Low FODMAP Diet

Low Fodmap DietHere’s everything you need to know about the low FODMAP diet

I read a great post by Lucy Whigham telling you all you need to know about the low FODMAP diet. The FODMAP diet is one to really consider if you find that you have SIBO and need to be sure not to feed the overgrowth of bad bacteria that you’re trying to get rid of. It’s also a consideration for IBS and IBD.

What does low FODMAP mean?

The acronym refers to the foods that you need to cut out. They are Fermentable, Oligo-, Di-, Mono-saccharides and Polyols. These are naturally occurring sugars found in a wide range of foods we eat everyday.

Fermentable – meaning they are broken down (fermented) by bacteria in the large bowel
Oligosaccharides – “oligo” means “few” and “saccharide” means sugar. These molecules are made up of individual sugars joined together in a chain
Disaccharides – “di” means two. This is a double sugar molecule
Monosaccharides – “mono” means single. This is a single sugar molecule
Polyols – these are sugar alcohols (however, they don’t lead to intoxication!)

What happens is that they are not fully broken down during digestion and that’s why they can’t be completely absorbed in you body. Instead, they remain in the digestive tract where they are fermented by the gut bacteria.

The fermentation leads to production of gas which causes excessive bloating, gas, pain, cramping, and even gurgling.

The other thing that happens is that water accumulates in the digestive tract which can result in frequent bowel movements and even diarrhea.

They have found that following a low FODMAP, i.e. keeping away there particular fermentable carbohydrates, for about 4-6 weeks, it can help you regain control over your digestive symptoms and improve your quality of life.

Clinical trials show that a low FODMAP diet significantly improves the symptoms of IBS with 60% to 75% of people showing significant improvement in gut symptoms.

Sometimes it’s difficult to pinpoint which foods in particular make your symptoms worse. Sometimes a flare up can happen because of stress and anxiety. Sometimes its because of changes in gut bacteria. Sometimes, it’s because of what you’re eaten.

You can think about dividing the FODMAP Diet process into 3 stages.

1 Elimination phase. Remove high FODMAP foods for four to six weeks . Here is the list of foods from Joe Leech that you can eat.
2 Re-challenge phase. Reintroduce FODMAPs in a controlled way to be able to identify the foods that are causing your symptoms. Here is a reintroduction chart from Joe Leech you can follow.
3 Maintenance phase.

Low FODMAP Diet

Cut out all five families of fermentable carbohydrates:

Fructans – wheat, rye, onions, garlic, various other grains and vegetables

Galacto-oligosaccharides – beans and pulses

Polyols – certain fruit, certain artificial sweeteners

Fructose – various fruits, honey and agave nectar

Lactose – animal milks, yogurts and some cheeses.

What can you eat on a Low FODMAP Diet?

Carbohydrates like rice, oats, potatoes, quinoa and buckwheat

Proteins like meat, poultry, eggs and fish

Vegetables and salads that are allowed

Words of advice

  • Cook from scratch.
  • Read Labels. There are lots os no no’s in pre-packaged foods.
  • Check with your personal doctor or dietitian first.
  • Keep a bottle of water with you at all times and drink up.
  • Black coffee, black tea, peppermint tea, and green tea are very low FODMAP and okay to have with no milk.
  • Keep a food diary: Record each meal you had and if you experienced any undesirable symptoms after each meal or later that day. It helps you recognize triggers and later on for the reintroduction phase.

Low FODMAP Diet Resource

Monash App

It’s only $11 to buy the Monash University FODMAPs app, available on iPhone and Android devices.They have a huge number of foods that have been tested for their FODMAP levels, as well as almost 100 original recipe ideas.

7 Nutrition Guidelines for a SIBO Diet

7 Nutrition Guidelines for a SIBO Diet

Kristy Regan Nutritionist for SIBO Diet

 

When you are first diagnosed with SIBO, choosing and following a diet can be overwhelming.

Here are 7 key suggestions for beginning the journey as suggested by Kristy Regan, who combines nutritional therapies, lifestyle education and counseling to assist her clients on the path to wellness.

Having personal experience with battling SIBO, she appreciates how nutrition and wellness therapies support us in healing.

She is passionate about sharing her insights and expertise in cooking, nutrition, and health.

 

  1. Assess your health.

    Complete a health assessment with a practitioner who is well versed with SIBO. I recommend discussing the following with your health care practitioner:

    1. How well are you digesting your food – do you hear bowel grumbling or have nausea after you eat?
    2. Are you seeing any undigested food in your stool?
    3. What IBS or SIBO symptoms are having including, gas, reflux, diarrhea, constipation, changes in bowel movement frequency, anxiety, food sensitivities, inflammation, etc.?
    4. Do you know what the underlying cause of your SIBO is? This can be helpful in determining the course of treatment, addressing any anatomical issues, adhesions, etc.
    5. Are you able to maintain your weight or are you losing/gaining weight?
    6. How is your energy level and sleep?
    7. Have you taken a SIBO test and know your results?
    8. What is your current stress level and is it having a direct effect on your health?

 

  1. Choose a SIBO diet.

    SIBO diets are meant to help mitigate symptoms and support healing but aren’t meant to “cure” SIBO. With SIBO, people tolerate different foods so everyone’s diet will look different. All diets for SIBO are meant to be a starting point. Test foods to see what you need to add or remove. Be careful of “legal/illegal” systems that don’t take your individual tolerances into account. Two of the diets I recommend are:

    1. Low FODMAP diet. This diet was created specifically for IBS. Monash University has an app that shows FODMAP levels in food that they’ve tested and can be a helpful reference. There are a large variety of foods in this diet so if you are having minimal symptoms and can tolerate high starch and fiber foods this can be a less restrictive but still helpful diet.
    2. Siebecker’s SIBO Specific Food Guide. This is a fairly restricted diet but may alleviate more symptoms. It is meant to be a starting point and then people are meant to test foods over time. For those who are having undesired weight loss, test and add in some starches like white rice or white potato. These are lower fiber, higher glycemic foods so they tend to not feed a bacterial overgrowth.

 

  1. Keep a food diary.

    If it doesn’t create anxiety for you, keep a food/mood/bowel movement diary to see which foods you may be reacting to and how your symptoms are changing. Review the diary with your health practitioner to ascertain patterns and specific reactions. Be careful to not eliminate too many foods. You need to maintain a variety in your diet in order to get enough nutrients. If you’re only eating a couple foods you’re also more likely to develop sensitivities to those foods.

 

  1. Ease digestion.

    If you’re seeing undigested food in your stool and having digestion issues, it’s helpful to peel, deseed, cook and puree your vegetables and fruits. Broth, soups, smoothies, vegetable purees and fruit compotes can be very helpful in easing digestion issues. Keep raw vegetables or salads to a minimum. Limit whole nuts/nut flours, beans, and rough foods until you can tolerate them. Add healthy fats to your diet, like ghee or butter, coconut oil and olive oil, to support satiety and overall health. Try to get a combination of healthy fats, carbs and protein in each meal and avoid processed foods with high FODMAP ingredients. Make sure to chew food well, enjoy your food and eat in a stress free environment whenever possible.

 

  1. Get creative.

    Create trades for foods that might cause issues. Use can substitute garlic oil for garlic (high FODMAP), use two egg yolks instead of an egg (for those who have a hard time digesting the protein found in egg whites), use the green parts of green onions instead of regular onion (high FODMAP).

 

  1. Invest in yourself.

    When your budget allows, choose organic foods, especially healthy oils and grass fed/free range meat and eggs. Meat from healthy animals is very important because animals are on the top of the food chain and if they are exposed to toxins via antibiotics/illness, GMO grains and pesticides, this gets passed on to the person eating it. Consider your food budget as part of your health insurance.

 

  1. Support the MMC.

    The Migrating Motor Complex (MMC) performs a “cleaning wave” in the small intestine when we leave 3-5 hours between meals. Avoid snacking if possible or snack closer to mealtime so you have at least three hours without food/caloric drinks (water is fine).

 

Starting a therapeutic diet can be frustrating. It’s important to remember the reason for a diet is to support healing and help mitigate symptoms. Tweak the diet so it works for you and make sure to get support along the way!

By Kristy Regan,

Who is Kristy Regan?

 

Kristy holds a Masters of Science in Nutrition. She is a frequent SIBO lecturer and was a speaker in the June 2017 SIBO SOS Summit, as well as a guest on the Healthy Gut podcast.
Check out her website, Vital Food Therapeutics, to set up a Skype appointment or see free SIBO diet recipes.

SIBO Treatments

Effective SIBO treatments are a challenge.

SIBO or Small Intestine Bacteria Overgrowth, has become a condition that many people are struggling with today.

SIBO is often a reaction to something that happened.

It can be low HCL, with too alkaline of a pH that results in abnormal pathogens passing through the stomach and accumulating in the intestines.

Sometimes it can be SIFO – small intestinal fungal overgrowth.

Other possibilities are

-acute gastroenteritis from food poisoning, -traveler’s diarrhea, or
-hospital acquired infection.

You see your digestive system eliminates waste through a process known as the migrating motor complex i.e. MMC.

Excessive methane/hydrogen gasses that are produced by overgrowth of bacteria in the small intestine has been linked to decreased MMC function.

It’s these kinds of conditions that cause damage to the migrating motor complex – MMC, allowing the accumulation of fermentable fibers in the small intestine.

Surgery with morphine can cause the migrating motor complex MMC to slow down, stop briefly or sometimes slow down for a longer time. Other reasons are trauma, injury, or even endometriosis that results in adhesions or partial obstruction in the small intestine. SIBO is considered a sequella of something else.

A recent SIBO webinar organised by Dr. Allison Siebecker lined up many practitioners nation wide with lots of good advice about how to deal with SIBO. She has a wealth of information on her website siboinfo.com

Generally, there are 3 options for treating SIBO:

1 Antibiotics

Rifaximin (Xifaxan) is the antibiotic of choice. It fights bacterial infection in the intestines only.

Rifaximin works differently from other antibiotics as it passes through your stomach and into your intestines without being absorbed into your blood stream and only treats the intestinal tract.

2 Natural herbal therapy

Allicin from Garlic (the highest potency formula I know of is Allimed)
Oregano
Berberine
Neem
Cinnamon

1-3 of these herbs,  4 weeks per course, at highest levels suggested on product labels.

or Metagenics Candibactin-AR with Metagenics Candibactin-BR

(we can special order these for you)

3 Elemental Diet

This approach starves the bacteria, but feeds the person, by replacing meals with an Elemental Formula for 2 weeks. Elemental formulas are powdered nutrients in pre-digested, easily absorbed form.

The diet has a 80% success rate.

We can special order Integrative Therapeutics Elemental Diet for you.

Other alternatives are:

  • Home Made combination.
  • Nestle Elemental Diet

Mona Morstein  recommends using PHGG Prebiotics, enzymes that contain bile and Klaire Labs Interfase.
Other prebiotics like FOS and Inulin are not recommended.

She says that sometimes it is necessary to be treating Candida as well with an antifungal.

Donna Gates recommends Time Restricted Feeding. She also says to stay away from fermented foods and kombucha. Wine with no yeast is acceptable.

Be aware of foods that are high in oxalates, like nuts and seeds, soy, beets, carrots, sweet potato, even curly kale and almond milk.  Oxalates are naturally-occurring substances found in a wide variety of foods and they play a supportive role in the metabolism of many plants and animals and in our human metabolism as well.   Oxalates are neither rare nor undesirable. Oxalates can become problematic if they over-accumulate inside your body. Coconut milk is acceptable.

Gary Weiner told us that sometimes the development of biofilm, which is a membrane that forms over the bacteria, may obstruct the ability to heal – Klaire Interfase is recommended.

He suggests that if you opt for doing the Elemental Diet, to go slowly when you reintroduce foods, starting with cooked foods.

Pea protein, fish oils, minerals and spirulina are recommended.

Retesting for SIBO is recommended 15 days after treatment.

SIBO Small Intestine Bacterial Overgrowth

What is SIBO? What can I do about SIBO?

SIBO causes digestive discomfortSIBO is actually an acronym for a digestive condition called  “small intestinal bacterial overgrowth,” which points to excessive bad or pathogenic bacteria in the small intestine.

Even though bacteria occurs naturally everywhere in a healthy digestive system, the small intestine is known to have relatively low levels of bacteria. The highest numbers of bacteria are usually found in the large intestine

The small intestine where the food mixes with digestive juices, and the nutrients from our food is absorbed into the bloodstream. This area of our digestive tract is the longest section. If a person suffers with SIBO or Small Intestine Bacterial Ovegrowth, nutrients are not absorbed properly causing malabsorption. This relates especially to iron as well as fat-soluble vitamins. Other symptoms, often present as well, are gas, bloating and even pain. This is often the case in people suffering with symptoms of Irritable Bowel Syndrome.

Small Intestinel Bacterial Overgrowth is very often treated with antibiotics. Unfortunately, although antibiotics reduce the bad bacteria overgrowth, it also kills off the good bacteria at the same time, which, in turn, depletes the necessary good bacteria.

In fact, a study published in the American Journal of Gastroenterology, showed that people with SIBO who were given antibiotics had a high recurrence rate and also that their gut-related symptoms increased during the recurrences.

Fortunately, a research study on herbal remedies have been found effective in treating SIBO as well. These include Oregano oil and Berberis that are mentioned in the study.

Taking a prebiotic that is known not to feed bad bacteria as well as a human strain probiotic has been shown to be extremely beneficial. Dr Jonathan Axe sites a pilot study from researchers at the Center for Medical Education and Clinical Research in Buenos Aires, Argentina, who found that probiotics have a higher efficacy rate than metronidazole for individuals with SIBO.

Dietary modification is extremely important. Follow the specific carbohydrate diet, or consider the FODMAPS or GAPS diet. Eat every 2 hours so you digest your food quickly and don’t have a lot of food sitting in your stomach at any one time resulting in damage to gastric juices. Low stomach acid is one of the main factors that result in SIBO because stomach acid kills bacteria in your upper Gastrointestinal tract.

SIBO Recommendations:

1. Genova Lab’s Breath Test (GSD5000) done at home, successfully identifies whether there is an overgrowth of bad bacteria in the small intestine or not. Once identified, take the necessary steps to resolve it.

2. Several supplements help reduce symptoms of SIBO.

  • Unlike Inulin and FOS, Partially Hydrolyzed Guar Gum PHGG is the one prebiotic that does not feed bad bacteria and may be used successfully to increase probiotic diversity. PerfectPass Prebiotic (PSN1000) is odorless and tasteless and easy to take in water.
  • PerfectPass Probotic (PSN2000) is a human strain, bacillus formula, that does survive through the stomach acid 100% of the time. It is suitable for those suffering with SIB0
  • Effective antimicrobials include Oregano oil (NHS1000), Grapeseed extract (CVR0621), Olive leaf extract (OLE1000) and Berberis (VTN2541).
  • Consider taking Proteolytic Enzymes on a regular basis in between your meals. They help repair the gut lining  (DWL1400).3 Dietary Changes

    3 D ietary changes

  • The SCD Specific Carbohydrate Diet is an excellent way to eliminate those foods that tend to feed the bad bacteria. Breaking the Vicious Cycle (GOT1000) by Elaine Gottschall will give you information as well as recipes.

  • Other diets to consider are
    FODMAPS and
    GAPS

Its All About Diet

Does Diet Really Matter?

It’s very interesting to note that the most recent Crohns and Colitis Foundation research includes finding a suitable model to be able to ‘rate’ patients with IBD on a continuum of severity so that they would not necessarily be subjected to harsh drugs if their condition was not that severe.

To me, this is the way of the future. Yes, if a person suffering with Crohns or Colitis is dangerously ill, then it would be appropriate to use immuno suppressant drug therapy. However, if it is mild, then why not start with dietary modifications and nutritional supplementation first?

Elaine Gottschall's Specific Carbohdrate Diet in "Breaking the Vicious Cycle"
Elaine Gottschall’s Specific Carbohdrate Diet in “Breaking the Vicious Cycle”

The late Elaine Gottschall remains a pioneer in her time. Imagine that she treated her daughter who had Ulcerative Colitis with diet alone so many years ago, long before we had the research and knowledge available to support her actions. The Specific Carbohydrate Diet (SCD) is a dietary program that has helped to create, as well as maintain, drug-free remission for thousands of people suffering with Inflammatory Bowel Disease.

Actually, to start off it was developed in 1951 by Dr Sidney Hass M.D., gastroenterologist and then it was later popularized by Gottschall, who was a biochemist, in her book called ‘Breaking the Vicious Cycle’.

Not only are food choices very important to those challenged with digestive issues, but healthy food choices for every one on a daily basis, affects your health. It affect how you feel today, how you feel tomorrow, and how you feel in the future.

Dr Oz is a great advocate for investigating healthy eating options. He interviews Dr Mark Hyman MD on a regular basis. Both are staunch believers in how important diet is. When you combine it with physical activity, your diet can help you reach and maintain a healthy weight, lower your risk of chronic diseases … be it digestive conditions, heart disease or cancer, ….and generally promote overall optimal health.

We know that unhealthy eating habits have led to an obesity epidemic in the United States. Did you know that about one-third of U.S. adults (33.8%) are obese and approximately 17% (or 12.5 million) of children and adolescents aged 2—19 years are obese? What’s more, they have found that even when people maintain a healthy weight, a poor diet can be linked to and associated with many health risks leading to illness and even death. We can name heart disease, hypertension (high blood pressure), Type 2 diabetes, osteoporosis, and certain types of cancer to be included in this list. So by making good food choices, you will protect yourself from these kinds of health challenges.

In a recent study  Kakodkar, S., Mikolaitis, S., Engen, P. et al. investigated the bacterial microbiome of inflammatory bowel disease patients on the Specific Carbohydrate Diet (SCD). Gastroenterology. 2013; 144: S552. They say

“Further evidence suggesting diet can be an effective treatment for some patients with IBD stems from the fact that diet has the potential to change the intestinal luminal environment, specifically the intestinal microbiome.  Our prior preliminary findings hint at a change in the microbiome of patients with IBD who follow the SCD. If following the SCD changes the microbiome significantly and/or reverses some of the dysbiosis reported in patients with IBD, this may be a low-cost intervention to induce and maintain remission with little or no known adverse reactions. As such, further interventional studies of SCD and diet therapies in general for IBD are urgently needed.”

Doesn’t this sound like it goes hand in hand with the thought behind the CCFA research of catogorizing patients with IBD on a continuum of severity and being able to give them a treatment plan that would, in fact, encourage their microbiome to heal?

The humans microbiome pops up as popular subject matter in journals and gut research all over the place. It’s very exciting that, literally for the first time in history, we’re finally learning enough about the properties of the human microbiome to manage treatment more completely. We now know, for example, about the importance of strain diversity. We also know which strains actually survive stomach acids. We never knew this before. We even have detailed research to show that Lactobacillus acidophilus and Bifidus, which are prevalent strains in most probiotic formulas, are actually contraindicated for those people who have an overgrowth of bacteria in the Small Intestine.

Genova Lab SIBO Small Intestine Bacteria Overgrowth Breath TestThat’s why I like to recommend the Genova SIBO test to my patients. It allows me to select the appropriate prebiotic and probiotic formulas as well as other supportive digestive supportive supplements for them, specifically, when the SIBO test is positive.

Steven Wright Specific Carbohydrate Diet Advocate
Steven Wright Specific Carbohydrate Diet Advocate

A few weeks ago, I listened to the ‘Healing Your Gut Summit’. They interviewed StevenWright, a staunch advocate of the SCD diet. His personal story of how he healed himself of IBS incorporating the SCD was fascinating to hear. Several doctors had diagnosed him with IBS.  He tried over the counter pills, high fiber, and different diets. His introductory diet experience with the Specific Carbohydrate Diet was successful and he saw results really fast. It took him 3 months to get through all the phases.

He gave lots of amazingly helpful tips but, above all, these were the gems that I went away with that I’d like to share with you today:

  • Learn to cook – just a little
  • Use fresh ingredients
  • You don’t need to say its a DIET – say its a lifestyle change
  • change your mind set – its not really restriction
  • look for curiosity
  • make subtle shifts in perspective

Here are some very beneficial support material that Steve has to offer:
SCD Lifestyle Free Quick Start Guide
SCD Lifestyle eBook
SCD Lifestyle Meal Plans