Shifting Gears

Earlier this week I had a meeting with my GI doc in preparation for surgery #7, which will happen on Wednesday of this week. Mostly I wanted to talk to him about managing my remicade infusions with all the surgeries, but I also had a couple of symptoms I had been noticing that I wanted to run by him. All in all he is happy with my progress and not making any changes to my treatment plan for now, except for one thing.

One of the things we talked about was diet and nutrition. I had been keeping a food journal for several weeks, and I was starting to notice some patterns. Some of my suspect foods (for example: dairy, even when properly fermented; tree nuts and peanuts in large quantities; fruit in large quantities) were some of the very same foods that are highly recommended on the SCD diet. Also, when I strayed from SCD, I noticed there were other foods that seemed to agree with me but that I wasn’t “supposed” to eat (for example: rice, sweet and white potatoes, oats). When I told him about some of the triggers I noticed, he told me he wanted me to try something called the low FODMAPs diet and gave me a brief explanation and some materials on how it works.

I have mixed feelings about this transition. On the one hand, I have spent so much time and energy doing my best to implement SCD. It also sort of fits in with my general view of what is good for our bodies (nothing processes, lots of fruit/veggies, nutrient-dense foods, and healthy fats). On the other hand, I wasn’t experiencing as much relief as I hoped while following it. To be fair, from the beginning I was told that to be effective you have to commit 100% to SCD, and I never was quite able to do this for more than a few weeks at a time. So I can’t say that the diet doesn’t work, I can only say that it doesn’t work for me. In my mind, if it is impossible to follow a diet and occasionally travel, go out to eat, or have a meal at someone else’s home, then it’s not a real option for me at this point in my life. Maybe it will be at some other time. Even  following the diet 90% of the time, I was starting to feel too deprived.

So, before I even talked to my doctor, I had thought about trying something else. He told me that the low FODMAPs diet is actually the diet with the most scientific evidence behind it for controlling symptoms of Crohn’s. I’m a scientist, too! I love scientific evidence!

I’m still learning about the low FODMAPs diet, but here is a quick summary of what I have learned so far. Like SCD, it works in part by altering the microbiome in the gut by restricting the type and amount of food available to gut bacteria. And, both diets limit foods that are thought to be difficult to digest. But, the specific foods that are identified as being hard to digest are different. SCD limits all simple sugars, grains, and starches, whereas low FODMAPs limits foods containing specific types of sugars that can lead to fermentation in the gut when too much of them is consumed (the acronym stands for “fermentable oligo- mono- di-saccharides and polyols). Also, whereas SCD requires the patient to completely eliminate these foods during a one-year introductory phase, low FODMAPs encourages patients to eliminate high FODMAPs foods completely for 2-6 weeks, then reintroduce them slowly to identify specific triggers. There are also quite a few foods that you can eat, even during this introductory phase, as long as you limit portion sizes. Best of all, the diet doesn’t depend on 100% adherence–just on reducing your overall FODMAPs load, because high FODMAPs foods are only considered problematic when you eat too much of them at once. In fact, except for the very short introductory period, 100% adherence is discouraged, mostly because many of the high FODMAPs foods are also important sources of prebiotics (compounds that encourage the growth and activity of beneficial gut bacteria).

I made a table comparing the types of foods that are allowed on the diet. This isn’t meant to be comprehensive, just a quick overview. As you can see, the main differences are that low FODMAPs allows gluten-free grains and a wider variety of sweeteners, but limits the type and quantity (usually to 1/2 cup per sitting) of fruits, vegetables, legumes, nuts, and seeds somewhat more than SCD.

Food Group Specific Carbohydrate Diet Low FODMAPs Diet
Grains None All except for wheat, barley, or rye
Meat, Fish, and Poultry All (unprocessed) All, unless processed with high FODMAPs foods
Dairy Hard cheeses and homemade yogurt Lactose-free dairy, low-lactose dairy, all in limited quantities
Fruit All fruit (except canned) Bananas, blueberries, melons (except watermelon), grapes, kiwi, citrus (orange, lemon, lime, pineapple, mandarin, tangerine), passion fruit, raspberries, strawberries, rhubarb, avocado, cherries, grapefruit, longon, lychee, pomegranate, rambutan, coconut, in limited quantities at a time. Also, no canned fruit permitted
Vegetables All except for starchy vegetables (white and sweet potatoes, yams, parsnips, yucca, taro, jicama, corn), seaweed and seaweed products, canned vegetables, artichokes, bean sprouts, okra, chicory, cucumber All types of leafy greens (kale, spinach, lettuce), red bell peppers, bok choy, cucumbers, eggplant, green beans, cabbage, parsnips, pumpkin, all types of potatoes, radishes, seaweed, winter and summer squash (butternut, zucchini, yellow squash, spaghetti squash, etc.), tomatoes, turnips, water chestnuts, carrots,  bamboo shoots, canned artichoke hearts, asparagus, beet, broccoli, brussels sprouts, celery, peas, snow peas, corn, all in limited quantities at a time
Legumes No legumes permitted, except for peanuts and properly soaked lentils, navy beans, adzuki beans, peas, and lima beans No legumes permitted, except for peanuts
Nuts and Seeds All, depending on form (flour, whole, milk) and stage of diet, in limited quantity All except for cashews and pistachios, in any form, in limited quantity
Nutritive Sweeteners Honey, aspartame, and saccharine (occasionally) Sugar (white, brown, cane, etc.), maple syrup, glucose, stevia, regular corn syrup (but NOT HFCS), brown rice syrup, all in limited quantity
Cooking Oils All except for soybean All
Herbs, Spices, and Seasonings All except for mucilaginous herbs and vegetables (aloe vera, marshmallow, slippery elm, etc.), spice blends, balsamic vinegar, and various additives All salsas, jams, chutneys, pickles, sauces, etc. made with permitted fruits and vegetables, mustard, mayonnaise, green onion (green part only), soy sauce, vinegar, most spices and herbs, homemade broth, butter
Beverages Most fruit and vegetable juices, weak coffee, weak tea made with permitted foods, dry wine, spirits, nut milks Juices and smoothies made with permitted fruits and vegetables, coffee, tea, beer, wine, nut milks, all in limited quantities

The hardest thing for me, for sure, will be cutting out garlic and onion (even for 2-6 weeks, assuming the reintroduction goes well!). If you’ve ever looked at any of my recipes, you can see they all start with cutting up lots of garlic and onion! On the other hand, it feels like such a huge relief to have permission to eat some gluten-free grains here and there that it might make up for it. Not that I plan on going nuts–I still fully believe that eating unprocessed foods and focusing on eating fruits, vegetables, and protein rather than filling up on grains is healthier for almost everybody–but it’s nice to have a little bit more flexibility. To me, this diet seems much more manageable in the long term. And, while I won’t go into any gory details, in the 6 days or so that have passed since my doctor’s appointment, as I’ve tried reducing my overall FODMAPs load without yet jumping in on the elimination part, I’ve experienced more symptomatic relief than I ever did on the SCD. 

So, yeah, I think I’m going to give this a shot. Before I try the elimination part, I think I have a bit more research to do. I’m also not going to try the elimination phase until after I’m (mostly) recovered from my next surgery, since it seems like a lot to ask others to manage when I am unable to help at all with cooking or shopping. In the meantime, I might take a bit of a break from writing as well while I scope out this new territory, but I will be back, hopefully armed with a whole new set of recipes!