For as long as I can remember, I've had "tummy troubles." Now, let's be honest. Digestive distress isn't something fun to bring up at a dinner party or on a date. If you suffer from stomach problems like me, you've probably spent most of your life trying to hide it.
As a child, I can remember waiting in the ladies room until I had to go on stage at dance recitals. High school track and field practices were interrupted by perpetual runs to the locker room. My childhood best friend knows just about every public restroom in the western (and now eastern) United States. Bless her!
While my stomach problems were always embarrassing, things became unbearable when I moved to New York City and started a "big girl" job. I had always worked, but for the first time in my life, I couldn't run to the bathroom. I had meetings, deadlines and responsibilities — and recurrent toilet timeouts were not on the schedule.
When winter arrived, the severity of my symptoms worsened. If you've ever experienced an East Coast winter, you know it's not exactly the time to be surviving on saltines and Pepto-Bismol. Marching to work in frigid weather requires stamina, and I found myself tolerating less and less food. Some days I could barely eat at all, and I'm a girl who likes her food!
As life became less tolerable, and WebMD self-diagnosis only led to neurosis, I finally sought help from a gastroenterologist. My doctor quickly diagnosed IBS, or Irritable Bowel Syndrome. The name was gross and the symptoms grosser, but sadly, they fit the bill: diarrhea, constipation, bloating, indigestion and nausea.
Say it with me, FODMAP (pronounced FAWD-MAP)
According to the National Institute of Diabetes and Digestive and Kidney Diseases, IBS affects about 10-15 percent of adults in the U.S. Of those, only five percent have received a formal diagnosis.
So, I wasn't alone. But what now?
My doctor had good and bad news. The good? IBS is increasingly treatable with dietary regulation. The bad? There really is no "cure" for the syndrome. It's all about maintenance. Sigh.
Just before the winter holiday, I visited a nutritionist. I knew I needed to change my diet, but I needed specifics. She explained that a new diet was taking the digestive world by storm (no pun intended) and it had a funny name. As I sat in her office on the verge of tears, I learned for the first time about the Low FODMAP Diet.
The Low FODMAP diet was developed by Monash University researchers in Melbourne, Australia about ten years ago. It is a relatively new way to regulate digestive distress through a three-step elimination, integration and maintenance system.
"So let's start with the term FODMAP. When we talk about what is a FODMAP, it really is a group of small-chain carbohydrates that are commonly mal-absorbed," Kate Scarlata, a registered dietitian, low FODMAP educator, author and blogger told NBC BETTER.
FODMAP stands for Fermentable, Oligo-Saccharides, Disaccharides, Mono-saccharides and Polyols. It's a lot to digest, I know. Stay with me here.
The diet is a way to regulate digestive distress through a three-step process: elimination, integration and maintenance.
Basically, FODMAPS are carbohydrates that draw water into the gut and give us those not-so-friendly tummy symptoms. The Low FODMAP diet is a three-phase diet wherein a patient eliminates "high FODMAP" foods and then slowly works them back in to determine what's bearable for the gut, and give it an all-encompassing chance to heal.
Dr. Peter Gibson led the research team at Monash University in Melbourne to develop the Low FODMAP diet. His team began testing foods to find gut-irritating commonalities. In the past, IBS had been treated to no avail. But Gibson was determined to find a way for patients to know just what their stomachs could, and mostly could not, tolerate.
"You would recognize foods were causing you a problem, but you wouldn't recognize correctly which foods cause symptoms, because we eat a lot of varied things in our diet," Dr. Gibson told BETTER. "What the diet has done is by recognizing the components in the foods, you have the power to know what you can and can't eat."
Phase 1: Elimination Implementing
The Low FODMAP Diet works in three phases.
"The initial phase is an elimination diet," says Scarlata. "That's where we remove all the high FODMAP foods from the diet. The patient will follow that for two to six weeks until they feel symptom control."
Now, this is where things get real. The list of high FODMAP foods that both my nutritionist and Scarlata suggest cutting out is a delicious mile long.
You begin by eliminating gluten, dairy, garlic, onions, soy, beans, apples, avocados, broccoli … you get the picture.
Needless to say, the elimination portion of the diet isn't pretty. But at this point, I was desperate to heal.
I was a dedicated, determined Low FODMAP soldier. I carried the lists and tools with me and stuck to my mission through demanding work schedules and holiday parties. I wouldn't even touch those buttery cookies, or indulge in more than one cocktail (another fun part of the diet.)
Full disclosure, I did not see results right away. I know now that the digestive system, like any body part in bad shape, takes time to heal. In the meantime, I lived on flavorless chicken broth, eggs and gluten free toast. But Scarlata's popular blog, and the promise of a better gut, kept me going.
The Second Phase: Reintroduction
As winter turned to spring and New Yorkers traded in puffy jackets for rain boots, so too was I stripped of my constant digestive agony.
Yes, I was eating half of the foods I was used to, and, yes, I lost some weight and nearly drove waiters mad, but it was worth it. I felt better. I felt like myself again.
I returned to the nutritionist and nearly cried again, but this time for a different reason. I felt cured.
She quickly warned me that the elimination phase, albeit successful, is not sustainable long-term. And, like she mentioned in the beginning, IBS is truly not 'curable.'
"FODMAPS are innately healthy foods," says Scarlata. "There is no reason to restrict them for 85 percent of Americans who do not have IBS or IBS Symptoms. So if you have no problem digesting broccoli, by all means, digest broccoli."
Thus, I entered the second phase of the diet, re-introduction. I slowly began eating apples, cauliflower and other "high FODMAP" foods. The re-introduction phase is tricky because every person reacts to different food in different ways. I know I'll never again eat a raw onion or have a milkshake, but for some, the Low FODMAP diet helps to reset the gut in a way that makes foods tolerable again.
So while I felt better and stronger, I realized the true gift I had received here was power. I no longer had to wonder what I could or could not eat. I slowly integrated foods that worked, and avoided others like the kiss of death (here's looking at you, garlic). I wanted nothing more but to hug my health care professionals.
Maintenance Mode: Control Stress and Digest
As I began to feel healthier, I craved more information on this whole gut-health philosophy. Unfortunately for me, there was a theme that kept resurfacing that just couldn't be ignored: Stress and digestive health are closely related.
"When [people] have a lot of emotional stress, [it] affects our gut, and if you've got bad symptoms, that's going to feed your anxiety," says Gibson. "It's a vicious circle going on."
Those daily stresses about deadlines, bills and relationships directly affect what happens in our stomachs. Both Scarlata and Gibson call this the Gut-Brain Axis.
"The gut-brain axis is very interesting, it's a bi-directional communication between the gut and the brain," says Scarlata.
What researchers have found is that the more stressed out we are, the more our symptoms ramp up.
The gut-brain axis is a bi-directional communication between the gut and the brain.
"Irritable bowel syndrome is all about gut-brain axis," says Gibson. "You can use the brain to influence the sensitivity of the gut. And we have done studies. And we are very interested in gut-directed hypnotherapy. And there is some good evidence that it works."
It turns out that an important facet of managing gut health is approaching life in a way that reduces stress, in order to ultimately ease digestive distress.
Though hypnotherapy isn't something I've been able to include in my own routine, running has provided an excellent way for me to de-stress. I also know my brain, and stomach, can't tolerate too much caffeine on those more hectic weeks. Unplugging at the end of the night also sometimes helps me to wake up feeling refreshed instead of nauseous. Once again, it's all about empowering yourself to know what works, and doesn't, for you and your symptoms.
Teach me how to FODMAP
Since I discovered the Low FODMAP Diet, my life has changed considerably. If you're asking yourself if you should try it (or reading this in the bathroom stall), here are a few FODMAP expert tips.
- DO find a health professional: "I always recommend people go on the Low FODMAP diet with a dietitian, if possible," says Gibson. From personal experience, it is much more doable when you have someone to guide you through the ins and outs of FODMAP eating.
- DO educate yourself. Scarlata runs a popular Low FODMAP blog and is the author of several books, including a new step-by-step recipe guide due out this fall. And Gibson's pioneering work is accessible through an app that dictates the various FODMAP content in foods, and helps you steer clear of the scary stuff (no more garlic bread, people.)
- DON'T be embarrassed to find a support system. When we go to restaurants now, my boyfriend backs me up by clarifying that I really CAN'T have those onions, "She's allergic!" he'll say to the waiter. We've looked at the FODMAP lists together, and my friends have them, too. Don't be embarrassed. You are not alone. "I do feel like we need to talk more about digestive health," says Scarlata. "We all poop, we all bloat, we all have diarrhea. It will only become less stigmatized if we become more open about it."
- DON'T think drinking Kombucha will magically cure your gut. Probiotics are good bacteria that help to keep our stomachs healthy. Recently, though, they've become so mainstream they've begun popping up in everything from granola to brownie mix. But experts say don't be fooled by that fitness blogger you see chugging Kombucha. "A lot of my patients come in sucking down bottles of Kombucha," says Scarlata. "They often don't help all patients. It's probably going to be a very individualized response because we all have our own fingerprint."
The best part about my FODMAP journey was taking back control of my health. Where I was once ruled by the aftermath of a bad eating day or slice of ice cream cake, I know now that I can turn back to the elimination phase of the FODMAP diet and settle my symptoms. And while I may never be fully "cured" I know there are tools and resources to help me manage the condition.
And experts are seeing progress in the right direction as well. Today, Gibson's research team at Monash University has worldwide partnerships in FODMAP education and research and THE FODMAP diet app has been downloaded by more than 100,000 people in over 30 countries. Scarlata, who has worked as a dietitian for 30 years, says she, too, is seeing results in treating IBS with the Low FODMAP diet like never before.
"Patients with IBS always knew food bothered them, but we really didn't have any tools to guide them," says Scarlata. "For me, it's just the most rewarding work because finally I have an application that I can provide my patients, and they can completely turn their life around."
When it comes to my life, it certainly has.