IBS—Free at Last!

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!

 

How to Talk to your Doctor about IBS

If you’ve been suffering from gastrointestinal symptoms that interfere with your work or social life, you would be well advised to bring them to the attention of your primary care provider. You might decide to make a special appointment for this, especially if your symptoms are new, or to bring it up at your next scheduled check-up.  How can you make the most of your doctor’s appointment?

• Start with your primary care provider.
• For your own safety, do not self-diagnose. You want your provider to evaluate your symptoms using all of his or her diagnostic skills, not just note in your chart “history of IBS”.
• When you make your appointment, don’t be shy about the reason for your visit, what we call your “primary complaint”.  Your provider will put your primary complaint at the top of the list for discussion during your visit. If you aren’t sure how to communicate this to the scheduler without a lot of potty talk you could try “change in bowel habits” or “abdominal pain”; even “GI issues” is better than nothing.
• Make a list of your symptoms and bring it to your appointment. When did they start? What seems to bring them on? Review the alarm symptoms in Is it IBS so you can tell the doctor everything that he or she will need to know to plan your work-up or to make a diagnosis.
• It is perfectly OK for you to bring up the subject of a referral to a specialist. Try some of the following phrases: “Do my symptoms warrant referral to a gastroenterologist for evaluation? Why or why not?”; “I’ve been thinking I’d like to see a nutritionist for help with my IBS. Can you suggest a registered dietitian who works with GI patients?”; Depending on your insurance and local operating procedures, you may be able to self-refer to a gastroenterologist or registered dietitian, but your specialist will have more to work with if your primary care provider formally refers you and sends along your medical records.
• Be respectful of the doctor’s expertise and talk as though your two are on the same team when requesting lab tests. “I’d like to be more certain it isn’t celiac disease before I start changing my diet—how could we rule that out? I’m concerned about it because of my anemia and because it runs in the family.” This approach works better than either demanding tests or expressing worry that you might have this-or-that disease, which the doctor may dismiss as anxiety. The “rule out” idea is important in the diagnosis of IBS and your doctor will find it easy to relate to.

Even if you have suffered with gas, bloating, abdominal pain, diarrhea or constipation for years, now is the time to put these symptoms back on the examination table; many new treatment approaches have been developed in the past few years, including elimination diets, probiotics, and new medications. No one should settle for learning to live with IBS without a proper evaluation and a chance to try these new therapies.

Is it IBS?

Are you one of the many people affected by uncomfortable or debilitating symptoms such as diarrhea, constipation, gas, bloating or abdominal pain? Could it be irritable bowel syndrome (IBS)? IBS is defined as abdominal pain and discomfort with altered bowel habits in the absence of any other mechanical, inflammatory, or biochemical explanation for these symptoms.  In other words, your gastrointestinal system just doesn’t work right, even though there doesn’t seem to be an obvious reason for it.

Some day-to-day variations in your bowel habits are within the normal range. It isn’t necessary for good health to have one and only one bowel movement every single day.  Likewise, some gas production and flatulence is normal. Everyone has it! According to the National  Digestive Diseases Information Clearinghouse, many people think they have too much gas when they really have normal amounts. Most people produce about 1 to 4 pints a day and pass gas about 14 times a day. However, if you are in pain due to your bowel habits or if they interfere with your work, exercise or social life, you might have IBS. You should not diagnose yourself. If you experience symptoms suggestive of IBS, seek a thorough medical evaluation to rule out other potentially serious conditions, especially if you are experiencing any of the following:

• Passing blood from the rectum
• Fevers or night sweats
• Aching joints or inflammatory arthritis
• Anemia or other abnormal lab results
• Unplanned weight loss greater than 10 pounds
• Change in bowel habits after age 50
• Poor growth or failure to thrive (in children)
• Itchy rash
• Family history of Crohn’s disease, ulcerative colitis, celiac disease, ovarian or colon cancer
• Foul-smelling or greasy stools
• Incontinence or soiling
• Urge to move bowels waking you from sleep

Your health care provider will consider the pattern of your symptoms and compare them to established diagnostic criteria. He or she will take your medical and family history, physical examination, and test results into account. In younger patients without “alarm symptoms,” an office visit may be sufficient to diagnose IBS. In patients with alarm symptoms such as those listed above, a more extensive workup may be needed. If you are a female, especially over the age of 40, be sure that your workup includes a visit to a gynecologist. Bloating and abdominal pain are not always related to the digestive system, even if they occur between periods or after menopause; diseases and disorders of the reproductive and urinary systems should also be ruled out.

After your IBS diagnosis, you will want to begin exploring the role of diet in managing  IBS symptoms. To learn more about the FODMAP approach to diet for IBS, please explore this site, www.IBSFree.net, or read my book, IBS--Free at Last! Second Edition, Change Your Carbs, Change Your Life.

How do FODMAPs cause constipation?

Question: I can understand how FODMAPs might cause diarrhea, but how do they cause constipation?

Short answer: I don't know. Skip the rest of this post if you're not keen on rambling speculation about  FODMAPs and the gut microbiome.

Long answer:

In so-called simple constipation, as opposed to IBS, fiber/FODMAPs sometimes will actually improve symptoms. But let's talk about IBS-constipation predominant (IBS-C), which rarely responds to increasing fiber in the diet, and which we might be attempting to treat with a low FODMAP diet.

There is no final answer to the puzzling question: "how do FODMAPs cause IBS-C?" In fact, it isn't likely that food or food components cause IBS, rather there are underlying problems such as disordered immune function, dysbiosis, visceral hypersensitivity, slow or rapid transit time, etc. Still, reducing the FODMAPs in the diet can help manage symptoms.

Here are a few things to think about. The Merck Manual says "Constipation is difficult or infrequent passage of stool, hardness of stool, or a feeling of incomplete evacuation."

One way FODMAPs affect bowel function is via osmotic activity; in other words FODMAPs have the ability to attract and hold fluid in the gut. If anything, we might expect this to soften stool and perhaps cause urgent, watery diarrhea. That seems to suggest that the osmotic activity of FODMAPs is not the main problem in IBS-C, although it clearly plays a role in people with diarrhea-predominant IBS. (We can't rule out that colonic distention due to increased fluid load in the gut causes constipation through some sort of broken feedback loop in fluid balance physiology, though.)

The other way FODMAPs affect bowel function is via their rapid fermentability and how that interacts with the type, amount, and placement of the resident gut bacteria in people with IBS-C.

Every single one of us is colonized by a unique set of microbes, as unique as our fingerprints. There is some preliminary work now showing that people with IBS may tend toward different populations of microbes than people without IBS, and that people with IBS-C tend to be colonized by more methane-producing bacteria. Limiting FODMAPs in the diet changes the food supply available and affects the microbiome in unknown ways. Using probiotics or antibiotics also affects the type and amount of gut microbes, and can sometimes improve symptoms. How these observations relate to "difficult or infrequent passage of stool, hardness of stool, or a feeling of incomplete evacuation" only time will tell.

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!