Fare Well - FODMAP Challenge Summer 2016

Fare Well - FODMAP Challenge Summer 2016

Katherine and Mollie, two Houston gals w/ food issues, enter the challenge phase of the low-FODMAP diet, together, like two Twinkies in a cellophane pouch.

I have come to face with my Twinkie, Mollie of Fit Fab FODMAP. We have lived parallel medical lives in Houston, Texas, and we did not even know about each other until recently, thanks to social media. One of our many similarities is that we both have had great success in managing our chronic GI pain with the low-FODMAP diet. Thankfully, we both love to cook and have found fun ways to modify recipes to fit the diet and our new lifestyle. 

This summer, we decided to embark on a FODMAP journey together...the hardest part of the low-FODMAP diet...the challenge phase. Read on for our daredevil plan.


FODMAP Challenge How To

During the challenge phase, one high-FODMAP food is reintroduced to the diet to see what the reaction is to this food item. The challenge food is typically consumed in a small portion initially and then slowly increased in size over a period of two-to-three test days out of one week. Then there is a rest of three days or until any symptoms subside. After things are back to "normal," the next food item is challenged, and so on and so forth. If a food item causes a reaction, then the food item is stopped.

Want to read more about how to challenge FODMAP foods? There is a great article on A Little Bit Yummy which is reviewed by a registered dietician, a good amount of information is provided in IBS Free at Last! (Book Fare review coming soon), and a small section with good sources of food item options and sizes is in The Complete Low-FODMAP Diet.

Cooked Up Plan by the Twinkies

Mollie and I will challenge one item a week, with one rest day between introductions of the same food. We want to be cautious and not upset our sensitive systems too radically. We will work through each category of FODMAP, testing at least one food item per category, for approximately 10 weeks. At the end of the challenge, we will reward ourselves with something awesome!

We will keep you, dear reader, informed of our progress on our respective websites. Mollie will keep you up-to-date on her amazing progress on Fit.Fab.FODMAP; check out her post to see her list of challenge foods. On Deliberate Fare, I will report my successes, symptoms (G-rated), and any funny moments. I will also report back any news from my registered dietician (RD). So, stay tuned to this post page.

Katherine's Plan of Action

Challenge

FODMAP Category - Food Item

Amount

Symptoms / Results / Notes

Week 1

Fructose - honey

1 tsp - 2 Tbsp

1 tsp - no symptoms; 2 tsp - no symptoms; did not test 1 Tbsp and 2 Tbsp as not realistic amount to be consumed in one serving. I used my Uncle Kelly's Indian Blanket Honey from North Texas, as I know how it has been sourced and it is as fresh as honey gets, folks!

Week 2

Lactose - milk

½ cup - 1 cup

½ cup - bloating immediately; gas, headache, and neck ache delayed by several hours. I used Organic Valley 1% milk. Recovery period = 5 days.

Week 3

Galactans - kidney beans

½ cup canned - ½ cup dried and cooked

½ cup - no symptoms! Tested both boxed beans and fresh beans which were cooked, frozen, and reheated (see Plain Red Beans). Also tried ½ cup dried and cooked beans with same results. So excited to have this protein source back in my life!

Week 4

Polyol/Mannitol - cauliflower

30g - 90g

30g and 60g - no symptoms! Roasted cauliflower in oven with coconut oil, salt, and pepper only. Yes! A new veggie!

Week 5

Polyol/Sorbitol - blackberry

3 - 10 berries

Time out (see The Real Deal update below)

Week 6

Fructan Bread - wheat wholewheat bread

Up to 2 slices

Tested half a plain bagel, two slices plain white bread, one slice whole wheat bread. Belly aches and not so great other stuff all the way.

Week 7

Fructan Bread - wheat pasta

⅔ cup up to 1 cup

Halt! No more gluten! (see Real Deal update below)

Week 8

Fructan Veg - garlic

¼ - 1 clove

No more testing for the remainder of the year (see Real Deal update below)

Week 9

Fructan Veg - onion

Up to ¼ onion

35g - no symptoms! Sautéed onion in grapeseed oil and served on corn tortilla.

Week 10

Make up

Week 11

Make up

Week 12

Make up

Notes: Due to my rheumatoid arthritis infusion schedule as well as the potential of random flare ups, included a few make up weeks; I like to give myself realistic goals so that I do not feel like a loser when I cannot stick to a strict schedule. Also, due to the medications that I take and my history of chronic migraine, I want to check with my RD before challenging the Fructan Fruit group (grapefruit and dried fruit); I will keep you posted on any change to that plan.

Wait. Why These Foods?

You might be wondering why I am challenging certain foods versus others. Firstly, the makers of the low-FODMAP diet urge that challenges be completed with foods that do not overlap in multiple FODMAP categories. So, although I would love to challenge watermelon, especially during a hot, Texas summer, I cannot because it is high in both Fructan and Polyol. Secondly, my RD encourages me to challenge foods which I miss from my pre-FODMAP days. For example, I really miss blackberries more than apricots, both high in Polyol, so I will challenge blackberries...maybe make a gluten-free blackberry cobbler...yum. Lastly, with the help of my rock-star RD, I have successfully challenged quite a few items over the course of a year, so I will not be re-challenging these items right now. I have already challenged lentils and garbanzo beans, the typical test foods of the Galactans group. Therefore, I will test kidney beans because they are high in Galactic and they are in a lot of southern food dishes which I am longing to make again, such as N'Awlins red beans and rice.

Goal!

The goal is to add more food items back into the diet. If my Twinkie and I each have success with one of the handful of food items, then think of the world of possibilities for us when dining out, cooking at home, and especially traveling! More food options, yes, please!

Gimme My Gold Medal!

Success should be its own reward...blah, blah, blah. I am a psychologist by training, and I know that humans are goal-oriented reward-seekers. I want my prize for crossing the finish line! I Will keep you posted on what I decide to award myself with once I make up my mind.

Update June 28, 2016: Mind made up. I love to venture out with snacks in-hand, and they often take up too much space in my handbag. Sign me up for a Longchamp Small Le Pliage Shoulder Bag in black. It can be folded into itself when not in use, has a zip closure, and is light-weight. Fill her to the brim! Wait, handbags are girls, right? I have never named one before, so not really sure. Let's try out the name Priscilla.

The Real Deal

July 5, 2016: Honestly, folks, challenging can be, well, quite challenging. It takes a lot of preparation to be sure that nothing that has been consumed before, during, or just following a challenge of a high-FODMAP item. When I first challenged milk, I had no immediate symptoms and thought I was A-OK, in the clear the rest of the evening. So, I had a slice of homemade Short and Sweet Shortcake which I had originally topped with coconut whipped cream. Unfortunately, the new brand of coconut cream that I used contained gum, which I have long suspected causes me severe stomach cramping. Well, of course, several hours later, I awoke with a jolt in the middle of the night from a big belly ache (and more)! Now I had not a clue whether the symptoms were due to the milk or the gum. Ugh! A retest was in order. I had to clear out my system, get back to "normal," and then psych myself into testing milk yet again. This time, it was hard to convince myself to try milk, because now I knew it was a 50-50 chance that I would have those awful symptoms again. I did it, finally, and found out that I do, indeed, have many not so great symptoms when consuming milk. So, there you go. I still believe gums are really not good for my gut, and those will be tested once and for all later down the road.

July 6, 2016: Friends, let me encourage you to pair challenge foods with other, low-FODMAP, safe foods. In my experience, it is hard on my sensitive stomach to eat something unusual on an empty stomach. So, for example, I have paired honey with my morning oatmeal and with polenta cakes. With milk, I poured it over a bowl of plain Cheerios.

July 22, 2016: Y'all, I had to take a time out from challenging for a bit. This is the very reason why I built into my schedule a couple of make up weeks...life sometimes throws you a curve ball...or an entire inning of curve ball after curve ball. If you've been following my Instagram or Twitter feeds, then you know that I had an Olive Episode. That's right, I ate two olives and had a major set back from those little, pitted fruits. The only thing I think of is that I am very sensitive to them when they are preserved (as most olives are), as preserved foods are migraine-triggers. No, I did not have a headache, but some migraines can be in your stomach...catch my drift? Needless to say, my coach (AKA my Mr. Wonderful) put me on the bench for a few weeks. Will report back to you as soon as I am added back to the starting line up roster.

August 3, 2016: Excited to be back in the saddle and challenging again. Had great success last week with kidney/red beans! Yahoo! For this challenge, I first tested boxed beans with the water drained and rinsed, heated and added to a plain corn tortilla. For the second day, I used my Plain Red Beans recipe, and ate the beans with a little Jasmine rice.

August 11, 2016: Had a minor set-back this week with lactose-free milk and then another set-back with cinnamon. The second of these two items really makes me more aware of my intolerance to histamine and tyramine, and I am going to start tracking that classification of food items. In addition to other inflammatory diseases, I have been diagnosed with mast cell activation disorder, and many persons with this disorder do well to avoid food items high in histamine and or tyramine. The interesting thing is that several of these foods overlap with migraine-inducing foods and others are similar to high-FODMAP GI upset foods. Go figure. No, I am not going to a strict low-histamine and low-tyramine diet at this point, as I have really had great success with a combination of my migraine-elimination and low-FODMAP diets...and honestly, removing more food category is going to leave me starving! However, keeping myself mindful of this additional group of foods will help me better assess when I am filling my food bucket too full of potentially troublesome foods. The one major change I am going to make to my diet is to go dairy-free. Let's see if that helps resolve some of my constant aches. P.S. Olives are strictly avoided for mast cell persons, so that explains that! P.P.S. My wonderful registered dietician is the one who helped me find out about the cinnamon being high in histamine and tyramine; I share this with you, friends, so that you can see how important it is to have a working relationship with a great dietician if going through food challenges and medical diets. Mary Alice Volkert, R.D., is worthy of an Olympic gold medal!

August 15, 2016: Still recovering from the cinnamon possession of 2016. Exorcism almost over. Cannot wait to challenge blackberries soon!

August 23, 2016: Decided to skip blackberries and try onion, as I was feeling really adventurous. It worked! Now I need to try it raw...but must muster more courage for that challenge.

September 26, 2016: This is why I love that I log my challenges. It's easy for me to see my progress and be happy with my journey despite the fact that I have not challenged for more than a month. Things happen...like getting a cold, having a flare up of my autoimmune disorder, and having a treatment for my RA (I do not like to challenge within a week before or after treatment as it is too risky). I am getting over an ocular flare up, and as soon as it clears, I will be back at bat wearing a clean, white jersey and a high ponytail.

October 24, 2016: After visiting with a gastroenterologist, we decided to do a two week period of adding in one serving of gluten daily before undergoing an endoscopy to assess, among other things, whether I have Celiac Disease. Scope is this week, and I am really trying my best to remain positive about what feels like a masochistic daily chore. At least it is giving me time to really test wheat! Hahaha. For now, I am resetting my goal to be finished challenging by the end of this calendar year.

November 4, 2016: We have the results from my endoscopy, and they are all pointing to at minimum a gluten intolerance and gastritis. A comprehensive blood panel should be back any day now to determine whether my issues with wheat are Celiac Disease. Either way, I have been instructed to not consume gluten again...ever...and to take it easy on my stomach with a strict low-FODMAP diet for the next several months. I am honestly OK with this verdict as my stomach really feels miserable from two solid weeks of gluten. Needless to say, testing the remainder of the items (blackberry and garlic) will just have to wait until my gut is healed after the first of the year. C'est la vie. Dr. Twinkie (AKA FitFabFODMAP Mollie) has instructed me to consume Cheerios, chicken, broth, and potatoes (our low-FODMAP version of a BRAT diet) for the next three to six days or until my stomach feels a bit better.

December 6, 2016: The comprehensive blood panel came back showing that I have indicators of and genetic markers for gluten-intolerance. The results of the panel combined with the results of the endoscopy have led my doc to ask me to keep a gluten-free lifestyle for the rest of eternity and (for the next several months) to be strict low-FODMAP. I'm working on more and more gluten-free baked goods recipes in order to keep my spirits up on this new restriction. So look forward to more and more gluten-free goodies on the website.

One really important thing I have learned from the gluten work up is that our tolerance for gluten, especially among the autoimmune community (persons with IBS, persons with Rheumatoid Arthritis, etc.), can become worse over time. It is a propensity thing that may have some environmental or biological triggers. So, one might be able to consume gluten all their life until something, for some reason, changes in their body or experience. Then gluten might just simply make them ill. Or it might develop into full blown Celiac Disease. So long story short, if you are having some troubles with wheat, barley, spelt, etc., then please do yourself a favor and have a comprehensive gluten panel performed (not just the standard blood work done at your primary care physician's office; the comprehensive panel looks at genetic markers and more and takes several days to two weeks for results). Treating gluten issues early, as in most medical issues, leads to better outcomes.

Side note. Under the guidance of my GI specialist, I started and completed a round of high-dose antibiotics to treat suspected small intestine bacterial overgrowth (SIBO), and it really seems to have helped with...some symptoms (let's leave it at that so that we can remain G-rated here). Super-excited at having some improvement!

Read about my new FODMAP Challenge 2017.

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