Let’s switch gears for now and talk about something timely.  We’re approaching late winter, which is where resolutions go to die.  People change their eating habits to achieve goals such as normalizing their lipid panel, maintaining glucose control to manage/prevent diabetes or improving PCOS symptoms.  As summer approaches, other folks shift their focus to The Beach Body.  Said body should not be a seasonal effort, but rather achieved with ongoing physical activity and an overall healthful diet throughout the year give or take a few days her and there.  While I can’t really help you with the former other than offering accountability via the Healthie app (which does work, BTW!) or encouraging the addition of weight bearing exercise, I can help with the latter. 

I’m a big believer in what’s called the Non-Diet Approach.  This means that instead of being “on” a prescribed diet, you make a series of small lifestyle changes that are meant to be sustainable.  A prescribed diet could include keto (very common now and lots of people think this will help with PCOS and diabetes management), calorie-restricted, high protein, low fat, etc.  At some point, restriction gets old, and at worst, restriction can lead to disordered eating and constant longing for “forbidden” foods. If the goal is achieved, the follower has to figure out how to maintain this while incorporating old habits again.  This is not a formula for long-term success. 

Alternatively, you can make changes such as adding physical activity in manageable and regular patterns, decreasing your tastes for pitfall foods (usually sweets), balancing meals for increased satiety, and forming meal prepping habits over time.  The key phrase is “over time.”  With the help of a nutrition professional, these changes can be made and tweaked along the way to maintain sustainability.

I find that once clients understand the reasons why changes are recommended, they are more willing to implement and stick with changes. For instance, it’s one thing to hear that including all macronutrients in meals is helpful for increasing satiety and preventing blood glucose spikes, and it’s quite another to put into practice. Sometimes it’s not easy to incorporate into meals, so the client may just feel it’s enough to eat protein, fat, and carbohydrate foods throughout the day instead. However, this will not be as helpful as eating them all in the same meal or snack. Once they comprehend that the combination will help slow the rate at which the meal or snack leaves the stomach and is absorbed in the small bowel, therefore raising glucose levels at a slow and steady pace, and ultimately increasing satiety. This is win for many humans. When I see this “a-ha” moment, it is usually followed by increased rates of compliance. Every meal and snack won’t be a homerun, but many will be and clients report feeling satisfied, more energetic, and overall improvement. There is a drawing in my office that helps explain this concept and I love using it. The look on my clients’ faces once they make the connection is priceless and never gets old!

Another key to sustained results is accountability.  Food journaling by itself increases compliance rates for some. Healthie also has a section for food journaling and provides an opportunity for ongoing communication between the dietitian and client.  This is super helpful, especially in the beginning of treatment. Full disclosure, this is not helpful for everyone, and I don’t recommend continuing with food journaling if it will lead to obsession, increased stress, or negative feelings. Once anything doesn’t serve you, give it the old ‘don’t let the door hit you where the Lord split you’ with my full support.

Perhaps the Non-Diet Approach makes more sense for you.  Speaking with a nutrition professional is a good first step.

Some of you may have heard of the Low FODMAP diet already. It certainly has a funny sounding name that does nothing to explain what it really is. It’s a phased diet developed at Monash University in Australia that includes the following phases: elimination, challenge, personalization, and liberalization. The word itself is an acronym standing for Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols. That means carbohydrates and fibers (fiber is essentially a carbohydrate that we can’t digest) that ferment in the bowel and may cause some people GI discomfort.

Who is most affected by FODMAPs?

Many of the people affected by such carbohydrates are those with increased visceral sensitivity due to Irritable Bowel Syndrome (IBS) which is a functional gut condition that is not life threatening. Other folks with Irritable Bowel Disease (IBD) can also benefit from the protocol to help with comfort and recover from flares, but IBD is a medical condition that can be life threatening.

Why FODMAPs irritate the gut

Carbohydrates that fall into those categories include lactose (disaccharide), fructan and galacto-oligosaccharide, also called GOS for short (oligosaccharide), fructose (monosaccharide), and sorbitol and mannitol (both polyols).  Those carbohydrates are found in healthful foods which makes identifying food triggers surprising and frustrating at the same time. Some foods contain high concentrations of those types of carbohydrates in a typical serving.

For the disaccharide lactose, if the body doesn’t have enough lactase enzyme to break down the disaccharide into monosaccharides of galactose and glucose to be absorbed in the small bowel, the lactose travels through the small bowel intact. Once in the colon, our gut bacteria consume it and cause gas, bloating and sometimes diarrhea or constipation. If the FODMAP is a fiber or a polyol, it can travel through the gut intact and the same thing occurs. Fructose is a monosaccharide which should be easily absorbed as it’s in the most basic form of a carbohydrate. What makes this interesting is that when fructose is present in a ratio in excess of glucose, our bodies use a different, less efficient shuttle system in the absorption process which creates a bottleneck in the small bowel. Once this happens, fluids are drawn into the small bowel to dilute the load causing bloating, pain and bowel changes. Fun times.

How the phases work

High FODMAP foods are limited or avoided for about 2 weeks to test if elimination improves symptoms such as gas, bloating/cramping, diarrhea and/or constipation. Once it is determined that symptoms are actually food related, each FODMAP category is systematically reintroduced (aka challenged) using foods containing only that FODMAP type. Symptoms are tracked during this period to identify tolerance levels of each FODMAP type. Following that is personalization, which uses the information gleaned from the challenge phase. Foods are added back into the eating pattern that have not shown to cause symptoms. Once some foods have been added and enjoyed, we look to add combinations of FODMAP types, all the while finding what tips and tricks can help the client have a varied eating pattern to attain optimal health while maintaining more comfortable days than uncomfortable days.

So, there you have it! That’s the Low FODMAP diet in a nutshell. Full disclosure: it’s not a cure all and it takes effort. Due to the complexity of the diet and drawbacks of remaining in the elimination phase for too long, this process really should include a qualified Registered Dietitian for constant assessment. Apps can be helpful too, but not a replacement for professional guidance. Sometimes it is ineffective and other non-diet alternatives should be explored. If you have been diagnosed with IBS or IBD and are thinking about trying the Low FODMAP diet to increase comfort, get in touch. It sounds very complicated (it kind of is), but I can help guide you through it every step of the way and help find alternatives should it not be the best option for you.