What It's Really Like to Be On an Elimination Diet
The low FODMAP diet is clinically proven to help tummy troubles. But is it easy? Definitely not.
I polish off a homemade gluten-free pizza with special no-garlic, no-onion tomato sauce piled high with loads of fresh mozzarella, and I'm full. But I reach into the fridge and grab a pint of Talenti gelato (sea salt caramel, if you were wondering). My husband gives me a strange look as I plop onto the couch with a spoon. "I'm overloading on lactose today," I say.
This is the reintroduction phase of my elimination diet, designed to provoke gastrointestinal symptoms, and for two days I get to devour one food grouping at a time before returning to a very basic and restrictive diet. Then I repeat the process with a different food group. I'm trying to figure out what's been causing my constant nausea, stomach cramps, and diarrhea. (Seriously, why do so many women have stomach issues?) After seeing two gastroenterologists and a nutritionist, I landed in the hands of a registered dietitian at Columbia University who recommended I try the low FODMAP diet, first developed by Australian researchers in 2005 and the only clinically proven diet for treating symptoms of IBS. The plan minimizes FODMAPs (fermentable, oligo-, di-, and mono-saccharides and polyols), which are types of carbohydrates that, for some people, are poorly absorbed by the small intestine, causing gas, bloating, and other tummy troubles.
When I first met with Sabrina, my dietitian, I started crying in her office when I described months of weird stomach issues that had been ramping up. Were it not for my total desperation, I would have never considered doing a strict diet like the one she was advising, which eliminated many of my go-to foods.
I had come into my first appointment armed with two weeks of food logs. She grabbed a red pen, circling all the FODMAPs I had eaten. Avocado toast (noooooo!). Brussels sprouts. Hummus. Asparagus. Apples. (What ever happened to "an apple a day"?) The red ink went on and on.
But I dove right in, cutting out gluten, most dairy, legumes, most alcohol save wine and gin, gum and mints (artificial sweeteners can be a big trigger for GI issues), tons of tasty, healthy fruits and veggies, and additives like inulin, chicory root, agave, and honey. And it sucked. I felt tired, cranky, and so hungry.
Here's the thing about elimination diets: They're not meant to last forever, so there is always a light at the end of the tunnel. That tunnel just seems really, really long. For four weeks, I stuck to the plan, which required I prep most meals myself, since it was nearly impossible to find restaurants that could be completely accommodating. The options for grab-and-go food were even more difficult. I mastered reading nutrition labels with a keen eye for hidden ingredients (who knew some deli turkey had milk in it?), and I hunted down all of the packaged foods that would be safe for me to eat, a huge challenge.
Committing to the diet meant extra time in the kitchen, lots of repeated dishes, bowing out of boozy brunch, and constant anxiety at every meal. It certainly wasn't trendy or sexy, but I did it and I was feeling 98 percent better than I had before-yes! But then came the reintroduction phase which was essentially designed to make me feel worse again. Talk about a roller coaster. Just when you're starting to feel good, you're forced to add foods back in with the sole purpose of causing your body distress in an effort to pinpoint a trigger for symptoms. But trying to make yourself feel sick is a total mind f*ck, with each bite like consuming a giant stress cookie, and I was a Cookie Monster. (Related: Why do you lose your appetite when you're stressed?)
Some of the food groupings didn't bother me at all when I reintroduced them. Others left me with an upset stomach again. Then on some days in between the reintroductions, when I was back to the basic elimination diet, I still felt like crap. The good thing though, was that I felt light years better than when I first started feeling sick, with more good days than bad.
I still don't have all the answers, but I'm working with my doctor and nutritionist to figure out a combination of dietary modifications and a special antibiotic that will keep my stomach from hating me. I've come away with a new appreciation for what people with food allergies and sensitivities have to go through-always being the person who asks a million questions at restaurants, skipping out on dinners with friends because they can't find something to eat, and looking sadly at the cupcakes laid out for office birthdays and baby showers (though maybe that last one isn't the worst thing in the world). And while I wouldn't recommend that anyone go on an elimination diet unless medically necessary and under the supervision of a doctor or food pro, I'm grateful that it helped me get back to feeling my best and thinking more mindfully about what I'm putting into my body.