The Low FODMAP Diet for Beginners – A Resource Package

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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.

Travel Series – Flying with Fructose Malabsorption

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I’m not a huge fan of flying. I’m not scared of it but I don’t find it enjoyable, either; long hours (15 hours between Melbourne and LAX) in cramped seating, recirculated air, mostly unsuitable foods and the bathrooms, if you can call them that, all add up to me not having a good time. I stress about connections until we make them and about whether our luggage will make it when we do.

We have had enough mishaps with changed departure gates, delayed planes and missing luggage (LAX is a disorganised hellhole) that Ev and I have become very adept at travelling light. The last time we went home to Australia, we got everything we needed for two weeks, including things for other people, in two carry on bags… and by “carry on” I mean the real carry on bags, not the giant suitcases that American based airlines let people take on and try in vain to cram into the overhead compartments, taking up space meant for everyone. Yes, that annoys me. If I’ve been responsible and packed my belongings into a small suitcase intended for overhead bins, perhaps with valuables in there, I am not impressed when I am told it HAS to be checked, because a 3/4 full plane has already run out of overhead storage. But I digress.

Some people truly do enjoy flying but for the rest of us, here’s how I manage eating with FM and dealing with potential symptoms while flying. It’s pretty appropriate timing, because Ev and I are going to spend the next week in Cabo, Mexico! We’ve been waiting for this holiday since we got back from Cabo last summer. As much as I prefer road trips and exploring different towns, not staying in the one place for too long, sometimes it’s nice to just go and veg out somewhere that is completely relaxing and not have to worry (so much) about the food. As I have said previously, for me, Mexico/Mexican food seems to be a safe bet if I eat plainly and avoid tropical fruits.

The other posts in the travel series can be found here.

I’m sure I’ll be posting photos of tropical paradise on my Instagram account, if you’d like to follow along.

Step 1: Plan ahead, Stress less

Most people don’t need to be told that stress can increase their IBS symptoms; I know I don’t. It’s not all in our heads, though. Research also demonstrates that the two coexist (see here and here), as the autonomic nervous system and certain hormones, which are triggered during times of stress, also act upon the gut.

To avoid stress related IBS and ensure as smooth a travel/flight experience as possible, plan ahead. Some things to consider are:

  • Book your flights as early as possible – cheaper flights means more money in your pocket and less concern about finances during your trip. It’s only a small matter but everything helps.
  • Have all your home-affairs in order well before you go, so you’re not panicking about getting emergency cash out for the house/dog-sitter or paying a last minute bill.
  • Pack early. This is something I can’t help but do, as it all adds to my excitement of going on holiday. It also means you won’t be up until 3 am the morning of your 8 am flight to finish packing your bags.
  • Check in online 24 hours before your flight, if you are able. This means that your seat is reserved on the flight, all you need to do is collect your boarding pass and check in your luggage.
  • Call the airline to ask what their menu will be and decide whether it will be safe for you. This is more important for long haul flights, as I’m pretty sure that standard fare on every flight under 3 hours is a bag of pretzels/mixed nuts and a soft drink/water. Actually, mixed nuts and water sounds fine, thanks. I’ll take that. Just make sure they’re unseasoned.
  • A few days before you fly, call the airline again and re-check your meal preference. I normally go for the gluten free meal and pick what I can from it, supplementing with food I’ve brought from home. The last time I flew between Melbourne and LAX I didn’t do this; my gluten free meal was a normal meal and my husband’s normal meal was vegan. No idea how that happened. What was worse – they don’t carry spares and everyone who had successfully ordered a gluten free meal had shown up for the flight. Which is why I was glad I’d also packed snacks…
  • Pack some non-perishable FODMAP friendly snacks; more on this later, just make sure you call the airline(s) and ask what you are able to take in carry on and what must be in checked baggage.

Step 2: Make some safe food flash cards

If you don’t speak the language, flash cards listing the ingredients you can and cannot consume in the language spoken by the airline/at the airport will help prevent a lot of confusion, if you decide to brave the food.

In fact, even if you do speak the local language, flash cards might still be a good idea as the idea of fructose malabsorption is still so novel that the apparently random list of ingredients that you cannot consume might overwhelm the staff and create an unwanted fuss.

Make sure the lists are clear and concise as to what you can and absolutely cannot consume.

Step 3: Eat plain before the plane

Each time I fly, I will eat plainly in the preceding week, for a few reasons:

  • I know that additional stress seems to set me off with foods I can normally tolerate, so why push boundaries?
  • I want to give my gut the week to calm down, as some foods cause delayed reactions that can last a few days. This way, if I do happen to react to something at the end of the second-to-last week before flying, I have seven days for it to pass.
  • If I am starting from a better place, in terms of my gut, then a small slip up won’t end up with such severe results as it would if my gut wasn’t terribly happy to begin with.
  • Do you want to have diarrhoea on a plane? Exactly.

Step 4: Pack your own food

This will not always be possible, due to customs regulations and such but if you are able, I highly recommend taking FODMAP friendly snack foods to tide you over during flights and layovers while you’re away.

Some ideas include:

  • A variety of foods for different meal times – who wants tuna for breakfast?
  • Non-perishable foods (or at least foods that will keep for a few days outside the fridge) are best.
  • Easily digestible foods that won’t tax your gut too much.
  • Pack the food in a freezer bag and take what you are allowed to inside your carry on luggage. Some carry on restrictions might prevent this, so put it on your list of questions to ask when you call ahead.

Examples of what I might pack:

  • FODMAP friendly veggies of your choice, such as carrot sticks, celery (if you can tolerate polyols), cucumber etc.
  • FODMAP friendly fruits, to a lesser extent, such as bananas and berries. These will need to be kept in a hard case, as they’ll bruise easily while travelling, so I generally wouldn’t bring them on a flight as they’re more likely to get squashed than on a road trip.
  • Muesli bars, like my strawberry pepita or fruit free bars. pictured below. Muffins are delicious but I find that they squash too easily.
  • Pre-packaged snacks, such as corn chips or rice cakes.

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Step 5: Be prepared for the worst

Sometimes, despite our best efforts, shit happens. Literally. While it’s not ideal, you can lessen its impact on your travel by planning for it. If you have an FM-ergency kit, your life will be a lot easier. (See what I did there? You can use it). Keep this in your carry on, you may need it on your flight as well as at your destination.

  • Analgesics to help with cramps – ibuprofen is a known gastric irritant, so I personally don’t use it but if it works for you then don’t stop. I prefer paracetamol (acetaminophen) to help ease cramps, which are not fun to have on a plane.
  • Dextrose/glucose tablets – to help offset any excess fructose that you may accidentally consume, using the co-transport method of absorption.
  • Any supplements that you take, such as a probiotic, digestive enzyme or multivitamin. It’s best not to disrupt your schedule, if possible.
  • Stay hydrated.
  • Wet wipes/baby wipes, in case of an emergency cleaning situation.
  • Any other methods that you know work, such as Buscopan (I’m not saying it does work, it’s just an example). I would advise against using something you haven’t tried before, especially on a plane. It’s best to try those things out at home, beforehand, where you can crawl into a ball and feel sorry for yourself without upsetting the rest of the flight and your holiday.

I hope these guidelines help you fly and travel successfully, as they have me. If you think of anything that I should add, please let me know.

I just joined Bloglovin.

<a href=”http://www.bloglovin.com/blog/11362999/?claim=wwe48jjmfg8″>Follow my blog with Bloglovin</a>

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I’ve just signed up with Bloglovin’, an online platform from which you can follow any blog you like – regardless of who or what hosts it – and it collates them into one easy-to-read feed for you. It’s essentially like the old Google Reader, which I used to use, until it was cancelled; definitely handy to use and it helps to de-clutter your email inbox, if you choose not to follow the same blog in two locations.

Feel free to head over there, sign up (for free, with Facebook or email) and follow me – and any other blogs you like. This way, you’ll never miss a post. Unlike if you just follow the Facebook page, as Facebook is now on a vendetta to make you pay for it to publicise your posts with your followers. Which would be fine if this was a business… but it’s not. So, if you only follow Not From A Packet Mix on Facebook and have been wondering why you’re not getting my weekly posts in your news feed, I would recommend either following by email or Bloglovin’, as well.

Happy reading!

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Travel Series – Road Tripping with Fructose Malabsorption

Along the Petaluma-Point Reyes Rd.

Road trips are possibly my favourite way to travel; you get to see so much more of the landscape than if you fly everywhere and I find that cities tend to look the same after a while. To be able to drive down the west coast of the USA and see lush greenery and snow-capped mountains turning first into farm land and then into a more arid landscape complete with mesas is pretty awesome. Also, California is full of eucalyptus trees, which reminds us of home and smell amazing, as well.

In my opinion, road trips are also the easiest type of holiday to take while on a low FODMAP diet, as you can really be in control of your food if you plan ahead and pack an Eski (cooler) with sufficient supplies.

I will outline below how I manage my meals on a road trip:

Step 1: Make an itinerary and food list

I am a list maker, so is my sister. It’s something we’ve always done, as we’re OCD control freaks who can’t bear to be disorganised. Plus, it’s fun. Luckily for me, Ev is the same… although he hates packing his own bag. But he’s not the one with FM, so that’s not such a big deal.

Being a list maker means that I like to plan each leg of the road trip with hours and distances and town names. This is good, as it will help you with step 2. Another way to make step 2 easier (well, the act of eating at the restaurants that you’ve researched) is to call ahead or go armed with a list of foods that you CAN EAT (make sure it’s labelled clearly, so you don’t get a plate of onions sauteed with apples on whole wheat toast) to make both your life and those of the wait staff and cooks much easier.

Step 2: Research local restaurants and eateries

Before you go out to dinner, you would find online menus or call the restaurant you’re thinking about going to and see if they can provide a meal for you; travelling is no different. The key to a relaxed holiday (and gut!) is planning. I know lots of people who like to wing it – I have never been one of them – but a “we’ll find something, don’t worry” attitude is more likely to lead you to either an irritated or hungry gut later on if you are following a FODMAP friendly diet.

Either before you leave home, or each day of your trip (if you have internet connectivity), scout out a few potential cafes and restaurants and note their locations with regards to your itinerary. What town will you be driving through at lunch time? Does the town you plan to spend the night at have a restaurant or supermarket that you can source meals from?

Some tips:

  • To reiterate – PLAN AHEAD.
  • Restaurants that already cater to other dietary requirements (gluten free, vegan, nut free etc) will generally be more likely to be able to create a meal for you.
  • Fast food chains can still provide salads – just request no dressing or croutons etc – and hot chips/fries will do in a pinch, as long as they’re suited to other non-FODMAP issues you might have.
  • Choose simple meals that require minimal alterations to be suitable – it’s both ridiculous and rude to think they’ll be able to make you an onion free lasagne but to whip up a salad sans onion and dressing is much easier and many restaurants make their salads as ordered, anyway.
  • Don’t forget about supermarkets, as you can always find gluten free breads/crackers, cheese and suitable veggies etc to fill your stomach.
  • Busier restaurants will find it harder to tailor a meal to you, so eat at quiet times, even if that does mean sitting down to dinner before 6 pm.
Breakfast - an omelette with potatoes and green capsicum.

Breakfast – an omelette with potatoes and green capsicum.

Dinner - a chicken salad sans croutons and dressing on the side.

Dinner – a chicken salad sans croutons and dressing on the side.

Step 3: Pack emergency foods

If you’re driving down a deserted highway and you can’t find anywhere to eat, things can get ugly; this is true even if you don’t have a food intolerance. I tend to become very irritable when I’m hungry (more like a 6 year old than a 26 year old) and I’m sure I’m not pleasant to be around when I’m like that. In fact, even when we’re not road tripping, Ev will tell me to eat something if I’m beginning to get grumpy.

I think packing an emergency food supply is a good thing to do for road trips, regardless of FM. Things to consider when packing a food kit include:

  • A variety of foods for different meal times – I know I wouldn’t want a tin of tuna for breakfast but would be happy to eat it any time after lunch.
  • Non-perishable foods (or at least foods that will keep for a few days outside the fridge) are best.
  • Easily digestible foods that won’t tax your gut too much.
  • Pack the food in an Eski/cooler/freezer bag/car fridge (whatever you’d like to call it) to prevent any mishaps of food left in a car on a hot day. Besides going hungry if your food has gone off, it’s also a waste of money.

Examples of what I might pack:

  • FODMAP friendly veggies of your choice, such as carrot sticks, celery (if you can tolerate polyols), cucumber etc.
  • FODMAP friendly fruits, to a lesser extent, such as bananas and berries. These will need to be kept in a hard case, as they’ll bruise easily while travelling.
  • Muffins, as sometimes a piece of fruit or a carrot stick just isn’t enough. Some good options include my banana nut or pumpkin and chive muffins.
  • Pre-packaged snacks, such as corn chips, rice cakes or gluten free pretzels.
  • Suitable GF or sourdough bread and sandwich fillings, such as ham, cheese, lettuce and tomato, or even just jam and Vegemite (though never together!).

Step 4: Be prepared for the worst

Even the most diligent planning can’t prevent a slip up here or there. A waiter might not take your request seriously, or simply misunderstand you; or you might sneak a food in and hope that your FM has gone on holiday elsewhere. Go prepared with a kit containing methods you know will help to alleviate your symptoms.

My emergency FM kit would include some or all of the following but yours may be different:

  • Paracetamol (acetaminophen in the USA) – ibuprofen is a known gastric irritant, so I personally don’t take it. I’m not recommending that you do take paracetamol but it’s my preferred method of choice for helping to ease intense cramps, which aren’t fun even when you’re not on holiday. At home I might try another method first (such as water or tea) but when I’m away from home I’ll go straight to the Panadol.
  • Dextrose – to help offset any excess fructose that you may have ingested, swallowing dextrose (glucose-glucose) ASAP will help to even out the glucose/fructose ratio and potentially prevent a reaction. This all depends on how much fructose you consumed, how much glucose you followed it with and your gut’s own behaviour.
  • Any supplements that you take, so for me this would include my probiotic and multivitamin. For you it may include digestive enzymes, ACV, bicarb soda etc.
  • Any other methods that you can take with you that is feasibly going to be useful in case of a reaction. For example, I will often drink tea with ginger, lemon and mint to help settle my gut but am I always going to have access to a kettle? Something along the lines of Buscopan or Beano would be more suitable for a road trip but I do not recommend relying on a product you haven’t tested before to stop a reaction unless you have no other choice. Buscopan (etc) might help some with IBS but it might not help at all or even worsen your symptoms.
  • Water and lots of it. Not only is it healthier for your gut and body to remain hydrated but if you have to take a tablet, it’s a lot easier to take it with water than dry. You could crush up some ginger, mint leaves and lemon slices and leave them sitting in your water bottle (remember to change them daily) to infuse the water and help keep your gut happy. Water is also useful for washing things… and on that note,
  • Wet wipes/baby wipes, in case of an emergency cleaning situation.

This sounds like a lot and if it overwhelms you, I’m sorry. Just please remember that you can still enjoy a road trip while on the low FODMAP diet with some extra planning; just like road tripping with kids or dogs… but we still do that!

If you have any other tips that I have forgotten, please let me know in the comments section below. Happy holidaying!

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Whole Grain Pumpkin and Chive Muffins – FODMAP/Fructose Friendly & Gluten Free

Whole Grain Pumpkin and Chive Muffins

I whipped up these little beauties after being inspired by the super-soft and fluffy zucchini quinoa muffins I made from Patsy Catsos’ cookbook, Flavour Without FODMAPs Cookbook – Love the Foods that Love You Back and before going on a road trip from Seattle to San Francisco and back.

If you’ve read the “My FM Journey” page, you will know that I was diagnosed with FM back in 2006, so I’ve had 8 years to perfect my methods of travelling on a fructose friendly diet. Granted, I can now have some onion and garlic, which makes life a lot easier than it used to be but you can travel while eating low your version of the low FODMAP diet – it just takes a little bit of extra planning.

These muffins lasted a week in an airtight container within an Eski (cooler) and remained fluffy the entire time. If I’d had some, I would have added in Feta cheese to give the flavour a bit of bite but they are still delicious without it and sometimes I wonder whether good Feta isn’t too expensive to waste in muffins and Parmesan cheese would also do. Either way, these muffins are a delicious savoury treat, perfect for a snack or to serve with soup.

Notes:

  1. Pumpkin is a tricky one. What we call pumpkin in Australia, Americans call squash. This difference in naming can make figuring out low FODMAP varieties even more difficult than it already is. Jap pumpkins (squash) are low FODMAP, as are the American pumpkins (that we don’t get in Australia).
  2. Brown rice is a whole grain, quinoa is a seed – they are very close in performance, baking-wise and I often sub one flour in for the other without issue. Thus, if you either don’t have or can’t tolerate one of them, the other works just as well.
  3. Almonds are low FODMAP in servings of 10 nuts – there is only 1/4 cup spread out over 12 muffins, so this will fall well under that.
  4. Buckwheat flour is reportedly a good substitute for almond meal, if you can’t tolerate almonds at all.
  5. Pepitas (pumpkin seeds) are low FODMAP, however as seeds are high in fibre, some cannot tolerate them regardless. Leave them out if you think you’re one of them, or swap them for another seed, such as sunflower seeds, flax seeds (linseed), chia seeds etc.
  6. The green parts of chives are low FODMAP.

Pumpkin and Chive Muffins

  • 2 eggs
  • 1/2 cup butter, softened
  • 300 g pumpkin puree
  • 180 g brown rice or quinoa flour
  • 45 g corn meal
  • 70 g almond meal
  • 3 tsp. baking powder
  • 1 1/2 tsp. kosher salt
  • 1 tsp. cinnamon
  • 1/2 tsp. nutmeg
  • 1/4 cup pepitas
  • 1/4 cup finely minced green chives
  • Optional flavour variations, to mix in at the end – 1/3 cup Feta cheese, crumbled; 1/4 cup sun-dried tomatoes, minced (if tolerated); 2 jalapenos, seeded and finely sliced.

Peel, dice and bake pumpkin at 180 C/350 F for 30 minutes, or until completely cooked, then puree it with your immersion blender or similar. If pumpkins are out of season, tinned puree will also do. Leave the oven at 180 C after the pumpkin has cooked.

Meanwhile, combine the flours, pepitas, baking powder, salt and spices in a bowl and set aside.

Blend the eggs, butter and pumpkin puree until smooth. Add in the dry ingredients and stir to combine before adding in the minced chives and/or any other flavour variation you’d like.

Divide the mixture between a 12 hole muffin tray and bake at 180 C for 18 to 20 minutes, or until a centre muffin tests clean with a skewer.

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Enjoy with a bowl of hot soup, or take as a snack to keep you going throughout your work/school day.

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