IBS—Free at Last!

How Long to Stay on Elimination Phase of the IBSFree Diet

Let's discuss some considerations around how long to stay on the elimination phase of a FODMAP elimination diet. The short answer is, don't stay on it any longer than you have to!

• An elimination diet is a learning diet, not meant to be a permanent restricted diet.
• The time period should be long enough for it to be apparent whether or not the low FODMAP approach will help the individual person.
• A low FODMAP diet, no matter what the duration, is not going to cure IBS, only successfully manage symptoms. So there is no particular benefit of staying on the restricted phase of the diet for any longer than necessary.
• As it is, even during the challenge process the underlying diet is selected from the foods that are suitable for the elimination phase, so it does last longer than it might seem at first.
• In order to get a balanced diet with a variety of nutrients from food, it is important to liberalize the diet as tolerated, using either food challenges as described in IBS--Free at Last! or a more cautious approach.
• Let's face it, lots of people have a limited attention span for dietary change. If we stretch the process out too long, we may lose focus, and could leave valuable information about how food affects us on the table.
• It is true that several of the clinical studies on low FODMAP diets happen to have been conducted with longish elimination phases of 6-8 weeks--that's where those numbers you read about come from, but I am not aware it has been shown that shorter elimination periods aren't effective.
• In fact, the osmotic effects of FODMAPs (pulling fluid into the gut) literally cannot take place after they have passed out of your body. "They must be present to win." So, for example, if a lactose intolerant person eats ice cream on Sunday night, has a bout or two of watery diarrhea on Monday and passes all the lactose remnants by Monday night, that lactose is gone. It cannot still be causing osmotic effects on Thursday, or 6 to 8 weeks later, for that matter.
• On the other hand, it is possible that people who tend toward constipation and have very slow transit times might still have some lactose on board for days. These may be people for whom the fermentability of FODMAPs is a bigger problem than the osmotic activity. At first it would seem that once the excess gas produced by fermentation has been passed, this effect of FODMAPs would also cease, and I have worked with many constipated patients who did feel much better withing a day or two.
• But, because FODMAPs basically feed the biomass (collection of microbes) in the gut, there could certainly be improvements that could build up over time for some people, as the biomass evolves.
• If you've been on the diet for weeks and weeks and you just aren't feeling better, staying on it longer, sadly, is not going to help. Time to try something else.
• If you are feeling better, its time to move on, using either food challenges or the more cautious approach described in IBS--Free at Last! 
• If you are working with a dietitian, he or she may be using FODMAPs in a slightly different way, with different timelines tailored to your personal medical situation. That's a good thing!

Bottom line, two to three weeks, is plenty of time in most cases to know if the FODMAP approach has worked. Re-read IBS--Free at Last! for help planning the challenge phase, and please consult a registered dietitian if you need individualized advice.

How to Talk to Your Doctor about FODMAPs

It now seems impossible to imagine that a mere 20 years ago you had to rely almost exclusively on the experience and knowledge of your personal physician for help with your medical problems. In today’s information-rich world, anyone with Internet access can personally review the latest research in medical journals, trade notes with other patients around the world, and easily find books that speak directly to the problem at hand. It is quite likely that patients like you may come across effective new therapies for your condition before your doctor does. Enter FODMAPs, the most effective nutrition therapy for IBS to come along in a long time.

Chances are, your doctor has never heard of FODMAPs (extra points for keeping up on professional reading for those who have). Hey, it’s OK to learn something new from a patient—the smartest doctors learn something new every day, and don’t try to pretend they know everything! To help your doctor save a little face, do mention FODMAPs when you make your appointment if you plan to make it a major topic of conversation at your next office visit, so he or she can do a quick bit of research before seeing you.

If your doctor asks you what the heck FODMAPs are, quote the following phrase in doctor-speak: “FODMAPs are rapidly fermentable, osmotically active carbohydrates that can cause symptoms in up to 75% of individuals with IBS. Lactose is an example of a FODMAP carbohydrate, but there are several others as well, including fructose, sugar alcohols, and certain types of dietary fiber.” Then, in a spirit of collaboration, ask your doctor for what you need:

· “Can you refer me to a dietitian for help with a low-FODMAP diet? I’d like to try it, since high fiber diet/fiber supplements/drugs didn’t help me.”

· “It helped, but there is still room for improvement. Are there any other treatments or diagnostics we could consider?”

· It didn’t help, so it would seem that dietary carbohydrate intolerance is not my problem. Can you suggest any other treatment options we haven’t tried yet?”

If you get relief from the IBSFree FODMAP elimination diet, be sure to let your health care provider know. You might inspire him or her to learn more about how FODMAPs can help other patients.                       

Registration Now Open for 2013 Workshops (RDs only)

Kate Scarlata, RD, LDN and I are so very pleased to announce the 2013 schedule for our workshop: What Every RD Needs to Know about FODMAPs. Our pilot workshop took place in 2012 in Portsmouth, NH and we've been fielding requests ever since for workshops at other locations. In 2013 we will be presenting two more workshops:

• Bridgeport, CT (at a hotel just 1 block from Amtrack transportation to/from NYC and beyond)
• Arlington Heights, IL (Chicago area)

Please click here for details and to register for one of these interactive, hands-on events! Each event is eligible for 5 CPEUs.

 

How to Talk to Your Restaurant Server or Chef about FODMAPs

 

 

© Andrey Kiselev | Dreamstime.com

It takes a minimum of 20 minutes to do a good job explaining FODMAPs to someone who has never heard of it before...you're just not going to do justice to the topic in 30 seconds with your restaurant server, no matter how hard you practice beforehand. Here are some tips for dining out that might help you get the sort of meal you are looking for:

 

• Start with those restaurants at which you are a regular customer.

• You might also have good luck with national chain restaurants; such restaurants have professional menu developers and documentation available for ingredients/allergens in each menu item.

• For a thorough discussion about your special dietary needs, make an appointment, or at least call the day before around 4 p.m., the slowest time of the day in most restaurants.

• Many restaurants are trying to cater to diners on gluten-free diets, so that is a good place to start, since a gluten-free diet automatically excludes fructan-containing grains. If you have to explain what you need in a real hurry, say “gluten-free, with no onions, garlic, sauces, or gravies.” (You and I know that gluten isn't a FODMAP but there is no need to try to explain all that to the restaurant staff, so save your breath).

• You can then go on to review the major ingredients and available substitutions in each meal. Choose simply prepared mains without sauces, since they often contain FODMAPs. Grilled steak, shrimp, or chicken is often available. Grilled or broiled fish and seafood (hold the crumbs) works well, too. FODMAP-friendly side dishes include tossed salad (hold the onions) with oil and vinegar, baked potato, french fries or plain rice (not pilaf), and simply prepared vegetables.

When mealtime arrives, relax, and enjoy your meal. Your food for an occasional restaurant meal does not have to be 100% perfect for this diet, as it would have to be for a food allergy or celiac disease. Be sure to thank your server, the cooks, and the restaurant manager for their help, and don't forget to tell your friends or give them a good review!

Boxes, Bags, Cans and FODMAPs

Oh, for the simplicity of whole foods! One glance at an orange or an onion tells you everything you need to know about what's inside. Not so for the many convenience foods that are part of our lives. When was the last time you made your own ketchup or yogurt? Many people have never served a salad dressing or spaghetti sauce that didn't come out of a bottle.

Where to begin? Well, you've got to have a look at the ingredients on the food label, and consider them one at a time. If any of them are high in FODMAPs, then that food is off limits for the elimination phase of the IBSFree diet unless or until the complete product is analyzed for FODMAPS and turns out to be low.

What are your resources for this task?

• Online, try the manufacturer's web site, your favorite large grocery store website, or my new favorite: Shopwell.com to review ingredients ahead of your shopping trip.
• The food label itself. Always double check the actual product; web sites can become out of date, and manufacturers can choose different ingredients in different regions.
• Your book, IBS--Free at Last! The book has pages and pages of label reading tips (the word "label" appears 43 times in the book, and I can't re-write the whole thing here!).

Let's use Enjoy Life Crunchy Sugar Cookies as an example. The manufacturer's web site lists the following ingredients, which you will consider one by one:

• Flour Mix (White Rice Flour, Millet Flour, Buckwheat Flour); these three flours are low in FODMAPs
• Evaporated Cane Juice; another name for sucrose--allowed as long as total sugar per serving does not get too high; two of these cookies have only 7 grams of sugar, far less than the limit of 40 grams of sugar suggested in the book
• Palm Oil; all oils are low in FODMAPs
• Brown Pure Cane Sugar; brown sugar is fine
• Natural Flavor; this one would be tricky if is was in a soup, but its a pretty safe guess there aren't any onions or garlic in a sugar cookie.
• Salt; fine
• Vanilla; fine
• Baking Soda; fine
• Sodium Acid Pyrophosphate; had to look this one up--together with the baking soda, this helps the cookies rise. Not a carbohydrate, therefore not a FODMAP. All FODMAPs are carbohydrates by definition
• Xanthan Gum; does not meet the definition of FODMAP
• Rosemary Extract; herbs and their extracts are fine

Conclusion: These cookies are allowed on the Elimination Phase of the IBSFree diet! To see products that I've reviewed and ideas for your grocery list, check out my new aStore on Amazon.com or my Pinterest boards. Enjoy your cookies!       

Click here to read a post about using the Nutrition Facts Panel to evaluate a trickier example, soy sauce.

Survive Thanksgiving Dinner on a Low-FODMAP Diet

If you are in charge of the food preparation for your Thanksgiving dinner you can manage to serve a complete meal that matches the FODMAP elimination diet. But most of us share the cooking duties with others on this holiday, so you may have to settle for doing the best you can to make lower FODMAP food choices. Here are some suggestions:

Appetizers: Cheese and rice crackers; olives, carrot, celery sticks from the veggie plate with a little dip (not the french onion dip, though), potato or tortilla chips, shrimp, scallops or water chestnuts wrapped in bacon.

Beverages: A glass of wine; a frosty beer, or a classic martini, perhaps? Skip the sweet or fruity drinks.

Main: Turkey. Yeah, no FODMAPs here. A tablespoon or two of gravy, or more if it was thickened with cornstarch or sorghum flour.

Sides: Mashed potatoes made with lactose-free milk; tiny "no thank you" portion of stuffing"; mashed squash; 1/2 cup portion of either green peas or green beans or sweet potatoes (with marshmallows if you must--OK for FODMAPs). Skip the creamed onions, cabbage salad and waldorf salad.                         

Cranberries: OK, in my family, the cranberry sauce gets a food group all its own! Cranberries themselves are low in FODMAPs. Avoid the canned cranberry products that are sweetened with high-fructose corn syrup; instead, look for Grown Right Organic canned cranberry sauce. Almost any home-made cranberry sauce or relish made with granulated sugar will be OK, too. Make my grandmother's cranberry-orange relish today and it will be ready by Thanksgiving!

Dessert: Unless you make it your self with lactose-free milk (comes out fine, by the way), don't go near the pumpkin pie, which is usually made with lactose-bomb evaporated milk. Yes, there is wheat flour in the crust, but a blueberry pie will be lower in FODMAPs than some of the alternatives. You could consider a continental style dessert of cheese and fruit (grapes, clementines, fresh pineapple?) Make some fudge or peanut brittle to share, or splurge on some fancy chocolates.

Remember, its not all about the food! Take time to cultivate non-food holiday traditions with your friends and family, too. Please leave a comment if you'd like to share a non-food holiday tradition or a low FODMAP holiday food idea. Happy Thanksgiving!

 

Diarrhea: Still a Problem?

Have you been following the FODMAP Elimination Phase yet are still experiencing diarrhea? In my book, I purposely focused very narrowly on FODMAPs. The protocol is specifically meant to help you find out whether FODMAPs are contributing to your symptoms. Although the FODMAP approach is very effective for many IBS sufferers, the fact remains that FODMAPs are far from the only cause of diarrhea. Perhaps this would be a good time to review other possible causes. As you know, my philosophy is that the causes below will NOT apply to everyone, but each one should be considered in turn to see how it might apply to you.

• Caffeine can stimulate a bowel movement. Try going "de-caf" if this is unwelcome.
• Smoking, especially the first cigarette of the morning, can trigger a bowel movement.
• Alcohol can be a GI irritant. We are talking the alcohol itself, not the beverage it is in. Try abstaining from all forms of alcohol. Or, to assess the affects of alcohol in isolation, next time you indulge try a small serving of vodka, which is essentially pure ethanol and water, and see if you notice any ill effects.
• Supplements and medications. Magnesium supplements can cause diarrhea, in fact are often used as laxatives. If you have diarrhea, don't take a magnesium supplement unless it has been prescribed by your physician for a specific reason. Discuss your prescription medications with your pharmacist to find out whether any of your medication might be contributing to your diarrhea or might contain hidden FODMAPs. For example, lactose is often used as a filler, binder, or coating on tablets. Sorbitol is often used to sweeten liquid medications. Really study your pharmacy records or medical records to see if your symptoms began soon after beginning a new medication.
• Fatty foods can cause bouts of diarrhea. Many people can tolerate a teaspoon of olive oil on salad or in cooking but not fried food or greasy meats. Try forgoing the chicken wings and barbecued ribs but don't give up the essential fatty acids in small servings of healthy fats.
• Complete lack of fiber in the diet can leave some people with "unformed" stools. Try some FODMAP-friendly forms of fiber such as oat bran, rice bran, ground flax or chia seeds. These may gel the stool into a more formed state.
• Dysbiosis--the wrong balance of microbes in your gut--may be a factor. This may be especially likely if your IBS developed after a bout of gastoentiritis or antibiotic use. Now that you've reduced the fermentable carbs in your diet, introduce a probiotic. Try one for a month. If it doesn't help, try another. Good candidates: Lp229V (Jarrow, Goodbelly or TuZen (Canada)), B. infantis (Align), LGG (Culturelle), VSL#3, or S. boulardii (Jarrow or Florastor).
• Stress and/or anxiety. "Bowels turning to water" is more than a literary phrase to describe that response to anxiety or fear that many of us have experienced. The gut-brain connection is very real. A stress management practice of some kind can help, whether it be deep breathing, yoga, meditation, prayer or whatever interests you. "Practice" is the key word, so that you will be well-prepared to calm yourself when stress inevitably comes along.
• Hormones. Discuss your symptoms with your gynecologist. It is common for women to experience bouts of diarrhea at the beginning of the menstrual period. Endometriosis can play a potential role. Hormone replacement therapy can occasionally cause diarrhea.
• Food allergies. Classic food allergies can include a GI component such as diarrhea. If you have ever had symptoms such as hives, facial or oral swelling, or shortness of breath related to a bout of diarrhea, consult an allergist for a proper evaluation.
• Food (or food chemical) sensitivities. There are a number of of types of bad reactions to food that do involve your immune system but are not considered classic food allergies. You can still experience diarrhea when eating particular foods (or food chemicals) that your immune system over-reacts to, even if you are not "allergic" to them. There is growing evidence in the scientific literature that inflammatory changes in the gut are present at the cellular level in many cases of IBS. Examples of food chemicals that one could be sensitive to are amines, salicylates, solanine, benzoates, nitrates, food dyes and more. Many of them occur naturally in food, so cannot be spotted on the food label.
• Diseases of the gastrointestinal tract. Don't diagnose yourself with IBS. Discuss your symptoms with your healthcare provider so that diseases or disorders such as ulcerative colitis, Crohn's disease, celiac disease, diverticulitis, bile salt or fat malabsorption, pancreatic enzyme deficiencies, and cancer can be ruled out.
• Oh my gosh, lets not forget parasites, either current infections or past infections that have left residual damage to the small intestine...polluted or unprotected well water, drinking water while camping or backpacking, or eating unsafe food at certain travel destinations are common sources of parasitic infection.
• Or...

I will stop here for now, but may add to this already overwhelming list as I think of more.

You just can't possible take on all these "maybes" at one time without affecting your life beyond reason, which is why I cut the project down to size to just FODMAPs in my book. Still, reviewing this list with the health care provider who knows you best might shed some new light on your symptoms if FODMAP elimination hasn't done the trick.

Constipation: A First Time for Everything

Feeling a little constipated on the Elimination Phase of the diet? This may be a rather new experience for some people following the protocol in my book or on a low FODMAP diet for the first time.

This is a good time to review basic constipation prevention measures. After all, FODMAPs isn't everything!

* Increase your water consumption. This might need extra attention if you were previously drinking a lot of coffee, fruit juice, or regular soft drinks. Your body might be missing those fluids, even if it is not missing the FODMAPs!

* Increase your activity level. Even some light walking after meals may help. Consult your physician before sharply increasing the amount or intensity of exercise.

* Eat higher fiber choices from the allowed grains and starches, such as oatmeal/porridge, oat bran, winter squash, brown rice, rice bran, quinoa, corn pasta, and potatoes with the skin.

* Try larger portions of the allowed vegetables.

* Eat regular meals. Nothing in = nothing out?

* If your doctor has advised that you use laxatives or fiber supplements, use them every day to PREVENT constipation, rather than waiting to TREAT constipation. The latter approach often leads to a viscious cycle of contipation-overtreatment-diarrhea-nothing in the pipeline-constipation. Half a dose or even a quarter of a dose daily together with a low FODMAP diet might do the trick--experiment.

* Check your supplements. Calcium supplements, especially calcium carbonate, are sometimes culprits. On the other hand, adding a magnesium supplement might help prevent constipation. Doses over 350 mg/day (for adults) may have laxative effects. Work with your health care provider to choose an appropriate dose.

* Probiotics, taken regularly, might help.

Hello FODMAPs--Nice to Meet You!

Have you been diagnosed with irritable bowel syndrome? Not sure what to eat? In the past, your doctor might have automatically recommended a high fiber diet. A high fiber diet is certainly worth a try considering fiber’s many well-known health benefits; increasing fiber intake with high fiber foods and fiber supplements can resolve some cases of IBS. However, if a high fiber diet made your symptoms worse, instead of better, it’s time to learn about FODMAPs, a promising new nutrition approach for IBS.

If you’ve never heard the term FODMAP before you are not alone! The term FODMAPs was coined by Australian researchers Susan J. Shepherd and Peter R. Gibson; they found that a low FODMAP diet helped up to 75% of their IBS patients. A low FODMAP diet avoids foods containing certain sugars and fibers capable of causing diarrhea, constipation, gas, bloating and abdominal pain in people with IBS. Examples of FODMAPs include:

• Lactose (also known as milk sugar, found in milk, yogurt and ice cream)
• Fructose (also known as fruit sugar, found in fruit, high-fructose corn syrup, honey and agave syrup)
• Sorbitol, mannitol, and other “-ol” sweeteners (found in certain fruits and vegetables as well as some types of sugar-free gums and candies)
• Fructans (a type of fiber found in wheat, onions, garlic and chicory root)
• GOS (a type of fiber found in beans, hummus and soy milk)

These five types of FODMAPs have several things in common: They can be poorly absorbed during the digestive process. They are rapidly fermented by the bacteria that live in your gut. They can alter the fluid balance in your gut. Together, these effects can lead to bouts of IBS symptoms within hours of eating a high FODMAP meal or snack. By reducing the overall dietary load of these carbohydrates, you can often reduce your troublesome GI symptoms.

Ironically, many high-FODMAP foods are otherwise healthy choices, and are often recommended by health care providers. For those who can tolerate them, high FODMAP fruits, vegetables, milk products, legumes and whole grains may be wonderful foods!  But people with IBS often have to limit their portions of these foods or suffer the consequences.

Click here for a downloadable PDF of this chart. This is not an complete list of high or low FODMAP foods, but hits many of the highlights in the diets of people with IBS.

Common high FODMAP foods or ingredients	Low FODMAP alternatives
Soy milk; cow’s or goat’s milk, yogurt, ice cream	Lactose-free cow’s milk, yogurt, ice cream; rice, coconut or almond milk
Beverages, syrups or condiments sweetened with high-fructose corn syrup, honey, agave	Beverages, syrups or condiments sweetened with granulated sugar, evaporated cane juice, brown sugar, 100% pure maple syrup
Dried fruit, fruit juice, trail mix, fruit bars	Fresh or frozen fruit
Apples, pears, stone fruits (cherries, peaches, plums/prunes, apricots, avocados, mango), watermelon, blackberries	Small portions (1/2 cup) of strawberries, blueberries, cranberries, grapes, pineapple, cantaloupe, honeydew melon, kiwi, ripe bananas, oranges, lemons, limes, grapefruit
Garlic, onions, broccoli, cauliflower, cabbage, mushrooms, sweet corn	Garlic-infused oil, chives, spinach, lettuce, fresh tomatoes, cucumber, carrots, zucchini, bell peppers, white potatoes, small portions (1/2 cup) of green beans, peas, sweet potato
Wheat, barley or rye; breads, cereals, pastas or baked goods made of wheat, barley or rye; high-fiber bars or cereals	Oats, rice, cornmeal or quinoa; breads, cereals, pastas or baked goods made of oats, rice, cornmeal or quinoa
Sugar-free candy sweetened with sorbitol, mannitol, maltitol	Small portions (1-2 ounces) of sugar-sweetened candy
Beans, baked or refried beans, hummus	Firm tofu
Pistachios, cashews	Small portions (1 handful) of other nuts, nut butters or seeds

© 2012 Patsy Catsos, www.ibsfree.net

A FODMAP elimination diet may be recommended by your doctor or dietitian. An elimination diet is a “learning diet” with a strategy and a plan; close monitoring of your symptoms will help you learn how the food you eat affects you. At the beginning, you may limit all of the FODMAPs in your diet. Soon, it will be time to reintroduce FODMAPs one type at a time. You may find that only one or two FODMAPs are responsible for most of your symptoms. In the end, most people find they can still have their favorite high-FODMAP foods in moderation. For example, if you discover high-FODMAP grains are a problem area but pizza is your favorite food, your new knowledge can help you to decide how to handle it: choose pizza with a thinner crust; have fewer pieces; use a wheat-free crust; eat less other FODMAPs at that meal, eat it less often, or go for the gusto and endure the resulting belly-ache. The ultimate goal is for each person to eat the most varied diet that he or she can tolerate, not to restrict the diet with a one-size-fits-all rules.

There are a few things you can do to get your low-FODMAP diet off to a good start:

• Consult your doctor to rule out other causes of your symptoms; celiac disease in particular should be ruled out before trying this wheat-free diet, since going wheat-free will interfere with the accuracy of future celiac testing.
• Choose a trial period when you have a little extra time for label reading and home food preparation.
• Eat mostly whole foods, simply prepared, during the low-FODMAP trial. No labels, no label reading—easy!
• If eating out, choose simply prepared foods with easily recognizable ingredients, such as grilled steak or fish, a baked potato and a green salad (hold the onions) with olive oil and balsamic vinegar.
• Get some guidance from a registered dietitian, especially if you have other health conditions that affect your diet. Word is now getting out in the health care community about FODMAPs, but some doctors and dietitians may not yet be “in the know”. Mention your interest in FODMAPs as you schedule your appointment, so that your dietitian can be well-prepared for your visit.

Don’t just learn to live with your IBS symptoms. Instead, learn about FODMAPs! Try an elimination diet, and find out if a low FODMAP diet is right for you!

Paperback Launches: IBS—Free at Last! Second Edition

I am thrilled to announce the release of IBS—Free at Last! Second Edition. Change Your Carbs, Change Your Life (2012 Pond Cove Press)!

IBS should not make you skip a beat—get your groove back!

Tired of missing the fun because of your irritable bowel syndrome (IBS)?

Confused about what to eat?

Think you’re the only one who feels miserable while eating healthy foods like fruits, vegetables, beans, and yogurt?

You are not alone. IBS affects up to 15% of teens and adults. If you have IBS, you might be missing more than a good time. Although not a hot topic around the water cooler, IBS is the second leading cause of missed work and school, after the common cold. If you could get your groove back in just a few days by trying a new kind of diet, would you do it?

High-fiber diets for IBS are old school. You deserve to have the latest information on how the foods you eat might be causing your IBS symptoms. It’s time you learned about FODMAPs!

Registered dietitian Patsy Catsos spells out a diet program to help you find your FODMAP food triggers. Thousands of readers of the first edition of IBS—Free at Last! (Pond Cove Press, 2008) were the first to benefit from her program. Now it’s your turn.

What readers are saying about IBS—Free at Last!

“IBS—Free at Last! is a must-read for anyone with IBS who thinks they have tried it all. Many books about IBS claim they are revolutionary; this one truly is life-changing.  As a registered dietitian, I have observed first-hand how reducing FODMAPs in the diet can really work to reduce IBS symptoms quickly. My well-worn copy of IBS—Free at Last! is my go-to reference for the FODMAP diet; now Ms. Catsos brings us a second edition that is even better than the original, with expanded menu ideas, travel tips and all new Frequently Asked Questions from her readers. Her practical advice and realistic approach to the FODMAP Elimination Diet is inspiring and empowering; it offers the IBS-sufferer something that is so often elusive—hope!”—Niki Strealy, R.D., L.D., Author of The Diarrhea Dietitian: Expert Advice, Practical Solutions and Strategic Nutrition

“I was just stunned—within two days on your FODMAP Elimination Diet I felt relief. I can’t believe that I’ve been miserable all these years and not one doctor asked me anything about my diet. I had every test in the book and ‘eat more fiber’ drilled into my head. I was trying to be a good patient and it was just making me worse. It’s been two months and I feel like I’ve died and gone to heaven.”—C.F.

“The book is full of great information on a new way to treat IBS through diet. It is easy to read, goes through each step of eliminating, then reintroducing, FODMAP carbohydrates, and explains the science behind it. My IBS symptoms improved dramatically after restricting FODMAPs in my diet…The book really changed my life and health!—CA Dietitian

“Your book, IBS—Free at Last, is a dream come true for my whole family!”—C.D.

Ms. Catsos translates the science of FODMAPs into practical information. This book contains your game plan for a FODMAP Elimination Diet:

* Menus

* Shopping list

* Label reading tips

* Lists of low- and high-FODMAP foods

* A few recipes to get you started

What’s New in the Second Edition?

* Updates based on the latest research

* More on coping with FODMAP intolerance and how to enjoy your favorite foods again

* Answers to over 100 of the best reader questions

*Free downloads for readers on www.IBSFree.net