Fodmap Diet

Low Fodmap Pizzas

Last night, I had guests for dinner and I made three different low Fodmap pizzas for the main course. I use a normal wheat base because I don’t have an issue with wheat. An interesting fact is that only about 10% of my IBS clients have an issue with wheat. It is one of the least problematic Fodmap-containing foods. However, if you are either Celiac or among the 10% who have an issue with the fructans in wheat, then here is an interesting low Fodmap pizza base I used many years ago during a short Paleo phase: https://www.strandsofmylife.com/pizza-paleo-style/ Or you could create a more classic one like this one from the Monash University blog: https://www.monashfodmap.com/recipe/pizza-dough-8-topping-ideas/

Following are the toppings I used:

Pesto (you can find the recipe here: https://www.strandsofmylife.com/low-fodmap-pesto-pasta/ ), pre-grilled eggplants, cherry tomatoes and mozzarella cheese.
Preservative-free bacon (pre-cooked until crisp and chopped up), Crème freche (as a base layer) sprinkled with salt, pepper, thyme and nutmeg, sundried tomatoes, jalapenos and a little grated cheddar cheese on top.
A classic: canned diced tomatoes, oregano, capers, mozzarella, preservative-free ham and basil.

I ended the meal with carrot cake and a dollop of cream. Here is a low Fodmap one: https://www.strandsofmylife.com/carrot-cake-gluten-free-low-fodmap/

The Confusion of the Changing Fodmap Content of Foods

By Suzanne Perazzini 5 Comments

You may have seen on the Monash Fodmap blog or on the Monash Fodmap app that the Fodmap content of food keeps changing. That is not only confusing but troubling for those trying to follow a low Fodmap diet accurately.

It’s good to know why this is happening. Fodmaps are short-chain carbohydrates and their levels can vary as a result of several different factors beyond our and the researchers’ control.

First, let me give you a couple of examples of radically changed amounts. Instead of 10 strawberries, we can now only have five. Blueberries have also changed, but in the other direction. We used to be able to have only ¼ a cup, while now we can have a full cup.

The Monash Fodmap team have discovered there can be large differences in the Fodmap content of food depending on the country the food is grown in.

So let’s get to the reasons why this may be true:

The soil

The soil’s nutrient content has changed and more fertilizers are used. This is due to global warming causing the soil to be drier and less rich in nutrients. This can cause plants to change their chemical structure in order to survive. Hence, the Fodmap content being affected.

The storage of foods

Fresh produce can be stored for up to a year before reaching us. Some are even picked before they are ripe, stored in cold environments like freezers, then artificially ripened. This treatment causes the Fodmap levels to rise, in particular, fructose and fructans.

Our preference for sweeter foods

Most of us love sugar and the farmers are producing fruits and vegetables with higher sugar content so that they sell better.

Where does this leave those of us following the low Fodmap diet?

First of all, these changes only affect you if the particular Fodmap that has increased is one of your personal triggers. For example, if fructose is an issue for you, then the halving of the permitted amount of strawberries is significant, but not for those who have no problem with fructose.

It’s important to have guidance while learning how to implement the diet because of the many factors that make the difference between success and failure in eliminating your symptoms. Only once your symptoms are under control, can you reintroduce foods to expand your diet. Getting your symptoms under control is the tricky part. As a low Fodmap coach, I am on the lookout for foods that, even though they are low Fodmap, may be causing issues for my clients. About 20% of my clients don’t eliminate all their symptoms even while on an accurate low Fodmap diet. Through their filling out of daily diary pages, which I analyse and transfer to a spreadsheet, I am able to identify these “extra” foods that are preventing success. This also takes care of the changing Fodmap content of foods.

If you would like to discuss the possibility of becoming a client so I can guide you through the stages of the diet to create a safe final diet for you, then fill in the application form on this page and book a complimentary call so we can discuss your particular case. You are under no obligation to follow through with coaching. This is simply a call to see if I can help you and whether this would be a good fit for you.

For more information about the changing Fodmap content of foods, read the article on the Monash Fodmap blog.

Life with Irritable Bowel Syndrome

By Suzanne Perazzini Leave a Comment

IBS affects the quality of life of those who suffer from this chronic condition. A research study carried out in The Netherlands came to the conclusion that our quality of life is only 62% of that of a non-sufferer. So the impact is enormous. Of course, the degree to which our lives are restricted depends on whether we are already on the low Fodmap diet or not. If we have already been through the stages of the diet to find our triggers and expanded our diet to something manageable, then we are far better off than those who are still on the journey to finding how to control their symptoms. However, on the whole, those of us with IBS face life in a different way. Below I have put together a list of ways in which our lives can differ, though this naturally varies from one person to another.

Our focus on toilets

I have had IBS all my life and it took years before I realized that not everyone has the same relationship with the toilet that I do. I always took longer in there and never felt completely satisfied with the results, but I thought that was normal. Even though I now have my symptoms under control for the most part – stress can still send the train off the rails – I always like to know where the nearest toilet is. Not that I ever have such an urgent need to go that I could have an accident since I have IBS with constipation. However, the urge can be there and denying that urge causes pain and enormous discomfort. Miserable is an understatement, and you often have to hide it if you are in company.

I had a client who never went more than a block from her house for fear of shaming herself. Fortunately, now she is on the diet she can go wherever she wants, but I bet she still has an eye out for the nearest toilet. The trauma of being without a toilet when you need it never leaves you.

Post-traumatic stress syndrome

And that brings me on to PTSD. You might think there are worse things that can cause PTSD and that’s true. But it doesn’t change the fact that most people with a certain level of IBS have all had traumatic incidents in their past. I have heard many horror stories from clients that make your heart go out to them for what they have suffered.

Personally, my traumatic moments have all been connected to travel, when I have been out of my comfort zone and had a certain loss of control over my own situation. For example, group travel, when you have to follow a schedule, can cause issues. This has never stopped me travelling but it means I have often put myself at risk of having an unpleasant episode with the resultant pain and distress. Some may choose to not take that risk, which leads to my next point.

Travelling difficulties

Whereas most people jump at the chance to travel without a thought for their gut, some with IBS, depending on their type of IBS and the severity of it, may choose not to travel at all. The thought of being in a train or bus for a prolonged period of time fills you with horror. I had a client who couldn’t get on a plane even though we had her symptoms well under control because of an exceedingly nasty incident when the hostess wouldn’t allow her to go to the toilet because the plane was landing. The trauma will probably affect her for the rest of her life.

Those with IBS with constipation may seldom have the fear of an accident but we usually need to spend a much longer time than normal in the toilet and this is embarrassing and sometimes impossible when you are travelling with other people. A quick visit to the toilet is a luxury that we seldom experience. Thus, our bowels can get into quite a state at not having the time to evacuate, with pain and misery being the result.

If you are fearful of travel, I recommend independent travel by car or even a cruise. With car trips, as long as you are with people you know well, it just means a little extra planning to find toilets along the way so you can easily stop if necessary. Once you have them marked on a map, you can have the peace of mind that nothing terrible will happen. I also recommend having an emergency kit in the car, that you can grab on your way to the toilet, just in case – toilet paper, spare undies, wet wipes etc. On a cruise, you have your own cabin and there’s no travel involved once you reach the boat. I have found the staff on cruises very accommodating of my food requirements and have never had an issue while cruising. I made a video about my experience on board a ship HERE.

The fear of eating out

People love to eat out to experience delicious food in good company. That is not so for us. Many of my clients had got to a point where they didn’t eat out to avoid the inevitable issues that come with not knowing your triggers or not being able to take them into account when ordering food. However, if you do know your triggers, it simply requires some planning. I still always ring the target restaurant in advance and discuss how to eat there safely with my major triggers of onion and garlic. As long as the restaurant is of a reasonable quality, I have never found one that is not willing to work with me. I do recommend avoiding buffet meals because they are a minefield and for sure you will step on at least one mine.

Analysis of invitations

Leading on from eating out, we look at invitations differently to most. We need to analyze what is involved and how that could potentially affect our gut. This could include a day out on a boat, a weekend tramping trip, a new job, a date with a new boyfriend. Anything outside our normal daily routine makes us pause and think about it. There is seldom an automatic “Yes, we would love to be included.” These days, I would say yes to most invitations but I still need the time to organize my thoughts and perhaps ask a few questions about how things will unfold. We need to plan a lot more than others.

These are just a few of the ways that we see life differently. I am sure some of you can add to this list in the comments.

In order to reduce the impact of IBS on your life, you need to do the low Fodmap diet to find your triggers. If you have tried by yourself but still have wonky bowel movements and feel discomfort after a meal, do get in touch and book a complimentary, obligation-free phone call to discuss the possibility of becoming one of my coaching clients. Book your call here after filling in the application form: https://www.strandsofmylife.com/coachingprogram/

Is Sushi Low Fodmap?

By Suzanne Perazzini Leave a Comment

Sushi is considered a healthy food because it is generally low in fat but it is an unbalanced food which is also low in protein and vegetables. The largest component is rice. For an occasional meal that is fine but before we decide to add this to our list of foods we can consume, we have to investigate each of the parts that make up the whole.

Rice:

Rice is low Fodmap but when it is prepared for sushi, sushi vinegar is added. Many commercial sushi vinegars contain high fructose corn syrup, so if fructose is a trigger for you, you will need to check the ingredients of the rice component before purchasing. If you make the sushi yourself, you can use ordinary sugar instead. The brown rice option is always the healthier choice because the inclusion of the rice fibre slows down the absorption of the sugars in the rice.

Nori:

Nori, which is wrapped around the rice, is a dried, edible seaweed, which is low Fodmap so we do not need to worry about this component of sushi.

Fillings:

You will need to analyze the fillings and choose according to your Fodmap triggers. Avocado contains sorbitol but is okay in small amounts, which is all you get in a sushi roll anyway. Avoid any of the mashed foods like tuna, which could easily contain onion or garlic, which are high Fodmap and cause issues even in small amounts for some. Any protein meat that looks marinated, for example in teriyaki sauce, should be avoided because they could contain high Fodmap ingredients. The cleaner and simpler the filling, the safer it will be as long as it is naturally low Fodmap.

Amount:

This can vary from person to person but remember we should eat more frequent smaller meals to avoid irritating our hypersensitive digestive systems. I would eat only three pieces for a meal, but those who have a higher need for calories, could be fine with six.

Any food that is made of many parts has to be analyzed in the same way. You need to be able to put a tick beside each individual ingredient before deciding it is safe to consume.

Other IBS Gut Irritants besides Fodmaps

By Suzanne Perazzini 4 Comments

Short chain carbohydrates or, as we know them, FODMAPs, are mal-absorbed in the digestive system of those with IBS. The low Fodmap diet will help rectify that. But, even after implementing the low Fodmap diet, we could still have symptoms and that’s because there are other gut irritants that can affect the gut. Let’s have a look at them:

Caffeine

Caffeine is a stimulant which increases gut motility (the speed of the gut) by increasing the contraction of the muscles that push food through the gut. This can result in looser stools, which is not ideal for those who have IBS-D (IBS with diarrhoea) while being more helpful for those with IBS-C (IBS with constipation). However, it can cause cramping and discomfort in both kinds of IBS. Caffeine is found in tea, coffee, chocolate, cocoa, some carbonated drinks like coca cola and in energy drinks. Those with IBS-D should avoid all of these as much as possible. Those with IBS-C can use them as a tool to help with constipation, but there is a very fine line to walk before they cause issues.

Ingesting too much air

Carbonated drinks: they contain carbon dioxide, which is ingested when you drink carbonated drinks. The last thing an easily irritated gut that tends to be gassy because of undigested Fodmaps needs is more gas.
Drinking through a straw: when we drink through a straw, we take in the air that is already in the straw each time we suck on it. That adds up to a lot of air by the time we finish a glass of liquid. Drink directly from a glass or cup.
Chewing gum: When you chew gum, you swallow more often and some of what you’re swallowing is air. Also, many turn to gum that is artificially sweetened because they are worried about sugar but often the sweetener the chemist makes up is more dangerous than that which comes from nature and is often high Fodmap as well. Gum has no nutritional value anyway so throw away your gum and never touch it again.
Smoothies: Even if you manage to make a smoothie that is low Fodmap, which is tricky, you ingest a lot of air with it. The process of mixing the ingredients in a blender incorporates air into it. In fact, you will notice, your smoothie has more volume after it has been processed. That extra volume is air. Many low Fodmap websites will have low Fodmap smoothies, but those recipes are not taking into account the effect all that extra gas has on the gut. Avoid smoothies and eat whole foods without messing with them.
Rushing your meals: when you eat fast or in stressed situations like in a car or meeting, you ingest a lot more air than when you eat in calm surroundings and take your time. You are also less likely to chew your food well when rushed so it is arriving in your stomach without the benefit of it being partially digested by the digestive juices in the saliva in your mouth. So, slow down, stop what you are doing and enjoy your meals in a peaceful way.

Fibre

Fibre is a double-edged sword. Too little and we don’t form good stools that exit easily. Too much and we irritate the gut causing bloating and discomfort. Exactly how much we need per day varies. Those with IBS-D will need less while those with IBS-C will need more, and how much more will need experimentation. There is a very fine line between feeling good and feeling bad with fibre. Some can tolerate a permitted serving of oats and chia seeds each morning while others will feel crampy and bloated from that much. Fibre is an essential part of our diet and keeps the colon healthy, so do test your limits with it and then stick to that level to stay healthy and free of fibre-induced symptoms.

Fat

In a similar way, fat is a gut irritant yet essential for good health. Every cell in our body needs fat so we mustn’t go too low in our fat consumption. Like caffeine, fat increases the motility of the gut so too much will be an issue for those with IBS-D while those with IBS-C can experiment to take advantage of this increased motility but have to be careful to avoid the bloating and cramping from having too much. Try to stick to only one source of fat per meal. For example, if you have egg, avoid cheese. If you have salmon, avoid adding mayonnaise. Make sure your ground meat is as low fat as possible – preferably only around 3% fat. And even then, don’t add an egg or cheese or mayonnaise for example. Become aware of what foods contain fat and try to avoid layering your fats in a meal.

There are other gut irritants like additives in food and alcohol but they can be avoided easily while some of those listed above are tricky because we need them in our diet and they can even be used beneficially by those with IBS-C, but too much and we suffer.

Getting rid of your IBS symptoms is complicated and requires many layers of attention where your diet is concerned. If you have tried by yourself but still have wonky bowel movements and feel discomfort after a meal, do get in touch and book a complimentary, obligation-free phone call to discuss the possibility of becoming one of my coaching clients. Book your call here after filling in the application form: https://www.strandsofmylife.com/coachingprogram/

Why is “stacking” such a problem in the low Fodmap diet

By Suzanne Perazzini 8 Comments

The low Fodmap diet is so much more than just the list of good and bad foods that your health practitioner hands you – if they mention the diet at all!

It is a complex and confusing diet that, when done accurately, is miraculous. Therefore, don’t give up on it just because you are not having immediate success with it. The list of good and bad foods will get you only so far.

Those of us with IBS malabsorb Fodmaps (the short-chain carbohydrates in food). We are not allergic and we are not intolerant to them. Thank goodness or we would die of malnutrition because Fodmaps are in fruit, vegetables, grains and legumes. In fact, everywhere except in protein meats and pure fat. So, we have to choose the correct foods and eat them in the correct amounts per meal. Easier said than done and that’s where most people get confused. But add the issue of “stacking” to the mix and most people throw their hands in the air in desperation.

I have mentioned how important amounts are in this diet and that’s where the issue of stacking can come in. For example, you can have ½ a cup of canned lentils per meal and you can also have ¼ a cup of canned chickpeas per meal. But these two foods contain the same Fodmap – galacto-oligosaccharides. If you have both in the same meal, you have just doubled the permitted amount of galacto-oligosaccharides per meal. Another example, if you have the permitted ½ cup of sweet potato and the permitted ¼ stalk of celery in the same meal, you will have doubled the permitted amount of mannitol you can have per meal.

Therefore you have to know not only the amount of each food you can consume but what Fodmap is in each permitted food so you can avoid “stacking”.

If you can put all this together and not stray from the diet, you will be on your way to eliminating your IBS symptoms. However you still need to take into account other gut irritants that may waylay your best efforts. I will talk about those next week.

Meanwhile, if you know about all this and still can’t get the diet right, please do book a free phone call with me to discuss your IBS and the possibility of private coaching. I have had well over one thousand clients through my 6-week program and I have a success rate of more than 95%. There is life on the other side of this distressing affliction.

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