The Low FODMAP Diet for Beginners – A Resource Package

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How to Complete a Gluten Challenge while remaining Low FODMAP (with Seitan Recipe)

How to complete a gluten challenge while remaining Low FODMAP - NOTFROMAPACKETMIX

Updated on 28.01.17

For reasons that I have mentioned before, it is crucial to get tested for Coeliac disease (CD) before you begin any elimination diets that cut out the gluten containing grains – this includes the low FODMAP diet, which eliminates wheat, barley and rye for the two month elimination period due to their fructan content. Oats also contain a protein called avenin, which is very similar to gluten and can also cause issues in overly sensitive individuals. There are many reasons why it’s important to be correctly diagnosed (which includes ruling possible differential diagnoses out) but I’ll expand on the most relevant to fructose malabsorption (FM) or the low FODMAP diet.

What is the difference between Coeliac disease and non coeliac gluten sensitivity?

Coeliac disease is an autoimmune condition in which your body’s immune system reacts to the plant-protein gluten (found in wheat, barley, rye and their derivatives) in such a way that your small intestine lining becomes the target, causing damage to your small bowel and villous atrophy. Villous atrophy in turn leads to a reduced surface area for nutrient absorption, which can contribute to malnutrition, malabsorptive disorders, osteoporosis and many other secondary complications, such as an increased risk of certain cancers. To rule CD in or out, a blood test to check for tissue transglutaminase antibodies is performed and followed up with an endoscopy to confirm any damage to the small intestine.

Non coeliac gluten sensitivity (NCGS), on the other hand, is not as well understood. It is the label given to those who test negative for CD, yet are still apparently affected by gluten. One study suggests that it is not the gluten in the grains but the fructans (acting alone or in combination with the gluten) that are causing sufferers to be symptomatic. Other research hints that it might be an innate immune response, rather than the adaptive immune response of CD, which causes the reaction to gluten-full foods and leads to symptoms that are very similar to those experienced by Coeliacs. Because there is no science-based standardised test to check for NCGS, the diagnosis is one of elimination – other conditions, like CD or a wheat allergy, are ruled out but you find you still improve on a gluten free diet – and NCGS is the possibility that is left.

If you do in fact have undiagnosed CD or NCGS, the low FODMAP diet isn’t anywhere near strict enough to be considered safe for you, as after the elimination phase comes the reintroduction phase, in which you are encouraged to test out foods higher in fermentable carbohydrates – this includes offending grains, which will just make you sick again. If you have CD, you must limit your gluten exposure to basically nothing (less than 20 ppm in the USA is considered safe), so even a contaminated chopping board or deep fryer could make you sick, let alone testing out a full slice of bread. If you have already been diagnosed with CD, you can skip those foods, saving you time and gut hurt… or any of your other symptoms that are caused by gluten.

Furthermore, if you have undiagnosed CD or NCGS, once you have finished the elimination phase and begin to test out wheat, rye and barley, you’ll realise that they bring on symptoms (either IBS or other) and you won’t know whether FM or CD is behind them – and to test for CD, you need to have gluten in your system for an established autoimmune reaction to be visible. If you haven’t been eating gluten, any damage from CD, or any sign of the relevant antibodies, will begin to disappear, meaning that you may test negative, regardless of whether you have active Coeliac disease or not. This is called a false negative result.

How to complete a low FODMAP gluten challenge

If, for one reason or another, you find yourself having been on a long term gluten free diet, yet needing to test for Coeliac disease, there is unfortunately no other way to confirm the diagnosis than to complete a gluten challenge. Instructions vary slightly but, in general, it is recommended that every day, for somewhere between six to twelve weeks (ask your gastroenterologist what they would prefer), you must consume the equivalent of four slices of bread if you’re an adult, or two slices of bread if you’re a child.

Given that:

  • The average bread slice weighs approximately 30 g,
  • Bread is typically at least 10% gluten by weight.
  • This means that the average slice of bread contains approximately 3 grams of gluten.
  • Extrapolating from the number of slices necessary for the gluten challenge, the gluten requirement works out to be 12.0 g of gluten for an adult and 6.0 g of gluten for a child, daily.

After writing the previous post, it seems almost hypocritical to tell you that I had to complete a three month gluten challenge in 2014. You can read my diagnosis story here but, long story short, I tested negative to Coeliac disease (both the antibody blood test and endoscopy) back in 2006 but then tested positive for fructose malabsorption. However, after eating largely gluten free (I didn’t worry about minute levels of contamination), I found myself, at the beginning of 2014, experiencing worsening IBS symptoms and extreme fatigue/brain fog. Ev even asked if I was broken. Now, I felt pretty certain that the culprit was the spelt flour (non-sourdough) that I had been consuming, after reading that it was low FODMAP – note, only sourdough spelt is considered low FODMAP, I had just read inaccurate information. However, the question stood: was it the fructans or the gluten that was causing this relapse?

I know that many people out there would happily re-eliminate the spelt flour and move on with their lives – but I’m not one of them. If there’s a question, I’m the type of person who needs to know the answer. So, I spoke to my GP, who referred me to a gastroenterologist and I began a twelve week gluten challenge. However, I know that fructans in wheat (and to some extent, rye) make me sick – what was I to do? The answer to your low FODMAP gluten challenge question is: SEITAN.

Seitan is a vegan protein/meat replacement that is made from vital wheat gluten, which is normally 75-80% gluten – and coincidentally, registers as low FODMAP. Now, let’s do some maths… stand back.

  • An adult needs to consume 12.0 g of gluten per day, a child 6.0 g.
  • Let’s assume that the vital wheat gluten (gluten flour) was only 75% gluten, to be safe. However, if you can get a more pure version of it, do so, as the more gluten it contains, the less likely it is to contain any FODMAPs.
  • 12.0 g / 75% = 16.0 g, so an adult would need to consume 16.0 g of the vital wheat gluten, daily, to ensure we are getting at least 12.0 g of low FODMAP gluten. A child would obviously only need to consume 8.0 g.
  • The recipe below is in grams, to keep it simple: 240 g of VWG will give fifteen 16.0 g servings or thirty 8.0 g servings.

You could just pop your seitan chunks like a form of medicine and be done with it but it was fun to experiment with it in cooking and I probably ended up consuming more than the 12.0 g of gluten on the days when we did so… which might have contributed to my gut’s unhappiness and the fatigue.

Seitan with Italian Herbs and Spices

Based off Bob’s Red Mill’s basic seitan recipe.

Seitan Dough

  • 250 ml FODMAP friendly stock or water
  • 1 pinch asafoetida
  • 1 tbsp. dried oregano
  • 2 tsp. salt
  • 1 tsp. pepper
  • 1 tsp. dried rosemary
  • 1 tsp. dried sage
  • 240 g gluten flour/vital wheat gluten

Broth

  • 1.5 L of water
  • 1/4 cup soy sauce

In a large pot (I cannot emphasise this enough, seitan balloons!) bring the broth mixture to a boil.

Meanwhile, mix the gluten flour, herbs, salt and pepper together in a large bowl. Slowly add in the stock and stir/knead until it’s a sponge-like dough. It should be tacky to the touch but not wet. Tip it out onto a well floured bench (use more gluten flour) and knead it for a minute or two, until it becomes tougher and more elastic.

Cut it into sixths, then roll them out into logs and divide each one into twenty. There you go, you now have 120 pieces and four pieces equals one daily serving of gluten for an adult.

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Place the seitan dough in the boiling water and boil for one hour. Watch how it expands – I needed to swap saucepans halfway through.

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After boiling, the seitan still isn’t good to eat. At this point, I like to think of it as “raw” meat. The flavour is nice, thanks to the spices, but the texture isn’t great. Spread the seitan out on a tray to dry, then use it in stir fries, pan fry it, bake it – it all works.

Baked seitan:

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Pan fried seitan with mirepoix as a dipping sauce:

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For those who were just curious, I hope you found this piece interesting. For those who have fructose malabsorption or IBS and need to complete a gluten challenge – good luck. I didn’t find it fun, in terms of fatigue, but I hope you fare differently.

After getting back to a normal diet (still no active Coeliac disease, phew), I have learnt that I can cope with a bit of gluten every now and then, so it’s clearly not as big of an issue for me as the fructans are. Luckily, that means that I can still enjoy (proper) sourdough breads in moderation. Yum.

This post is intended for educational purposes only. Please run anything that I have written here by your doctor or dietitian (etc) to make sure it is suitable for your individual case.

In terms of FODMAPs, vital wheat gluten is generally considered low but it is not recommended for consumption during the elimination phase of the low FODMAP diet. As always, it’s best to not need to do a gluten challenge at all, by testing for gluten/wheat related conditions before an elimination diet has begun but this isn’t always possible, for a variety of reasons.

Unfortunately, you might react during a gluten challenge (that’s the point, after all); this method just minimises the chance of that reaction being due to the fructans in wheat as much as possible.

Ten Reasons to get tested for Coeliac Disease BEFORE Going Gluten Free

Ten reasons to get tested for coeliac disease before going gluten free

As many people are aware – and just as many people aren’t – gluten is a protein that is found in the grains wheat, barley and rye (and their derivatives). A very similar protein, avenin, is found in oats, and can also cause a gluten-like reaction in some very sensitive people.

Gluten is the trigger behind the autoimmune disease known as Coeliac disease and is also a known gut irritant for some people with irritable bowel syndrome (IBS) or any of the inflammatory bowel diseases (IBD). For these people, eliminating gluten from their diets is crucial to improving both their gut and overall health. For others, it might be completely unnecessary.

Now, obviously, the reasons listed below are relevant for those who have access to testing for Coeliac disease, either by blood test or endoscopy. If you, for either medical, financial or geographical reasons, cannot be tested for Coeliac and you feel like gluten-containing foods set you off, then nobody can stop you from doing what you feel is necessary, using whatever resources you can find. However, I strongly urge anyone who feels like they have symptoms, either IBS-like or other, that are related to food to go and see their medical professional of choice.

So, here they are:

The top ten reasons to check with your doctor before you begin a gluten free diet

  1. Coeliac disease testing relies on a reaction to gluten: Coeliac disease (CD) is an autoimmune disease in which your immune system reacts to the presence of the protein gluten as it would to an infection – with an immune response that attacks your own tissue, damaging your intestinal lining, which can cause both symptoms of IBS (pain, gas, bloating) and reactions elsewhere in the body (joint pain, headaches etc). Tests for active CD rely on looking for specific antibodies, via a blood sample, or evidence of CD specific damage to the small intestine, via a gastroscopy/endoscopy. If you have already eliminated gluten from your diet, your test results will not be reliable, as any reaction may have disappeared and you could in fact be showing a false negative.
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  2. To differentiate between Coeliac disease and Non Coeliac Gluten Sensitivity (NCGS): If you suspect that the consumption of gluten containing foods precedes your IBS or any other symptoms, it is important to know which you have. If you have CD, you know that you must be careful down to the tiniest speck of contamination – less than 20 ppm, in the USA. It is unknown how “strict” those with NCGS must be, medically speaking, in terms of gluten contamination. It might be as strict as CD, less strict, or even dependent on the individual – but if you have ruled out CD, you can then work with your doctor to decide what’s best for your own case based on current medical knowledge.
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  3. Coeliac disease is genetic: If you have CD, one of your parents must be carrying the gene and may also have an active form of the disease, which can sometimes be silent. If you have children, it’s important to know what their chances are of developing CD in the future – this includes a blood test to check for genetic susceptibility (did you pass on the gene?) and a test for active CD, if you did.
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  4. Self-diagnosis can be very dangerous; you might miss the actual diagnosis! If you are having worsening digestive symptoms, gluten isn’t the only potential cause. It could also be ulcerative colitis, Crohn’s disease, or colon cancer. Each requires proper medical management, which might include a gluten free diet but it certainly won’t be limited to it. If you are not accurately diagnosed, the repercussions to your health could be severe, if an undiagnosed condition goes untreated.
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    Following on, if you go gluten free without any testing or medical advice, you will not get the chance to hear about other potential causes. Symptomatic malabsorption of fermentable carbohydrates is now thought to be much more common that NCGS, with a study showing that those with NCGS who began to follow a low FODMAP diet had significantly improved symptoms. This is not saying that those with NCGS don’t have a real problem, just that the culprit might not be the gluten in the wheat – it might be the fructans.
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  5. Coeliac disease doesn’t just cause digestive distress: The most commonly known symptoms of CD include gas, bloating, gut cramps and altered bowel movements etc. However, long-term, unchecked CD can lead to a whole host of issues, including (but not limited to), malnutrition, lactose intolerance, osteoporosis, infertility and even an increased risk of certain cancers. It’s definitely advisable to rule CD in or out and hopefully reduce your risk of developing one of the possible secondary health issues by following a strict gluten free diet with medical assistance as required.
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  6. Save money on healthcare: In some countries, only certain medical tests are covered by Medicare (or the equivalent) or private health insurance. Chances are that you are more likely to be financially covered for a science-based diagnostic test for CD than you are for any alternative-medicine-based tests, so why not try the standard tests first and see where they get you, before going down the potentially more expensive route. A proper medical diagnosis of CD (or any other food related illness) might also mean that your school/college/university has to provide you with suitable foods, saving you money and time on meals that you might otherwise have to prepare for yourself and bring from home.
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  7. Save money on unnecessary gluten free products: If you compared the grocery bills of two people who ate the same diet, except one of those people bought gluten free versions of the processed foods (bread, cereals, pasta, sauces, cookies etc), you will find that the gluten free person spends quite a bit more. If you don’t have a medical reason for buying gluten/wheat free products, you will save a decent amount of your weekly grocery bill by buying the normal versions of the products. This goes for FODMAPs, too, though we aren’t at the point of being a fad diet and most people are still finding out about it from their doctors/dietitians etc.
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  8. Just because it’s gluten free, doesn’t mean it’s healthy: Is a doughnut healthy? Not in my eyes. Is a gluten free doughnut automatically healthier? Definitely not. If you eliminate gluten by eliminating processed gluten-full foods and replace them with gluten free whole foods and the occasional gluten free grain like rice or corn then yes, your diet will likely be healthier than before. However, if you just replace your bagels and cupcakes with a gluten free version, you are doing nothing for your non-gluten-related overall health.
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  9. Social acceptance: It’s unfortunate but many people will judge those who are self diagnosed or follow what they perceive to be a fad diet. I try to educate waiters about fructose malabsorption and the fructans in wheat (if they ask, of course) when I order a gluten free meal – partly because I want to spread awareness of fructose malabsorption and FODMAPs but also because I want to distinguish myself from those who do follow “gluten free” as a fad diet and have my dietary requests taken seriously. It’s sad that I need to do this but necessary, which I’ll explain in #10.
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  10. Food safety and cross contamination: As I mentioned in #9, wait or kitchen staff (or, sadly, even family members) might take it upon themselves to decide exactly how gluten free your meal must be. If you don’t have a formal diagnosis of CD or NCGS from your doctor, these people are more likely to slack off with the meal prep safety and feed you contaminated food, which will ultimately affect your health and wellness. This unfortunately goes for many food intolerances, even nut allergies!

Fad gluten free (or anything-free) diets are a pet peeve of mine. I try not to be too zealous about certain things in life – I don’t want to annoy friends of mine who are not interested in digestive health, after all – but when it comes to “going gluten free” on a whim, I can’t always hold my tongue. To my friends and family, I do apologise. To my readers, though, I feel it’s something that should be put out on the internet again and again, to make as many people as possible aware of the dangers of uneducated dieting.

This article is written for educational purposes only and is not intended to replace a proper medical assessment. Please run anything written here past your own health care practitioner to make sure it is the right course of action for you.

How to Manage your Irritable Bowel Syndrome with the Low FODMAP Diet

Hi guys, I’m really excited to announce that I was asked to write an article about fructose malabsorption for Suggestic, a website that deals with nutrition, food intolerances and restaurant suggestions. Well, apparently I was a little enthusiastic – I didn’t want to miss anything – so I needed to split the article in two. I have already shared part one, so here goes part two:

Last week I talked about fructose malabsorption, its link to irritable bowel syndrome (IBS) and the similarities it shares with non-coeliac gluten sensitivity (NCGS). This week, I will expand on the “fructose friendly” dietary management strategy for fructose malabsorption – the complete low FODMAP diet – that is gaining traction as the frontline dietary method for combating IBS symptoms.

IBS is generally understood as a long-term or recurrent disorder involving the function of your gastrointestinal system, usually due to imbalances of intestinal motility, function and sensation, leading to symptoms of digestive distress. It is a common occurrence in Western countries, with up to 30% of the population being affected at some point in their lives, women generally more-so than men.

What are FODMAPs?

FODMAPs” is an acronym that stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols and describes a group of readily fermentable carbohydrates that are not well absorbed in the small intestines of some people; if these carbohydrates are not broken down and/or transported through the intestinal wall and into your blood stream, they continue down into your colon, where the resident gut bacteria digest them, leading to a build-up of certain gases and short chain fatty acids, which can alter the water content of your large intestine. These products of fermentation are the causes for the wind, bloating, abdominal cramps/pain and altered bowel movements that you associate with your fructose malabsorption, lactose intolerance or IBS.

The list of FODMAPs includes:

  • Monosaccharides (single sugar units) – fructose (when consumed in excess of glucose) and galactose.
  • Disaccharides (double sugar units) – lactose.
  • Oligosaccharides (multiple sugar units) – fructans (FOS, inulin), galactans (galactooligosaccharides or GOS)
  • Polyols (sugar alcohols) – sorbitol, mannitol and other sweeteners ending in “-tol.” Some polyols, such as sorbitol and erythritol, have the added effect of decreasing the rate of fructose absorption in the small intestine even further when consumed in large enough amounts.

There are hydrogen/methane breath tests that can check whether you malabsorb fructose, lactose and/or sorbitol but the other FODMAPs must be properly eliminated and then tested with a reintroduction trial (outlined below) to know whether they are causing your symptoms…”

Read more at Suggestic.com

Once again, let me know what you guys think! I sincerely hope I didn’t miss anything out – I’m planning on writing more about the links between carbohydrate malabsorption and nutrient deficiencies soon, when I have some time over the holidays.

Thank you for taking the time to read it! Have a great weekend guys – and stay tuned for the easy to make chocolate peanut butter cookie ball recipe that’s very coming soon.

Natty xo.

Could Fructose Malabsorption be the Cause of your Irritable Bowel Syndrome Diagnosis?

Hi guys, I’m really excited to announce that I was asked to write an article about fructose malabsorption for Suggestic, a website that deals with nutrition, food intolerances and restaurant suggestions. Well, apparently I was a little enthusiastic – I didn’t want to miss anything – so I needed to split the article in two. Here goes part one:

“So you’ve gone gluten free. You had coeliac disease ruled out first – as you should – but you still felt that wheat was a big trigger for your irritable bowel syndrome (IBS). You feel better off wheat – less bloated, more energy – but you’re not quite 100 %. What could it be?

I’m sure that many of you have by now heard of the study behind the media storm that apparently refutes the existence of non-coeliac gluten sensitivity (NCGS). Gluten is a protein that is common to the grains wheat, barley and rye. Contrary to what many of those journalists would have you believe, the researchers did not say that people who identify with NCGS are imagining it; rather, that it might actually be a different component of wheat, other than gluten, or in combination with it, that is causing them to experience IBS-like symptoms, including digestive distress, bloating and others, such as fatigue.

What then could be the culprit behind your wheat-triggered IBS? The answer: it might be fructans (also known as fructooligosaccharides or FOS). Fructans coincidentally happen to be found in large enough amounts to cause symptoms in the gluten containing grains, which includes all varieties of wheat, barley and rye; and they, along with fructose, made my first year of university… let us just say, “interesting.”

Growing up, I always had a fussy gut. When I was going through the last two years of secondary school, it got a little worse but not bad enough for me to really take notice, other than joke about it with friends. It was not until I was in my first year of university that it really got going, dictating not only the parties I could go to but things as seemingly insignificant as which seat I would take in the lecture theatres and what I could wear (think room for bloating). Luckily, my mum had an eye on me and about half way through the year (after end of semester exams really took their toll on my IBS) she read an article about coeliac disease. Digestive distress, nausea, fatigue, brain fog… I ticked most of the boxes, however, I did not have active coeliac disease. My gastroenterologist (since retired) had a game plan though and the next thing I knew I was being sent off to have hydrogen/methane breath tests to check for both lactose and fructose malabsorption*.

I had heard of lactose intolerance before, but fructose malabsorption? Well, fructose malabsorption was my answer and explained why the gluten free diet that my GP had advised me to trial earlier had helped significantly – but not completely…”

Read more at Suggestic.com.

Let me know what you guys think and please share – as awareness of fructose malabsorption spreads, it is more likely that people will be correctly diagnosed and the variety of food choices for us will increase, both at restaurants and in supermarkets.

Read part two here.

Have a great night!

Natty xo.