Weighty Issues Part 2 – FODMAP
This is the second entry in a multi-part series I am writing about my experience with weight loss and diet/digestion tweaks. Please refer to Part 1 of the series at http://morethanpkd.com/weighty-issues/. At the end of the last entry I was embarking upon a FODMAP elimination diet with subsequent reintroduction of individual FODMAP items to establish which groups cause my Irritable Bowel Syndrome (IBS) symptoms and interrupt my triathlon training/racing. I have since completed the period of eliminating all FODMAPs and establishing a clean baseline diet, and all the reintroduction phases so here’s a run down on how it all went….
FODMAP stands for “Fermentable, Oligo-, Di-, Mono-saccharides And Polyols“; short chain carbohydrates and alcohols that are poorly absorbed by the small intestine. FODMAP sensitivity was discovered/defined by IBS studies at Monash University. Sensitivity to high FODMAP foods can cause bloating and gas, fluid retention, weight gain/inability to lose weight, constipation and/or diarrhea as well as antagonising a host of auto-immune responses. I personally experience reflux, indigestion, bloating, gas, fluid retention, nausea, digestive cramps and irritation, constipation and/or diarrhea after ingesting certain high FODMAP foods.
I undertook the FODMAP elimination and reintroduction under the supervision of Chantelle Wardini, Sports Dietician, from Bites Health Clinic. My diet during the elimination phase consisted ONLY of set portions of rice, fish and/or tofu, oranges, banana, strawberries and nuts in limited quantities, calcium fortified rice and/or almond milk, and veggies from the low FODMAP list. This was supplemented, according to my training needs, with small quantities of low fructose, gluten free sports gels, RW Garcia ‘blue’ maize chips, low FODMAP vegetable baby food squeezy packs and rice crackers. After much experimentation I found caffeine free Gu gels were the easiest brand for me to digest.
A typical baseline day (without training/racing supplementation) looked like:
Meal 1: 1 cup boiled rice with 1/2 cup almond or rice milk plus 1/2 cup orange
Meal 2: 15grams mixed nuts, 2 cups salad, 1 hard boiled egg or serve of protein powder
Meal 3: 2/3 cup rice, 2 cups salad, 80grams fish/tofu
Meal 4: 1 Hard boiled egg and 2 cups lettuce
Meal 5: 1/3 cup rice, 90grams fish/tofu, 2 cups salad/veggies
Optional Meal 6: 1/2 cup frozen banana ‘ice cream’ plus 1/2 cup strawberries
In my first week of this baseline elimination I lost almost 3kg and my body pretty instantly transformed. No one loses fat that fast so it was clearly water weight and this assumption is further supported by the visual evidence of a reduction in bloat and water retention. High FODMAP foods were definitely causing me to retain fluid. On the baseline diet I pretty immediately started to look and feel lean, strong and healthy again!
After 3 weeks of establishing this low FODMAP baseline I kicked off the reintroduction phase starting with my first FODMAP group; Fructose. Normally the first FODMAP food group reintroduced is Lactose but Chantelle allowed me to skip this one as I had already known, for quite some time, that I am most certainly Lactose Intolerant! In order to test Fructose I ate the baseline diet but with the addition of half a mango or 2 teaspoons of honey per day, for 7 days, whilst keeping a daily record of my IBS symptoms (what and how bad), bowel opening frequency (nothing is sacred with FODMAP screening) and bowel type judged by the ‘Bristol Stool Chart’ shown below (Type 3 and 4 are the ideal style of poop apparently! LOL!).
I mildly reacted to the honey on Day 1, fared a little better with mango on Day 2 but it all went to shit (literally) over Days 3-6 with either food. Given that mango and honey are both right up there on my list of ‘I like’ foods I was pretty despondent at this result but thankfully Chantelle assured me that there is generally a way around Fructose Malabsorption and that is to pair the ingestion of Fructose with the ingestion of Glucose. Fructose is a rapidly fermentable sugar normally absorbed into the wall of the small intestine, but in the case of people who suffer from Malabsorption, our bodies require Glucose to be present in equal amounts in order for the Fructose to be properly absorbed. In the absence of Glucose, Fructose continues down to our large intestine where bacteria cause it to ferment and release gases that cause IBS symptoms. Mango and honey are used as the Fructose test foods because they contain high levels of Fructose versus Glucose and hence are high in the ‘Fermentable’ list of FODMAP foods. Not all fruits are high in Fructose nor have a Fructose/Glucose imbalance so I can eat some fruits just fine and others in strict moderation and/or paired with extra additional Glucose to ward off any ill effects. It is believed that Fructose Malabsorption is a product of fruit having become so much more available and dominant as a food group in the typical Western diet by comparison with what our ancestors ate.
After each week of reintroduction of a high FODMAP food, you follow that up with a week or two of returning to the baseline low FODMAP diet to settle things back down again. My next test group was Fructans (polymers/chains of Fructose molecules), which are found in wheat, garlic, onion and some other vegetables. I was already well aware that raw and barbequed onions are not my friends (but they taste soooo good on the BBQ!) and that bread/pasta etc makes me bloat and retain water, but I assumed the latter was Gluten Intolerance. Well, it turns out that I am not actually Coeliac but I have Gastritis and am most certainly sensitive to Fructans, which are present everywhere that wheat/gluten is anyway (including in oats sadly). You would think that it’s impossible that someone who grew up on Italian food could possibly not know they suffer from adverse reactions to garlic and onions but I am living proof of having been completely unaware until testing one clove of garlic daily on top of my baseline diet. In my defence, FODMAP sensitivity does often build up slowly over time before becoming really noticeable/problematic but there was no denying the oh so pleasant garlic burps, reflux, nausea, irritation and flatulence I enjoyed after adding the prescribed clove to my cooking this time around! Again I was despondent because what is food without the flavour enhancement of garlic and onion? Sadly, there is no real antidote to Fructan Malabsorption so my only solution is to avoid/limit these foods especially around training/competing. Chantelle has thankfully armed me with a list of foods high in Fructans, which I have pretty much memorised by now. On the upside, this has prompted me to find some good alternative herbs and spices for flavour and to seek new restaurants when eating out. Lucky I’m also used to reading ingredient labels in detail!
Next up on the FODMAP list was Mannitols; a sugar alcohol commonly found in fruits and vegetables, particularly mushrooms, and as an artificial sweetener in some chewing gums, protein supplements/bars/powders, mints and medications. Mushrooms were my test food and again, BAM!, I reacted on Day 1 and then for the next 6 days. I wasn’t particularly surprised by this because cauliflower is high in Mannitol and has always given me gas, pain and a dodgy tummy. Again, there is no antidote to ‘fun’ with Mannitol so it’s just a matter of avoid it or suffer the consequences.
Galactans were also no surprise to me as being a problem. They’re the ‘windy’ FODMAPs in legumes (lentils, chickpeas, beans etc) and cruciferous vegetables such as cabbage and brussel sprouts. People who have issues with digesting Galactans and Fructans lack a particular intestinal enzyme that would otherwise break these foods down. What has been described as a pleasurable ‘fart attack’ for some, becomes a problem for those who suffer from IBS as the gas gets trapped in our bowels resulting in very painful distension (bloat), constipation and/or diarrhea. Imagine feeling like your guts are going to explode and then you’ll have some idea of what this feels like. Not cool! I really enjoy the taste of lentils and mexican style beans, and have found that I can tolerate very small portions of these foods, but I’ll reserve that ‘indulgence’ for rare ‘special’ occasions and certainly never close to training peaks or competition.
Last up was the Polyol called Sorbitol, another sugar alcohol that you’ll probably recognise from packets of gum, protein supplements, mints and medications but which is also commonly found concentrated in dried fruits. Dried Apricots were the test food here and I hadn’t observed any ill effects previously but I was already very well aware that Xylitol, another Polyol, is a major ‘no go’ for me. The first two days of adding in a few dried apricots was fine but by Day 4 I was in serious anguish and had to contact Chantelle for a ‘treatment’. She advised me that peppermint tea or ginger might help with the pain, bloat, flatulence, constipation and water retention. Thankfully multiple cups of tea finally did the trick and I was saved from the outcomes (or lack thereof, if you get my drift) of The Apricot Challenge. I love the occasional really ripe fresh apricot so no doubt during their annual season I might sneak in one or two but I will not miss the dried version at all. If the FODMAP elimination/reintroduction process is good for anything it’s certainly good for putting you right off the foods that do not agree with you!
So where does all this leave me? Well, my first question to Chantelle was “But how did this happen?” – How do you go your whole life happily eating pretty much anything, with an iron stomach, only to then find your intestines eventually staging a revolt at a seemingly random array of carbohydrates? Her answer was that there are lots of possible reasons: the cumulative effects of stress (tick that box), over exposure, how many types of bacteria we have in our bowel and what they do with what we eat (everyone has a unique combo of critters living in their bowel), the sensitivity of our bowel and surrounding muscles, how our brains receive and interpret signals from our gut, how mobile our abdominal walls are etc… My second question was to ask for full lists of the foods that fit into the groups that caused me the most problems. I then went home and wrote myself 3 lists to stick up on my fridge. They were: 1) Staple Foods (basically the baseline diet and anything else I know is fine), 2) Sometimes Foods (items that I had little reaction to, or that I’m not meant to eat often for PKD reasons, that I can occasionally add for a treat or change – I have to be careful here though because if I add serves of different problem foods too close together I can end up in the same strife as exceeding my tolerance limit for even just one problem food), 3) Never Foods (items that really just aren’t worth the suffering or that are really bad for PKD). A few weeks on I have just about committed these lists to memory and have a pretty good set of daily meal plans worked out for myself.
People now ask me “But what do you do when you go out?”. Well, I believe that everyone should always read the ingredients lists on any takeaway or packaged food they buy anyway, so that’s no biggie. And it’s not so hard to find things I can eat, being a clean eater regardless. Salads are fine without onion and with the dressing on the side. I can tolerate a little garlic and onion etc in dressings at the moment so it’s not too major, similarly with seasonings on proteins; things aren’t so bad yet that a little garlic salt is going to send me racing to the bathroom. Fish, eggs, tofu, oils/fats and rice are all fine and there’s plenty of veggies, nuts/seeds and fruits that I CAN eat without any significant issues. I guess you could describe my diet as a kind of Ovo-Vegetarian/Pescetarian/Paleo hybrid with a BIG emphasis on low FODMAP fruits and veggies. I do miss raw vegan food, even though it was always a case of digestive roulette. I always have a safe haven in most Japanese food (my all time favourite cuisine) which is interestingly rather devoid of high FODMAP ingredients anyway and if worse comes to worst there is always a pack of plastic forks and a trusty can of tuna or veg hidden in the glove box of my car for emergencies! I do sometimes get FODMAP’ed and even occasionally accidently FODMAP myself but that’s life I guess.
And is IBS/FODMAP sensitivity in any way linked to PKD and/or Endometriosis? Interestingly a lot of sufferers of both these afflictions report IBS/FODMAP issues which isn’t surprising I suppose since Endo involves the lower abdomen anyway and PKD certainly effects digestion and nutrient absorption. However, plenty of people who don’t have PKD or Endo experience IBS or are sensitive to at least one FODMAP group or another so perhaps it’s just coincidence. Overall I am glad to have answers now though as knowledge gives me the power to control my weight and appearance, how I feel, and how I perform in my daily life and beloved sports of trail running and triathlon.
© morethanpkd.com | 2015