Over the last 5 years, the low FODMAP approach has become the gut healing diet du jour, with everyone from naturopaths to conventional MD’s prescribing it for IBS relief. On today’s episode we get into the nitty gritty of what eliminating fermentable carbs from your life actually looks like, the healing potential for your SIBO, and how this diet can effect your long-term gut health for better or for worse.
If Allison Siebecker, our guest on episode 1, is the queen of SIBO, Kate Scarlata is definitely the queen of FODMAP’s. She’s been writing out this dietary approach for IBS and creating tons of research on her site since long before people like myself were aware of it. She is also the author of several books, her latest of which is called The Low FODMAP Diet Step by Step.
A quick taste of what we’ll cover:
- What the FODMAP acronym stands for
- Fructose malabsorption and why it effects people with SIBO more than others
- How to navigate the complicated ingredient lists for low FODMAP quantities
- Kate’s tips for keeping the flavor in your meals without garlic and onion
- Her strategies for reintroducing these ingredients back into your diet without fear
- What really constitutes a failed test or on-going insensitivity and what other milder symptoms might mean about your SIBO recovery
- And so much more…
Resources, Mentions and Notes:
- Kate’s website
- Kate’s book, The Low FODMAP Diet Step by Step
- Monash’s Appfor low FODMAP food portions
- Fody Foods’ low FODMAP condiments and sauces
- My free e-cookbook, Healthy Weeknight low FODMAP Meals
- My course with a month-long low FODMAP meal plan: 4 Weeks to Wellness
- My post that summarizes a lot of these strategies: The Best Diet and Lifestyle Choices to Heal, Treat and Prevent SIBO
- Join the SIBO Made Simple Facebook Community Page
This episode is brought to you by Fody Foods, my favorite resource for condiments, sauces and spice blends that are low FODMAP and use real ingredients to promote digestive health. Everything is Gluten-Free, Dairy-Free, non-GMO, and most importantly, delicious. The garlic-infused oil and tomato-basil sauce are my personal favorites. Use code SIBOMADESIMPLE at checkout for 15 percent off your order!
LOW FODMAP 101 – HOW TO USE THIS DIET TO TREAT SIBO SYMPTOMS
Phoebe Lapine: Thanks so much for coming on the show, Kate. As I mentioned to you off-line, I discovered your work five years ago when a bunch of my readers started asking me about the Low-FODMAP diet and lifestyle. And, since then, I’ve obviously had my own personal experience implementing some of your tips. So, just to catch everyone up on how you became kind-of the defacto expert on Low-FODMAPS, can you tell a little bit about your journey?
Kate Scarlata: Absolutely. So, I’ve been a dietitian for 30 years. But, it really wasn’t until I was pregnant at 30 years old with my middle son. And I developed some colicky belly pain and I called the nurse and she thought it was just maybe the flu, I just wasn’t convinced. And I went into the hospital and I ended up having scar tissue from a previous ovarian cyst surgery strangle my small intestine and required six-feet of my small intestine to be removed while pregnant.
And, so, certainly that life-changing event kind of cascaded me directly into wanting to learn more about digestive health and started experiencing, you know, a sensitive stomach. I had six feet of my small intestine removed. So, certainly, that affected digestion and started working more and more with patients that had irritable bowel syndrome.
And, lastly, about 10 years after I had my son; after the surgery, I developed Small Intestinal Bacterial Overgrowth. And I was really lost trying to fend for myself because no one was really talking about Small Intestinal Bacterial Overgrowth or SIBO. So, it’s just kind of a combination of effects.
And then, being a dietitian I was asked to write a book on irritable bowel syndrome, which made me further, sort of, get an understanding of what was out there in the scientific literature and that’s when I first really got introduced to the Low-FODMAP diet. And the research and made sense for me, personally, for my sensitivities but, also, I just I knew this is going to be an important diet or an important nutritional approach to helping patients manage symptoms.
Phoebe: Amazing. So, for those who are not familiar, can you explain what this acronym stands for and how it translates as a diet?
Kate: So, I really like to think of it as a nutritional approach, which we’ll break down in a moment, it is called a Low-FODMAP diet. But, it’s really an elimination diet that hopefully you’re not on full-time and you understand how to, sort of, expand it. But to back up, FODMAP is an acronym and it stands for Fermentable; meaning these carbohydrates create gas. And then, ODMN and P are different types of carbohydrates. O stands for oligosaccharides, and hopefully, you never need to say that word again. But that stands for two really main oligosaccharides, fructans and, the galacto-oligosaccharides which are types of fibers that are found in things like wheat, onion, and garlic. And then, the D in FODMAP is a disaccharide; which just means it’s a two-chain sugar and in the FODMAP realm, it’s really just standing for lactose because lactose is really the only two-chain sugar that’s commonly malabsorbed. And then, you have M in FODMAPS which is monosaccharides standing for fructose. And fructose is found in a number of different foods but, it’s really only problematic or causes symptoms typically when it’s in excess of glucose in a food.
So, examples of foods that have excess fructose would be honey, mango, agave, high fructose corn syrup and, you know, some other — some small amounts of foods. And then the P in FODMAPS stands for polyols, and these are natural sugar alcohols that are found in a number of different fruits and vegetables. Anywhere from cauliflower to sweet potato to fruits that have a stone in them like apricots and plums, and these are also commonly malabsorbed. So, the key piece of FODMAPS is there is small carbohydrates and when you have a small carbohydrate in your gut, it tends to pull water in. Also, the nature of FODMAPS being small, they’re very easy for bacteria to consume and break down and convert into gas.
We all have trillions of bacteria in our gut and they do a number of really positive things but, part of what they do is also ferment carbohydrates. And FODMAPS are basically fast-food for these microbes and for some people, all of that gas can really trigger cramping and abdominal pain and some digestive distress.
Phoebe: So, one of the things that you point out in your book and, you may of just kind of explained it in a long-winded way just now, but I think some people are confused that people aren’t actually allergic to FODMAPS, they’re just simply sensitive. Can you explain why it’s not an allergy and, kind of, the reactions in the body that are different?
Kate: Right. So, allergies really tend to trip-up the immune system. They can contribute to G.I. symptoms but most often contribute to shortness of breath, respiratory distress, and worst case scenario, an anaphylactic reaction that could lead to death. Where food intolerance — which is where FODMAPS fit in — don’t have the same kind of trigger to the immune system, you’re not at risk of dying when you consume FODMAPS from a food sensitivity or intolerance standpoint. And food intolerance generally occurs, in my opinion, due to bacteria being in the wrong place. Like bacteria being in the small intestine is going to contribute to FODMAP intolerance because the bacteria get to the FODMAPS before they even have an opportunity to be absorbed or partially absorbed or digested. And an example of food intolerance that a lot of people know about is lactose intolerance. We don’t have the enzyme lactase to break down lactose. A lot of people lose that ability to make that enzyme that breaks lactose apart and, in some people that extra lactose arrives in the colon and contributes to a lot of G.I. symptoms
Phoebe: So, are there certain foods in this web of FODMAPS that seem to give people more trouble than others?
Kate: You know it’s a very individual. So, if I fight — had to say which is the most likely FODMAP to bother most people with IBS — I would say onion hands-down is the most problematic. But because we all have our individual gut microbiome, it’s like our own fingerprint of microbes and they reside in different places and different people, it really is somewhat variable.
I’ve had patients that have seen me that are extraordinarily sensitive to excess fructose in their diet and less troubled by onions, wheat, and garlic which are longer-chain carbohydrates. they’re a little bit different in the sense of size and so, it’s very individual.
Phoebe: And do you see any themes with your SIBO patients or do you suspect that maybe the majority of your IBS patients actually have SIBO?
Kate: I think that there’s definitely an overlap with a lot of individuals. I don’t think SIBO occurs; the research doesn’t support it, suggesting that everyone with irritable bowel syndrome has SIBO. However, I would say there is definitely an overlap and you know some people think that IBS and SIBO are just on a spectrum. There’s alterations in gut bacteria and, you know, SIBO patients are like it’s like IBS on steroids. I really think a SIBO is its own thing
Phoebe: So, how do you use the low FODMAPS approach with your SIBO patients?
Kate: I use the Low-FODMAP approach with my SIBO patients pretty much the same way I do with my irritable bowel syndrome patients. And, that is, we want to get them treated with an antibiotic first and foremost. That’s sort of the evidence-based model for bacterial overgrowth the small intestine we also want to work with. I work with the G.I. doctor to see if we can determine the cause of bacteria in the small intestine because it’s not normal to have excess bacteria in the small intestine. So, if we can, kind of, get to the bottom of that and that might be someone who has Celiac disease that was undetected. Or they have Inflammatory Bowel Disease that was undetected or, in my population of patients, a lot of them had severe constipation.
And when your colon is full of stool, your small bowel doesn’t work as effectively and so, managing the constipation is really relevant and so we’ll work, you know, try to figure out what type of constipation that patient has, work either with a physical therapist, work with certain kinds of laxatives, get rid of that problem, treat the SIBO, and then I’ll usually implement the Low-FODMAP diet. after the antibiotic therapy along with therapy is to correct the underlying problem when possible. We can’t always identify the problem that’s caused the SIBO and then, just do the diet and do the reintroduction and figure out what foods are triggers and which are not and, you know, it’s very similar.
Phoebe: So, when doing the diet after, kind of, the kill approach, is your main goal a healing goal? Is to, kind of, get to the bottom of that individual dietary footprint and see what people can actually tolerate or not at any given time? What’s, kind of, your main strategy?
Kate: So, my main strategy is to — is kind of two-fold — it’s to starve out any remaining bacteria in the small intestine. Again, FODMAPS are fast-food for gut microbes. And then; secondly, to determine if FODMAP intolerance is part of the SIBO story for this patient. So, if it is a contributor, are they malabsorbing a lot of fructose? And, therefore, it becomes food for the microbes in their small intestine.
So, I kind of, work on both things. I will say, it’s really important to know that there is no diet that’s been supported by the research and science for SIBO, it has never been studied. There have been some studies that have had patients with Small Intestinal Bacterial Overgrowth, kind of, looped into the Low-FODMAPS diet with IBS patients. But, we really don’t have science to support any one diet so there’s lots of websites out there that are touting, you know, SIBO-specific diet. This diet, that diet, and you just, you know, you have to go with a grain — you know, look at it with a grain of salt. This is all we have but, again, there’s no science to support, really, what we’re doing. It’s, you know — we’re doing it to help patient symptoms. But it is important to know you can say “this will definitely help you, we have research to support this,” we don’t.
Phoebe: And, you know, we should take all of this with a grain of salt. But, there are so many other diets out there that are kind of like Low-FODMAP 2.0 and seem even more restrictive especially with low carb approaches. I’m curious if you think — if you’ve seen at least clinically, there’s any need for that or if just, simply, the Low-FODMAP elimination diet? Which, for many people, is quite restrictive as well, usually gets the job done.
Kate: So, for my experience, I would say the bulk of patients do really well on the Low-FODMAP diet and I’ve seen thousands of patients with Small Intestinal Bacterial Overgrowth. And because I’ve had it myself, it’s always on the top of my thought process when a patient comes in and has symptoms that would warrant that being part of the differential diagnosis for them. But there are some patients that do malabsorb other carbohydrates and that includes sucrose.
You know, they just did a study at Digestive Disease Week, they looked at a group of IBS patients that really were just remaining symptomatic and 17% of them could not malabsorb sucrose. So, I do think that in some patients we do need to look beyond the Low-FODMAP diet for them. But I wouldn’t say from my clinical experience, which is thousands of patients, that that is common. It does occur but in less than 20% of my patients.
Phoebe: And this may be kind of a dumb question but, is fructose malabsorption something that’s completely separate from SIBO? Is it caused by SIBO, like, kind of, what’s the link?
Kate: Right. No, It’s not a stupid question at all and you probably — there are some people that have genetic differences and they don’t have as many fructose transporters. So, because of that difference, there are going to be too much fructose it will just be too much for their body because they don’t have the same number of transporters to get that fructose into the bloodstream. And then, there’s also the notion of fructose — is a very small — it’s just a one-chain sugar. So, it’s readily digested quickly by bacteria in the small intestine so it’s probably a mix of both fructose malabsorption occurs in one in three people. So, it’s very common but that doesn’t mean that it’s a problem for one in three people so you can be malabsorbing fructose and have zero symptoms and your body is absolutely fine with that.
Phoebe: And why is that?
Kate: Probably due to the nature of the bacteria. We are the bacteria. If the fructose is being malabsorbed and there’s a ton of bacteria in the small intestine that don’t belong there, that’s probably going to cause some symptoms because the fructose is going to be consumed and gas is going to be created. The small intestine is really not designed to have a lot of gas in it because there’s not usually a lot of bacteria in it so that is probably causing some symptoms. And also, just the nature of the bacteria in the colon. So, some bacteria are really good at breaking down carbohydrates and creating gas and others are not so depending on the nature of your bacteria in your colon. Your symptoms will be different so you could have two people that malabsorb lactose and one becomes very symptomatic and the other one does not. So, malabsorption does not equate to intolerance and that’s the same for, like, a fructose malabsorption versus the fructose intolerance.
So, really, what it boils down to, and I think this is such an important message, is really honing in on your body and listening. You know, so many people have food fears or just rule out certain foods because they’re on a FODMAP list, and yet if they eat them they have zero symptoms.
My husband and I laughed the other day because I got that new pasta that has the orange box — so we bought — I bought some lentil. They didn’t have the chickpea so, I was, like, let’s try the lentil. And then I threw in some chickpeas into the marinara that I needed, and I’m thinking “this is going to be a disaster area, let’s just try this” and both of us were, kind of, like, looking at each other, like, I wonder if this is going to be a bad night and we felt great —
Kate: — no symptoms whatsoever. Though I think — it’s just you got to listen, you got to try and get away from like food rules that are on the Internet and become one with your body. And really listen to what’s working. What makes you feel good. What are you enjoying? Because your body is really smart and it lets you know if it didn’t work out.
Phoebe: Well, I have a lot of follow-up questions about that in terms of reintroduction. But first, I want to actually focus on some of your amazing tips for people who are actually in the thick of the diet because there a lot of lists, it’s not just a simple “yes” and “no” column, you know, amounts matter. So what are some strategies for, kind of, like dealing with his jigsaw puzzle of quantities, for remembering them, for limiting food waste and managing portions when you’re just trying to get, you know, get through the day and making yourself some meals?
Kate: Well, I think, like, you know, Nutrition 101, balance your plate. If you’re balancing your plate and you have some, you know, grains you have some protein, you have some produce, and healthy fats. Often, the portion control gets taken care of beautifully, just with that balanced plate. And also, just encourages normal digestion. If you have too much fiber, your stomach’s not going to empty as well. If you have too much fat, can cause distention and just feeling not great. People with IBS have a lot of fat intolerance as do SIBO patients. So, balancing your plate is really important and then using, you know, tools, like, the Monash app. They have a really great app that really delineates what food portions constitute a Low-FODMAP portion if that kind of tool works well for you I think that’s a good one. But, in general, I really just focus on what do you like to eat and how can we balance that and end up on a nice plate that’s attractive visually and tastes good. And if you can do that, you’re probably taking your FODMAPS down especially if you take all the high FODMAPS off.
I really try not to get patients into too much of a micromanaged diet. You know, take your FODMAPS from, you know, if you’re throwing onion and garlic into everything and you have, you know, bagels and sandwiches every day and we remove the onion garlic and the bagels you’re probably gonna feel remarkably better. So, it’s not a FODMAP-free diet, we’re just taking it down from where you were and if you need to tweak along the way you tweak along the way. I think when you get too micro, you add too much stress you put too much on that the diet. Is the only part of your treatment plan it becomes more stressful than therapeutic.
Phoebe: No, I think that’s a really important message especially for people who are just getting to know this diet and really feeling the weeds with the charts etc. It can feel, I mean, I know when I was looking at the Monash app and trying to be, like, I don’t know if this is this 1/4 cup of butternut squash, it was quite overwhelming. But I think that’s great advice and do you recommend that people who do feel overwhelmed, as you said, just simply start with focusing on that high FODMAP column and not worrying so much about the quantity issue for medium FODMAP foods?
Kate: Well, what I usually do is bring out the Low-FODMAP list and say these are the foods that are probably going to work best in your belly and let’s focus on what you can eat and looking at this list, how can we make up some breakfast, lunch, and dinner ideas? And let’s focus on how we can balance your meals as well. So, you know, that oatmeal bowl looks great but you have no healthy fats or produce in it, how can we help with that? So, instead of focusing on what you can’t have, focus on what you can and look at that list and try to think big picture nutrition. How can I maximize nutrition in every bite? And, you know, how can I fit in some of my favorite foods to you know? We all love chocolate, how can we fit in a little bit of chocolate? Or can we do chocolate dipped pineapple or chocolate dipped strawberries when we’re feeling, like, maybe really want that cheesecake that’s sitting in the fridge and is probably not gonna be included on the Low-FODMAP diet. So, that’s kind of how I approach it with patients. I do show them the High-FODMAPS list so I can point out “yes, you are eating FODMAPS right now. That you’re eating the wheat. That you had onion and garlic etc. etc.” If you’re not eating FODMAPS and you still don’t feel well a Low-FODMAP diet is not gonna help you, right? So, that’s important too, are you even eating FODMAPS? I have patients that come to my office that are eating six foods which is, you know, the worst possible scenario. So, again you got to be eating them and food needs to be part of the, you know, that food exacerbates your symptoms. That’s when you think “okay, maybe Low-FODMAPS will, you know, not help.”
Phoebe: So, for those who may be considered themselves “foodies” and feel very married to the idea of garlic and onion everything maybe, they just consider themselves Italian. What are some recommendations you have from a creative standpoint for getting some of the flavor back into your meals in the kitchen?
Kate: You can use garlic infused oil, shallot-infused oil. And I use them all the time. Fody Food has a great extra virgin olive oil that’s infused with garlic and shallot all as does [innaudible] which is another one of my favorites. Or if you’re, you know, in your kitchen and just have the olive oil in the skillet, add your garlic just in, like, two pieces. Infuse the flavor and remove it and the reason you can do that is that FODMAPS are water soluble so the fructans that are in the garlic and the shallots and onion will not actually infuse into the garlic and the shallot and the onion will not actually infuse into the oil. But the flavor will so as long as you’re not eating the flesh, that’s a great way. Other ways to get onion flavor are the greens of leaks, you can also use scallions. Chives add really nice onion flavor, there’s lots of herbs fresh herbs. Cilantro, basil, rosemary, thyme that you can add and in plenty of spices that are also Low-FODMAP so no need for tasteless meals.
Phoebe: I completely agree and how about eating out I found that to be the most challenging part, personally. Especially since garlic and onion is hidden in so many things. Do you have any pointers for how to, kind of, navigate a menu or troubleshoot with waitstaff?
Kate: Definitely. Well, the first thing is grab that menu online and look at it and just, kind of, try to pinpoint what meals potentially may be lower in FODMAPS. And, usually, a grilled fish or chicken you can get Low-FODMAP. There may be a salad that you could ask them to not add the onion or not add the mango or something that maybe is the pear or another FODMAP that might be in it. And then, call the restaurant around 3:00 o’clock, non-busy hours, see if you can talk to either the chef or someone in charge in the kitchen so they can get a sense of these other alternatives that you possibly can you get a piece of chicken or fish done simply with olive oil, salt and pepper. That way, when you go to the restaurant that evening you feel a little bit more confident and you can order without, you know, feeling, like, “I’m on a special diet and have to go to the whole rigmarole.” You can just say “Oh. I called earlier and they said they could get me, you know, salmon with olive oil and salt and pepper, can I have that with a baked potato, and the salad looks really great, in lieu of the salad dressing I’d like olive oil and red wine vinegar please, on the side.
The other thing is, you know, it might just be that your diet isn’t perfect that evening and do your very best. Again, if you’re going to be stressed about every food decision that’s going to upset your gut so, you know, just work with the menu. A plain burger or maybe some French fries gives you a good excuse to have French fries out, you know, that kind of thing. Yeah just, you know, do your best. Take your FODMAPS down, it doesn’t have to be FODMAP free night.
Phoebe: Yes, I love that advice. And speaking of stress, I have gotten more questions than any other regarding the Low-FODMAP diet, about the challenge phase. And people who feel so much better being a little bit more restrictive getting some FODMAPS out, who then start to feel a little bit panicked when it comes to that idea of reintroduction. Can you tell us a little bit about, kind of, how the challenge phase works, what the timing is like, and how you should interpret different levels of discomfort?
Kate: Yes. That’s a really good question. So, just like many things in the nutrition world the reintroduction part of the diet really hasn’t been worked through in the research setting. So, everyone does it a little bit differently all with the same goal in mind and differences are okay, there’s no one way to do every diet. So, slight changes person to person and how they employ the reintroduction is, in my mind, perfectly fine. I like to do a cautious reintroduction I think, in part, because I know what it’s like to have a terrible stomachache and SIBO and I want to go gentle on my patients.
What we do with the reintroduction — it takes about eight weeks, maybe ten — some patients will do a couple reintroductions’ and then just, kind of, hover there for a little while and then do some more down the, you know, in a month and that’s fine too. Life’s busy and you want to do your reintroductions when life isn’t too crazy, you’re not on a business trip or something like that. We keep the patient on the Low-FODMAP diet or the individual, and then we reintroduce by FODMAPS subtype. And by subtype, I mean lactose or excess fructose or fructan.
So, for instance, if I was doing a lactose challenge with my client, I would have them stand a Low-FODMAP diet and they would add a half a cup of milk to one of their meals and that’s all they would do, day one. And then on day two, they would add a cup of milk to their diet and we see how things go. They will track any symptoms that they’re experiencing and then on day three, I would have them go up to a cup and a half of milk unless they never, in a million years, would have a cup and a half of milk. Then, I would say just stay at a cup of milk and they track their symptoms and then what constitutes a failed challenge is an IBS-like flare, onset of diarrhea, severe constipation, pain, cramping, a really negative outcome. So, if the outcome of milk is a gas bubble traveling through your colon that you can feel, you have passed the lactose challenge. Gas is not a failed challenge, a little rumbling in your belly is not a failed challenge. It’s really something remarkable that you don’t want to happen and, so, that’s really important for people to understand. And then, with fructose I would pick again, a food that only has excess fructose because what I’m challenging is not that food, per se, but how the body tolerates that excess fructose. So, I might give the client a tablespoon or two teaspoons of honey or a tablespoon of honey depending on their preference and start and then increase.
Phoebe: And do you recommend– you said add the milk to your meal. I know that from talking to other people about, kind of, a traditional elimination diet challenges — it’s the idea of, kind of, reintroducing something in isolation. In the case of FODMAPS, is it fine to incorporate it into other things or do you want to just drink that milk on its own?
Kate: No. I actually incorporate it into the meal. And the reason I do that is food works synergistically in the body and we very rarely eat or drink things completely in isolation. So, you know; for instance, protein will enhance fructose absorption. Sometimes, fat can slow things down a little bit and enhance absorption, so I like it in a mixed meal. I think that’s going to represent how that food is typically going to be consumed. If the patient or client was a milk drinker and they wake up in the morning and they like to have a big cup of milk in the morning by itself and I know that I might say “let’s try it out on its own.” But because food really does work synergistically and we eat food typically together that, to me, is more relevant to how it’s going to be adapted in the body.
Phoebe: That’s really interesting. So, your recommendation is to try and introduce in the way that you would be eating it in your daily life.
Kate: Yeah. Yeah, I agree with that.
Phoebe: Wonderful. So, in terms of the discomfort factor that was really interesting for me to hear in terms of what constitutes a failed challenge. And I think that at least for SIBO people since it is the idea of– or the question in some ways of whether or not the bacteria is gone. Feeling any sort of symptom can be alarming, what are the reasons why you may be just having some bloating or some– a little bit of cramping besides the fact that you may have some lasting bacteria?
Kate: Well, first of all, a little bit of bloating is very normal. We do have bacteria in our small intestine, just not a lot of them. I think it’s just normal. I don’t know what else to say, I mean, I know the fear is there and I understand that fear firsthand. But, you can’t get that nuanced or you’ll never expand your diet, you really never will. And it is the problem with a Low-FODMAPS diet is that it does change the gut microbiota and the microbiome. And we don’t know if that’s a good thing long-term or a bad thing, it does reduce some probiotic bacteria that normally are found in the colon and it does change the pH a little bit making a little less acidic.
Acidity is important in the colon to keep pathogenic bacteria at the bay or minimize their growth. So, you know, there’s this notion of the stricter you are with the diet, the more you’re a winner or you’re controlling and, you know, there really is — and I try to put my finger on that sort of notion, it’s so far from really the truth you’re, you know, you’re starving the good guys and it’s really a balancing act. The other thing is, one meal that maybe makes you asymptomatic is not going to set you back to SIBO. I mean, I firmly believe that but it, again, becomes intuitive. So, if you feel yucky and you eat something and you eat it again it makes you feel yucky then, maybe you need to start listening to your body’s messages. So, what I’ve learned with my bacterial overgrowth — and I don’t have a door and on the ileocecal valve between my colon and my small intestine which makes me very high risk for SIBO, but what I really learned — what’s worked really well for me, and again we’re all individuals. So, I’m really intuitive to my body so, if I did start — if I feel, like, Okay I’m feeling a little more gassy or troubled, and that happens for more than a few days then, I dial back my FODMAPS a little bit. And, usually it’s a meal or two and then I feel fine.
Now, that’s not scientific; I can just tell you that works really well for me. So, I don’t jump out of the hoop and go crazy if I get a gas bubble or panic. I’m over that. But, I was like that for a little while because having SIBO is no walk in the park. But the more you trust your body and your intuition with it, the better off your diet. The more liberal your diet, the more, you know, your quality of life will be better. And just, know, when to dial it back. But one little upset or one little thing should not put you into an alarm state. It’s when it stays like that for, you know, a few days and there’s no other really obvious — you know, you’re going to the bathroom regularly there’s no other changes, no other alarm — you know symptoms to warrant a doctor’s visit. Just dial back the FODMAPS for a couple meals and see if that makes sense.
Phoebe: Yes. And I love that, you know, you can still try the lentil pasta and add chickpeas to it. Have no fear —
Kate: Exactly. I didn’t throw the whole can of chickpeas but I did add chickpeas in there and I was, like, “Whoa. This is good. I know it’s good.”
Phoebe: So, since our microbiota is constantly changing; if you discover if you have — a failed challenge, you discover that you really don’t tolerate certain FODMAPS really well, how often should you retest since things, you know, are constantly evolving or should people think of these, some of these types of intolerances as more long-term?
Kate: You know, from my experience I would say there are some intolerances that seem to be more long-term. However, there are many that seem to change. As, like, I used to not be able to do a lot of fruit at one meal. So, like, a fruit smoothie would be very limited in the amount of fruit that I could have. And now, I tolerate an acai bowl out which it probably has, you know, three servings of fruits and I feel wonderful. So, my tolerance has changed to that which is really great. So, I think — usually, what I tell my clients every one to two months, try to reintroduce something that maybe you didn’t tolerate so much before but, you’re missing and you want to expand your diet even if it’s a smaller amount.
You know, one thing that I still don’t tolerate; a whole apple. But my husband and I have a cottage in Maine and we go up there and they have this sandwich on sourdough bread. And they put thinly sliced Granny Smith apples on it and it’s so good and we split it and I’m fine with that, like, it’s totally fine. So don’t say, like, apples are off the table or this special pear and blue cheese salad that you want to try and you’re picking out every pear maybe keep in a couple pear slices and see how you do, instead of being so black-and-white. I really encourage my clients to be a little bit gray and keep on trying and more often than not, they’re able to expand their diet.
Phoebe: That’s great. So, last but not least there’s always the question with, is it what you’re eating or how you’re eating it? Which do you find is more important and in what scenarios do you try and point people towards the how you’re eating it if, you know, the Low-FODMAP diet isn’t turning up a lot of answers? Like, how people chew their food for example. Kind of more lifestyle habits in regards to eating versus just the ingredient itself?
Kate: I think it’s really a combination. I really think it’s essential that we slow down. We really think about what we want to eat so that there is a joy factor with what that is, we’re not just eating because we got to. We are hungry and this is what we can eat that that we’re really thinking about that. It’s exciting to eat it, that we want to eat it, and that we’re not rushed and slow down and we do chew our food.
Digestion starts in your mouth so, you know, there’s enzymes carbohydrate, digestive enzymes in your mouth and the teeth really break down the food so that it can be exposed properly to acid in the stomach. So, there’s so many important steps with proper eating. Chewing, calming your gut down. Your gut and brain are so highly linked, they started with the same cells in utero and then separate. So, the gut and brain are constantly talking to one another. So relax, that’s very important but it does also matter what you’re eating and that’s a variable person to person. And there’s no one list for every single person. So, keep trying to select foods that bring you joy because I think a healthy diet also encompasses the, you know, fun and the taste in the joy of eating the food as well as the nourishment that food supplies our body. So, it’s a balancing act of both of those factors.
Phoebe: Well, Kate. This has been so informative and you explain, you know, the whole concept of the Low-FODMAP approach so well, is there any mistakes you see in your practice or any piece of advice that you didn’t cover that you want our listeners to know?
Kate: You know, I think the biggest thing is to be careful where you’re getting your information because there are so many gut health sites that sound very scientific or sound just so believable. And, really, tout a lot of fear-related messaging and it really — it does such a disservice to the IBS community and people out there really struggling to try to find the right nutritional approach to help manage their very debilitating symptoms. And, you know, it’s if you’re miserably uncomfortable it’s really easy to fall for, you know, “I’m going to buy just $300.00 packet of supplements and I’m going to be better because this doctor said that I will be and said so in a very convicted way.” So, just — I think it’s important to look at the background of these people. What are their messages?
Phoebe: If there’s a lot of fear-related messaging, what would be an example of the fear-related message?
Kate: Antibiotics are the atomic bomb to your gut. If gluten-free diet helps you why don’t you avoid all grains? Those are real messages and it worries me because it puts so much fear out there and it really doesn’t have to be that hard. Just be careful where you’re getting your information. Don’t get sucked into spending a lot of money on unnecessary supplements.
Phoebe: That’s amazing advice; perfect advice to end on. Thank you so much, Kate, for coming on the show with your levelheaded approach to all of these complicated dietary conundrums. I am so excited for people to listen to this episode.
Kate: Thank you so much for having me on.
Disclaimer: The information shared in this podcast is not meant to provide medical advice, professional diagnosis, or treatment. The information discussed is for educational purposes only and is not a substitute for medical or professional care.
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