Tag Archives: FODMAPs


Yield to the almighty onion

Today is Tuesday and that means it is Tip Tuesday for those on the low FODMAP diet.

Providing some real time tips for you in light and fun way. 

TAKE CAUTION!  This is posted for your safety!! :)


So…what’s the deal with onions?  They seem to be the biggest trigger for most people with IBS.  Onions are a member of the fructan family.  Fructans, also known as oligosaccharides, are the “O” in FODMAPs.  Fructans can be termed:  fructo-oligosaccharides (FOS), oligofructose or inulin depending on the chain length of the carb, or the number of sugars held together in the fructan molecule. The longer chain fructans are termed inulin.

First, let me say, onions, for the 80-85 % of people without IBS, are not the bad guys.  Fructans are well known to increase healthy intestinal bacteria, increase calcium absorption, maintain the intestinal mucosal barrier, and reduce risk of colon cancer.  

But for those with IBS, onions are a well-known dietary symptom trigger.  

Because of the health benefits of fructans, staying on the low FODMAP diet indefinitely is not recommended. More research is needed to look at the impact of staying on the low FODMAP long term.

Fructans range from l-o-n-g carbohydrates chains to small carbohydrate chains;  tolerance may be variable depending on the number of carbs strung together.  We know that FODMAPs with the smallest amount of carbs have the greatest osmotic effects (bring water into the intestine.); we also know that the smaller the FODMAP the faster it tends to ferment.  Onions tend to have a smaller number of chains of carbs –even compared to garlic–so perhaps this is why I see less tolerance to onion in my patients.

So what about onions for FODMAPers…

Onions are everywhere. Lurking in our foods and hidden in our food labels. They seem to like to go undercover.  Do not approach them, stay on marked trails! If provoked or attacked by an onion, always try to fight back… with the low FODMAP diet, of course!

Tips to avoid onions while on the FODMAP elimination diet:

  • Look for the term natural flavors in your ingredient list, this can denote onion or garlic, especially if the food is a savory or salty item.
  • Leek, onion, shallots will contain fructans so limit them during the elimination phase.
  • Onion powder, minced onion, onion salt are concentrated onion (fructan) sources so avoid while on the elimination phase of the diet.

Enjoy the onion flavor while on your FODMAP elimination phase by trying the following:

  • Use the green part of scallions (green onion), green part of leeks, or chopped chives to your favorite recipes which have acceptable FODMAP amounts.
  • Add a dash of asafoetida powder (just a scant amount) to impart onion flavor in your dish.  Use gluten free asafoetida powder, if you are following a gluten free diet.
  • Saute onions in olive oil to infuse flavor, remove onions and use flavored oil immediately for the dish you are preparing. {Fructans are water-soluble so will not leach into the oil}.

Did you know In America, most of the fructans in the typical American diet come from wheat? Next, comes onion! Chicory root –added to so many foods and supplements is a fructan too! Be on the lookout for this sneaky additive in your ingredient lists.  I have recently found chicory root in yogurts, granola bars, calcium supplements and probiotics.

Have you found chicory root lurking in any unusual places?




Chocolate Chip Cookie Dough Cheesecakes

We all deserve a little treat now and again, right?  So, today, I am sharing a recipe from my childhood that I morphed a bit into a gluten free and low FODMAP treat.  The recipe of the day: Chocolate Chip Cookie Dough Cheesecakes.  Please take a peek!

mini tortes

As a dietitian, I am all about eating healthy most of the time.  If the goal of eating healthy is to live a long, healthy and productive life, I do believe a little treat can fit in.  I worry sometimes about people that feel guilty about eating a little taste of cake… like it’s evil.  I am a bit fearful that nutrition and eating in the US has become somewhat of an obsession….and not at all in a good way.  I am happy that Americans are more aware of the relationship of food to health but I am sad that food has become a substance of calories, fats and ‘nutrients’ or chemicals rather than looked at as simply food that we eat to nourish and enjoy.   In part, this transition has become a necessity as modern manufacturers don’t always have our back–their goal is pure financial gain and getting an inexpensive manufactured food into the hands and mouths of consumers to make the almighty  $$ buck.  But the fallout of food obsession can have dire consequences —food  becomes feared and obsessed over and along with it a new form of eating disorder called orthorexia nervosa is emerging.  Learn more about orthorexia nervosa  here.

Don’t get me wrong,  I think being an informed consumer is a good thing. I think eating real foods grown in nature is a great goal. I hope that the food manufacturing world will be more transparent and that consumer’s will know exactly what we are eating when we buy packaged foods.  I realize that many of my clients can’t eat anything they want because they have a sensitive intestine.  I am hopeful that we all listen to our bodies and when a food or drink creates pain or digestive woes that we listen and minimize the offending item.  But eating something simply because it has minimal calories or is full of green vegetables but you hate the taste and get very little enjoyment from consuming it…to me, misses the big picture. Food should be nourishing but also enjoyed right?  Too much of a “good” thing–be it water or spinach–can cause harm.  Jamming 2 bags of spinach into a green drink can up the phytates and oxalates to levels that minimize mineral absorption and increase risk of kidney stones in susceptible individuals. More isn’t always better.

I am not one to rant about my beliefs, though my husband may beg to differ with me! Ha! But just wanted to say, I think we need to be a bit more gentle on ourselves with our many “food rules”.  It can be exhausting and stressful to worry about every bite.  I do understand how scary eating can become when every bite seems to trouble your tummy.  And I am hopeful that this area of digestive health will continue to blossom and help us all connect the dots.  Just be mindful that trying to be perfect or ‘clean’ with your diet every single day might just be asking  yourself to do the impossible.  And from a ‘big picture’ health vantage point, this attempt to be perfect rather than eating healthy the majority of the time, probably won’t add years to your life….but rather less life to your years.

Okay…on a lighter note…let’s eat cake! :)

This recipe is partially homemade and partially made with some semi-prepared ingredients…making it super easy to whip up.  It’s also very adaptable.  I made my cheesecakes in my 3 inch torte pans, but these can be made in muffin tins w/ paper liners for easy removal.


Chocolate Chip Cookie Dough Cheesecakes


  • 8 ounces of Farmer cheese (I use Friendship brand which has 0 grams of lactose)
  • 2 large eggs
  • 1/4 cup vanilla infused sugar (OR sub in 1/4 cup sugar and 1 teaspoon vanilla)
  • 1 tablespoon brown rice flour
  • 1 package refrigerated gluten free chocolate chip cookie dough (I use, Immaculate GF chocolate chunk cookies)


  1. Preheat oven to 350 degrees.
  2. Prepare 12 muffin tins by lining w/ paper liners or lightly oil 6, 5 inch tart tins
  3. Press 1 cookie dough 'glob' about 1 tablespoon into muffin tin or 2 'globs' or 2 tablespoon into tart pan, press lightly to form a crust.
  4. In medium bowl, mix farmer cheese,eggs, vanilla sugar (or sugar and vanilla extract) and brown rice flour until creamy.
  5. Top 'crust' with about 1-2 tablespoon of cheese mixture--should leave a bit of outer crust showing.
  6. Bake at 350 for 20-30 minutes. Cheese mixture should be firm and cookies lightly browned on sides and cake tester comes out clean.
Schema/Recipe SEO Data Markup by ZipList Recipe Plugin

How to make a low FODMAP meal final pdf

How to Make a Well-Balanced Low FODMAP Plate!

Hello Friends,

In the ever changing world of FODMAPs, it is my hope to keep you up-to-date in a quick yet informative way via my blog.  I will be focusing most of my upcoming Tuesday posts on quick tips…conveniently called, Tuesday’s Tips!  So be on the lookout!

Today’s Tuesday’s  Tip:  How to Make a Well-Balanced Low FODMAP Plate, a handout to help guide you in planning a well-balanced AND healthy low FODMAP meal.How to make a low FODMAP meal final pdf How to make a low FODMAP meal! Click here for printable.

Hope you are having a great week!  Plan ahead: this weekend is The Global Outreach Symposium on IBS with Mark Pimentel, one of the key MDs studying small intestinal bacterial overgrowth and IBS.  This event is planned for Los Angeles, California but is available global via webinar.  Click here to learn more!

Lemon Zested Blueberry Crisp

Hello FODMAP friends,

There is nothing quite as tasty as a fresh picked blueberry bursting in your mouth on a warm summer day! YUM! In fact, berry picking in the summer is one of my most favorite warm weather traditions. My favorite… the blueberry.

I created a recipe combining two of my most favorite flavors–lemon and blueberries and made a delightful blueberry crisp.   Really, how can you go wrong with those flavors?

Check this out!lemon zested blueberry crisp ready to eatI mixed up a crisp topping with a little brown rice flour, oats, chia seeds, shredded coconut and cinnamon –and just 1/4 cup of melted butter.  So good.

For those on the low FODMAP or gluten free diet, this recipe is created especially for you! Gluten intolerance folks should be sure to select gluten free oats and chia seeds.

My recipe was featured on Stone Soup, a blogging platform of the Academy of Nutrition and Dietetics that features many tasty and healthy recipes created by dietitians.  Check out Stone Soup for some great recipes for you and your family!

Blueberries offer a big nutritional bang for their buck! A top dog for their super rich antioxidant content, blueberries are key for brain health and memory functioning. They help keep our ticker healthy by minimizing cholesterol levels and plaque formation. Blueberries, also, keeps inflammation at bay and since many major diseases such as arthritis, obesity and diabetes are inflammatory—we could all use some anti-inflammation nutrition. The polyphenol components of blueberries may play a part in bone health too! An additional perk, blueberries may even lower risk of breast cancer.

To learn more, check out this USDA’s website for review of interesting studies featuring blueberries or some of their active components.

I admit I am obsessed with blueberries. I add them to my meals every chance I get. Here are a few ways you too can boost some blue in your diet:

  • Top your yogurt (lactose free, of course, if you are lactose intolerant) or oats with some fresh blueberries
  • Whirl some frozen blueberries and Greek yogurt (lactose content in Greek yogurt is typically far less than traditional-check your personal tolerance to this high protein food or sub in lactose free yogurt) for a quick and easy smoothie.
  • Toss some sliced kale, feta and blueberries together with lemon and olive oil dressing for a refreshing summer salad.
  • Add blueberries to your favorite pancake or muffin recipe for an occasional breakfast treat.

Want to try my Lemon Zested Blueberry made healthier Crisp recipe? Well, then, here you go!

blueberry zested crisp ready to eat

Lemon Zested Blueberry Crisp


  • Serves: 6
  • 1 1/2 pints fresh blueberries, washed
  • 1 tablespoon corn starch
  • 2 tablespoons fresh lemon juice
  • 1 tablespoon lemon zest
  • 1/4 cup granulated sugar
  • Topping:
  • 1/4 cup brown rice flour
  • 1 tablespoon chia seeds
  • 1/2 cup oats (quick or old fashioned work)
  • 1/4 cup packed brown sugar
  • 1 teaspoon cinnamon
  • 1 tablespoon shredded coconut
  • 1/4 cup butter, melted


  1. Preheat oven to 350 degrees
  2. Add blueberries to 8 x 8 square pan.
  3. Sprinkle cornstarch, sugar, lemon juice and zest evenly over berries and stir to combine.
  4. Make topping by mixing all topping ingredients in small bowl until blended.
  5. Place topping mixture over blueberries evenly.
  6. Bake for about 25 minutes--topping should be slightly brown and blueberries bubbling on the sides of dish.
  7. Let cool for about 5 minutes and then evenly dish out.
Schema/Recipe SEO Data Markup by ZipList Recipe Plugin


I am working on some fun new FODMAP education handouts.  I will be posting a cute one later this week. Stay tuned.  Have any ideas for handouts you would like to see? Post a comment.

In the twitter world: Sue Shepherd, the dietitian that coined the term FODMAPs and initiated the research in this area of digestive health  will be answering questions live via twitter on  Wed, July 16th at  9 PM Victoria Australia time or IN BOSTON (US-EST) that translates to 7 AM, Wed, July 16th.  Follow hashtag #eatkit

Enjoy the weekend.  See you soon


Monash U gives thumbs up to dark chocolate (FODMAP update)!

Okay, I stumbled on some new info this morning…and since chocolate has been a HOT topic…

Drum roll, please!

You can officially say, yes, to chocolate….dark chocolate that is.  But the quantity limit is about 2 tablespoons of mini semi-sweet chocolate chips or 30 grams.  BUT….yes, I will take it!  I have been allowing small amounts of semi-sweet chocolate chips in my recipes…. but today, I can rest easier knowing that they are officially allowed!Dark chocolate

White chocolate and milk chocolate had moderate amounts of lactose–so are ‘yellow or amber lighted’ on the app.

Click here to see the info as stated by the Monash Uni researchers!



FODMAP twitter chat!

What are your thoughts about twitter?Unknown-8

I know many people think twitter is a crazy waste of time.

To be honest, I joined twitter somewhat reluctantly as I had no clue what it was about…and what value it might add to my career.  But, other dietitians urged me to give it a try.  So…I joined.

At first,  I spent very little time tweeting. I was a bit unsure of what I should really even say.  But, soon enough, I realized I could follow other health care professionals around the globe that shared my interest in digestive health and I started to shared information that I knew–and in return, I received information I was seeking from others.  Now…I have to say, I love twitter!Unknown-9

One of my favorite things about twitter is twitter chats.  And this is where you all come in.  I will be moderating a twitter chat with two very smart Monash University FODMAP researchers, Jaci Barrett and CK Yao, on March 24 at 7 PM EST US time (Boston)….that would be March 25 at 10 AM Melbourne time and March 24 at 11 PM London time! And I hope to have participants from all over the globe.  You don’t have to tweet during a twitter chat–you can just follow the tweets! But if you want to ask a question….of course chime  tweet on in!

So here is how it works.  Get a twitter account.  Follow me @KateScarlata_RD I will be on twitter at 7 PM EST US on March 24 at 7 PM with the Monash researchers and will start asking questions.  If you want to follow all the questions I ask and all the answers that roll on in… put the twitter chat hashtag in the search bar on your twitter home page.  The twitter hashtag needs to be placed on all tweets associated with our ‘chat’.  The hashtag is #fodmapchat

When you put fodmapchat in your search section on your twitter home page you will start to see tweets related to our fodmapchat! You will need to keep refreshing your search bar to get the current tweets that are being typed in.

If you look closely in the grey search bar below on my twitter page–I typed in fodmapchat.Screen Shot 2014-03-13 at 8.22.54 PM

The twitter chat goes fast–lots of answers and tweeting back and forth.  The chat lasts for one hour.

Remember if you want to ask a question– be sure to put #fodmapchat in your tweet–or it will likely get missed.  I can’t promise that all questions asked will get answered but…many questions will be answered!  And if you have any burning questions–leave a comment and I will try to ask them during the chat!

OH…and I gave away two 21 Day Tummy Cookbooks today! Congrats Donna and Lora!

Chocolate Covered Pineapple…in preparation for Valentine’s Day

Okay….here it is….my latest addiction.

Semi-swet chocolate + fresh sliced pineapple= Heaven

Sooooooo tasty.  And really one or maybe two little chunks and your sweet tooth should be completely satisfied.

chocolate covered pineappleSince Valentine’s Day is just around the corner…you might want to treat your sweetheart to these tasty sweets!

Can you say…YUM!?

Valentine's treat chocolate covered pineapple

Chocolate has not been officially tested for FODMAPs to my knowledge but if you choose a lactose free chocolate chip with a lower fiber content (1 gram or less per serving)…you may find in small quantity you can tolerate it…..of course, listen to your body and adjust your diet accordingly.

And…if pineapple isn’t your favorite fruit….you can always get creative with other fruits…and perhaps even a smattering of nuts or coconut!

chocolate covered fruit

Chocolate Covered Pineapple


  • 1 cup semi-sweet chocolate morsels such as Trader Joe's
  • 1 teaspoon vegetable oil
  • 1 whole pineapple, sliced into spears or chunks


  1. Cooking time may vary, but I placed my chips and oil in microwave safe dish and cooked on regular setting for 1 minute.
  2. Carefully remove bowl and give the chocolate a stir.
  3. Place bowl of chocolate back in microwave for another 30-45 seconds and stir to create a creamy chocolate blend. {Microwave cooking times vary this may take less or more depending of the power of your microwave}
  4. Place cut up pineapple on a few paper towels to remove moisture on the outside of the fruit.
  5. Dip chunks into chocolate using fork and place on parchment paper lined plate.
  6. If using spears, just dip half of the spear in chocolate (that will be enough chocolate!)
  7. Refrigerate chocolate dipped pineapple for about 30 minutes if you can wait that long!
Schema/Recipe SEO Data Markup by ZipList Recipe Plugin

21 Day Tummy Give-A-Way {Cookbook and Book!}

I am beyond excited.  21 Day Tummy was featured on The Doctor’s today How exciting is that?

book The doctors

Another opportunity for FODMAPs to get some well deserved attention.

I do want to explain something though…because there seems to be a little confusion around why I might have modified FODMAPs in a plan designed to lose weight.

The low FODMAP diet principle was included in the 21 Day Tummy primarily for one reason… to soothe and calm digestive symptoms such as gas, bloating, diarrhea, constipation and IBS symptoms. You see, the 21 Day Tummy plan is NOT only a weight loss book but also one designed to minimize digestive woes! A 2 in 1 plan! And we all know that gas, bloating and IBS are VERY common. It is estimated that up to 1 in 5 people suffer with IBS! The book helps the reader identify their personal ‘belly bullies’ i.e. symptom triggers.

We learned the 21 Day Tummy plan was effective in managing GERD (gastro-esophageal reflux) in 2 of the 21 Tummy Diet testers (we put 12 people on the plan for 3 weeks). Two of the testers who suffer with reflux noted immediate improvement on the plan and during the diet were able to discontinue their acid reducing medications.  This did not surprise me as there is a link with fructan (a source of FODMAPs) intake and GERD symptoms.

But could the low FODMAP diet also help with weight loss?  Perhaps.  The potential connection {NOT fully researched at this time} could be the microbes (gut flora) within our GI tract.  Methane producing microbes are linked with higher body mass index (ie more methane producing microbes in the intestines are found in heavier individuals) and methane gas in the intestine not only causes constipation but microbes producing methane seem to be able to extract greater amounts of calories from the food we eat.  Does the low FODMAP diet starve these methane producing microbes? We don’t know for sure….yet.   But there is some speculation that the low FODMAP diet helps individuals with constipation predominant IBS because of the potential impact on these ‘bugs’…. starving the methane producing bugs means less methane, less constipation and just maybe better weight management.  BUT…for now…this is speculation and a bit more time and research is needed.

Just remember  21 Day Tummy is a plan designed for the person with digestive symptoms that also needs to lose weight BUT if you want to just enjoy the amazing recipes and learn more about gut bacteria, inflammation, belly fat and how that all connects to your health…I think it’s a great read with excellent science for just about everyone! 

And the great news…is that there is a sequel to the 21 Day Tummy.  Yup! A cookbook jam packed with the most amazing recipes. Here it is!cookbook

And good news? I have two to give a way!  Just leave a comment on this post for a chance to win! The recipes are:

  • Low FODMAP
  • Full of real foods
  • Magnesium rich ( a nutrient most of us fall short on) that plays a role in nerve transmission and muscle contractions
  • Sources of low FODMAP fiber
  • Quick to make
  • Super yummy

So…here’s a snap shot of a few recipes for the cookbook to get your mouth watering! Not the best pictures as I took a picture of a picture with my iPhone! :)

Blueberry Corn Muffinscorn blueberry muffinPoached Eggs and Grits!

Ya’ll will love this recipe.  I fell in love with grits in college at Emory U in Atlanta! MMMMmmm..polenta

Blueberry Shortcakes…..
blueberry shortcake

And more good news! Leave a comment about why you are interested in reading the 21 Day Tummy and I will enter you in a chance to win a book!

eHJMAgAAQBAJSo…share your thoughts and I will share some books!

…and if you are already a 21 Day Tummy reader feel free to share your experiences.

Small Intestinal Bacterial Overgrowth (SIBO)

Okay, I am about to get all science-y on you.   Are you ready?  Thinking cap on? I attended a great conference last weekend, a SIBO symposium sponsored by the National College of Natural Medicine in Portland, Oregon.  Top SIBO specialists that presented most of the information  at the symposium included: Mark Pimentel, MD, FRCPC, Allison Siebecker, ND, MSOM, LAc, Leonard Weinstock, MD, FACG and Steven Sandberg-Lewis, ND, DNANP Having had SIBO myself back in 2003 and again in 2013….and having close to 65 % of my client test positive for SIBO–I have a vested interest in this disorder! {In fact, I wrote an article for Today’s Dietitian back in 2011 that you can access if you choose to check it out.   Click here for the article. } What is SIBO? SIBO is an acronym that stands for small intestinal bacterial overgrowth. Normally, the small intestine provides a home for  few bacteria but in SIBO, bacteria that normally reside in the colon, sneak up into the small intestine and wreak havoc.  Symptoms of SIBO mimic those seen in IBS but bloating is typically the most troubling complaint. How do you get SIBO? The researchers at the conference reviewed several factors that may contribute to or predispose  someone to developing SIBO:

  • Infection (such as post-infectious IBS)
  • Decrease in pancreatic enzymes
  • Decrease in bile acids (bile acids normally emulsify in the intestine and don’t allow bacteria to grow).
  • Stress-decreases motility of the intestine so bacteria can build up in the intestine.
  • Low stomach acid

Some diseases and syndromes are associated with SIBO include some well accepted in the medical community and some ‘new kids on the block’ disorders that are linked with SIBO but more research is necessary to provide a definite link. Disorders that are well accepted as associated with developing SIBO include:

  • Scleroderma
  • Small intestinal pseudo-obstruction
  • Adhesions (scar tissue) that may cause the intestine to kink like a garden house
  • Pancreatic insufficiency
  • Small intestinal diverticulosis (small pouches that develop in the small intestinal wall)
  • Low stomach acid (achlorhydria)
  • Diabetes
  • Radiation enteritis  (inflammation of the small intestine following radiation therapy)
  • Immunodeficiency (Ig A def, T-cell deficiency)
  • J-pouch, ileo-cecal valve resection

Dr. Weinstock mentioned several other disorders that may increase risk of SIBO but more research is needed, these include:

  • Crohn’s disease
  • Celiac disease
  • IBS
  • Liver disease
  • Restless leg syndrome
  • Rosacea
  • Parkinson’s disease
  • Chronic renal failure
  • Hypothyroidism
  • Post-chemotherapy
  • Fibromyalgia
  • Rheumatoid arthritis
  • Interstitial cystitis

Wow…right!? Testing:  The consensus at this conference was to undergo a lactulose breath test to evaluate for SIBO. The test should measure BOTH  hydrogen and methane gas.  Some GI doctors are not fully on board with this the breath test for diagnosing SIBO as it is not a validated test… but for now…it is the least invasive and most likely test to be used in clinical practice. Dr. Pimentel provided info on what he deems a positive test: A positive methane test is anything >3 PPM during the testing w/ in 90 minutes. A positive hydrogen test is >20 PPM (not necessarily 20 PPM rise above baseline but rather any reading 20 PPM would be a + test) w/in 90 minutes. Interesting to note:  hydrogen sulfide producing bacteria use up 5  hydrogens to produce this gas and methane gas uses up 4  hydrogens–so it is possible to have a flat line hydrogen gas reading during the breath testing but still have SIBO.  New testing is being explored to test for hydrogen sulfide gas but is not fully developed yet. Treatment: The consensus at this conference was first line treatment was antibiotics, followed by a prokinetic (a drug that enhances your intestinal tract’s motility) for 3 months and a repeat breath test and a diet low in fermentable carbohydrates. For a + hydrogen test the recommended antibiotic therapy included:  550 mg Rifaximin three times a day for 14 days.  Caution was made to ensure to stick with this course and do not miss a pill to keep therapy as effective as possible.  Dr. Pimentel did note that higher doses would not warrant better results. For a + methane test the recommended antibiotic therapy included:  550 mg Rifaximin three times per day in combination with neomycin 500 mg twice a day for 14 days OR Rifaximin 550 milligrams three times per day with Metronidazole 250 milligrams three times per day for 14 days. Prokinetic: Dr. Pimentel mentioned erythromycin 1/4 tablet or 50 mg at night.  He reiterated the importance of taking erythromycin on an EMPTY stomach.  Probiotics: There was a difference in opinion regarding the use of probiotics for this condition.  Dr. Pimentel does not recommend them at this time but some of the other physicians do.  Probiotics mentioned included Align and Culturelle (Nature Health and Wellness w/o inulin). Probiotic studies have revealed that they enhance motility–but more research in this area is needed to provide individual recommendations. Diet:  There is no evidenced based diet to use with SIBO.  There needs to be research in this area!!  Diets that were discussed and utilized by these practitioners includes: low FODMAP, specific carbohydrate diet (SDC), a combo SDC and low FODMAP and Cedar Sinai’s Dr. Pimentel’s protocol.  Again a difference in opinion from the speakers. Dr. Siebecker likes to use a combo of the SCD and low FODMAPs diet while an individual has SIBO with a transition to low FODMAP for prevention. For those interested in learning more about this, check out Dr. Siebecker’s site here.  She mentioned that in individuals that seem to tolerate sucrose (table sugar) and grains/starch/fiber or in the underweight client low FODMAPs may be a good starting point.  Dr. Pimentel feels sucrose (table sugar) is well absorbed and is okay on the diet for those with SIBO (of course, within reason!). And lastly some key take-aways for me from this symposium:

  • SIBO is not a diagnostic term–it is a condition that arises due to something else.  Work with your doctor to determine WHY you developed SIBO.  If you don’t determine the cause, it will likely just come back.  Dr. Pimentel feels the decrease in MMC (migrating motor complex or ‘cleansing waves’) is the primary cause of SIBO in seen in IBS.  Remember in order for the MMC to initiate a cleansing wave you must be in the FASTING state–so avoid grazing and try to space/snacks meals 3-4 hours apart. You can include water or coffee in between meals.
  • Methane + constipation is harder to treat and should be treated with rifaximin and neomycin together.  This combo drug therapy may be better than neomycin on its own in terms of minimizing risk of neomycin drug resistance.
  • Methane bugs tend to come back sooner.
  • Methane gas appears to come primarily from Methonobrevibacter smithii which is actually not a bacteria but rather a microorganism from the Archaea kingdom. These microorganisms do not have a cell nucleus. Methane bacteria are linked with higher body weight (>BMI)
  • Dr. Pimentel said he would like to frame IBS patients as non-methane IBS or methane + IBS vs. IBS-C and IBS-D: treatments differ for the two based on gases.
  • Use a prokinetic drug and diet to help minimize risk of re-occurance.
  • If you have a SIBO  relapse within 1 month, it is likely in 50% of individuals that another disease is causing it.  If no relapse, pull back on erythromycin or prokinetic after 3 months.
  • Diet for SIBO should be customized–work with a dietitian or health care practitioner with SIBO knowledge!
  • Dr. Pimentel’s theory in regard to diet during antibiotic treatment is to NOT be on a low fermentable carb diet while using antibiotics as the microbes go in a hibernation phase and are less likely to be eradicated….I  tell my clients that fermentable carbs are somewhat like cheese to a mouse–let those microbes come out to eat so you can get ‘em with the antibiotic!!

Why rifaximin might not work for some?

  1. SIBO too severe for symptom relief in one course
  2. Methane bacteria benefit from dual treatment: rifaximin + neomycin
  3. Bacteria may not be sensitive to rifaximin
  •  NOTE: Rifaximin has two forms: the alpha form has the anti-microbial while the beta form is not anti-microbial  (some forms found outside US such as India may have a combo of beta and alpha which would be LESS effective).

Herbal therapies such as herbal antibiotics that may be helpful: berberine herbs, allicin for methane producers, oregano & neem were all mentioned.  Of course, if you choose to try herbal therapies do so with a knowledgable practitioner.  Just because a product is an herb doesn’t mean that it will not have side effects! Personally, I find a low FODMAP diet keeps my SIBO at bay with meal spacing a key component! I have worked with some clients that have needed a bit more of a strict diet including removal of some grains and leanings toward the SCD diet but I have found that has been more of an exception than a rule.  Prokinetic drugs to add a longer duration of therapeutic benefit for many but not all of my clients have tolerated them.  Trying alternatives to erythromycin might offer benefit such as trying prucalopride or cisapride. Congratulations if you made it this far with my ramblings! Is your brain full from this post? Ha! More to come in this exciting area of digestive health! Stay tuned!

Dr. Oz says “F” is for…FODMAPs


To say I am on a mission to get the word out about the low FODMAP diet for those experiencing digestive discord:  gas, bloating, and simply miserable belly busting misery….would be an understatement.

Years ago, when I was combing through the research and stumbled upon the term FODMAPs, I had an “Ah-ha” moment.   The science of how a low FODMAP could minimize gas, bloating and tummy trouble just made sense.  And for someone troubled with post-intestinal surgery belly misery…I was anxious to find some answers…not only for me…but the many clients that sought my advice.  So, today, for me…is a big victory.  Although I will continue to educate and spread the word about the low FODMAP diet, I feel so very happy that FODMAPs hits the big time!fodmap

Reader’s Digest provided me with an opportunity to blend a weight loss plan with a scientific approach to minimize IBS symptoms, reflux, and general tummy trouble in one, 21 day menu plan.  And Dr. Oz took notice! Yay!

So….FODMAPs took center stage today on the Dr. Oz show today, with author, Liz Vaccariello…and for that, we all deserve a little celebration!  Woot! Woot!trifecta

If you would like to join in for a facebook chat about 21 Day Tummy with Liz Vaccariello and I–we’ll be live on a Reader’s Digest Facebook page tonight at 7 PM EST.  {Sorry for short notice!} We’ll be talking up all of the “Belly Buddies” found in the 21-Day Tummy diet plan–turmeric, ginger, monounsaturated flats, anti-inflammation buster magnesium and so much more.  Come join the fun and bring your questions!