Have you Heard of Histamine Intolerance?

Today’s topic: Histamine.


As much as I love working with my patients….I also, truly love to spend time learning.  It’s not unusual for me to print out 3-4 research articles, hop into bed at night with my highlighter and do some light reading. :) Ha!

When I was writing my Complete Idiot’s Guide to Eating Well with IBS back in 2009, I included a few sentences introducing histamine intolerance to my readers. I find this condition very interesting ….and I am convinced it’s more common than it is diagnosed. I personally am on a mission to learn more and as always…share what I learn.

Disclaimer:  I don’t want every person with IBS that follows my blog to feel the need to remove all histamine from their diet! Nor do I want you to feel overwhelmed by this complicated topic I am about to embark on.  I do know that some people that follow my blog may very well have histamine intolerance. For this small subset of folks, the goal is to enlighten you to get the help you need.

What is histamine? Histamine is a natural substance, a biogenic (meaning: resulting from the activity of living organisms such as, fermentation) amine that is present in many foods and produced by a small subset of human cells, including mast cells, basophils, platelets, histaminergic neurons and enterochromaffine cells. Wow! That is a mouthful!  

Histamine is a neurotransmitter (brain chemicals that communicate information throughout our brain and body) produced in an allergic reaction, often associated with causing itching, redness, swelling, cough or rash. Histamine regulates sleep and also aids in digestion by playing a role in stomach acid secretion.

What is histamine intolerance?  Histamine intolerance results from an accumulation of histamine and the inability of the body to completely degrade it. In healthy people, dietary histamine can be rapidly detoxified by enzymes called amine oxidases, particularly, Diamine Oxidase (DAO) enzyme.  Some individuals have low levels of these enzymes; therefore, are at greater risk for histamine toxicity.  Gastrointestinal diseases can contribute to a decline in these histamine degrading enzymes.

Similar to FODMAPs, histamine can have a  cumulative effect on symptoms. Small amounts may be tolerated but multiple sources of histamine in the diet will ‘fill your personal threshold bucket’ and symptoms will ensue.  In order to assess if histamine is a problem for you, it is necessary to restrict all of the histamine-associated foods.  A food intake and symptom log are essential while undergoing both the elimination and the re-introduction phase of histamine foods.  Working with a dietitian knowledgeable in the low histamine diet is key.  Food lists for histamine are variable online.  It is my understanding that this in part is due to the fact that analysis of histamine in food has not been done for decades.  Another area of needed research!

Symptoms of histamine intolerance:

  • Diarrhea
  • Headache
  • Flushing
  • Rash/Urticaria (hives)/eczema
  • Arrhythmia (irregular heart beat)
  • Low blood pressure-due to vasodilation caused by the histamine
  • Wheezing
  • Runny nose
  • Watery eyes
  • Angioedema-swelling of face/hands/lips
  • Heartburn-due to increased acid production
  • Itching- typically of the skin
  • Abdominal Pain

The ingestion of histamine-rich food or of alcohol or drugs that release histamine or block DAO may provoke allergic-like symptoms in patients with histamine intolerance. Symptoms can be reduced by a low histamine diet and/or managed by antihistamine medications.

Do I think all patient’s with IBS have histamine intolerance? NO! But… histamine intolerance can contribute to abdominal pain, diarrhea, and heartburn–certainly common IBS symptoms, for some people.  Dr. William Chey, MD, Professor of Medicine, Director of the GI Physiology Laboratory, and Co-Director of the Michigan Bowel Control Program at the University of Michigan weighs in on this discussion, “Anyone who has hay fever already knows that histamine plays an important role in allergic responses caused by things like pollen and animal dander – many popular medications like Benadryl and Claritin block the effects of histamine. The fact that some foods contain histamine has been largely overlooked. It is quite plausible that consuming foods which contain large amounts of histamine or stimulate the release of histamine from cells in the gut could cause GI symptoms in some people.”

Unfortunately, we don’t have a definitive (accurate) test to determine DAO enzyme levels or their functioning capacity or histamine levels, at this time. If you present with 2 or more of the common symptoms of histamine intolerance, improve on a histamine free or low histamine diet and anti-histamine medications, you fit the criteria for having histamine intolerance.  A more severe disease state, an occult systemic mastocytosis should be excluded as your diagnosis by measurement of serum tryptase.  This is a condition in which a person has abnormally high amounts of mast cells.  You don’t need to have mastocytosis to have histamine intolerance.

Histamine and Food: High concentrations of histamine are found in products of fermentation such as aged cheeses, sauerkraut, wine, processed meats and  canned fish. Vegetables such as spinach, eggplant have histamine too.  In addition to histamine containing foods which I have provided only a partial list, there are foods that have the capacity to release histamine. Foods that have been linked with histamine release include: citrus fruit, papaya, strawberries, pineapple, nuts, peanuts, tomatoes, spinach, chocolate, fish, pork, egg whites and additives and spices.

Alcohol is not only rich in histamine but also inhibits the DAO enzyme to help degrade histamine.

Drugs that release histamine or inhibit diamine oxidase (DAO) can be found in this reference, in TABLE 5 which is also cited below.  Some medications included in this list are metoclopramide (reglan), Cimetidine, and Amitriptyline.

Here are some general tips to minimize histamine in diet:

  • Avoid or reduce eating canned foods.
  • Avoid or reduce eating overly ripened and/or fermented foods (aged cheeses, alcoholic drinks, products containing yeast, stale fish)
  • Histamine levels in foods vary, depending on how ripe, matured the foods are–with higher levels the more ripe or aged.
  • As much as it is possible, only buy and eat fresh food.
  • Don’t allow foods to linger outside the refrigerator – especially meat products or eat left-overs.
  • Choose fresh (not aged) meats, fresh white fish or choose those that have been flash frozen.
  • Consult a registered dietitian knowledgeable in histamine to help manage your diet modifications and help you balance your diet

If you are a health care professional or pretty savvy with medical jargon, check out this review article about histamine intolerance.

Could alterations in our gut bacteria play a role in histamine intolerance?

Um, yes.  Gut bacteria are capable of producing histamine. Little microorganisms in our intestine can produce histidine decarboxylase—converting protein in our gut to histamine. Amy Burkhart, MD, RD, an integrative medicine practitioner in Napa, California notes,”Though its benefits are controversial, I have had patients with dysbiosis/small intestinal bacterial overgrowth experience improvement on a low histamine diet. The low histamine diet is challenging and not necessary for all dysbiosis patients but can be beneficial in selected cases. Once the dysbiosis improves the tolerance to histamine containing foods also tends to improve.”

For further information on histamine containing food lists and research on this condition, here are some articles/resources/references for you to check out:

The Histamine Chef  Great site for all sorts of information written by a journalist–with many research articles provided and expert interviews.  Check out the interview with expert Dr. Janice Jonega

Dr. Janice Jonega’s site and fact sheet on histamine intolerance.

Amy Burkhart’s site (Amy is an MD and RD)  with a great article on histamine here.

Royal Prince Alfred Hospital Allergy Unit has some good resources on food intolerances (Sydney, Australia hospital)

Am J Clin Nutr 2007; 85:1185-96 Histamine and histamine intolerance  Excellent review article!

And if you lasted this long….Yay! You have a chance to win one of my latest products! A FODMAPer tote!! Now for sale on my website here!  For a chance to win,  simply leave the comment: #fodmaper  and I will select one random winner soon!

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Bacon wrapped pineapple

I love creating party appetizer recipes and this one makes the low FODMAP diet taste soooooo good.

The salty bacon paired with the sweet and tangy pineapple is a winning combo.IMG_0980editJust wrap half a slice of thinly sliced cooked bacon around a bite size piece of pineapple. Drizzle with a little pure maple syrup and feel the love.

IMG_0974editTo save time–I bought pre-baked bacon and heated it up in the microwave.  Wrapped it around the pineapple pieces and drizzled with a little pure maple syrup.  I baked these tasty morsels  for about 5 minutes to just warm up the pineapple. If you want, you can cook for a few minutes longer to brown up the pineapple and crisp the bacon a bit. Either way…it is all good. :)

pineapple bite

Bacon wrapped pineapple


  • Adapt ingredient quantities to number you are serving --FODMAPers limit to about 5 pieces
  • 10 slices pre-cooked bacon, cut in half (Or cook up raw bacon slices until slightly crisp)
  • 20 bite size pieces of pineapple
  • 1 tablespoon pure maple syrup


  1. Preheat oven to 350 degrees.
  2. Warm bacon in microwave --just making bacon a bit more pliable to wrap (15 seconds) around pineapple. Or cook bacon, if using raw, until slightly crisp.
  3. Wrap pineapple pieces with bacon and secure with toothpick and place on cookie sheet.
  4. Drizzle pineapple pieces evenly with pure maple syrup.
  5. Bake for 5-10 minutes just to warm.

Russ and I are hosting  a little ‘ugly sweater’ party this weekend! :) …So the appetizer planning is fully underway.  I like to have fun, easy but creative appetizers that everyone can enjoy.  Even though bacon isn’t the healthiest of foods, it makes a nice treat at a party.  Hopefully these will be a hit!  Have a great rest of the week!


Getting the Most Out of your Visit with the Gastroenterologist

It takes two. In every relationship, there is a little give and a little take, right? This is true for your patient-doctor relationships too!UntitledMy message to you today:  Be an active partner in this relationship! You and your doctor should work collaboratively together in an effort to help you feel your very best. Your relationship with your doctor should feel like a partnership…not a dictatorship! Mutual collaboration and respect is key! If you can’t work together with your doctor, it just might be time to find a new one. Just sayin’!

Last summer, in June 2014, I had the pleasure of meeting Dr. Doug Drossman at the University of North Carolina Patient Care Day: An Expert Update on Treatments for Functional Gastrointestinal Disorders. We both spoke at this event that featured interactive workshops. My talk, of course, was on diet, particularly the low FODMAP diet. Dr. Drossman’s talk focused on how to make the most of your doctor’s visit. As a world renowned leader in functional gut disorders and the President of the Rome Foundation, Dr. Drossman specializes in both biopsychosocial medicine and gastroenterology.

In 2012, Dr. Drossman founded the Drossman Center for the Education and Practice of Biopsychosocial Care (DrossmanCare) which focuses on improving healthcare by improving doctor-patient communications. Improving patient-doctor communications is shown to improve healthcare outcomes for both patient and doctor! No surprise there!

In my opinion, given the sensitive nature of taking about GI symptoms, your relationship and comfort level with your gastroenterologist is particularly important! During your meeting with the doctor, you should feel you are being heard. Unfortunately, in this technology focused world we live in, doctors are sometimes buried behind their computer! This does not help the patient-provider relationship one bit! Try to get your provider to talk to you face to face to get their undivided attention!

Here are a few resources to help you make the most of your doctor’s visit:

For starters, Dr. Drossman shared this great video with me…to share with you. I suggest you take a look at the video with Dr. Drossman and Dr. Chey titled:  Health Body, Healthy Mind, Talking about your GI health found in this link. I think this video shows the reality of  the impact IBS has on real people! YOU are not alone. IBS impacts up to 1 in 5 Americans! It’s easy to feel you are all alone when you have a  functional gut disorder. Most people keep their symptoms to themselves, right? But… providing honest and open dialogue is SO important at your doctor’s visit. Even if you feel embarrassed to discuss your bathroom habits, be rest assured your gastroenterologist has heard it all! The more accurately you tell your story, the more helpful your doctor can be in helping you manage your symptoms or identify a treatable condition.

Prior to your first appointment, write a few notes including the following:

  • Create a timeline:  when did your symptoms start and did they accompany a trip out of the country, with an episode of gastroenteritis or food poisoning? Or have you had them most of your life? Did they worsen or occur after a stressful event?
  • Do you have a family history of GI issues? Do you have any  family members that have Celiac disease, inflammatory bowel disease or perhaps a relative with chronic belly aches or IBS?
  • How often are your GI symptoms impacting your quality of life? Are you able to work outside the home? Do you travel without worry? Can you eat at restaurants? Are you in pain daily?
  • If you had to rate how you feel on a scale of 1-100% (100% being the very best), what number best represents how you feel on a general basis?
  • Do your symptoms wax and wane or do you have symptoms daily?
  • What symptom or symptoms do you find the most problematic?
  • Have you found any tricks to help manage your symptoms?
  • List all the medications and supplements (including herbs!) and dosages you are currently taking.
  • Be prepared to talk about your poop! Yes, this can provide key information about what is happening in your body!

For additional hints on how to talk to your doctor, check out two more resources that Dr. Drossman generously shared:  How to Talk to Doctor handout from UNC’s Functional Gut and Motility Center and this blog post provides even more tips on preparing and making the most of your doctor’s visit.

After you visit with your gastroenterologist, ask them what is the best way to get hold of them if you have a question. Not all doctor’s keep an active email thread going and would prefer you called their office. Knowing what is the preferential way of communicating for your doctor and utilizing this way of contacting him or her is a way to show your respect and enhance communication.

I hope this post helps you make the best of your time with your gastroenterologist.  If you can’t work respectively and collaboratively together, you may need to part ways and find a new doctor.  Remember though, it takes two.  Do your part to help create a healthy and successful relationship… to ultimately guide your treatment and better your health!


4 toasts

Toast Toppings!

I don’t know about you but I love toast.

And sometimes I like to get a little fancy with it too? 4 toastsWhat’s your favorite toast topper?  This week I created a few different toast topping combos.  MY toast topping started with toasted Deland Bakery’s Oatmeal bread.  Talk about simple ingredients, Deland Bakery has got that covered: oatmeal flour, filtered water, sea salt and baking powder. It is not gluten free but it appears low FODMAP.   Tolerance to oats can vary–so certainly feel free to sub in your favorite bread option or try your tolerance to just one slice.

Here’s a few of my toast topper combos that I came up with. I always try to add a little produce to any meal, some protein too, and then maybe a little unexpected ingredient.

Toast topper #1:  Carrot Cake: Shredded carrots, vanilla infused lactose free cream cheese, walnuts and a sprinkle of cinnamon sugarcarrot cake toastToast topper #2 Veggie and cheese: Red pepper, cilantro, lemon zest, crushed red pepper and a little ground pepper too, and a scoop of lactose free cottage cheese! Mmmm

red pepper and cilantroToast topper #3  Egg, peppered ham, Dijon and shredded cheddar (a little butter might make it even better!)ham and egg toastTopper #4 Peanut butter, sliced bananas, sprinkle of pepitas (hulled pumpkin seeds) and chia seeds. Oh… and a little drizzle of pure maple syrup.banana toastDo you have any favorite toast toppers? I hope my ideas inspire you to step up your toast game!

My Way Better Snack Chip and Sprouting post stirred up some fun comments and many of you wanted the chips! But, I had to select only one winner and the randomly selected winner was: Lisa H. and Lisa has been notified by email.

Don’t worry….I will be doing another give-a-way very very soon!


Chocolate and FODMAPs

After a long wait, the Monash team analyzed chocolate last year and the news was glorious! YES….small amounts of dark chocolate would fit the low FODMAP diet criteria. IMG_1008edit-1 FODMAPers around the globe rejoiced! And I was one of them!

For those who don’t know my history, here is a little recap:

I am a registered dietitian and a low FODMAP diet follower.  I have learned which FODMAPs trigger my symptoms and back off eating them when I want a calm belly.  For me, the low FODMAP diet was a long awaited answer to my very sensitive tummy post intestinal resection.  When I was pregnant with my middle son, I developed a strangulated  intestine and required immediate surgery to save my life–and that of my little growing baby within. It was a very scary time. I was in the hospital for 10 days and every morning the obstetric nurse came with the doppler to listen for my son’s heart beat.  Honestly, I cried every time I heard it.  Despite a miserable post-operation course, I felt so grateful that my son survived this trauma.  Every day that I see my college aged grown boy, I feel extremely blessed.  With 6 1/2 feet of my intestine removed along with of my ileo-cecal valve (the door between the small and large intestine), I struggled with terrible pains and cramping…daily. I later developed small intestinal overgrowth (yikes!) which as many of you know…is NO fun! Unfortunately, I am a high risk for small intestinal bacterial overgrowth since I don’t have my ileo-cecal valve.

But the low FODMAP diet has kept me in check. Fortunately, I had my nutrition degree throughout this ordeal and kept abreast of the research in GI nutrition. I learned about the low FODMAP diet back in 2009. Since then… I have been a new person.  It’s been such a rewarding experience to share what I have learned about FODMAPs with all of you. Really. Rewarding.

So…le’t talk chocolate. I mean, really, what’s more important? Ha!IMG_1014editt-1

Monash gives dark chocolate the ‘green light’ for a 30 gram portion.  Because chocolate can be a GI irritant and  is high in fat–tolerance is variable. Bottom line: Don’t over do it!!  So what’s a 30 gram portion–about 2 tablespoons of semi sweet morsels.  For cocoa, the limit is 2-3 heaping teaspoons–about 1 heaping tablespoon.

In an article in Antioxidants and Redox Signaling in November 2011 titled: Cocoa and Chocolate in Human Health and Disease, the authors note that cocoa has more phenolic antioxidants than most foods. Epicatechin (a natural plant phenol antioxidant) in cocoa provides a favorable effect on the blood vessels (lowers blood pressure). Cocoa polyphenols provide anti-inflammatory effects too. Cocoa can protect our nerves from injury and inflammation, protect the skin from UV radiation when applied on the skin( ie cocoa in lotions), and may help us feel full, preventing over eating. Chocolate may improve our mood (Ah…ya think? Yup.)  The summary of this article: The benefits of eating moderate cocoa or dark chocolate consumption likely outweighs the risks. Yahoo! :)

I am a big fan of fruit dipped in a little chocolate because a small amount just really hits the spot! IMG_0996edit-1I simply melt 2 tablespoons of semi-sweet chocolate chips with a drizzle of vegetable oil and heat in the microwave about 30 seconds and stir. Sometimes you need to heat the chocolate a little longer to get the morsels to melt (microwaves vary)–just watch the chocolate closely as you don’t want to burn it.

Choose a semi-sweet chocolate chip that has low fiber (1 gram or less) such as Ghirardelli semi-sweet chocolate chips. The potential FODMAPs in dark chocolate are fructans and GOS, fiber sources.  So, I like to choose those with lower fiber amounts. Some fair trade chocolate is quite high in fiber.  Of course, milk chocolate should be avoided as it contains lactose.

Just a little chocolate added to fruit makes a delicious dessert.  You can dip the fruit in the chocolate or drizzle the melted chocolate over a low FODMAP fruit kabob.  I like to add a little sprinkles because I think they are fun.  Nonpareils typically are made with sugar, cornstarch and confectioner’s glaze–so would be low FODMAP.

No major recipe today, just melt, dip or drizzle–it’s really quite easy.


Way Better Snack Chips

Sprouted Grains, Seeds, Legumes and a Give-A-Way!

Happy New Year! I am very excited for a great 2015…how about you? My BIG goal this year is to share more low FODMAP and lifestyle tips to help you live your best symptom-free life! Today’s topic: sprouting! A little lesson in why sprouting grains, seeds and legumes is a good thing for your health!WBS chips and bowl

First, let me tell you that I am a nutrition ambassador for Way Better Snacks.  I have been fortunate to work with this company that shares my passion for healthy foods on the go. Way Better Snacks incorporates sprouted grains, seeds, and legumes into their products.

So…why sprout seeds, grains and legumes? Sprouting seeds, beans and grains delivers many healthy benefits including:

  • Increased vitamin and minerals
  • increased antioxidants
  • increased digestibility
  • increased nutrient absorption

Sounds like a good idea for those of us with digestive distress to incorporate more sprouted foods, right? I think so!

Seeds and grains have anti-nutrients such as lectin, phytic acid, and tannins. These are natural substances that inhibit digestion and proper absorption of nutrients. Sprouting reduces and eliminates these anti-nutrients. This allows your body to better absorb the healthy nutrients found in these foods. 

A few words on these anti-nutrients found in some of our favorite seeds, cereal, grain, nuts and legumes:

Phytic acid is a major phosphorus storage compound of most seeds and cereal grains contributing about 1 to 7% of their dry weight.  Phytic acid binds to minerals such as zinc, calcium and iron.  This binding can result in insoluble salts that the body can not digest or are poorly absorbed.  So the nutrients are in the foods—but your body doesn’ t have access to them. Boo :(

Tannins are acidic substances distributed widely in plants. Tannins can be good and bad. They can accelerate blood clotting, reduce blood pressure and lower blood fats. They also can lead to liver damage and impact the immune response.

Lectins are carbohydrate binding proteins that are associated with causing inflammation.

Sprouting enhances the antioxidants in seeds and grains too! Antioxidants help protect our cells from damage from free radicals, which can cause cell deterioration, aging and disease!

Sprouting also helps enzymes in the seeds and grains to become active. These enzymes help our body better absorb the nutrition found in the grains and seeds. When beans are sprouted there is an increase in protein, reduction in phytic acid, and a reduction of the oligosaccharides. That’s right, oligosaccharides are FODMAPs! This is explained by an increase in alpha-galactosidase (an enzyme) levels that occurr during the sprouting process and help reduce oligosaccharide content.

So…there you have it.  Sprouting grains, seeds and legumes has health benefits that might be a great option for the digestively challenged!

Way Better Snacks offers snack foods made with sprouted ingredients, pure and unprocessed ingredients, delicious flavors (a few, YES, appear suitable for my FODMAPers!), Non-GMO verified, many are gluten free, Kosher, and all are made with no additives, no preservatives or no artificial ingredients!!

And guess what?  Today, I have a fabulous Way Better Snack Give-A-Way for one lucky winner!!Way Better Snack Chips

The give-a-way includes: 3 bags of the Way Better Snack Multi-Grain chips, a wicked (letting my Boston–come through) cute T-shirt, a sweet as can be bowl and wooden tongs for serving. Way Better Snack Multi-Grain chips are certified gluten free and contain lots of sprouted goodness: sprouted flax seed, sprouted quinoa, sprouted brown rice, sprouted daikon radish seed, sprouted chia, sprouted broccoli seed.

Want to win?  Simply leave a comment and tell me “I want the chips!” and I will enter your name in for the Way Better Snack Swag Give-A-Way.

And lastly, I wanted to share a couple pictures of my vacation.  Russ and I took our 3 kids to St. John for an amazing 7 day journey last week! BEAUTIFUL!! TrunkBay2

Picture above: Trunk Bay courtesy of Kevin Scarlata

We swam with turtles, sting ray and fish! We hiked. We walked past a field of wild goats and 2 donkeys! …And we laughed and ate to our heart’s content and enjoyed every single minute!  St John

Picture: Chocolate Hole Bay 

I promise I will get to your questions on the blog….I am just catching up on all my emails!


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Low FODMAP Tips for the Holidays!

It’s time to get FESTIVE and enjoy some down time with family and friends! Image 3Just a few tips to keep your spirits and tummy happy and calm during the holiday season!

  • If traveling to your celebration, pack a ‘car or plane picnic’–a low FODMAP meal, suitable snacks (peanuts, gluten free pretzels, low FODMAP energy bar such as Go Macro peanut butter) rather than relying on fast food or other convenience options  that might not have suitable choices for your sensitive tummy.
  • Bring along your favorite low FODMAP appetizer or side dish or two to share–this will ensure you have something to enjoy during the holiday gathering too.
  • Pack plenty of your favorite low FODMAP beverages–water, peppermint tea, seltzer (if you tolerate the bubbles!) to keep hydrated during your travels and when you arrive at your destination.
  • Indulge in low FODMAP appetizers such as shrimp cocktail (add a splash of lemon-hold the cocktail sauce or just add a little), scallops and bacon, hard cheeses, olives, potato chips, baby carrots, bell peppers, cucumbers and other suitable veggies.  Bring along a lactose free dip made from Green Valley lactose free sour cream or lactose free cream cheese.
  • Ask the host in advance what the menu will be so you can get a heads up on what you can or can not eat during the celebration.
  • Eat a snack prior to going to the event so you can focus on the social aspects of the party rather than just the food!
  • Maintain your exercise routine! It’s easy to move away from your morning walk with all the hustle and bustle of the holiday but this can impact your digestive system!
  • Keep the libations to a minimum! Alcohol is a GI irritant!  Maybe just one glass of white or red wine? :)
  • Looking for appetizer recipe inspirations? How about trying the Pineapple Walnut Cheeseball, Buffalo Chicken Meatballs, or Lemon-y Kale Hummus?  Of course, I have a ton of recipes in my recipe section! Check it out here!

I am looking forward to family time and a bit of relaxing.  Wishing you the same! I will be away on vacation through the New Year! See ya next year! :)

Holiday wishes



A Time of Giving

It truly is better to give than receive.  7daysofgiving

During the holiday season, the Scarlata family tries to make it a point to share a little love for those in need. The holiday season can be a time of great fun and festivities but for some people it can also be a time of stress, reflection and loss. The pressure of purchasing presents can be a financial burden too.  This year, we put our heads together to come up with a few small gestures of giving to hopefully put a smile on someone’s face during the holidays.

We find it particularly fun to give when no one is looking.  We have sent anonymous grocery gift cards, left money with the cashier at the local deli to pay for a neighbor’s lunch order, paid for the car behind us in the coffee drive thru.  But equally important is visiting the elderly, treating those who have made your life a little easier during the year, sending a text message of gratitude, reconnecting with an old friend…small gestures of kindness can turn around someone’s day.

This year–our family goal was to come up with 7 days of giving. Here’s what we came up with:

  1.  Create homemade cards for the women that are living temporarily in our local women’s and children shelter.  Every year two Moms in my neighborhood head up an effort in which other mom’s contribute to gift boxes for the moms at the shelter.
  2.  Make homemade sweet treats and spend time with elderly neighbors–it’s one of my favorite traditions.
  3. Send a little gift package to a friend’s brother and children who’s wife is terminally ill.
  4. Buy coffee for the person behind us in my beloved Starbucks.
  5. Send a small gift card anonymously to a family in our hometown that could use a dinner out with him family.
  6. Distribute hats, gloves and blankets for the homeless.
  7. ?  Please leave a comment and share what you plan on doing during this season of giving. We need one more idea!

When you take a minute to think about it, there is always someone in your life that could benefit from a little surprise love from YOU.






Baby Greens with Pomegranate, Goat Cheese, Orange & Pecans

‘Tis the season for pomegranates! I love these little juicy jewels! So…I decided to incorporate some tasty nourishing pomegranate seeds into a salad recipe.  Here is what I came up with…goat pomegranteI added a little of this and that and made this yummy salad. Fancy, right?

I think pomegranates add a little the holiday spirit, don’t you?  The red seeds with the salad greens just screams FESTIVE to me.  And anything with orange, pecans and goat cheese is a true friend of mine.  I think this salad might make a nice addition to my holiday menu and maybe yours?!

FODMAPers: Pomegranate seeds have a 1/4 cup limit per the Monash U. app.pomegranateSince nut and fruit quantities are limited on the low FODMAP diet, I used these ingredients sparingly just to add a splash of color and flavor.

plated salad

Baby Greens with Pomegranate, Goat Cheese, Orange & Pecans


  • Serves 6
  • 6 cups baby salad greens such as romaine, arugula, spinach
  • 1/4 cup pomegranate seeds
  • 1/4 cup goat cheese, crumbled
  • 1/4 cup pecans, lightly chopped
  • 1/2 orange, peeled and sliced into bite size pieces
  • Dressing:
  • 1 1/2 tablespoons fresh lemon juice
  • 1 tablespoon pure maple syrup
  • 1 teaspoon Dijon mustard (I use Maille, choose one without onion/garlic)
  • 2 tablespoons olive oil
  • Salt and pepper, to taste


  1. Layer washed baby salad greens on a medium size platter
  2. Sprinkle with pomegranate seeds, goat cheese, pecans, and orange pieces
  3. Whisk lemon juice, maple syrup, Dijon mustard, olive oil and season with salt and pepper.
  4. Drizzle dressing over salad and enjoy!

I hope you are surviving the hustle and bustle of the holiday season!


When your diet is only a piece of the pie!

When it comes to managing IBS and other functional gut disorder symptoms, your diet might be only a piece of the pie.pieceofthepie

From burning reflux, debilitating gas or bloating to urgent diarrhea or unrelenting constipation, digestive health distress impacts millions of Americans. These symptoms can truly stop people in their tracks and can disrupt their quality of life.

What I have learned from working with patients with functional gut disorders is that diet often plays an important part in symptom control but it may be only part of the treatment plan. Thinking of a pie chart, diet might only take up one-quarter of the pie for some individuals or maybe one-sixth for another.  In essence, each person has their own digestive symptom pie!

Don’t get me wrong, many individuals with digestive symptoms will respond to diet changes alone….but not all!  For those with functional gut disorders such as irritable bowel syndrome, constipation, bloating, diarrhea and gastroparesis, a more comprehensive strategy and treatment plan is likely.

My friend and colleague, Dr. William Chey, MD, a Professor of Medicine, Director of the GI Physiology Laboratory, and Co-Director of the Michigan Bowel Control Program at the University of Michigan and leading US gastroenterologist in functional gut disorders eloquently notes , “Food is the great enabler. In healthy people, food can turn an otherwise mundane event into a highly pleasureable, even memorable experience. On the other hand, for people with gastrointestinal problems like gastroesophageal reflux disease, irritable bowel syndrome, diarrhea, constipation, or fecal incontinence, food can serve as an important trigger for symptoms that lead to embarrassment and misery. Most often, food isn’t is THE cause of a problem as much as it unmasks a problem in function or sensation that is already there.”

Sensitivity to foods can be related to the types of microbes in our intestine, where they reside and how much gas they produce, the way the intestine handles the gas and fluid present in the intestine, how the intestine moves—too slow or too fast or the degree of sensitivity of the intestine.

Patients with functional gut disorders require diligent detective work and a collaborative treatment plan that involves the patient, the gastroenterologist and the dietitian.  I firmly believe a collaborative team effort can lead to better outcomes for the patient.  As in most facets of work, a team effort results in a more comprehensive outcome than work done individually. Collectively, a team can offer the patient much more than each provider could do for the patient on their own.  And of course, we all learn from each other.

When I educate someone on the low FODMAP diet, I often tell them, that the diet will pull out some of the trees from the forest.  What I mean by this, is  the low FODMAP diet often settles down some of the primary symptoms …i.e. “clears some trees”…and then I will be able to identify better what else might be contributing to their remaining digestive distress. Janine Clifford-Murphy, MS, RD, a dietitian that specializes in the low FODMAP diet and works with me in my Medway practice finds, “Sometimes, patients overlook the role of fat in their diets as they focus on the low FODMAP foods. Once they realize cheese and butter are very low in lactose, they might be tempted to overdue it. Subsequent discomfort is often misinterpreted as FODMAP or dairy related, when it might be just too much fat at one time.”

After the initial low FODMAP diet trial, I will call the patient’s gastroenterologist to discuss the possibility of other testing or perhaps try alternative dietary modifications (modify fat intake, trial of low histamine or gluten free, adjust fiber intake) in an effort to manage any persistent  symptoms.  Most dietary trials should be undertaken with a dietitian to help ensure nutrient intake is adequate. Overly restrictive diets can backfire and set up the stage for weight loss and malnutrition which ultimately can impact the health of the individual and their GI tract!

Many of my clients have presented with overlapping digestive health issues such as small intestinal bacterial overgrowth (SIBO), pelvic floor dysfunction, alteration in stomach emptying such as fast emptying called dumping syndrome or delay in emptying called gastroparesis. These overlapping issues alongside IBS require additional therapies often beyond diet.  According to Mark Pimentel, Director of the Gastrointestinal Motility Program and Laboratory at Cedars-Sinai Medical Center and leading SIBO researcher, “Classically, SIBO is characterized by bloating and distention after meals. Up to 70% of IBS patients may have SIBO. This is now based on small bowel culture studies. ”  If you find the low FODMAP diet is not providing adequate relief, you and your team (I hope you can find one!), can work on figuring out what other over-lapping issues might be a piece of your pie. If bloating or fullness after eating is a primary issue for you perhaps SIBO is present.  SIBO symptoms mimic those found in IBS. Testing is typically done via glucose or lactulose breath testing.

According the the Mayo Clinic, “Up to 50% of patients with chronic constipation have pelvic floor dysfunction (PFD, or dyssynergia). This condition is characterized by impaired coordination between pelvic floor (e.g., puborectalis) relaxation and abdominal wall motion, which is necessary for normal defecation. However, PFD is not widely recognized as a possible cause of chronic constipation. As a result, many patients with medically refractory constipation do not receive optimal therapies that enable them to recover normal bowel habits.”  If chronic constipation is part of your GI picture, discuss whether you should be evaluated for PFD with your GI doctor.

Work closely with your dietitian and gastroenterologist to find ALL potential pieces of your health care puzzle…so you can feel your very best!