The IBS Elimination Diet and Cookbook: The Proven Low-FODMAP Plan for Eating Well and Feeling Great

by Patsy Catsos MS, RD, LD

Overview

The complete guide for overcoming IBS by discovering your triggers and building a personalized, doable, and fulfilling diet around nutritious, delicious foods that let you finally feel your best.

Patsy Catsos, MS, RDN, LD, pioneered the use of the low-FODMAP diet to find your unique FODMAP fingerprint when she self-published IBS—Free at Last!, ushering in a new era of treating IBS through diet instead of medication. Written for at-home use, her book quickly established itself among doctors and other specialists as an invaluable tool for anyone suffering from IBS, Crohn's disease, ulcerative colitis, SIBO, and gluten sensitivity.

This new, definitive edition offers the theory along with a program that walks you through eliminating FODMAPs (difficult-to-digest carbohydrates found in a variety of otherwise healthy foods) and adding them back one by one—the most usable, thorough program available. And its 56 delicious recipes, 24 full-color photos, and comprehensive guides to high- and low-FODMAP foods make this the bible of the low-FODMAP lifestyle. Here is your plan for eating well while finally feeling great.

Note: This is the updated and expanded edition of IBS—Free at Last, including its landmark 8-step program.

Product Details

ISBN-13:	9780451497734
Publisher:	Harmony/Rodale/Convergent
Publication date:	04/11/2017
Sold by:	Random House
Format:	eBook
Pages:	304
File size:	99 MB
Note:	This product may take a few minutes to download.

About the Author

PATSY CATSOS, MS, RD, LD, is a leader in the field of low-FODMAP diet. A nutritionist based in Portland, Maine, with a BS in nutrition from Cornell University and a master’s degree in nutrition from Boston University, she completed her internship at Boston’s Beth Israel Hospital and now maintains a private practice. She also speaks at conferences for other nutritionist and doctors.

She was first to publish a book about the low-FODMAP diet, IBS—Free At Last! in 2009. Before long, it was adopted not only by IBS sufferers, but by health care professionals and major medical centers. Her step-by-step elimination diet is updated for ultimate usability and effectiveness in this new edition, The IBS Elimination Diet and Cookbook. It helped set the standard of care for patients using diet, not medicine, and continues to be the most recommended by doctors.

She lives in Portland, Maine, with her husband, Paul.
 
www.ibsfree.net

Read an Excerpt

A Revolution in IBS Treatment
What do apples, multi-grain bread, cauliflower, yogurt, high-fiber breakfast cereals, and hummus have in common? These “healthy” foods all contain fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs), and they can trigger symptoms of irritable bowel syndrome (IBS). Ironically, for many years it was thought that foods like these would help everyone with IBS. And even today, many health-care providers still have not moved beyond traditional one-size-fits-all “fiber” therapy for IBS—if they give any dietary advice at all. If you are reading this book, it may not come as a surprise that high-fiber IBS therapy, beloved by doctors everywhere, doesn’t always (or even usually) work! If thirty-three IBS patients are told to eat more bran, only one of them is likely to report improvement of his or her symptoms over the next month. Clearly, we need to do better.
There is now proof that changing the types of sugars and fibers in your diet can help you achieve lasting relief from IBS symptoms. The FODMAP approach, developed in Australia and now used around the world, is increasingly recognized as the most effective way to manage IBS with diet. Up to 85 percent of patients report significant improvement of their IBS symptoms when they have followed a low-FODMAP diet. The 35 million Americans with IBS (about 11 percent of the population) are no longer left to their own devices, desperately looking for help with their symptoms. There is no longer any reason for doctors to stand by helplessly, to give the same old “high-fiber diet” advice or, worse yet, to tell patients that diet doesn’t matter.
When I wrote the first edition of IBS—Free at Last! in 2008, almost no one knew about FODMAPs outside of Australia; the challenge was to get the information to the IBS sufferers who needed it. Its publication coincided with exploding consumer interest in nutrition and non-drug therapies for IBS. Connected by social media and with ready access to published medical literature, people began to learn self-help strategies directly from each other, without regard to international boundaries and without the filter of what their health-care providers knew or chose to share with them. This meant that patients often learned about FODMAPs from the Internet, or from my book, before their doctors or dietitians did. We are witnessing a revolution, with nutrition emerging as first-line therapy for IBS, and it has been a patient-driven phenomenon.
Today, the challenge for many IBS sufferers is actually dealing with too much information (and misinformation!). Word spreads fast on the Internet, sometimes presented by people with a thin grasp of nutritional science. Pretty recipe pictures on Pinterest and lists of high- and low-FODMAP foods are not enough. To get the best outcome from a FODMAP elimination diet, you need a strategy and a plan. You need help in cutting through the confusion about FODMAPs and IBS, and in getting down to work. You deserve trustworthy guidance, and you can find it here. With this book, you can conduct a dietary experiment to learn how FODMAPs affect you by eating only low-FODMAP foods for a few weeks, then reintroducing high-FODMAP foods and monitoring your symptoms. You will learn which FODMAPs affect you and which ones don’t.
That’s what this book is. This revised and expanded version of IBS—Free at Last! is your guide to understanding the science of FODMAPs and finding your unique FODMAP fingerprint. And it offers fifty-six delicious recipes to get you started on your new pain-free lifestyle, as well as tips and plans for eating when you don’t have the time and resources to cook every meal from scratch.
You may wonder: Why are FODMAPs so complex? and Why do I need to learn so much in order to follow this diet? It’s because of where the FODMAP data come from; how they are affected by the natural variability of food; what the difference is between FODMAP data and FODMAP teaching tools, such as are included in this book; and how these different tools can be used, depending on where you are in the elimination phase of the program. There’s a lot of conflicting information online, so it’s good for you to have a little backstory before you embark on this journey.
FODMAP Background
The FODMAP concept was created by researchers at Monash University in Australia, and this group continues to publish most of the available FODMAP food composition data—these published data tables are the primary sources for the program. An example of FODMAP data is: “There are 1.2 grams of sorbitol in 100 grams of an apple.” We can’t get too attached to such data, though. Different varieties of apples, different growing conditions, and different degrees of ripeness make each apple unique, and the same holds true for each type of fruit or vegetable, as well as for every batch of grain or loaf of bread.
Most people do not have the time, interest, or know-how to plan a low-FODMAP diet directly from the data tables published in the medical journals. So health-care professionals and educators create tools to communicate this information to patients and readers. At the heart of each tool is a list of low-FODMAP foods. For example, I developed the tools in this book—the Low-FODMAP Pantry (page 81) and the label reading tips on pages 91–97—based on the available data about the FODMAP content of foods at the time of publication. I built my unique approach to the data on the way people actually eat and live—a methodology that has made it possible for my patients to stick with the diet and reap its benefits.
Tool creators make decisions about which foods to include on a low-FODMAP diet based on cut-offs they have determined for what is considered a “high-FODMAP” food. There are no scientifically proven rules for determining these cut-offs or deciding what the food portions should be. Each tool creator or project team decides these things independently. They filter the FODMAP data through their different lenses; that’s okay, because different tools can help different people. That’s also why you can expect some minor variations in the FODMAP tools and corresponding recipes. Don’t worry; these few minor discrepancies won’t diminish the overall impact of lowering the FODMAP load of your diet.
In this book, I’ve determined whether a food is low in FODMAPs based on standard serving sizes, such as 1/2 cup of vegetables. I made this decision, which admittedly errs on the side of oversimplification, so this complex and technical diet is easier to learn and easier for you to remember. Another developer’s FODMAP tool might shrink the vegetable servings to as small as necessary to give those foods a green light. For example, in my program, Brussels sprouts are not suitable for the elimination phase of the program because 1/2 cup contains too many FODMAPs. However, in the Monash University Low FODMAP Diet app, which uses a traffic light system, a serving of two Brussels sprouts gets that green light.
Conflicts can also arise when the context is fuzzy. For example, if you searched the Internet to answer the question “Can I eat Greek yogurt on a low-FODMAP diet?,” you would get a variety of answers. So, you need to be clear whether you are following a strict elimination/reintroduction program or are eating a relatively low-lactose diet after completing the reintroduction phase. Now, let’s answer your question: No, Greek yogurt is not recommended during the elimination phase of this program because it contains several grams of lactose per serving. Yes, it is a good choice for a relatively low-FODMAP diet because it is lower in lactose than other yogurts. So, as you see, both responses are true. Greek yogurt may be a perfectly good choice after the reintroduction phase—if you’ve found you can tolerate several grams of lactose at once. You will need to remind yourself of where you are in your program as you review such confusing or seemingly contradictory information.
Likewise, if you are comparing two tools created by the same person, keep in mind that the food lists with later publication dates are likely the more accurate ones. As more primary data is published, the FODMAP status or recommended portion sizes may change. For instance, the food lists in this book are more up to date than those in my previous books.
As you can see, learning about FODMAPs means also learning to live with some uncertainty about the suitability of the foods for your diet. The inevitable discrepancies can cause a little anxiety about whether you are “doing it right.” Don’t let those worries distract you from the big picture. Even with some uncertainty, substantially lowering your overall FODMAP intake will help you decide whether FODMAPs are impacting your IBS symptoms, and if that’s the case, you will be able to manage these symptoms more effectively.

Table of Contents

Foreword xi

Preface xv

Part 1 IBS and FODMAP Basics 1

A Revolution in IBS Treatment 3

FODMAP Background 5

How to Use This Book 9

The Nutshell Version of the Program 10

IBS-Do You Have It? 12

Diagnosing IBS 14

Tips for Talking with Your Doctor 16

Change Your Carbs, Change Your Life 17

Some Questions About IBS 18

FODMAPs-The Big Picture 21

Seeing the Forest Instead of the Trees 22

What Is the FODMAP Elimination Diet? 24

Possible Outcomes of the Program 24

The Benefits and Risks of a Low-FODMAP Diet 26

Is a FODMAP Elimination Diet Right for You? 27

The FODMAP Top 40 Foods 31

Some Questions About Low-FODMAP Diets 32

Part 2 The Two-Phase Program 43

The Elimination Phase 43

Strategies for Elimination Success 43

Some Questions About Starting the Elimination Phase 46

Step 1 Get Ready 47

Step 2 Record Your Baseline Symptoms 48

Step 3 Plan Your Diet and Go Shopping 52

Meal-Planning Tips 53

Sample 7-Day Menu 55

Common Menu Variations 60

Really Quick Meals 60

Vegan Meal Ideas 62

Weight-Gain Ideas 63

Dining-Out Ideas 64

Grocery-Shopping Tips 66

Shopping List for the Sample 7-Day Menu 68

Step 4 Eliminate High-FODMAP Foods from Your Diet 70

Low-FODMAP Pantry Tips 70

Some Questions About the Diet 71

The Low-FODMAP Pantry 81

How to Read Product Labels 91

Low-FODMAP Ingredients 93

High-FODMAP Ingredients 94

Step 5 Monitor Your Symptoms and Compare Them to Your Baseline 105

Your Weekly Checkup 105

Dealing with Constipation During the Elimination Phase 108

Dealing with Unwanted Weight Loss During the Elimination Phase 110

A Question at the End of the Elimination Phase 110

The Reintroduction Phase 111

Strategies for Reintroduction Success 111

The Timing of Symptoms After Reintroducing FODMAPs 113

Step 6 Reintroduce FODMAPs and Monitor Symptoms 114

Plan A One FODMAP at a Time (Challenge) 116

FODMAP Reintroduction Schedule for Plan A 118

Plan B One FODMAP at a Time (Cautious Reintroduction) 125

FODMAP Reintroduction Schedule for Plan B 127

These Foods Contain FODMAPs 134

Plan C Food-by-Food (Cautious Reintroduction) 138

Food Reintroduction Schedule for Plan C 141

Step 7 Evaluate Your Results 143

In Search of Clarity-Understanding Your Results 143

Some Questions About the Program Results 145

Step 8 Enjoy the Most Varied and Nutritious Diet You Can Tolerate 146

Strategies for Coping with a FODMAP Intolerance 146

Coping with Specific Intolerances 148

Lactose Intolerance 148

Fructose Intolerance 150

Mannitol and Sorbitol Intolerance 151

Oligosaccharide Intolerance 152

Program Conclusion 155

Extra: FODMAP Lite-An Alternative Approach 156

Part 3 The Recipes 159

Tips and Tricks for Adapting Standard Recipes 160

Recipe Measurements 164

Basic Recipes 165

Breakfasts 177

Appetizers, Sides, and Snacks 183

Mains 190

Desserts 215

Part 4 The Details 221

The Science Behind the Diet 221

Carbohydrate Basics 221

FODMAPs Unpacked 226

The Effectiveness of Low-FODMAP Diets for IBS 229

The Risks of Low-FODMAP Diets 231

Complicated Foods Unpacked 232

Meeting Your Nutrition Needs 238

Low-FODMAP Sources of Fiber 239

Low-FODMAP Sources of Protein 241

Low-FODMAP Sources of Calcium 243

Beyond FODMAPs 244

Managing IBS-Related Anxiety 244

Probiotics 245

Vitamin and Mineral Supplements 247

Fiber Supplements 248

Other Adverse Food Reactions 249

Acknowledgments 251

Bibliography and Recommended Reading 253

General Index 267

Recipe Index 280

Editorial Reviews

[T]horoughly researched and well-thought out and executed resource for patients and practitioners alike. I know I'll reference the book the next time I work with a client needing FODMAP restriction.”—Today's Dietitian

"In this book, Patsy Catsos has done an exemplary job of helping people both identify and then manage IBS. For some, this may be a miraculous shift. Thank you, Ms. Catsos, for your clear delivery, excellent organization and empathic writing style. Your book with be a blessing for many, and can also serve as a handy reference for the professional as well.”—Brenda Watson, CNC, New York Times bestselling author of The Skinny Gut Diet

“As a digestive health dietitian and IBS expert, I can attest to the low FODMAP diet as an effective nutrition solution for the majority of those who suffer with IBS. The low FODMAP diet can truly be a life changer! Patsy Catsos unravels the complexities of the low FODMAP diet for the reader providing all the details of the low FODMAP elimination and re-introduction diet in this comprehensive guide. The Q and A format that Ms. Catsos provides throughout the book will answer all the reader’s burning questions and more.”—Kate Scarlata, RDN, New York Times Bestselling Author and IBS Expert

“Dietary triggers are the most notorious provocateurs of IBS symptoms. The IBS Elimination Diet and Cookbook by Patsy Catsos, a leading nutritionist and FODMAP expert, is a must-have survival guide. Her delightful book is an authoritative but user-friendly resource of how to use the right food as powerful medicine for IBS.”—Gerard E. Mullin, MD, Associate Professor of Medicine, The Johns Hopkins University School of Medicine, and author of The Gut Balance Revolution, The Good Gut Guide and The Inside Tract

“Long a leader in IBS and low FODMAP education, Patsy Catsos dives deeper than ever before in this book, with up-to-date medical insight and real world strategies. This is an invaluable resource for my IBS patients.”—Miechelle O'Brien, MD, PhD, co-Founder TrueSelf Foods (Low-FODMAP Foods Made Easy)

“Whether you're a health care professional or a consumer trying to filter through the flood of information on IBS, you definitely want to pick up a copy of The IBS Elimination Diet and Cookbook. Patsy does a wonderful job getting right down to exactly what you need to know to get your IBS symptoms under control with a nutritious and varied diet that is manageable and gets results. . . . Beautifully referenced with a scientific based bibliography, you will find yourself coming back to this gem of a resource over and over!”—Dr. Sheila Dean, DSc, RDN, CCN, CDE, IFMCP, Integrative & Functional Nutrition Academy, Co-Founder

From the Publisher