I’m really excited for this next post because Sarah has been a huge source of information and support for me in my FODMAPs journey. Her story is so similar to mine, it’s eerie. And yet, it’s a comfort knowing there are others out there who have also been struggling without relief, been dismissed or overlooked due to vague symptoms, and been unwilling to give up in searching for dietary solutions. I’m so glad she’s agreed to share her background here.
On my honeymoon in Norfolk Island.
Hello everyone! I am Sarah, an American ex-pat who lives in sunny Perth, Western Australia and a long-time reader of Elise’s other blog, Hungry Hungry Hippie. I am also a big enthusiast of this new blog project, and I want to thank Elise for starting creating a space dedicated to providing information on following a plant-based low FODMAP diet. The Internet is filled with (often inaccurate) information about the low FODMAP diet, but there is a huge gap when it comes to those of us who like to fill up on whole plant foods. On one fructose malabsorption forum I frequent, most of the members seem to feel terrible eating vegetables and stick mainly to meats, fats and white rice. I understand how limiting your diet can get when your digestive system won’t cooperate, but I am determined to make this diet work with a plant focus!
Before I tell you a bit more about my experience with the low FODMAP diet, I want to highly encourage you to try some Elise’s recipes. There are simple and delicious. Currently, I am loving her FODMAP-free seitan. I was skeptical at first about the addition of brown rice flour (rather than the usual chickpea flour I add to my seitan, which is high in FODMAPs), but I am a convert! Though brown rice flour can be gritty, the texture of this seitan is amazing. I also highly recommend giving her granola a try. So crunchy and the perfect level of sweetness!
Before I get into the details about how the low FODMAPs diet helped me, I will give you a bit of background. For as long as I can remember, I have had digestive issues. Even when I was very little, I would suffer from fairly frequent cycles of what I would now call IBS-C. I also knew from a very young age that I was not able to tolerate sweet foods very well – even fruit! I remember telling my doctor in my very early teens that I felt like my food was fermenting in my gut. And you know what? It was! But there was no information about FODMAPs at that time. Instead, my doctor at the time (and may doctors thereafter) was rather dismissive, and chalked it up to my gender and automatically assumed I was high strung just because I was a good student. This doctor was but one among many to tell me I had IBS and to manage my stress, drink a lot of water, and exercise. All of which I already did, and none of which were apparently working.
This early experience had a big impact on me, and over time I began to think that the symptoms I was experiencing were all in my head. I even held the belief until very recently that IBS was just a diagnosis doctors give to women in a half-hearted attempt to tell them something and get them out the door. The reactions of many people close to me to my digestive distress only confirmed this belief. I was generally told that it was normal to be bloated and gassy, particularly for someone who was a vegetarian. However, I have been vegetarian for most of my life (18 years!), and I had a strong suspicion this was not about my vegetarianism. Even so, I pushed those feelings down and denied I had anything other than a ‘sensitive stomach’ for years. I continued to exercise 6 days a week, drink 3-4 litres of water a day, and ate heaps of fibre; yet still I saw very little relief. I found a lot of little things that did help, like doing yoga (I aim for at least minutes daily – I highly recommend this class), eating chia seeds and changing the ratios of soluble to insoluble fibre. However, I tried many more tricks that didn’t work at all…from supplements like slippery elm bark and HCl to warm lemon water and abdominal massaging. Even with the small changes, I could never rid myself of the bloating, pain, distension, wind, and constipation (sorry – no one ever said talking about IBS was pretty!). The worst symptom for me was actually acne. I didn’t have acne as a teen, yet the healthier my diet became, the more I started to develop acne. It was painful and scarring, and I was often told that I should clean up my diet even more or perhaps this was a sign of ‘detox’. As someone who never had an unhealthy diet and hasn’t touched meat for 18 years, I had a hard time swallowing the line that I was “detoxing”. I knew something else was going on, and now I know that my story is rather familiar among those who are helped by a low FODMAP diet.
This acne appeared 8 years ago, when I switched from vegetarian to vegan diet, and it was accompanied by an increase in some of my digestive symptoms. As so many vegans I knew described vast improvements from making the switch to a vegan diet – from weight loss to improved digestion to beautiful clear skin – I became even more puzzled about what was wrong with me. I had exactly the opposite experience, as the switch actually seem to cause additional symptoms. Resolving the cognitive dissonance was a struggle, and I convinced myself for a long time that my new diet had helped…at least slightly. However, eventually I had to admit that my ethical brain and my second brain* (i.e. my GI system) were not in agreement, and I went on a quest in an effort to find relief.
Unfortunately, I was trying to solve them all separately, but it would later turn out that they were all related! I have always been a relatively healthy eater. Even as a child, when I was given the task of picking vegetables for our dinner from the garden, I would eat half of the vegetables before they made it inside! I never really believed that the foods I loved could be causing me such grief because I ate what some might consider an ‘optimal’ diet (if there is such a thing). My diet was based mainly on vegetables, with regular consumption of healthy plant-based proteins, healthy fats, moderate consumption of grains and fruit. I saw a number of professionals about my woes, but nothing I tried seem to work.
Fast-forward to 2011 when I read about the low FODMAPs diet. I am a pretty hardcore skeptic, so my first encounters with the information were accompanied by sighs and exclamations of another food trend based on pseudo-science. However, when I saw it on Elise’s blog, my mind opened just a little bit. I had read her blog long enough to know that she suffered from many of the same GI issues as me, and I also suspected that, as a nurse, she would have looked at this information critically. So I set off to read as many journal articles as I could. When I realised that it was indeed possible that all of these healthy foods I loved so much could be the very things causing me digestive distress, I knew I had to at least try.
Late last year, I finally took the leap and consulted with a dietician who specialised in the low FODMAPs diet. I went through a 6 week elimination diet, followed by systematic introduction to each of the FODMAPs. Through this process I discovered my biggest triggers are fructose, sorbitol and fructans. This was huge, as prior to the diet I was eating apples (fructose and sorbitol), garlic and onions (fructans) daily! I also discovered that I could not eat galactans (legumes) in large amounts, and I definitely couldn’t eat them with another group – particularly fructans. This is a huge finding, considering the most common option for a vegetarian when dining out is a bean-based veggie burger on a wheat bun!
Now I know why this delicious tofu burger from The Juicy Beetroot always causes me grief! (But it’s worth it…sometimes.)
I won’t lie and say that I think eating a low FODMAP diet as a vegetarian who loves vegetables is easy. I don’t think it is. I have found through the elimination diets that some of my favourite foods (like apples) are off-limits for me, and other favourites can only be consumed in small amounts (like kale). However, I will say that it gets easier as I learn more about what I can replace old staples with and where my boundaries are with old favourites. The challenges aside, eating low FODMAP has brought me something even more important: the freedom to choose. I can choose to eat something that will cause me symptoms, or I can choose to abstain. Before, I could never seem to find a pattern, and I felt so out of control. Hummus wouldn’t bother me one day, but it would the next. I felt fine at the beginning of the day, but would always end up in pain by the end.
Like so many other IBS sufferers, I had tried eliminating so many foods over the years, but it never worked until I learned how to reduce my daily FODMAP load. After years of feeling like I was crazy, followed by years of frustration as my symptoms increased, I was finally in control. Sure, I still get frustrated when I have symptoms or when I have to make the choice between eating something I love or staying symptom free. I also have periods in which I rebel, and I throw caution to the wind because I just want to eat without so much thought and planning. However, it is not so much easier to bring myself out of those moments of frustration because I am armed with both a rational explanation and the tools to put it into use.
This post is already exceedingly long, so I will close here. If Elise will have me again, I would like to write a follow-up post. I’d like to share a few ways I have learned to cope with FODMAP restrictions. I am particularly looking forward to sharing my tips with you about travelling on a low FODMAP, plant-based diet. In a few weeks time, I will be preparing and packing for another trip to Tasmania, so it will be an opportune time to document my preparations and share with you what I’ve learned about maintaining a low FODMAP diet on the road.
Finally, I just have one closing comment to those people who laughed at a much younger me when I claimed food was fermenting in my gut: who’s laughing now?
Wedding in 2010.
* There’s some really interesting research out there on the gut-brain axis. I highly recommend this podcast episode as an introduction.
Thank you so much Sarah. Yes!! I will have you again!!
Thank you for sharing Sarah! Your story sounds very similar to mine. Being raised a vegetarian i always thought that the IBS symptoms i always felt was just something that every vegetarian felt and like you, when i turned to a diet completely free of animal products my symptoms got worse! To think that I don’t have to feel this out of control with my symptoms! I look forward to hearing your tips, especially regarding traveling. Thanks again!! People like you (and Elise!!!) who are sharing stories and making this FODMAPS info more digestible, excuse the pun;) are truly lifesavers!! And tummy tamers!
quick question. kale is problematic to you?? is it a high FODMAP food?
Posted by herenowithlove | April 23, 2012, 1:45 pmI love reading the lowFODMAPs stories. I am new to the diet (Oct 2011) and relatively new to the whole twitter, blogs, web world. I am a foodie, not vegetarian but USED to love eating tons of varied veg. Sadly I am now reduced to very few because of reactions to all FODMAPS. I am reading and experimenting with foods all the time. Thank you for all stories. The lowFODMAPS Club seems to be growing all the time.
Posted by Sandra | April 23, 2012, 3:35 pmKale doesn’t seem to be problematic for everyone, but it is for me (I still eat it a few times a week because I love it so much..I just have smaller portions than I used to). Although kale isn’t listed in the Monash booklet, I do think that kale has been tested now and has fructans/polyols according to Patsy Catsos: http://www.ibsfree.net/ibsfree_at_last/2012/04/summary-of-updates-in-second-edition.html.
Posted by saraheclement | April 23, 2012, 5:17 pmi dont seem to have issues with kale, so this surprised me too. i had kale on the elimination plan and felt fine. how do you tolerate cabbage sarah?
Posted by elise | April 24, 2012, 10:25 amI can do cabbage in moderation now that I’ve been through elimination. I usually eat it in the form of sauerkraut though, which I tolerate better. I had kale all through the elimination too, and that’s actually how I figured out it was causing me grief! I tried removing it for the remainder of the elimination and I was completely better. Unfortunately, I think I am addicted to kale because I just can’t seem to give it up :-/
Also, re: your comment on body awareness below, I think that’s a really good point! I hadn’t thought about that, but I think you’re on to something there.
Posted by saraheclement | April 24, 2012, 6:07 pminteresting…do you think if you’d done the elimination entirely without kale you’d tolerate it as well as cabbage now? i adore kale too!! moderation is so hard sometimes…
Posted by elise | April 25, 2012, 4:07 pmThank you, Sarah! I wish I had known all this when I was younger like you and Elise…. This info is helping me so much. I, too, thought it was normal to have a tummy ache every night. BTW, all the people on this blog seem to be women. Do men have FODMAPS sensitivity too? All the men I know seem to have guts of steel (either that or they don’t admit to problems….)
Posted by Nan | April 23, 2012, 7:10 pmThat’s a great question! There are some men on the fructose malabsorption yahoo group (most of whom also follow a low FODMAP diet). I actually think about this a lot, and I think it’s a combination of the two things. I think women might have more problems, and I often wonder if there’s a hormonal component (?) or if it is related to the way women’s bodies respond to stress, anxiety, etc? I am not sure. I also think that a lot of men just aren’t bothered by it. My husband seems to have a lot of the same digestive problems as me, but they don’t bother him at all and he just doesn’t think that they are abnormal. Research on people with IBS has suggested that those of us who have IBS experience the same things, digestion-wise, to those without IBS. The key difference is that we feel pain or discomfort when others do not, and I don’t think they know why that is yet. With fructose malabsorption, for instance, the breath test isn’t a great indicator of who can be helped by a diet that limits free fructose because some studies have found that people who don’t experience pain or discomfort emit just as much hydrogen and methane gas! It’s all very fascinating, but still in need of research to understand WHY it is that people with IBS feel the way they do.
Posted by saraheclement | April 23, 2012, 7:56 pmive been curious about this too. youre probably onto something with your theories sarah, but i swear its because men don’t have the same body awareness that females do.
and even if they did notice a link between their gut and the food they ate, the social norm is that guys don’t talk about it. i rarely hear a man address feeling bad after a meal but i dont think that means they never do…more that it’s not “manly” to do so.
maybe?? but maybe not??
Posted by elise | April 24, 2012, 10:21 amelise, i really think you’re right about the body awareness aspect not playing as big of role in mens lives. i mean, i can only speak from my experience but i’ve noticed that my boyfriend will eat something that doesn’t agree with his body (dairy) and not even be phased by the fact that he has to rush to the bathroom shortly after eating the particular food. i’ve never heard him question why he gets stomach aches or the runs from certain foods, he just doesn’t seemed phased by it.
for me, this is so hard to wrap my head around because i feel like my digestion can effect my entire day. will this be a good day or a bad day?
Posted by herenowithlove | April 24, 2012, 9:49 pmi know what you mean. i feel like i have a fairly high pain threshold, but sometimes my GI symptoms determine how my entire day goes…at least they used to. its much better now that im following a low fodmaps diet. unfortunately i still have constipation to deal with and this past weekend threw a wrench in my normally managed symptoms since i was out of town. i did my best to mind my fodmaps, but it doesnt help the fact that i still have ibs that flares up with new/different environments/eats. my bloating and pain was minimal thanks to my diligent meal choices, but i didnt have a BM for 6 days.
Posted by elise | April 25, 2012, 4:14 pmElise, I can relate. Sounds like my travel troubles… When I travel even miralax doesn’t work its usual miracles (it takes longer to work or I have to double up doses).
Another question – does anyone besides me have “gut sensitivity” besides the literal gut sensitivity of IBS? I rely greatly on my “gut feelings” when making choices or decisions. I have to “trust my gut” because it is usually very reliable. My instincts are good and I have learned to follow them. I know that the gut is like another brain in some ways (neurochemicals, etc.) Do others of you have this kind of gut as well? Do you think there is a link?
Another question – how many of you out there also have GERD or other reflux issues? I have major reflux issues that affect my voice (which is very terrible because I am a singer). Are IBS people likely to also have reflux problems?
Posted by Nan | April 26, 2012, 2:07 amhmmm…im not sure if i can give my gut that much credit. i definitely dont crave meat or other non-fodmaps foods. in fact, i literally want bread with hummus at all hours of the day – not a pair i do anymore. but every once in a while i have this weird sixth sense/foresight about a meal that wont react well with me. usually its a GERD inducing thing – like excess grapes or cereal with a lot of milk. those are the ones that cause the most reflux. but i also have reflux with some breads. usually more dry ones that just “sit in my stomach” and wont go down. there are other things too, but i cant think of them at the moment. but basically, the answer to your GERD question is yes. on work days its so hard for me to figure out what to do because i come home late, eat dinner late, and then have to stay upright for a certain amount of time so my food goes down. it sounds weird written out (and completely anatomically inaccurate), but im just trying to describe the way it feels.
Posted by elise | April 27, 2012, 9:24 amFantastic Sarah, thank you.
Posted by B | April 23, 2012, 7:27 pmElise, I know exactly what you mean….sometimes I feel like my digestive system is some kind of weird picky creature or finicky pet that I have to cater to!
Posted by Nan | April 27, 2012, 7:34 pmI literally teared up reading this post. I have lived so many years being frustrated with my bloating and constipation. Over the past 8 years I have read hundreds of books and been on hundreds of websitesn trying to figure out what was wrong with me. I have eliminated red meat, sugar, soda, processed foods, fried foods, and white carbs with absolutely no relief. I run 6 miles a day, lift weights 5 days a week, and drink 3 liters of water a day. After doing all of this I still have a bloated belly that looks like I’m 4 months pregnant 80% of the time and constipation on a weekly basis. It has truly taken over my life. My poor husband has to hear me complain about it all the time. I can not wait to start following the FODMAP diet!! My husband and I travel a ton with our company and I know how hard it is to eat healthy on the road. It will definitely be even more difficult eating only foods on the FODMAP diet but I am dedicated to doing it. Sarah, I would LOVE for you to write a post on traveling while following this diet. Thanks for the inspiration. I truly hope this works. Elise, thank you so much for starting this website…..I have spent the past 4 hours on here and can’t stop reading.
Posted by Tara | June 29, 2012, 3:12 pmThanks everyone for the info and comments. I have been living with IBS-C, except for the flareups that I call attacks for over 50 years, I was a colicky baby before dairy intolerances were ever known. Currently, doing two programs, BloodSugar Solution by Mark Hyman, MD and Fodmaps. Also leaky gut issues will cause heaps more intolerances, so stay away from those bad foods for you, not just for the pain, but they will create additional intolerances. I see an acupuncturist who does NAET for food issues, which helps some. It does get tiring at times to deal with all this, but it helps to know you aren’t the only one going throough it.
Posted by Laura | July 13, 2012, 12:39 pmi agree – its so nice knowing there are others facing the same issues. because at least the pain isnt exclusively your burden to carry. best of luck laura!
Posted by elise | July 13, 2012, 1:18 pmWow, reading this post and the comments is like reading about myself. I’ve just started on the FODMAPS elimination diet and have had normal BMs for 3 days now. I cannot remember the last time that happened!!! I agree with the above comment that there must be a hormonal component for women. I’ve had IBS for about 7 years now and the only time I was symptom-free was when I was pregnant! I could eat anything I wanted. (it was awesome) I’ve seen several GI docs and they all seemed stumped. I’ve discovered FODMAPS on my own and this diet has already helped me more than any of the doctors’ suggestions.
Posted by Caroline | August 4, 2012, 11:01 amhi caroline! im so glad you found this community then. isnt it nice to know youre not alone?
Posted by elise | August 6, 2012, 1:11 pmHi Sarah and Elise – I too have a relatively long history of trying to work out what was causing my tummy upsets. Visits to Dr’s and Dietitians told me nothing except I had IBS. Like many of you I turned to the internet to ‘self diagnose’ and found FODMAPS – what a revelation! Sarah your story about being able to choose what I eat really resonated with me!
Anyway…this is not my main reason for writing today. I have recently read “The China Study” by T Colin Campbell that has confronted me with compelling evidence over decades of multiple studies proving the nasty effects on our health caused by eating animal protein. I have a strong family history of breast cancer and the studies linking animal protein to breast cancer (and other cancers) has been enough to convince me to try everything to prevent it from claiming me as another victim. However this means eating a Vegan diet may be my strongest defence – not something I am familiar with, nor is it going to be an easy choice to make, when I usually cook for a meat loving family!
So again I have turned to the internet to research my shrinking choices of Vegan, FODMAP free food. I am not thrilled by the prospect of ‘cooking’ 2 sets of meals as I am very time poor, working full time but also take work home, mum. I fear I will get bored with the limited foods I am currently eating and be tempted to turn away from trying to stick to a vegan diet. If you have some vegan low FODMAP recipes please post them! If I can present delicious vegan alternatives to my family perhaps we can all benefit from being vegan!
One last thing – the possible link with hormones is an interesting one. I developed lactose intolerence when I was about 12 weeks pregnant with my third child 16 years ago, and noticed many FODMAP symptoms about 8 years ago when I was diagnosed with peri menopause at 40. Coincidence? perhaps more research is needed!
Thanks, Merridee
Posted by Merridee | September 24, 2012, 6:44 pmHi Sarah. Thanks for sharing your story. What was the name/company of the dietitian that you saw in Perth? I’ve just moved here and am looking for one who specialises in FODMAPs. Thanks, Ceri
Posted by Ceri | January 27, 2013, 9:38 pmHi Ceri
Did you manage to get any information on a specialist dietitian in Perth, as I am also looking for one,
Posted by kris_ty | February 10, 2013, 9:38 pmHi all,
Visit http://shepherdworks.com.au/ – I live in Brisbane but have booked in for a consultation via the phone (the dieticians are based in Melbourne). Sue Shepherd and her team are the ones who have pioneered the FODMAPs in Australia and I have just purchased her book (The Low FODMAP diet) which has the most up to date research and guidelines to follow.
I have found amazing results within a week of being on the diet. I have had an extremely similar experience – over 5 years of trying to discover what is making my stomach do what it does (good one day, horrible the next) and this is the first time I’ve had a noticeable improvement. I could go on forever with things I have been told I could have, what to eat/not to eat, what supplements and medication I’ve taken, etc. etc. but one main thing I can pin point straight away that I have avoided (and haven’t previously) is soy. When I was diagnosed with lactose intolerance (after the endoscopy to see if I was celiac or not – which said I wasn’t) I was having a lot of soy (and also tofu). I was told by a colleague that her son’s allergist said if you are intolerant to cows milk protein you are nearly always intolerant to soy milk protein – and in the FODMAPS book soy beans are listed as something to avoid (according to your own tolerance) which would make sense as all the other beans/legumes and things in the GOS group (onion, leek, cabbage) give me absolute grief straight away.
There are of course a lot of other things (various fruits and vegetables) that I was consuming that are banned in the elimination phase of the FODMAP. I’m not saying I’ve been cured as I know there is still a long way to go for me to be symptom free, but this is the first thing I have attempted where I have seen a noticeable improvement in the first week – it gives me hope!
Posted by Bianca | February 19, 2013, 7:43 pmHi, can anyone recommend a forum for FODMAP-ers? Thanks very much.
Posted by chilledbunny | April 7, 2013, 12:46 pmHi, can anyone recommend a good forum for FODMAP followers please? Thanks.
Posted by chilledbunny | April 7, 2013, 12:48 pmthese are good ones:
http://www.ibsfree.net/
http://www.ibsgroup.org/forums/
Posted by elise | April 8, 2013, 8:57 amMany thanks Elise.
I don’t actually have IBS, but have multiple food intolerances as well as a stricture, and find the FODMAP diet, in addition to a low residue diet, a great help. Have been following both diets for a couple of years.
I’ll have a look at the 2 forums and see if it might be helpful for me to join
Posted by chilledbunny | April 9, 2013, 6:50 amYour style is very unique in comparison to other people I have read stuff from.
I appreciate you for posting when you’ve got the opportunity, Guess I’ll just book mark this web
site.
Posted by singinglessonstoriessite.com | April 27, 2013, 8:25 pm