Time to explain myself

On Friday, I had an appointment with Sarah, my dietitian, to discuss my low-FODMAP diet now that we know what foods trigger my irritable bowel symptoms. 

I am now at a point where I can gradually start re-introducing or increasing my intake of certain foods. And the thought of trying some of my favourites again is pretty exhilarating, which might seem a tad dramatic, but after two months without aioli, trying it again is pretty big deal. 

The point is, I can now find my 'new normal'. (Of course, I use the term 'normal' here very loosely.)

And as it turns out, the hardest thing about this new normal - because eating aioli certainly isn't difficult - has been explaining exactly what that new normal is. 

Talking about low-FODMAPs is one thing. But explaining my version of low-FODMAPs is even harder. People have been extremely supportive during my journey and it's nice to have opportunities to explain myself to those who are interested. But finding the right words is another matter entirely.

"It's changed my life", while accurate, doesn't convey enough information. But "here's a monologue on gastroenterology..." doesn't quite work either. 

  

It's a balance between having a simple explanation - so that I don't put people to sleep or, worse, put them off their dinner - and making sure that I don't shy away from the reality of my digestive problems. 

Because my reality might resonate with someone else. 

Irritable bowel syndrome (or IBS) affects about one in every six people (yes, really), which means that every person I talk to either knows someone with IBS or is struggling with it themselves. 

So, while explaining my diet might be (ok, definitely is) embarrassing, it's a conversation that might be needed. (Of course, a conversation can only get you so far - treatment of IBS should always be overseen by a doctor and / or a dietitian. See the Monash University app for more information about the low FODMAP diet.) 

Through trial and error, I've got my new normal summarised down to three sentences. Here are those three sentences explained. 

I am gluten intolerant, but I am also on a low FODMAP diet to manage the symptoms of IBS.

Irritable bowel syndrome is very common, but the symptoms and their severity can very a lot between individuals. For me, IBS means excruciating stomach pains. The low-FODMAP diet helps me to alleviate these pains and encourage normal bowel function. In fact, the low-FODMAP diet has been shown to improve symptoms in 76 percent of people with IBS. 

FODMAPs - or Fermentable Oligo-saccharides, Di-saccharides, Mono-saccharides and Polyols - are a group of sugars. For many people with IBS, some or all of these sugars are malabsorbed in the small intestine, leading to digestive discomfort. 

The low-FODMAP diet limits the intake of these sugars (the 'elimination phase'). Then, if symptoms are alleviated, the sugars are then re-introduced one by one to identify individual triggers (the 're-introduction phase'). Once these triggers are known, the diet is customised to achieve symptom control (the 'normalisation phase').  

This means that I can't digest certain foods properly (for example, apricots, milk and honey). 

FODMAPs are in a wide range of foods that fall under six broad categories. Here are some examples of foods that are high in FODMAPs.

Fructose (in excess of glucose) - honey, fruit, especially dried fruit or juice, and some vegetables 

Lactose - milk products (but not all dairy products - cheese and butter are ok)

Sorbitol - some fruit (e.g. apples, pears, blackberries, apricots, nectarines, plums), vegetables (e.g. avocado) and artificial sweetener  

Mannitol - some fruit (e.g. watermelon), vegetables (e.g. cauliflower, mushrooms, snow peas) and artificial sweetener  

Fructans - garlic, onions, wheat, rye and barley (and some other fruits and vegetables)

GOS (galacto-oli-saccharides) - legumes, such as chickpeas (and some other fruits and vegetables)

The elimination and re-introduction phases that I have been through have revealed which of these six broad categories are my triggers. 

It turns out that I malabsorb sorbitol, lactose, and fructose, especially sorbitol. Apricots are NOT my friend.  

On the plus side, I can tolerate mannitol, fructans and GOS pretty well. This means that, among other things, I do not have to live without aioli. 

Interestingly, I can absorb the sugars in gluten-containing foods (i.e. fructans) fine, which means that I am intolerant to gluten itself (the protein) rather than the FODMAPs in these foods. This confirms that my gluten intolerance is a very separate issue. 

But while I have to strictly avoid gluten, I just need to limit my intake of FODMAPs. 

Due to the potentially-damaging effects of my gluten intolerance, I have to be very strict in avoiding gluten. But that is not the case with FODMAPs - I'm not trying to cut them out entirely.

Foods that are high in FODMAPs are good for you nutritionally and eating them is not damaging. The diet is about symptom management, not exclusion. Tolerance for the different sugars can also change over time, so it's important to be continually re-testing tolerance levels to get the most enjoyment and nutritional value out of the diet.  

Mindfulness is important when it comes to managing symptoms. The effects of eating FODMAPs are cumulative, so it is important to be aware of how much of each FODMAP you are eating - even the ones that don't tend to cause you problems - and how they might interact. 

Non-dietary factors are important too - on one hand, stress and hormonal fluctuations can exacerbate symptoms. On the other hand, dietary supplements can help.  Probiotics and lactase enzymes can help enhance tolerance, and peppermint capsules can help with symptom management. 

Burger Fuel gluten-free C N cheese burger with aioli (but no onions).

So this is where my version of the low-FODMAP journey starts. 

I'll be sticking to my rice porridge, back to eating aioli sometimes, and avoiding apricots like the plague - with lots of other food groups in between. 

I'll be cutting back on lactose, except on the odd occasion (as in, I'll be eating a whole packet of lactase tablets at Christmas to enjoy our delicious family traditions). 

When I'm eating out, I won't be as strict as I have been, so some of my blog posts won't be relevant for everyone's version of the low-FODMAP journey (but I'll give you information where I can). 

Most of all, I'll be feeling my way as I go - discovering my limits and eating lots of delicious treats on the way.

I hope you'll join me on the next phase of my journey.