Irritable Bowel Syndrome is a gastrointestinal disorder that affects about 10-15% of people worldwide. Some of the most common symptoms of IBS is bloating, feelings of excess gas, diarrhea, or constipation – or a combination of both – and abdominal cramps and pain.
While scientists and researchers are still unsure of the exact causes of IBS, many believe that it is due to – or triggered by – one or more of the following:
- Hereditary; genetic pre-disposition
- Elevated stress levels
- Infections of the gastrointestinal tract
- Abdominal surgery
- Too many antibiotics – or taking antibiotics for too long
- Dramatic changes in diet
Many people suffering from IBS experience significant, prolonged discomfort – and it’s often severe enough for them to miss work and spend less time with their friends.
Suzanne Perazzini is a nutritional therapist, coach, and an IBS liberator who has suffered from digestive issues all her life. She is also the author of The Inspired Life: Low FODMAP Coaching Program and the author of two Low FODMAP cookbooks. She started her journey into the Low FODMAP lifestyle through blogging, researching, and experimenting with ways that would help her address her chronic digestive problem. Her journey led her on her mission to help other IBS sufferers learn how to manage and treat their chronic digestive problems by using the Low FODMAP diet.
How IBS is Diagnosed:
Suzanne explains that IBS is diagnosed through an “exclusion process,” – meaning that to “test positive” for IBS, you must first test negative for other types of gastrointestinal disorders such as Crohn’s Disease.
Low FODMAP Diet:
The Low FODMAP Diet has been tested and created at the Monash University in Australia. It has been scientifically proven to significantly reduce IBS symptoms through a complex, carefully designed diet and meal program.
FODMAP stands for:
- F – Fermentable
- O – Oligosaccharides
- D – Disaccharides
- M – Monosaccharides
- A – And
- P – Polyols
According to Suzanne, for people suffering from IBS, by following the FODMAP diet accurately, sufferers can expect to experience a significant reduction in their symptoms – or even be symptom-free – within as little as 1-2 weeks! She stresses the importance of strictly and carefully following the diet as designed, however, because “one wrong food can cause symptoms to return and stay for up to two days.”
Following the initial elimination period and once you are symptom-free for at least a week or two, Suzanne says it’s okay to begin to slowly reintroduce FODMAP foods into your diet to help you identify which groups trigger your symptoms.
However, Suzanne also mentions that Monash University warns that when you go on the Low FODMAP diet, since you are taking out a lot of the prebiotics from your diet – which is what regulates your gut bacterium – it is critical to get through the elimination period quickly.
What to Expect on the FODMAP Diet – From Start to Finish:
- When you begin, you focus on what you can
- By the end, you focus on the much shorter list of things you can’t
Foods Okay to Eat During the FODMAP Elimination Period:
- All meat proteins
- Fat – but be careful! Suzanne explains that some fats can be IBS irritants for some people, so eat in moderation.
- Strawberries, raspberries, oranges, pineapples, melon – in certain amounts.
- Vegetables such as zucchini, spinach, potatoes, pumpkin, sweet potatoes, kale, radishes, fennel, celery – in certain amounts.
Tips for Reintroducing FODMAPs:
- Go slow. Introduce one group at a time – except for oligosaccharides.
- Start with small portions early in the day on the first day of FODMAP reintroductions.
- If you pass the first, small-scale test – on day two, eat your normal amount within that group – again, except for the oligosaccharides group.
- If you “fail” the initial test – wait a few days to give your gut a much-needed rest and to become symptom-free before trying again.
- Test each oligosaccharide food individually and separately.
FODMAP Success & Long-Term Compliance Rate:
Suzanne explains that the compliance rate for the Low FODMAP diet – long-term – is extremely high “because the alternative is typically pain, discomfort, and time away from work and friends.”
Additional Tips for Managing IBS:
Suzanne stresses on the importance of managing your stress levels if you have Irritable Bowel Syndrome because – even with the perfect Low FODMAP diet plan figured out – high stress can cause your symptoms to flair or get worse!
Managing Stress with IBS:
If you need a few tips on how to manage your stress, consider one of these stress-relieving activities:
- Deep breathing techniques
- Muscle relaxation techniques
- Get plenty of sleep and exercise
Strands of My Life
Strands of My Life is dedicated to helping people with IBS live a more comfortable life through coaching and mentoring chronic sufferers through the complex FODMAP diet program. Founded by Suzanne Perazzini, a fellow IBS sufferer, Strands of My Life offers two cookbooks: The Low FODMAP Menus Cookbook and The Low FODMAP Snacks Cookbook for people living with chronic Irritable Bowel Syndrome. Additionally, Suzanne also offers an IBS Insider Club as well as a one-on-one six-week coaching program to help IBS sufferers learn how to effectively manage and treat their IBS symptoms through the FODMAP diet.
FREE Giveaway – Exclusively for The Low Carb Leader Podcast Listeners!
To claim your FREE Low FODMAP Diet Food Chart, visit www.strandsofmylife.com/dan
Connect with Suzanne Perazzini:
- Strands of My Life on Facebook
- Strands of My Life on Twitter
- Strands of My Life on Pinterest
- Strands of My Life on YouTube
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040 – Irritable Bowel Syndrome and the Low FODMAP Diet
Hey, guys. This is Jimmy Moore from Livin’ La Vida Low-Carb, and you’re listening to The Low Carb Leader podcast.
Hello, and welcome to The Low Carb Leader podcast. I am your host, Dan Perryman, and you have joined me for Episode 40. Today’s episode we are talking with Suzanne Perazzini. She’s going to be talking all about IBS, irritable bowel syndrome, and the FODMAP diet. She is a sufferer of IBS herself and has been treating the condition for many years. So I think you’re going to enjoy what she has to share.
First, though, I want to announce that I will be starting an Ab Challenge May 15th. You can go to Facebook, The Low Carb Leader. Click on sign up, and you will get all the information. So we had a great Tabata Challenge a couple months ago, and we’re looking forward to this Ab Challenge just in time for the summer. You may have noticed if you’re a follower of the podcast – if you’re not a follower you can hit the subscribe button, and then you will be a follower – but I have added a couple different short podcast segments, one called Hot Topics, which is just a 10-minute podcast in a Q&A format, and I hope that you enjoy that. Most recently I just added Success Stories. I just published the first one with Nora, and it’s just ordinary people like you and me telling their stories about how keto or low-carb changed their life for the better. So I really enjoyed talking with Nora, and if you want to share your story on the podcast just email me at Dan@thelowcarbleader.com.
Speaking of Facebook, I have almost 50,000 followers on the Facebook page, The Low Carb Leader, and all the followers seem to enjoy what I post. It’s really just about recipes and comedy and sometimes some serious stuff, but I really like the interaction with the Facebook fans. So check that out. I’m also on Instagram @thelowcarbleader and Twitter @Daniellperryman. So come check me out on social media.
One last thing. I’m very excited that I will be speaking at KetoCon. The topic of my presentation is how keto can transform healthcare. KetoCon is a ketogenic conference sharing science and stories of keto. It’s going to be held in Austin, Texas, September 1st through the 3rd, which is Labor Day weekend. And you should really think about coming out and checking out the conference. And if you haven’t been to Austin it’s a pretty cool city. And if you cannot attend, the conference will also be streamed so you can check it out virtually. I think it’s going to be a great conference. All right, enough announcements. I know you will enjoy the interview with Suzanne, so here we go.
Today we are speaking with nutritional therapist, coach and IBS liberator. Suffering from digestive issues all of her life, she started a blog and began researching and experimenting with ways to address her chronic digestive problems. As a result, she discovered the low FODMAP diet, which finally lifted the burden of IBS from her life. Today she is an author of the Low FODMAP Menus and Low FODMAP Snacks cookbooks and the creator of the Inspired Life Low FODMAP Coaching Program and the IBS Recipe for Success course. She now works as an online coach teaching people all over the world how to implement the low FODMAP diet and how to make the necessary lifestyle changes to support their IBS. She now lives with her Italian husband, Adriano, and 25-year-old son, Dario, who I understand is an architect now in New Zealand, in a house overlooking the Pacific Ocean. So we should all be a bit jealous. Welcome to the show, Suzanne Perazzini.
Thank you very much, Dan. That’s a wonderful introduction. My son is now 26. Just he would want that clarified, I’m sure. Anyway, thank you so much. I’m really excited to be able to talk with you about IBS and the low FODMAP diet.
We just talked and said that it’s 5 PM Sunday here, and it’s 10 AM Monday there in New Zealand.
That’s correct, yes.
Kind of take us through how you became interested in this low FODMAP. I read your bio, but it’s a very interesting story about how you suffered from irritable bowel syndrome your whole life and kind of walk us through that, if you would.
Suzanne’s Lifelong Struggle with IBS
Yes, so I have had it all my life, as you said. But when you’re younger you kind of cope with it. You get on with life, and you also don’t necessarily know that you are different from anybody else because not too many people talk about your toilet habits. So I stumbled on through life knowing that there was this uncomfortable thing always irritating the enjoyment of life. But it wasn’t until my father died about 10 years ago that it really got a lot worse. And we know that stress can either cause IBS or kick it up a notch. And so it got bad enough that I started to really Google it. I mean in the past, of course, you couldn’t Google anything, and you relied on doctors, and they were always a bit vague about what was going on with me.
So I Googled and I Googled, and eventually I came across the low FODMAP diet, and it did talk about it being a scientific diet, but it was so complicated that I just kept passing it by and trying other things. I tried the paleo diet for only three months because I pretty quickly realized that it was making me worse, and I understand now why it was making me worse. And I tried lots of different things, dairy free, gluten-free, all the classic ones that you read about on the internet. But the low FODMAP diet kept popping up over and over again. And eventually I stopped and looked at it, and it was my diet. There were all the symptoms. It described me, the person they were describing with the symptoms. So I had to do something about it. And it talked about the hydrogen breath test for at least two of the FODMAP groups, which is fructose and lactose. I know overseas they can also test for sorbitol, but they didn’t offer that here. And I rang up my local doctor and spoke to a nurse and asked about the hydrogen breath test, and she had never heard of it. But she was curious enough to want to investigate it for me, and she got back a couple of days later and said that just down the road, literally down the road, was the only center in New Zealand that did the hydrogen breath test. So off I went, and I had my testing done. And I was working in the corporate world at that time, and my boss was getting pretty annoyed with me by the third time I had to go because you do it on three different days a week apart for three hours each time. So he was very understanding for the first time, less for the second. By the third time he was getting slightly annoyed. But anyway, I did the tests. The test for fructose, they give you a big sweet drink of fructose, of course, and I was as sick as a dog, and they had to put me in recovery I was so sick. So without any actual testing I knew that that was a trigger.
A week later I went back and did the lactose, and that didn’t react at all. So I knew I was home and hosed as far as lactose and the dairy was concerned. We have since found, of course, that the hydrogen breath test for fructose is inaccurate. There’s been a recent research study that has shown that, unfortunately, and also it only tests for a few of the FODMAP groups. So you still have to do the low FODMAP diet to find out about the other groups. And of course that’s what I did. I started the low FODMAP diet as best as I knew how because we’re talking about five, six years ago. And there was very little information back then.
Anyway, over time I figured out all the puzzle pieces and put them together, and I felt so much better than I had ever felt in my life. And so I knew I had an answer. At the time I had a blog that was a cooking blog, a food blog, and had been going for several years. So once I discovered the low FODMAP diet and knew it was for me, I changed that blog over to focus completely on IBS and the low FODMAP diet. And the readership just started to shoot up really fast. And I gave them recipes and information week by week. And now I’m close to a quarter of a million page views a month. Now that’s built over that time, and eventually I was getting so stressed out at my job. I worked in real estate, extremely stressful industry, and I couldn’t get rid of all of my symptoms. And I knew that stress was a factor, so I went home one day for the Christmas holidays and never went back. And I started up my business coaching the low FODMAP diet, and the rest is history.
Kind of going back to the beginning we say IBS, irritable bowel syndrome. What are the symptoms around IBS physically, emotionally? How would somebody identify in themselves if they have IBS?
IBS Symptoms and Diagnosis
IBS is a disorder that’s diagnosed – a diagnosis of exclusion. So once you’ve been tested for all sorts of other things and they find nothing, so they do colonoscopies and find no inflammation, etc., then you are diagnosed with IBS. And it’s always more or less the same symptoms of bloating, feels like excess gas, either diarrhea or constipation, or there is a third type that’s mixed. You swing between the two. You get pain from cramping. You can have a bit of nausea sometimes, although that’s more connected to you having reflux, and reflux is present in about 80% of people with IBS. They think the mechanism is the same. So those are the main symptoms, bloating, gas, either constipation or diarrhea or both, and painful cramping.
So you have to exclude everything else before they’ll diagnose you with IBS?
Unfortunately, yes, that is the only way they can do it because there is nothing physiologically wrong, nothing they can see. And that’s why in the past it was thought to be a psychological problem, and we do know that the brain plays a part in this because we’ve got a faulty connection between our brain and our gut. The messages are kind of misinterpreted, and we’ve got a hypersensitive system. But there’s nothing they see, so that you have to exclude the inflammatory bowel diseases like colitis and Crohn’s and so on, and gut infections. So they will do a range of testing, and then at the end of that if they’ve found nothing they say you have IBS and send you out the door.
Once you have IBS, or once you believe you have it, is the low FODMAP diet the answer in your mind?
The Answer to IBS
It is absolutely the answer, and it’s been scientifically proven. It was researched and created at the Monash University in Australia, and that was back in – the research studies were done in 2006, 2008, but there wasn’t another comprehensive research study until last year, 2016, which was done at the University of Michigan. So now that that has come to more or less the same conclusion, which is that 75% of people with IBS are significantly helped by the low FODMAP diet, so not until that research study came out did the medical profession really get on board. And I’ve seen an enormous change since that second research study. Now I have people referred to me by doctors. And health practitioners are saying the words, “the low FODMAP diet,” even if they don’t fully understand it because it is such a complicated diet. But at least they’re saying those words so the patient can go home and Google it and find some help.
Yeah, that sounds like it’s promising that it’s kind of hit mainstream medicine because otherwise you won’t get the referrals, and they won’t buy into it. And being in the hospital business, if it’s not mainstream it’s very difficult to have doctors embrace it.
Exactly, and that’s been the annoyance, of course, for my clients for a long time. And they all come to me complaining about the medical system. And I’m like, but if they don’t know about it and they’ve got systems in place that mean that there have to be two research studies before they take it on board, they can’t help you because they don’t know. And systems that put two research studies in place to back each other up are just sensible at the end of the day because the research studies are not always that accurate, or the parameters are not always that wide to make it a viable result.
Right, that makes sense. So what is the low FODMAP diet? Take us through that. And also, you mentioned it was very complicated at the beginning, and just comment on that as you’re talking through. Is it still very complicated? Do you need help implementing it?
Low FODMAP, Explained
It is a very complicated diet. I mean if you think about a lactose-free diet you can take out dairy and you’re done. Gluten-free, you take out wheat, barley and rye, and you’re done. FODMAPs are carbohydrate, and they’re in all fruits, all vegetables, grains, legumes, pulses. They’re in everything, of course, except protein and fat. So it’s carbohydrates are one of the three macronutrients. Protein, fat and carbohydrates. So you can’t cut them out or you would be eating like a dog [inaudible 0:14:01.3] meat and bones and fat. So it’s about eating the quantity that keeps your gut calm and the types of FODMAPs. So FODMAP stands for the F is for fermentable. The O is for oligosaccharides. The D is for disaccharides, which is your lactose and milk. M is for monosaccharides. It’s your fructose. A is for and, and P is for polyols, which are the sugar alcohols, sorbitol and mannitol. So that’s quite a mouthful, but it’s just describing the different carbohydrate groups. And the individual won’t have a problem with all of those groups. In fact, only 25% of people with IBS have a problem with lactose, 45% with fructose, etc.
So the Monash University who created the diet took all the foods containing FODMAPs and drew this line across and said above this line is high FODMAP. Below this line is low FODMAP, and you can eat those in certain amounts. So the amounts is really, really important. So for example, we can eat half a cup of zucchini. That’s low FODMAP. But a full cup could be high FODMAP. So we can’t go above the permitted amounts for the foods. That’s one of the complexities of it. And also if you were to eat two vegetables that have the same FODMAP in them together at the full permitted amounts, obviously you’re doubling that FODMAP. And again, you’re into high FODMAP territory. So that line they’ve drawn is as accurate as they can get for the average person. So it’s going to be different for everybody. But that’s where we start. We start on the elimination diet, which means we only eat the low FODMAP foods. We don’t go near the high FODMAP foods. And we presuppose you have a problem with all of the FODMAP groups, which as I mentioned you won’t have, but we have to presuppose that so you start eating on the low FODMAP foods in the correct amounts and the correct combinations, and you stay there until you are symptom free, which if you do it accurately should only be a week or two. But I emphasize the word accurately because even one wrong food and the symptoms will come back and could stay for up to two days. And then you can start again.
So during the elimination stage it’s not worth stepping off the wagon at all because it sets you back. So you go through the elimination stage, you become symptom-free, and then you start reintroducing foods to see which of the FODMAP groups trigger you. And the groups, fructose, lactose and the polyols, and you can test one food and it will tell you for the whole group, which is very handy. But the oligosaccharide you have to test them food by food. All of the oligosaccharides are reasonably indigestible, things like onions and garlic and wheat. And most of the population have a little trouble digesting it. It’s just that they don’t feel it the way that we feel it with IBS with our hypersensitive system. So those foods you make a short list of whatever you like and you think you would include in your diet and you test them separately.
Now we do have to get through this system fairly quickly to create this final diet that’s perfect for you as an individual. It will be different from my diet, different from the next person’s diet. It’s your combination of what triggers you. But we need to get through it fairly quickly because the Monash University warns us that when we go on the low FODMAP diet we are taking out a lot of the prebiotics from the diet, and the prebiotics regulate the gut bacteria. So we don’t want to go too long on that elimination stage or we could start reverting back to having symptoms because the gut bacteria are getting out of whack again. So we need to march through it. We do the elimination diet, get you symptom-free, onto the reintroduction, create that expanded diet that includes more prebiotics and that will keep you safe for life. And it is a diet for life or until they find a cure for IBS.
So Suzanne, on the elimination diet what would you be allowed to eat to start off with?
So you can eat all protein meats because obviously they’re proteins and don’t have carbohydrates. You can eat fat, but you do have to be careful because with irritable bowel syndrome it’s a little bit wider than just the FODMAPs in food. There are other got irritants like fat and fiber, alcohol, caffeine, etc. and fat is one of the things that we have to control carefully. We need as much as we can because obviously every cell in our body needs fat, but too much and it will tip the balance over into symptoms, bloating and gas. And everybody has their own fine line with that. So we can eat all proteins, fats in moderate amounts depending on your tolerance level, and then we can eat fruits like – and these are just examples – strawberries, raspberries, oranges, pineapple, melon, vegetables, zucchini, spinach, potato, pumpkin, sweet potato, kale, radishes, fennel, celery, etc. There’s a long list of them, but all of those in certain amounts like only a quarter of a stick of celery, so very small. So you might even find some lessons that don’t include it because it’s such a small amount. But it’s all about the amount. Sweet potatoes, half a cup, a potato is a full potato, and so on and so forth. So you have to work not just with the list of foods, but with the amounts as well.
So when you start this elimination diet do most of the people respond really positively, or do people still have problems and then they have to take even more stuff out?
That varies. Those with IBS with diarrhea get a really quick result, and most of my clients, if they’re following accurately, and they normally do, can get a result within a few days. And they’re just totally amazed that their diarrhea stops dead, bloating, gas, gone. It can be super quick. Those with constipation have a harder time with it, and that’s my type, unfortunately, of IBS. So we kind of have to layer a constipation diet over the top, and that’s about getting your fiber levels right. We know that too much fiber will trigger symptoms of bloating and gas in us, but we need it to form really good, consistent stools. So we build the fiber levels very gradually in the diet, and that can take a couple of weeks to really iron that out and get that right.
Now there is a percentage of people, and I’d say shooting a percentage, about 20% who do have something else going on besides the FODMAPs. They have I call it their own personal idiosyncrasies. So it could be something like nuts. They’re reacting to the salicylates in nuts, the oxalic acid in spinach is another one. Some people have a problem with eggs. And some, of course, have a problem not just with the lactose in dairy, but also with the casein, the protein part in dairy. So this is just a few examples of things that I’m looking for in my clients if their symptoms are continuing. We then have to test taking those things out until we get to the symptom-free stage.
Are these problems genetic, or are they created through somebody’s diet, or is it a combination of both? Because I find that really interesting that some would have a constipation issue, some would have diarrhea issue. I’ve heard of the casein allergies to protein, but what is the cause of it, or what does the research say around that?
So they don’t exactly know the cause yet because they don’t know the mechanisms, etc. It’s very, very early days with these studies, but there’s a list of things that we – they are suggesting, and one of them is hereditary. They know from research studies that a child or a sibling of somebody with IBS is more likely to have it than in a family without IBS. The other triggers that start it are stress, so a prolonged or deep stress can trigger it. Gut infections, of course, can trigger it. You get over the actual infection, and you’re left with IBS. It seems to be that abdominal surgery where the digestive sys—the gut, is actually touched and moved around, that that can trigger it. Too many antibiotics, or too long a period of being on antibiotics, that’s another definite trigger of it. So there’s a few things that we know can possibly trigger it, and I always ask my clients that question. And we normally get it down to one of those things there. There are other possibilities, of course. Dramatic change in diet can do it. So if you suddenly go from maybe a vegetarian diet to a paleo diet, or a vegan to a paleo, which is two extremes, then it’s possible that you could end up with IBS.
Do you see more clients that are vegan, vegetarian, paleo, or is it just across the board? Or is there a certain diet that seems to cause more of this?
Now with the other diets everybody with IBS has been through a journey, through various different health practitioners and various different diets that they’ve tried themselves. They all have a list of diets. The paleo they’ve nearly always tried, the SCD, etc. I won’t – and I know this sounds mean, but I won’t actually take on vegan clients because the one thing that doesn’t hurt us is protein in meats. But a vegetarian is fine because there are some proteins like small quantities of lentils and tofu that we can have, but they also eat cheeses and eggs, so it’s possible to put together a low FODMAP diet for a vegetarian, and I’ve had many vegetarians come through the program. Vegans, it’s just too hard to get the nutrition that they need. A lot of people come to me after the paleo diet, certainly, but I can’t put stats on any of that. No, I’m sorry.
That’s interesting. So how would a vegan approach IBS if protein and a really low-carb diet and you have to take all these foods out? It seems to me it would be very difficult for a vegan to address IBS then, right?
I think it’s almost impossible. Now having said that, I know that there is a blog out there by somebody who is a vegan on the low FODMAP diet, and that would be – and I don’t know the name of it, but that would be worth seeking out if you were a vegan, and she might know something more than me about how to put that together. Obviously they do eat lentils, which we can have small quantities of, and chickpeas, but we’re talking about like a quarter of a cup of chickpeas, very small amounts per serving. And tofu, half a – I think three quarters of a cup of tofu. So they’re not large amounts. It’s super difficult over a day to get the amount of protein that you need. But if you’re vegan, I would say Google vegan low FODMAP diet, and you’ll find her website, and she might be able to help you with that.
Yeah, that’s a great tip. So once you start the elimination diet and then you start reintroducing the foods into your diet, what is the timeline there? Does it usually take 3 to 6 months to completely figure it out, or is it longer than that or shorter?
Finding the Right Low FODMAP Diet for You
Shorter than that. My coaching program is six weeks, and it’s done and dusted in six weeks. So normally it’s about 2 to 3 weeks to get completely symptom-free and then three weeks for the reintroduction because for fructose, lactose, sorbitol mannitol, it’s really only necessary to test one food, then we can get through that fairly quickly, although we do do a half a test and a full test. We don’t go charging in because most people obviously are working and have got children and they can’t be laid flat on their back from a test. So we go in at half a dose and then a full dose. If they don’t pass at any stage we normally need a couple of days for them to come back to where they were before continuing with the testing. The only thing that takes a bit longer, and that depends on the individual lists, are the oligosaccharides, which as I mentioned have to be tested one by one. And sometimes at the end of the six weeks my clients have still got a small group of things that they can test whenever they want, but they know exactly the system of how to do it, and it’s no longer essential that they get it done quickly because they’ve already been able to add some of the high FODMAP foods back in and increase their prebiotics.
You mentioned testing. Are you talking about eating the foods and seeing what the reaction is, or is there actually testing that you do?
No, exactly what you said. So for example, if we’re testing for fructose, we test with half a cup of mango because mango is a fruit that only has fructose high in it, so you can only test with a food that has that particular FODMAP because many of the foods have more than one FODMAP in them. For example, watermelon has got three of them in it, so you never use that for a test. So you test with a half a cup of mango. You just eat it at breakfast early in the day so you can watch through the day what the reaction is, and if you pass that, the next day you try with a full cup or whatever amount you think that you would normally eat. So you test that. If you pass that, you pass fructose. That’s how the testing is done.
Oh, gotcha. You know, I’m starting to see the complexity around this because if you were doing this on your own you would have to know that mangoes only have fructose as you introduce it, and then watermelons have different – I can see why it would be very difficult to do it yourself.
Yes, it is extremely difficult to do it yourself. The Monash University has a phone app out, and everybody should have that, but in order to do the testing you really need their booklet. There is a Monash University booklet which shows the foods in graph form and shows you what FODMAPs are in them. And the app’s unable to do that. The graph form just makes the testing really simple. So I have set foods that I test every single client with for those particular FODMAP groups, yes.
You reintroduce the foods, and then you get to a point where you know the type of foods, the quantity of foods that you’re good with. And then what do you do after that?
So at the end we know what their major triggers are. So let’s say it’s lactose, so we know that we have to continue with lactose-free milk and yogurt and lower amounts of the cheeses. We know what their minor triggers are. Maybe it’s fructose. So for example with the mango you can have the half a cup but not the full cup. And we know what don’t trigger at all, and that group can then go completely back in. So we’re building [this out 0:29:39.0] as we go through those last three weeks so that by the end we know what can go back in.
The difference between like the elimination diet, you focus on what you can eat. By the end, when you know your triggers, you’re focusing on what you can’t eat, and that’s a much shorter list than what you can eat. So you then it makes life easy. You go out to eat at a restaurant and you know what you’re telling the wait staff. I can’t eat onion. I can’t eat garlic. And I can’t have anything that contains gluten, even though gluten, I just want to clarify is not our problem because it’s a protein, but the fructans is the carbohydrate in wheat, barley and rye, and we do have a problem with those, or those of us who have that as a major or minor trigger. So at the end, you know what you can’t eat, and that’s the knowledge you keep with you, and then you eat everything else. So it’s a different emphasis.
So you create these plans for people. What is the compliance rate like a year out? Do they stay on it, or do you see that people fall back?
The compliance rate is really, really high. When the alternative is pain and diarrhea or constipation, cramping, you can’t go to work, you can’t go out with your friends, the incentive is enormous to stay on this diet. It’s not like somebody trying the paleo diet and then slipping off it. They won’t have any really clear-cut symptoms. With us, as I mentioned before, one wrong food and we are right back where we were, and all of my clients at some stage fall off the wagon because they start to feel so good they kind of convince themselves that maybe there wasn’t a problem after all. It’s human nature. How can you feel so good and have all these issues? So they test it, and then they’re emailing me crying with all their symptoms again.
Well I would think the success is just probably amazing to some of your clients that have suffered from these debilitating conditions their whole life and then within six weeks they’re feeling great. That has to be an amazing feeling for your client.
How Low FODMAP Changes Lives
Most of them are just blown away at the difference. I get these incredible emails of gratitude. And I remember one farmer in England on his weekly phone call he was so excited I could hardly hear what he was saying. He was so ecstatic about the change in his life. And also a long-distance runner who used to run across deserts, and of course there’s no bushes in the desert, and he had diarrhea. He was just ecstatic, and his energy levels had gone up. He could run for hours on end without any issues. It completely changes people’s lives. People who have been housebound who are now going out. And a lady who wrote me this wonderful email about walking the dog, how she used to have to walk it up and down in front of her house so that it got some exercise but she could run back inside, and that she was going right around the block after a week, and then by the end of the program she was walking in a straight line without any thoughts at all about having to get back home. And she said the freedom that she felt, freedom from fear, was something that she would never forget. Now it just completely changes lives in a really, really dramatic way.
Yeah, that’s incredible. We briefly talked before we started the interview about emotional and physical effects on a person. And you, I read in a transcript from a podcast you were on, that you actually gave up a job at one point because of your IBS. Do you want to tell that story real quick?
Well, there’s been jobs I haven’t taken that I would have loved to have taken because the toilet was too central, and in that particular case all the other people were males. It was an architect’s office, actually. They were all males, and the toilet was central. I can’t work in a place like that when you’ve got IBS. No. And it’s a secretive affliction, very secretive. People don’t talk about it. The other one that I had that I did leave after about eight months, the toilet was all also pretty central. There were men and women there. But they could clearly see when I went and how long I was in the toilet. And there weren’t many toilets. So there would be people outside knocking as well. So I started to make sure that I held on tight until lunch time, and then I would walk all the way up to the shopping mall up the road and go to the public toilets up there. And I managed to train my body to be able to do that to go at home before I went to work, to go at the lunch time and to go once I got home again. There was a lot of pain and cramping and difficulty in between that, but that was my solution. We people with IBS find devious methods to get through life.
That’s the part of it that I don’t think people realize. And like you said, it’s kind of a secretive issue. I mean it’s not like you share that you have IBS with people. So you’re dealing with this physically, and you’re emotionally dealing with it. I’ve actually learned a lot about this today. If somebody believes that they’re experiencing this type of problem, two scenarios, they have not went to a doctor yet or they have went to a doctor and they’ve gone through all the testing. For those that have not gone to a doctor, what would be the first step?
What to do if you think you may be suffering from IBS
Well, the first step is that you have to have this diagnosed. You can’t guess by yourself. I mean people do, and they come to me without having had a diagnosis, and they’re very keen to do the diet anyway, and there is no harm in doing that because if you go onto the diet and it takes away your symptoms, we know it was IBS because if you had an inflammatory bowel disease or SIBO, small intestinal bacterial overgrowth, the diet would not take away your symptoms. So you can always try the low FODMAP diet. If it works, you’ve got IBS. But I would still suggest that you go to a medical practitioner, have everything else excluded first before making the decision that you’ve got IBS, and then you can dive into the low FODMAP diet.
If you have a diagnosis of IBS and not IBD, this is the only thing that works. There are no medications that work. Maybe one day there will be, but at the moment there aren’t. Some of them are Band-Aids, of course, Imodium for the diarrhea and MiraLAX for your constipation. But they’re not necessary once you’re on the low FODMAP diet and you’ve got the diet sorted, and in the case of the constipation side also those fiber levels sorted. You might end up having to take, say, some magnesium to help with the constipation. But that’s less of a devil than something like MiraLAX, taking that for the rest of your life. So the only solution is the diet, but you do also have to make lifestyle changes to support that diet because of how stress, lack of sleep, lack of exercise, all those things affect your IBS symptoms. You can be on a perfect low FODMAP diet, and if some stress suddenly hits you from somewhere you can get your symptoms back. So we do have to come at IBS multipronged attack to make sure that we’re covering all the bases to keep you – to get you and keep you symptom-free.
Right, so you encourage people to exercise, encourage them to get good quality sleep and manage their stress somehow. Do you recommend meditation, or do you recommend anything in particular to manage stress?
For stress in particular meditation is wonderful, but it can take quite a while to kick in. So do it, yes, but I actually teach really, really simple methods like deep breathing, which we know deep breathing, deep rhythmic breathing reverses the idea that you’ve got stress. It makes your adrenaline flow away. It calms down your heartbeat, keeps your frontal lobe open, which of course closes when you’re under stress so that your amygdala, the primitive brain can take over with the fight or flight response because whether in the past we were faced by a tiger in the pathway, or now we just sit in our chair and stress ourselves out with our own thoughts, the fight or flight response is the same, what happens in the body. And the only one of the things that happens when we’re in fight or flight response that we can control is our breathing, which normally goes fast and shallow. So if we even that out and make it deeper and rhythmic, then it fools the body into thinking there is no stress, and the other things reverse off. And deep breathing is something you can do anywhere anytime and nobody has to know you’re doing it, and you can do it throughout the day. Somebody cuts you off in traffic, start your deep breathing because we want to stop the message of stress going from our brain to our gut because as I said, there’s the faulty messaging system going on there. If the gut gets involved, we’re done for. So we’ve got to cut that message before it gets down there. And deep breathing is the quickest, easiest one that nobody can see when you’re doing it. I mean there’s other things like guided imagery, muscle relaxation. But people might see what you’re doing there, especially if you’re spacing out with your imagery [inaudible 0:39:09.4].
In our final moments what would be the one or two tips you would give somebody who is experiencing these type symptoms? What should they do?
Dedicating Yourself to the Low FODMAP Diet
The only advice I can give is go on the low FODMAP diet. People – I have a Facebook group which has got over 3000 people in it, which I only started about six months ago, and it’s too big now for me to go through everything that happens in there, but I see people all the time trying different medicines, trying lactose-free, gluten-free, all sorts of different things. You have to do the low FODMAP diet. We know what the solution is. It’s been scientifically proven. Don’t fluff around with all these other things just because the diet is complicated. You have to do it, and you have to get help for it so that you implement it accurately. A lot of people try the diet kind of half pie. They dabble in it, and then they say oh, it didn’t work for me. No, it’s not going to while you’ve still got that one food and that apple is still there, or the pear is still there, or the mango is still there. So do the low FODMAP diet. Make a decision. Dedicate yourself to getting it right with help, and you will see such an enormous difference. And you’ll stop wasting your life trying to find a solution with year after year going by still with all the same misery.
Yeah, and in six weeks you can feel much, much better. You created a special giveaway for this podcast, and if you could tell us how we can reach you because I’m sure that listeners are very interested in this and maybe some of them want to work with you. So how can they contact you?
My website is strandsofmylife. That’s strands with an S of my life.com, and if you want to get an accurate up-to-date food chart completely free, my gift to you, go to strandsofmylife.com/Dan, d-a-n for our wonderful host.
Well thank you. We will link all your resources on the show notes. And real quickly tell us about your books. What encouraged you to write two cookbooks?
Well, there is such a lack of knowledge out there, and people didn’t know how to put together tasty food. They knew how to put a piece of fish and a bit of broccoli and a potato on their plate, but if you wanted something more complex they had no idea how to go about it. So I wrote both of those a few years ago now, but I have another one out that I’m very excited about that’s about to come out. It’s with the publisher in the US at the moment. It’s not only a cookbook, but it’s also my six-week low FODMAP diet plan. So everything that I teach my clients on the one-to-one program is going to be in this book. So if you are self-motivated you can do it completely by yourself. Now that book won’t be coming out for several months yet, but I will certainly be letting the world know when it does.
If you get the free resource at strandsofmylife.com/Dan – and we’ll put the link in – they can get on your mailing list, and then when the book comes out they’ll be the first to hear about it.
Exactly. Perfect. So make sure you get onto the mailing list and you will know everything that’s happening in my world. And I put recipes out regularly. I’ve got hundreds on my website, hundreds – must be hundreds by now – videos that I’ve been doing once a week for several years, and just lots of articles and information about IBS and the low FODMAP diet. So you’ll have a lot of fun going around and around my site, gathering this information together and becoming more knowledgeable about it so you can make really good choices.
That’s so cool. So my final question, your Italian husband, do you guys eat Italian food?
Yes, we absolutely do, and I cook four times a week and he cooks three times a week. And we cook low FODMAP for dinner. He can have his high FODMAP foods for the rest of the day, but we always sit down very Italian-style, sit down at the dinner table every night and have dinner together. And it’s a low FODMAP dinner, so no garlic, no onions, and none of the things that are my major or minor triggers.
And does your son put his iPhone away when he eats with you?
Definitely not allowed to have an iPhone at the table, definitely.
That’s awesome. Well, Suzanne, thank you so much. This has been an amazing interview and very informative, and I have learned a lot about IBS and the treatment. And it sounds very hopeful that there is a solution to IBS out there. So thank you so much for sharing with us today.
Well, thank you very much, Dan. It’s been a pleasure talking to you, and the more that this knowledge about the diet can get out there, the more people can learn about it. It’s so sad that there is a solution and they don’t know.
Right. And so once again, strandsofmylife.com is the resource, and I encourage you to reach out to Suzanne because it sounds like she can help you work through your issues. So Suzanne, thank you for calling all the way from New Zealand today, and I really appreciate your time.
Thank you very much, Dan.
All right. Take care.