Carena Lowenthal is a registered dietitian, certified health & wellness coach, and herself an IBS-sufferer. She works as Epicured’s concierge dietitian to make sure customers have an excellent experience using Epicured to manage digestive illnesses.

I was 22 years old and a dietetic intern at Albert Einstein Hospital in the Bronx. I was taking a patient’s medical history at the bedside when she said to me, “When are you expecting?” I looked at her shockingly, my reply, “expecting what?” I had no idea that my discomfort and apparent belly bloat had gotten me to this point. I thought it was normal that once in a while, I ate something that didn’t agree with me, and my belly went from ‘relatively’ flat to looking 6 months pregnant. And I also thought everyone had gas, like lots of gas was normal! I could never have anticipated what lay ahead. I went from here to a few years later with severe symptoms to a GI doctor, getting my first colonoscopy at age 25, to a diagnosis and medication. It wasn’t until many, many years later when I heard about the low FODMAP diet at a lecture at Mount Sinai, from the guru Kate Scarlata, that I realized I could control my symptoms with diet. And I was a Registered Dietitian.

I had my focus on diabetes, cancer, working with tube feeding and supplements, in and out of ICU’s. I really never took the time to heal myself. Fast forward to now. I’ve taken the time to find out what I can and cannot comfortably eat. I follow a low FODMAP diet 80% of the time. I know my limits and myself. I feel 100% better about my GI health, and Epicured has been a huge factor in this. I eat clean, balanced, appropriate portions of delicious food, fully prepared for many meals a week. Then I cook or eat out other meals, knowing what will work with my body. And the difference in how I feel is tremendous. I can wear the pants or dresses that show off my belly instead of hiding it. And after my last colonoscopy, I wanted to celebrate! I had a clean bill of health. I still don’t understand why my GI doctors hadn’t suggested earlier making changes to my diet. I also don’t understand why I didn’t make my own changes. But live and learn… now my goal is to educate others suffering from IBS or IBD with IBS symptoms to make the changes and choose health.

Credit: Ben Fink Productions for Epicured

Carena Lowenthal is a registered dietitian, certified health & wellness coach, and herself an IBS-sufferer. She works closely with members of Epicured’s Clinical Network to make sure that their patients have an excellent experience using Epicured to manage digestive illnesses.


LOW FODMAP ELIMINATION DIET

By now you probably know about what a FODMAP elimination diet is. You avoid an extensive list of foods that are high in FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols). But once you take these all out for the 2-6 weeks usually recommended by a Registered Dietitian, then what?

THE RE-INTRODUCTION PHASE

This is a basic overview, not to take the place of a dietitian-supervised approach.  Because if you go through the work of doing the elimination, you might as well be assured you are re-introducing correctly. That said – there is a way, an order, and a method for monitoring symptoms that you need to know – and working with someone with expertise in this area, you are more likely to get to the root of the problem, identify the food group(s), then narrow down your specific intolerance(s).

A quick overview:
During the “testing phase”, you will re-introduce one food group at a time with a washout period in-between the groups. On day 1 of a food, you will have a smaller portion size (1/2 the general normal size portion).  Then on day 2, if you had no symptoms from day 1, you will have a full portion size of that food. Then you wait at least 2 days before starting the next food.
The typical test foods are:
  • Polyols (Sorbitol) – Blackberries
  • Polyols (Mannitol) – Mushrooms
  • Lactose – Regular Milk
  • Fructose – Honey
  • Fructans – Garlic
  • Fructans – Onions
  • Fructans – Bread
  • GOS (galacto-oligosaccharides) – Black Beans

Note: Portion size counts when you do the re-introduction. The sequence of foods that you reintroduce also matters in some cases. Finally, once you know the food group, it is possible to narrow down further your specific intolerance(s).

HOW CAN EPICURED HELP?

Credit: Ben Fink Productions

All of the fresh, delicious and healthy food from Epicured is 100% low FODMAP and gluten-free. So you can safely use Epicured while you are on the elimination diet.

This is a huge help for anyone – especially those that typically order in, eat out, don’t like to cook, and really anyone that just wants to have help with the restrictions. Then when you are doing the re-introduction, well you are still safe to use any of the Epicured meals or snacks. And finally, once you are back to your personalized diet plan, you can still use Epicured whenever you like. While eating low FODMAP all the time is not recommended once you’ve identified your triggers, it’s fine to supplement many of your meals with Epicured.

 


LOOKING FOR MORE RESOURCES?
Try our Low FODMAP Cheat Sheet
This content is for informational purposes only and does not take the place of medical advice.

Carena Lowenthal is a registered dietitian, certified health & wellness coach, and herself an IBS-sufferer. She works closely with members of Epicured’s Clinical Network to make sure that their patients have an excellent experience using Epicured to manage digestive illnesses.

 


ABOUT IBS AND THE LOW FODMAP DIET: If you are one of the 15-20% of the population with IBS (Irritable Bowel Syndrome) and you haven’t heard of the low FODMAP diet, you are certainly not alone. I am a registered dietitian with a digestive issue and I only heard about it 5 years ago! The diet can be so valuable to people suffering from IBS, myself included, that I decided to take the elimination challenge and can now speak first-hand, about how life-changing this could be.

Let me start with what FODMAP stands for: Fermentable Oligo-, Di-, Mono-saccharides And Polyols.
FODMAPs are essentially a bunch of short-chain carbohydrates that are poorly absorbed in the small intestine and pass into the large intestines where there are fermented by the bacteria that live there. They may also pull water into the large intestine. Both of these actions may cause symptoms such as abdominal pain, gas, bloating, diarrhea and/or constipation.

THE FODMAP “ELIMINATION”

The list of permitted foods is very specific. While certain foods will be easily identifiable, for others you will need to consult with a list to get started. You’ll typically begin with a strict “elimination” diet that usually lasts between 2 and 6 weeks.

Low FODMAP Turkey Meatballs with Basil & Pomodoro Sauce. Photo: Ben Fink Productions for Epicured. 

If you are feeling relief during the elimination phase, you can add back certain foods, with one of the FODMAP groups at a time, in small amounts, to see what you are most sensitive to. This I would recommend doing methodically with a registered dietitian. There is a good chance that after the challenge you may be able to add back and tolerate a certain amount of a food you are sensitive to in a given day, or at a particular meal, but this will vary with individuals. I will go through the dietary carbohydrates and some of the foods that contain them, but definitely consult with a complete list from a reliable source.

“FODMAPS” 101

Fructose: a natural fruit sugar found in many fruits, honey, high-fructose corn syrup and agave can be a problem either due to the lack of an enzyme in the body or the ratio of glucose to fructose in a fruit. Fruits with a high glucose: fructose ratio are generally well tolerated, such as blueberries, strawberries, cantaloupe, honeydew and ripe bananas, but those with a high fructose: glucose ratio such as apples, watermelon and mangoes may not be.
Lactose: a carbohydrate found in dairy products can be a problem due to a partial or complete lack of the enzyme lactase which digests lactose. Foods such as cow’s milk, yogurt and ice cream are lactose containing foods.
Fructans: are carbohydrates that are completely malabsorbed because the intestine lacks an enzyme to break their fructose bond. Wheat accounts for most of people’s fructan intake, which can be found in breads, cereals, and pasta, but they can also be present in onions, garlic and other vegetables. This is not to be confused with Celiac Disease, or a gluten sensitivity which is related to the wheat protein, gluten.
Galactans: are carbohydrates that are also malabsorbed because the intestine does not have the enzyme to break them down. Beans, peas, and lentils are primary examples.
Polyols: also known as sugar alcohols, are found naturally in some fruits and vegetables and also added to sugar-free gum, mints, and cough drops. The names of some of these artificial sweeteners end in ol- like sorbitol, xylitol, mannitol, and malitol. Apples, pears, stone-fruits, mushrooms, and cauliflower would also be high sources of polyols.

GETTING STARTED

It may seem like a lot of foods will be “off limits.” But keep in mind this is only during the elimination phase and hopefully you will be able to add back some of your favorite foods, or other versions of them.
More importantly, we are here to help you! Epicured’s Michelin-star chefs and registered dietitians have developed wonderful low FODMAP, digestion-friendly recipes for all of your favorites, like: Pad Thai, Tikka Masala, even chili! Our entire menu is even permitted during the elimination phase!

 

LOOKING FOR MORE RESOURCES?
Download: The Monash University FODMAP App
Follow: @katescarlata on Instagram

Our delicious Autumn Salad has just the right amount of broccoli and brussels sprouts to be FODMAP-friendly.

PASSOVER ON THE LOW FODMAP DIET

Passover time can be a real dietary challenge for anyone following their centuries-old family traditions, but even moreso for people with IBS following a low FODMAP diet. Here’s how Epicured can help!

We have Passover-friendly (Kosher style, not Kosher) meals that will work with your body to help you feel good.  So, you can steer clear of the heavy, traditional dishes that you may normally give in to…

Here are some of my FAVORITES:

Zucchini “Spaghetti” Pomodoro
Hawker Lettuce Wraps with Chicken
Frittata Muffins with Tomato and Herbs
Dragonfruit or Coco Berry Smoothies

And for those of who are eating rice, beans, nuts, and seeds, you might like:

Thai Green Curry with Chicken, Tofu or Veggie
Tofu, Chicken or Beef Teriyaki Donburi
Tofu Tikki Masala
Veggie Tacos Especiales
Sesame Crusted Wild Salmon
Truffled Mac and Cheese
Pulled BBQ Chicken
Veggie Tortilla Soup
Warm Autumn Salad