Supplementing a low-FODMAP diet

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OLYMPUS DIGITAL CAMERA

Some nutrients can be tricky to get enough of on the low-FODMAP diet, especially during the early elimination phase. Many people get all the nutrition they need from following a good, balanced eating plan, but it’s not a bad idea—when giving up such an array of foods, including wheat and milk—to take a balanced B vitamin supplement (a naturopath suggested a blend called “B-50” to me several years ago) and a calcium supplement. Also, most of us in northern climes can benefit from taking D-3. Finally, an age-appropriate multivitamin is a good idea. Be sure to check with your health care provider regarding supplements.

Experimenting with Reintroducing FODMAPs

Experimenting with Reintroducing FODMAPs

I keep reading that three years is too long to stay on the low-FODMAP diet, no matter how delightful it has been to feel so good. We’re urged to reintroduce some of the FODMAP sugars at two months.

So tonight my tummy is noisy, uncomfortable, and generally unhappy… but the symptoms aren’t nearly as awful as before I went on the diet. My dietician is encouraged.

On page 46 of Dr. Sue Shepherd & Dr. Peter Gibson’s The Complete Low-FODMAP Diet, they suggest “Reintroducing the FODMAPS one at a time… to determine which contribute to your symptoms and how much of each you can tolerate.”

Well, yes. Limiting my diet too strictly for too long could mean missing some vital nutrients. I didn’t feel brave enough to do this alone, and I wanted an accountability partner, so three weeks ago I contacted a licensed dietitian and started this phase of the journey.

Polyol sugars are least likely to create IBS symptoms, and reintroducing polyols via mushrooms and then dried apricots seems to have been a success. My dietitian suggested a gradual (three-day) reintroduction of each food, maybe because I’ve gone without them for so long. She said to expect some mild symptoms, but not to back off unless they become severe. I’m simply reminding my system that these substances are food.

We’ve moved on, as per the “reintroduction plan” chart on page 47 of the book, to lactose. This week’s introduction was 2% milk. Next week: ice cream (because of its higher fat content). Oh, twist my arm!

It might take months to complete the challenge plan, and we expect setbacks. I suspect I’ll flunk fructose and fructans. But it’s great to know that the strict introductory phase doesn’t have to last for life.

Low FODMAP Diet for Irritable Bowel Syndrome

Ethical Nutrients has an excellent chart on their site explaining the low-FODMAP diet for people with Irritable Bowel Syndrome. You can read the article here. It’s a great resource for those who are new to the FODMAP diet, and people who want more of the diet’s scientific background can always pick up a new fact or two.

Asafetida Facts – What is it and where do I find it?

Asafetida Facts – What is it and where do I find it?

Several CCF recipes, and many recipes on other FODMAP-related websites, call for a spice called “asafoetida” (my US spell checker wants to call it “asafetida,” so let’s go with that). Here are some asafetida facts:

  • It takes the place of onion and/or garlic surprisingly well – half a teaspoon or less can flavor a whole pot of soup or stew. It’s fantastic in chili.
  • Since it contains none of the problematic sugars found in onion or garlic, FODMAP dieters can tolerate it. Introduce it as you would any other “new food,” by monitoring your sensitivity.
  • It’s an ingredient in Worcestershire sauce. Who knew?
  • The raw powder smells VERY strong. That’s because it contains several sulfur compounds. Fortuitously, the stinkiest ones (2-butyl 1-propenyl disulfide and other disulfides, for you curious folks) are broken down by the heat of cooking. This leaves only diallyl sulfide, which is also in onions and garlic. Voila—the delicious “bite” you’ve been missing.
  • That doesn’t change the fact that in its uncooked state, the disulfides make this spice STINK. Store it double wrapped in an airtight container that you never hope to use for anything else. I use a dedicated measuring spoon, too.
  • I found it at my local food co-op. Since it’s widely used in Indian cooking (dal, lentil curries, etc.) you might also find it in a store with a good ethnic food section. It’s also available online, but when I checked around, 9 out of 10 sites were “out of stock.” Buy local if you can, even though this wasn’t produced locally. You’ll still support your small-retailing friends and neighbors.
  • It was brought to Europe by Alexander the Great, and the first recorded mention was in eighth-century-BC Babylon, so it’s been around a long, long time.
  • It’s produced by digging the soil away from the taproot of a 3-5 foot plant that’s in the same botanical family as carrots – Ferula assafoetida, of the family Apiaceae or Umbelliferae – and it’s native to Afghanistan. They gash the root and let the sap ooze out. It slowly solidifies into a dark brown blob. Maybe that (and the stench) is why one of its folk names is “devil’s dung.” The spice is also called “hing.”
  • It’s used medicinally in Thailand and India to aid digestion – and counteract flatulence – and some people believe it contains natural antivirals. But here in the “west,” we have medicines for those conditions that don’t smell so terrible … so I do not recommend using asafetida as medicine. Just enjoy its flavor—cooked—in your soup or casserole.
  • Or this tasty chili.

Here’s an entertaining article on asafetida. With pictures!

The FODMAP-friendly Vegetable List—plus Eating Out

veggies

The basic “generally allowed” list is below. First: If you’re just starting your digestive recovery, you’ll probably find it helpful to cook your vegetables pretty well. I know … there are more nutrients in raw or tender-crisp veggies. But if the food doesn’t stay long enough in your digestive tract for those nutrients to be absorbed, they do you no good. So temporarily (at least), I suggest cooking them until tender-soft (at least), not tender-crisp.

Speaking of cooked vegetables: If you’re eating out, a safe menu request is PLAIN meat, chicken, or fish—cooked in olive oil or butter, but WITHOUT the usual sprinkle of seasoned salt, which generally contains olive oil or garlic—and some white rice with butter or olive oil and herbs but NO ONION OR GARLIC—and a side of well cooked vegetables from the safe list. You’ll probably have to repeat well cooked at least twice for your server to actually hear it. This is a new concept to contemporary chefs: Why would anyone want their veggies other-than-crispy? Keep sending them back until they’re done, if you do find that this helps your tummy. Don’t be a martyr and eat things that you know will cause problems.

And carry a safe muffin into the restaurant if you have any doubts.

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Low-FODMAP First Aid for Flare-Ups and Setbacks

first aid

Low-FODMAP First Aid for Flare-Ups and Setbacks

First and foremost: Please, Please, Do Not Panic. And Do Not Despair. This is NOT your fault. I know—it’s a heartsick, incredibly lonely, what-did-I-do-to-deserve-this sensation. But TRY to relax. That’s easier said than done, but is it any easier to take from someone who has shared your frustration?  I hope so. Pray, if you are the praying kind. If you’re not, contact a friend who is, and ask for the comfort of prayer. Just knowing that somebody cares HELPS. Truly.

Some of our insides are helped to relax by a mug of warm watered wine: ½ cup red wine in a coffee mug, filled with water and microwaved, and then sweetened with a teaspoon of table sugar or a sugar-dextrose blend. Sip slowly. The Apostle Paul told his young friend Timothy, “use a little wine because of your stomach and your frequent illnesses” (I Tim. 5:23).  I wonder whether Timothy had IBS. But take just ONE mug of w.w.w. Alcohol is no friend to an irritated intestinal lining.

Next: Get out a package of chicken drumsticks (free-range and organic, if possible—I can’t promise that will make a difference, but I don’t know that it won’t). Toss them into a soup kettle and add water to cover. Also two teaspoons of salt and two tablespoons of cider vinegar. Not the super-healthy vinegar with the cloudy residue; just plain old vinegar. And if you have it on hand, a couple of tablespoons of coconut oil. Lacking that, extra-light olive oil might be nice. Fats are soothing. The vinegar and salt will help draw healing nutrients out of those nice fat marrowbones in the drumsticks, or so I’m told.

Now cook some white rice. Not the wonderfully healthy brown stuff. For the moment, you want gentle. White rice is gentle. Eat a bit now, if you’re hungry. Monitor your symptoms. What’s your “transit time”? Does it usually take 24 hours for food to go through? When will you know whether the rice is decelerating the flare-up? Knowing that will help you find your patience.

Meanwhile, do you need an Immodium or some Pepto-Bismol? Take it. Does a whole one shut down the works for days? Cut it in half. Or quarters. But relax. Please, try to relax. Give yourself some slack. This happens. You are not a failure when your IBS is acting up. Try to get some rest.

Let the soup simmer overnight. If you or your housemate can’t stand the smell of chicken boiling all night, COOK IT IN A CROCK POT IN THE GARAGE (I’ve already had one person tell me that this tip was a marriage-saver, if not a lifesaver).

When morning comes, have some more white rice if you feel like eating. Maybe warmed, with a bit of butter or almond milk and sugar. Black tea might be comforting. Just don’t brew it too strong. Take the meat off the chicken bones and put it back in the broth. Toss in some diced carrots and celery and parsley and sage. Add zucchini if you like. Now let the veggies cook until they’re MOOSH. I know, I know … tender-crisp vegetables have more food value. Dear friend, if you can’t keep that food inside you because it irritates your intestines, it does you no good. FOR NOW, cook it till it’s dead, so you can get your strength back. There will be some nutrition left if it hasn’t turned grey. When the veggies are truly soft, have some soup. With rice, if you like.

Here are some other suggestions for waiting out the flare-up.

I’ve heard that creamy peanut butter is also soothing to the intestines. Try a little, if you don’t have a peanut allergy.

You must take charge of monitoring your own sensitivities. Write down what you ate, and when, and how it affected you. You might eventually take this food log to a doctor or a dietitian. It will be an invaluable help to them … and to you. So write everything down.

Are you tempted to eat nothing but rice for a month? The patron saint (almost) of FODMAPers, Dr. Sue Shepherd, says in her wonderful book, The Complete Low-FODMAP Diet:  “Another approach is to abandon the FODMAP restriction and undertake an elimination diet, followed by a food rechallenge process. This method is time-consuming and tedious. It should be attempted only under the supervision of an allergy doctor and/or registered dietitian.”

So get professional help if the flare-up lasts. Don’t tough it out alone. Be kind to yourself. This is NOT your fault. Even if your family doctor can’t figure out what has gone wrong with your insides, the low-FODMAP diet helps about 75% of the people who try it. It helped me within a week. If you’re among the other 25%, consult a gastroenterologist, or a dietitian, or a naturopath. Meanwhile, you have a wonderful pot of chicken soup to see you through tomorrow. Most flare-ups are temporary. Wait it out. There’s a great deal of nutrition, and healing, in a good rich chicken soup.

And God bless you, my friend. You are not alone.

Piecrust-astrophes, October 2013

attitude

I’ve been baking FODMAP friendly long enough to give piecrust a try, and some Facebook friends sent helpful tips (thank you Kim, Erin, Lindsay and Bobbie! Unfortunately, your recommended flour blend and piecrust mix contain brown rice, which I can’t digest right now).

So I fired up the search engine … got out my GF cookbooks … and started experimenting. I wanted something with egg and vinegar, like my mother-in-law’s never-fail recipe. The cookbooks all suggest using a fairly starchy GF flour blend, keeping everything super-cold, and making sure sure sure not to use too much water.

King Arthur Flour’s website had a GF piecrust recipe that looked good. Besides egg and vinegar, it calls for “Instant ClearJel” (I substituted gelatin) and xanthan gum. I also substituted my own flour blend.

With some leftover chicken and veggies, I stirred up a sweet-rice-flour cream sauce and added herbs for an Experimental Chicken Pie. The filling was ambrosial; the crust was tough. Conclusion: try an even starchier flour blend.

First, another online recipe came highly recommended. The main ingredient was white rice flour, blended in a food processor until superfine. I tried filling it with a maple syrup-based pecan filling. For company.

Results: fabulous filling, but the crust was worse than ever! The filling boiled up between crust and pie pan, supergluing the crust to the pan—and it was gritty. Plainly I didn’t blend long enough. And who knows what else. My company was gracious. We scooped out the filling, doused it with chocolate ganache, and the free-eaters added vanilla ice cream. It was a great evening, but I had plenty left over.

A person can eat up just so much less-than-excellent pie in a week, which is why there is not yet a gluten-free piecrust recipe on Comfortable Comfort Foods. But I’m determined to find something that works—without gluten or brown rice flour! I think I will re-try the King Arthur recipe next week, with more potato starch in my blend.

Here’s hoping!

Reintroducing Foods

corn

Reintroducing Foods

Tummy, this is corn. Corn, this is my tummy. Please make nice.

It’s been wonderful to feel good on the FODMAP diet, but it has been tricky to share meals with my friends. Besides, when I started FODMAPing almost two years ago, I gave up quite a few other foods – anything with thick peels, woody seeds, or heavy husks.

Also, the new FODMAP book has “legalized” – in small quantities – some foods I’ve been avoiding. (Which ones? Please just buy the book. Yes, I’m serious. No, I don’t get a commission.)

So how are we supposed to reintroduce foods we’ve been avoiding? In the new book, Dr. Shepherd calls this “food challenges.” Here are some of her suggestions:

  • Test one new food at a time. For FODMAP sugars, she gives specific instructions group by group: test foods, and portion sizes, and to start with the Polyols.
  • Don’t try just a bite. Eat a normal portion. If you have a reaction, try that food again several days later, eating HALF a portion. If that still causes a reaction, avoid that group for now. “Your sensitivity to FODMAPs,” she writes, “may change over time.” Note this is for reintroducing FODMAP sugars, not suspected food allergies!!
  • Don’t change your diet in other ways while you’re trying to reintroduce foods.

Last week – just in time for the harvest! – I reintroduced fresh raw tomatoes. With peels. The verdict: stick with just one slice, for now. This week – crossing my fingers – cornmeal. It’s supposed to be FODMAP friendly. Here’s hoping!