If at first you don’t succeed, then try again
The first thing I did after being diagnosed with fructose malabsorption was to make an appointment with a nutritionist to learn what I could (or more like could not) eat on the low FODMAP diet. After learning the basics and asking the important questions, such as, “Can I still drink wine?” I proceeded to begin the elimination diet. This was a huge process for me because I had to completely change my relationship with food including learning how to cook differently. It was no longer about what I wanted to eat and what tasted good, but, about what would not make me sick. At first on the low FODMAP diet, I was bored with my food because the only food my stomach seemed okay with was potatoes, rice, and chicken. However, I was generally fine with that since I began to feel better. My stomach pains and sharp cramps were going away, I was less bloated, I had more energy, my fogginess was clearing up, and generally my mood was better.
A couple of months later, I went back to the nutritionist for a follow-up appointment. She recommended that I start reintroducing foods that were not on the low FODMAP list. This way, I could determine if there were other foods that I could tolerate, and if so how much. Generally, those diagnosed with fructose malabsorption can handle more foods than what is on the low FODMAP list, but, the foods and the amounts can be varying for different people. For example, most people on the low FODMAP diet can eat table sugar. For some reason, it bothers me so I try not to eat sugar and when I do, I eat dextrose, which is composed only of glucose instead of fructose and glucose. Additionally, I can eat small amounts of hummus even though it is made up of chickpeas and a little garlic.
The idea of reintroducing foods into my diet scared me and I was extremely reluctant. Even though I was bored with what I was eating, I was feeling better and after years of not feeling well, I did not want to risk getting sick again. It took many months and multiple conversations with my nutritionist before I started to do so. In the beginning and even now, it can be a roller coaster and there are definitely good days and bad days. But overall, it has been a good experience as I have been able to add a lot more variety to my diet. I am learning what is a trigger and what I can eat in small amounts. And when I go too far, I feel it, but I know that by sticking to the low FODMAP diet again for a couple of days, I will get back to being healthy.
Kate Scarlata, a registered dietician who is an expert on the low FODMAP diet, has provided helpful advice on how to reintroduce food in a post entitled Low FODMAP diet is NOT a FOREVER diet! You can click on the link for the full article, but, for a list of her guidelines please see below.
[Below portion taken from Kate Scarlata’s website, 9/2/2014]
- Are you doing the re-introduction correctly? Choose challenge foods that only contain one FODMAP. An apple would not be a suitable first line challenge food as it contains multiple FODMAPs. Honey or mangoes are good fructosechallenge food choices as they only contain excess fructose NOT other FODMAPs.
- Do remember to stick with your low FODMAP diet while attempting your FODMAP challenges. If you are dining out, drinking a few cocktails and attempting to add back FODMAPs…your results might be a bit skewed!
- If you failed ALL challenges despite being guided by a FODMAP knowledgeable dietitian, consider the possibility of an overlapping issue such as: small intestinal bacterial overgrowth, dumping syndrome, food chemical intolerance (histamine, salicylate), or gluten sensitivity, to name a few.
- Try ‘gentle’ food challenges! When challenging garlic (fructans), don’t add several cloves of garlic to your meal to really identify if garlic puts your belly in a tail spin.Try adding small amounts such as a 1/2 of a clove at first and up to 1 clove per meal.
Photo taken by Tela Chhe on Flickr