#038 Dietitian Erin Peisach Can Help You To Improve Your Digestive Health…From End To End!

RD Erin Peisach is specialised in Functional Bowel Disorders and her specialties include GERD, IBS, SIBO, Crohn’s, Colitis, Celiac, and EoE. Her aim is to educate her clients and guide them through five key areas: diet, supplements, physical activity, sleep and stress management.

In this episode, you’ll learn:

  • Erin’s own struggles with digestive issues.
  • How Erin realised that the low FODMAP diet helped her clients suffering from IBS more than other diets?
  • What is a Functional Bowel Disorders?
  • Erin’s approach in treating teenagers and young adults.
  • The difference between acid reflux and GERD.
  • Erin’s tips to heal acid reflux without medication.
  • What is DGL licorice?
  • How stress affects the digestive system?
  • The importance of finding the root cause of symptoms.
  • The difference between lactose intolerance, dairy allergy and dairy intolerance.
  • Can probiotics help IBS sufferers?

Click here to leave an iTunes review and subscribe to the show

Listen On Apple Podcast

Can’t listen to this episode right now? Read the transcript below

My guest today is Erin Peisach. Erin has a Bachelor of Science degree in Dietetics from the University of Maryland and she has completed her clinically focused dietetic internship program through Johns Hopkins Bayview Medical Center in Baltimore.
She is the owner of Nutrition by Erin which is a virtual nutrition private practice serving clients nationwide suffering from gastrointestinal disorders. Erin can help all those suffering from IBS, IBD, SIBO, GERD, acid reflux, Celiac disease, and other functional bowel disorders. In addition, she sees clients locally in San Diego as well, in California.

On her website, Erin has a lot of articles, videos, and beautiful recipes to help improve your gastrointestinal health and Erin’s aim is to provide nutritional lifestyle action-items that people can actually use. So here she is, Erin.

LARAH: Hi, Erin.

ERIN: Hi. Thank you for having me.

LARAH: Thank you very much for accepting to come on my podcast. It was one of your followers or clients that suggested that in one of my Facebook groups, so I took the opportunity to ask you, as you are very specialised in a lot of things that we are talking about on this podcast, especially IBS and the low FODMAP diet. First of all, would you like to tell the listeners a little bit more about your specialisations and how you came across the low FODMAP Diet?

ERIN: Yes, sure. My specialisation came how I believe most people become specialised — in their own health journey. So I always was suffering with digestive issues and I honestly didn’t really put the connection between my diet, my lifestyle, and a lot of my symptoms that were mainly IBS and acid reflux related. Over time, I eventually became a dietitian and with helping others and it kind of clicked a few years into doing my private practice. I really enjoy helping give back to these people, I really feel for them and I know what it’s like firsthand.

I took on that speciality about a year ago and I’m really excited about it. There are so many great opportunities to help people from a nutrition standpoint. But specifically, the FODMAP diet, when I was in school, we didn’t hear about this diet, we didn’t know about it, it wasn’t a tool that we had. I remember stumbling upon an article in one of the dietitian magazines that I read, “Today’s Dietitian”, and it kind of clicked because I was working with a patient with IBS and I couldn’t seem to help her just with some simple changes. We did gluten-free, we did dairy-free, nothing seemed to really help. And I found this article and I was like, okay, this might be it, this is what we need. So I remember using the diet with her, that was probably back in 2011 and then from there, diving deep in learning much more about it.

LARAH: Thank you Erin. That’s been a long journey for you, and since 2011 there is so much more knowledge now even in the US, because in Australia they started a little bit earlier. When I was diagnosed in 2013, I had never heard about IBS or the low FODMAP diet, but now it seems more common knowledge. When I used to talk to people about having IBS and having to follow the special diet, they didn’t really know what it was about. But now, I can talk to pretty much almost anyone and they will know what I’m talking about. So, that’s great, you were there right at the beginning as well.

ERIN: Yeah, yeah. And I think it’s great that it’s so much more well recognised and well known. But, of course, there are still people where it’s not their full time job to worry about nutrition. So I think there is still much more education to be had about the topic.

LARAH: Yes, absolutely right, yes. I also wanted to ask you, as you are specialised on Functional Bowel Disorders, would you be able to explain what that is and how does that compare/relate to IBS, or how does IBS fit into it?

ERIN: Sure, yes. So it’s kind of like this fancy term, Functional Bowel Disorder. It sounds a little confusing, but it really is what it sounds like. It’s more of a function, a malfunctioning, versus a physiological or something that you could visually see wrong with the bowel or with the digestive tract. So its almost this umbrella term when we say Functional Bowel Disorder, that does include IBS. IBS is a malfunctioning of the digestive system. But there’s other type of Functional Bowel Disorders, so for some people, they might just be chronically bloated or chronically constipated, or maybe they always have an upset stomach, or maybe they have nausea or heartburn. So these are things where they might go to the doctor or they might run some tests. They might do a scope, maybe a colonoscopy or an endoscopy, and they don’t see anything that’s really wrong. Maybe they don’t even see inflammatory markers in the blood work, but the person, they know something’s up. They’re really not feeling well and they’re having these digestive symptoms. So again, that might put them in the classification of a Functional Bowel Disorder. IBS is definitely in that umbrella.

LARAH: Yes, thank you, understood. And it is true that to diagnose IBS is not straightforward. I remember all the tests that my doctor finally sent me to do just to exclude other things and then to come to the diagnosis of IBS which, although it has really impacted my life, it’s definitely better than other conditions I could have had with the same symptoms.

ERIN: Oh, yeah, for sure. And that is part of the headache with getting a diagnosis, is that you almost have to exclude everything else that’s very serious and get a lot of these testing done just to say okay, it’s not Crohn’s, it’s not Coeliac, it’s not this or that, it’s IBS. And so sometimes I really find people come to me a little bit frustrated like, “Oh, my doctor just said IBS, and that’s about it.” And just because you have IBS doesn’t mean that there aren’t things you can do to address it, just because it’s not maybe as serious or severe; it can still really affect your quality of life, so I hope people are starting to understand that it’s not an easy condition to live with and it can certainly be helped.

LARAH: Yeah, and it can be really debilitating for some and affect their quality of life. And even people at work, it looks like it’s one of the main causes of people not turning up to work, IBS, so—

Nutrition By Erin Peisach ERIN: Oh yeah, yeah. And the amount of people even just going to see their doctor, their primary care doctor. I think there was a study that said that like 12% of primary care visits are due to IBS. So it’s affecting a lot of people and can definitely impact your social life and your spirit and your energy and all these things.

LARAH: Yes, and that’s why I like about spreading the word — and that’s one of the reasons why I’m doing this podcast and I have the blog. For 75% of people with IBS, the low FODMAP diet really works. I remember back before a new doctor came (to my local medical place) and he sent me to do all these tests and then diagnosed me with IBS, I saw quite a few doctors, and really, they only tend to treat the symptoms. “Take these tablets for the acid reflux, take these other things for the diarrhoea…” and it was never going to the root cause. So that’s why I’m such a big advocate of the diet. It’s because by doing some adjustment to what you eat, your life quality can improve so much.

ERIN: Oh, for sure. And I always say I love what I do because it’s such a low risk intervention, compared to some of the other options people are given. And it’s one of those things I think it should certainly be one of the first thing that people think about when they figuring all of this out is, “What should I be doing with the diet,” because again, you probably only have something to benefit. You’re not typically going to cause too much harm by making the diet healthier or improving the quality of your food.

LARAH: Yes, absolutely right. I also have an understanding that you have quite a bit of experience in treating teenagers who suffer from IBS. So we know that there is a lot going on during the teenage period and suffering from digestive issues, that’s on top of everything else that goes on into those poor bodies. Would you be able to tell a little bit more how teenagers come to you? Have they been diagnosed by their doctor or do they come straight to the dietitian? And what kind of approach do you use that might be different to treat an adult?

ERIN: Sure, it’s a great question. So I love working with teens, like high school age teens as well as college students, and it’s great because I really do treat them. They are adults, so we do the appointments together versus with a small child doing and playing more with the parents. So they’re really taking responsibility for their own health and their own decision, and the fact that whether it was their own decision or whether it was a family decision or a conversation they had with their doctor, they’re always going to be on board. I find that these individuals are very motivated and they’re really willing to do what it takes, so it’s a group population to work with. Of course, there are going to be challenges of things like, “Well, I don’t go to the grocery store, because I don’t drive yet. I don’t know how to cook.” Or if they’re in college, it might be something like, “I live in a dorm. I don’t have a kitchen and I just eat what’s accessible.” So there can be much more challenges, but at the same time, with any age group or any population, there’s their own set of challenges. So I just see it as really personalised…working with someone, what are their health concerns whether they have goals and whether there are barriers….and then, how can I help them overcome them? So again, no matter the age, I’m always going to personalise it to the individual. So yeah, in some cases you asked how are they finding me? Is it a referral? Is it they just found me on their own? It can be a mixture of the two depending on maybe the push from the parent to some degree. But, yeah, there’s a mix of people that may say, “Oh, I just found you online. I’m struggling and I’m having these digestive issues and I’m not quite even diagnosed yet.” Or it could be, “I went to see my gastroenterologist. I’m a newly diagnosed with Crohn’s disease and my doctor told me I must see a dietitian.” So I kind of get everywhere in between those two sets of people.

LARAH: Yes, thank you, Erin. And that’s quite amazing that you’re able to help that group as well because of what we said that with everything else that is going on in their lives, they might even think that on top of everything else there is another thing that is wrong with them — or their self-esteem may go down. So the fact that they can see a specialised dietitian and be guided, and really, even if their IBS is not healing because that’s not really a cure, but the fact that they’re able to manage their symptoms and have as a normal life as possible that a teenager can have — or a college student can have…that’s great. The more information there is out there, they’re hopefully going to see already, that at that young age, they’re going to treat food differently, and instead of grabbing all the junk food and convenience food there is around, they’re going to learn more about what to put in their body.

ERIN: Oh yeah and no one ever wants to have some kind of diagnosis, especially a digestive condition. But at the same time, if we’re going to look at the positive, at this early age these teens are taking it upon themselves to learn about nutrition and learn about their health — learn how their body interacts with different things in the environment — and that’s a great lesson to learn so early on. A lot of adults don’t even get to that point until maybe something goes wrong, right? So I think it’s great that they’re extremely motivated and willing to dive into the diet piece to improve their symptoms.

LARAH: Yes, absolutely, thank you. I have another question that I’ve been asked quite a lot by people who are following my blog and on Facebook — and it’s about acid reflux and GERD. So would you be able, first of all, to explain the difference and what’s similar and what the differences are between acid reflux and GERD? And also, I’ve seen on your blog that you talk about some specific myth busters for what it concern acid reflux, and I believe you have a way for people to heal their acid reflux without medication. Can you explain a little bit more about that?

ERIN: Yes, sure. So I do end up using these terms interchangeably and that’s where a lot of the confusion can lie. But eventually, acid reflux and GERD can sometimes be used interchangeably. The main differences would be that acid reflux is typically considered less severe and less frequent, whereas, if someone diagnosed with GERD or Gastroesophageal Reflux Disease — Again, there can be other symptoms associated with it and it’s typically something that’s then going to be treated, whether that is a lifestyle or diet or with medication, because there are some risks associated with not treating it. So again, you might hear the term heartburn or reflux or acid reflux, but they’re all like kind of within the same family, but symptoms can vary. So just because someone has GERD, sometimes they don’t even know. They might even say, “I don’t even feel acid in my esophagus.” That’s what we might think when we hear the term acid reflux — acid coming up from the stomach into the esophagus. They may not feel a thing, but then, when their doctor places a scope and they’re checking the esophagus and the stomach, they’re seeing signs of that damage. That acid can cause erosion and ulcers and inflammation, and it can really be a problem, so it’s definitely an important condition to address.

Your other question was how to improve it naturally, right? Or how to not have to take the medication route?

LARAH: Absolutely, yes.

ERIN: Yes. So typically —  and this happened to me because I suffer from acid reflux myself.  I went to the doctor and told them about my symptoms. I have a lot of belching, a lot of reflux, especially after heavy meals, that kind of burning sensation, and they essentially say, okay let’s do a trial of a PPI, or a Proton Pump Inhibitor. These are medications like Prilosec, Prevacid, Protonix….there’s a long list of them. They can be very helpful for a short term, but they’re really not supposed to be used for the long term. There can be a lot of problems with them — a lot of long term health implications. So it is important to address acid reflux or GERD, but by just doing the band aiding approach where you’re just suppressing acid production you’re doing yourself a disservice because we know — and it’s well known at this time — that we need that acid. That acid is such a huge part of digestion, protecting the body from any potential problematic bacteria that could come in from our food. It helps us to break down proteins; it helps kind of set the PH stage for the rest of digestion. It has a lot of features to it, so when we suppress the production of acid through these PPIs or these drugs, short term, your symptoms are going to improve, but long term you’re not really getting to the root cause like we previously talked about with IBS. So I think it is important to work with somebody, or again, maybe find some good resources online, to find out — what are your triggers? What is causing this in the first place? And that’s some of the questions that I might go over with my clients is why are you having acid reflux? When did it start for you? When do you notice it gets worse? What do you notice makes it better? I go over some of those really personal questions.

But I do you have an approach I like to use with my clients and I’m happy to share it with your listeners. It’s just some basic steps you can kind of go through and see if, after you finish this protocol, if your symptoms improve — if you’re GERD improves. So I can go over that if you’d like, if we have time, otherwise, I am also happy to send it you or provide a link to that handout if people want to read it on their own time.

LARAH: Yeah. if you can just take a few minutes to discuss it that’ll be great and then I will still link it to the specific article as well (free guide for subscribers).

ERIN:  Sure, sure. So I think that the complicated part of a lot of these digestive issues is that there are many reasons that we might have them and people can have multiple triggers or multiple reasons that they have these digestive issues. So, specifically for reflux, the first thing I always address is stress. So people might say something like, “Oh, I’m so stressed. I’m going to get an ulcer.”

We know that high levels of stress severely impair digestion, don’t allow the body to function as it should in a lot of aspects, but particularly with digestion — and it can produce even more stomach acid in the body which then the higher likelihood of that acid to come up into the oesophagus and cause acid reflux. But in addition to the actual physiology of the stress, we know that hormonally when we have stress… Think of all the behaviours that people engage in when they’re stressed. I don’t know about you, but maybe people like to eat to manage stress, maybe eat junk food or high fat foods or fast food. Maybe they like to smoke cigarettes; maybe they like to drink alcohol; maybe they don’t get good sleep. There are all these kinds of side effects of being stressed that affect our lifestyle, and again, that’s another trigger for the reflux, so it’s this catch twenty-two. You really have to get to that root cause, and I think get to the stress as soon as you can if you’re really working to improve acid reflux.

Another tip is when we’re talking from a physiology standpoint, we have to take the pressure off the stomach because often there can be too much pressure pushing on the stomach and that can push things up from the stomach into the oesophagus where, usually, there’s a little gatekeeper called the oesophageal sphincter. But with that pressure, it can make that sphincter, that door, a lot weaker, and then things can pass up into the oesophagus. So a really great tip for that is to achieve a healthy body weight. We know that abdominal fat, or fat around the stomach, the midsection — also, that comes with stress too, right? But when we have too much fat, then that actually can put too much pressure on the stomach. So trying to lose even 5% of your body weight can definitely be beneficial for acid reflux, as well as not really wearing like tight fitting clothing or things that are going to physically apply pressure to the stomach.

These are a few other things. So let’s talk about the diet, I think I’m here, I’m a dietitian — let’s talk about diet.  We know that the FODMAP diet can be beneficial for reflux. It’s not going to necessarily help everybody in every scenario, but again, when we’re talking about that pressure, we know when people eat high FODMAP foods that bacteria ferments, there’s carbohydrates, they produce gas, and gas can cause a number of the side effects or the symptoms that people feel. That can produce excess gas that then can rise up and cause upward GI symptoms, not just lower GI symptoms that we think of in IBS.

So a low FODMAP diet can be helpful, as well as identifying like specific triggers. So there’s some popular ones that commonly affect people, and then there’s really specific ones for individuals. So, I think, for me, when I eat really spicy food, or if I eat heavy foods that are like maybe fried, or eat too large of a portion, that can definitely be a trigger. Other things like mint, chocolate, tomatoes.

There’s a long list of common acid reflux trigger foods, so I think a combination of relieving the pressure through low FODMAP and figuring out your own trigger foods, you can really work through a nice elimination diet and get a lot of relief just by changing the diet. But again, it’s not always so straightforward; I think everyone is a little bit different. So it’s not only what you’re eating, but also how you’re eating. So making sure that you are chewing your food well because we know digestion starts in the mouth, making sure that your portions aren’t too large, you’re  not overeating or over filling the stomach. There is also the debate on whether or not drinking fluids while we eat, if that can cause acid reflux. But again, I think if you’re drinking a beverage, even if it’s just water with a meal, to me that can indicate maybe you’re not chewing so well. Maybe your foods are not breaking down or mixing with your saliva so you’re kind of using water to help swallow it. So I think if you are using fluid in that way, then maybe set the fluid aside and try just drink in between the meals, either before or after, rather than with the meal.

A few other things — again, I know this is very brief, but there can be some supplements and herbs that are really nice to help just release some of the inflammation and help heal the oesophageal lining and the stomach lining. My favourite one is something called DGL, have you heard of that?

LARAH: No, I haven’t.

ERIN: It’s a long word, deglycyrrhizinated licorice roots we can—

LARAH: Okay, yeah I know licorice very well—

ERIN: Yeah.

LARAH: –because in Italy we do have a lot of licorice and I actually chew on the licorice root as well.

ERIN: Okay.

LARAH:  We have a little stick of licorice root that we can buy from, I guess from the chemist. And otherwise, there is the pure licorice — extract of licorice. And I do always tend to ask to my sisters when they come to visit me to bring me a bag of licorice as well, because I can’t find them here.

ERIN:  Yes. It’s not Twizzlers and it’s not candy, but it’s licorice. But the other thing is the DGL — means deglycyrrhizinated — which is,  if you just have a regular licorice, it does impact some people’s blood pressure. So if you have the DGL, then that’s no longer a factor so you can just look for that on the label. But that’s a great product. You can use it preventively or you can use it as needed. If you maybe go out to eat or you have a social event that you know you’re going to be eating heavier food or larger portions, you can then take it when getting some of the reflux feeling, and it should kick in pretty quick to help relieve your reflux symptoms. So it’s a really nice herb.

I also tell people, even just taking digestive enzymes, have you used this before?

LARAH: No. You’re not talking about probiotics here.

ERIN: So the enzymes, these are things that your body is already creating that helps to break food down once we consume it in the stomach or in the small intestine. It’s so hard to break down into smaller and smaller particles so then be absorbed. So digestive enzyme you can take as a capsule with your meals and it can help people to feel much less bloated, less about pressure, more comfortable when they’re eating, and it’s really just something that the body is already producing. You’re just maybe using a little bit more to help support digestion.

LARAH: Okay, that’s interesting, Yeah, I’ll look into that.

ERIN: Yes. So those are some good products. There’s plenty of others, and again, I have a whole list I’m happy to share with everyone if they want to kind of go through that checklist and see what they can be doing to help from a natural standpoint of reflux.

LARAH: Yes, please. And I think it would be so useful for people because most people with IBS, I know that they have the issues of acid reflux and GERD. so that will really be useful for them.

ERIN: Yeah. And then another link between the two, we know that a lot of IBS can be caused by (SIBO) Small Intestinal Bacterial Overgrowth and that can also cause reflux. So that might be that common root cause that has to be addressed. And then, again, all the symptoms seem to improve simultaneously which is always great.

LARAH: Yes, and I noticed for me, I had really bad acid reflux without knowing, as you said, that it was acid reflux because it didn’t have any acid effect. I had unstable angina symptoms. In fact, I went to the emergency room quite a few times because I thought I was having heart issues, and then, eventually, they even did an angiogram and there was nothing wrong, thankfully, with my heart and that’s when the cardiologist said, “I think you have acid reflux.” I’d spent like a night at the hospital and I was feeling really silly that I actually went in the hospital for acid reflux. But what could I do—

ERIN: No, it happened.

LARAH: I went to my doctor with these symptoms and I said that’s what I feel and he says, “Well, I’m not sure what it is.” I had done all other tests that all came back negative and the only thing left to do was an angiogram and I was like, “Yeah, why not? Let’s do it.” I mean it was good that he made me do it, but on the other hand, I was like, “Oh man. If I had known earlier that it was just acid reflux —  not just, but nothing compared to having heart issues.

ERIN: Well, it’s better to be safe than sorry, so —

LARAH: Yeah.

ERIN: That’s a common mistake and it happens a lot where people don’t have classic symptoms, so it can be a confusing trying to figure out if you don’t have that classic like acid feeling.

LARAH: Yes, and then what I noticed that because I was quite a bit overweight. I lost 20 kilos in the last 14 months and I’ve noticed that my acid reflux has also improved by losing that weight, as you said, that is in the abdomen.

ERIN: Oh, that’s great. Congratulations.

LARAH: Yes, thank you. So it is a combination, as you just said, it’s everything to do with the digestive system. As you said, tress is a big, big part and that is also, for me, why I do meditation every day and yoga as well, just to keep my mind level and keep the stress at bay because it all goes together, doesn’t it?

ERIN: Oh, yeah. It’s a very powerful connection that people often overlook. Someone could be on the best diet, and they’re at a perfect weight, and they’re taking all these expensive supplements, and they still don’t get better because they’re chronically stressed. And that’s why I say, I think that’s really my number one — is dealing with the mind and really calming the mind to then improve digestion. It’s huge.

LARAH: Yes. Trying to get to the root cause of the issue rather than just working on the symptoms.

ERIN: Yeah.

LARAH: So another thing that I’ve seen on your blog, one of the articles you have written — it’s about lactose intolerance, dairy intolerance. I was wondering if you could just explain the difference between lactose intolerance and a dairy intolerance, or is a dairy intolerance really a dairy allergy? And while we’re talking about this, if you could also just clearly explain the differences between a food allergy, food sensitivities, and  food intolerance, as we tend to mix those terms and use them interchangeably even though they’re really different things.

ERIN: Yeah, this is an excellent question that definitely something that people can get confused by, so I’m glad you asked. Well, I like to use the umbrella term, adverse food reactions, which basically will just cover any negative way that your body could respond to a food. So that’s an overarching term. Then I like to break it down into two sections: so one would be it involves the immune system; and the other would be, it does not involve the immune system. So that’s a really a good way to classify the differences.

So when it comes to something like an intolerance issue, that does not involve the immune system. It involves a digestive incapacity or the inability to break something down and digest it fully which can then cause these digestive symptoms. In the case of lactose intolerance — lactose is the sugar that’s found in dairy — the body needs an enzyme called lactase, and if you don’t have enough of it, or if you’re taking in too much lactose than what your body is producing to break it down, then you’re going to have these symptoms of lactose intolerance. You might know people that have it and they might present very different. Like one person with lactose intolerance might have a little bit of cream in their coffee and that’s enough to set them off, whereas someone else, maybe they can have some dairy and they do okay. They can maybe even have 4 ounces of milk and they’re still okay, but if they have a full cup of milk, that would set them off. So we know it’s very much a dose dependent and if they took an external enzyme — people might take lactase or a lactaid pill —  that can then solve the problem. They can drink the milk, and again, they’re able to break it down. They don’t have the digestive complaints.

There are other kinds of intolerances, too. So maybe people have heard of a fructose intolerance or histamine intolerance. But again, these are pretty much related to the inability to break those substances down properly, whereas, when we’re talking about the immune system, that’s where we think of an allergy or sensitivity. So both involve the immune system, but they are both different. So if you say you have an allergy, that means something is very specific — you’re either getting blood work or you are getting a skin prick test that’s going to diagnose this and we use the term IGE, or Immunoglobulin E, which is the type of Immune cell that’s responding to the allergen. So as an example, many people are allergic to say peanuts, so when someone eats peanuts every time — well hopefully it only has to happen once or twice for them to know, but it’s a very predictable response. It can be a very, very small dose — even an inhaled peanut, like peanuts on the plane and if someone’s allergic no one can have peanut. So it can be even cross-contamination of the same cutting board or knife. It is a very predictable response and it’s usually pretty immediate. So you pretty much know, “Oh my God, I don’t want to go near peanuts. Every time I eat them my mouth swells off and I get itchy and I get a rash and it’s no good.” So, I mean, it can get pretty severe, though. Some people can’t breathe so well, they can even go into anaphylactic shock and there is death even by allergy. So it’s very serious. You do need to get clearly diagnosed by an allergist and make sure to avoid that food or that other type of allergen even if it’s a chemical in a food.

A sensitivity presents very different. It’s still involving the immune system, but again, much more confusing on how it might be diagnosed or what it looks like. We don’t have a set of these foods or common sensitivity foods like we do with allergy. So that’s, I think, why those terms can be confusing. So with a sensitivity, it’s very much dose dependent so we don’t always have just one molecule or one little bit of something. It could be, if it’s something like wheat, that you can have half a piece of bread but not a full piece of bread to cause a problem. It can have a delayed response so you might eat the bread and then it could be 4 or 24 or even 72 hours after you eat something that a symptom presents. So again, how do you figure it out? That can be very confusing to figure out. And then the other thing is the symptoms can be varied. So in some cases people might have like skin rashes but maybe they’re more chronic, they’re not like a high like they occur while we eat something but it might be something like eczema or psoriasis. There could be migraines or headaches. It could be IBS or digestive issues, It could be joint pain or inflammation. So it’s a very confusing topic —  I could probably talk about it for couple of hours —  but that’s kind of the rundown.

LARAH: Alright, thank you. I’ve understood a lot more now. I just wanted to clarify, so when people say I am lactose intolerant so I cannot have a lot of milk or any milk at all, but also I struggle with dairies, and we know that a lot of cheese, especially if it’s a hard cheese, it should not contain a lot of lactose that you are affected by if you’re lactose intolerant, that’s my understanding. But then they’re saying that they cannot really have cheese but they don’t have an immune system reaction like an allergy. They are sensitive to dairies —  is that what it is?

ERIN: Yes. So that can be confusing for sure. So people can have one or all three of these things. Like someone could be lactose intolerant, be allergic to milk, and be sensitive to different dairy products that contain milk. So that can all  be confusing, but you’re right. If you have something like a hard cheese — let’s say a cheddar cheese — we know that’s not considered a high FODMAP because it’s not high in lactose. It is very low in lactose. So if you eat the cheddar cheese and it’s not because of the lactose that you’re having an issue, then you might think, okay is it some of the other mechanisms? Is it a sensitivity? Do I have some kind of an allergy? Well, we know that a milk allergy is very common, but typically in children. And again, it would be all the dairy; it wouldn’t just be I’m allergic to cheddar cheese because it’s the protein that you’re allergic to, so it probably going to be like all kinds cheeses or all kinds of dairy.  Whereas this sensitivity that could be a factor at play. It could also be a food chemical that’s in the cheese. As an example, tyramine is a naturally occurring food chemical that’s in each cheese, so what if it’s sensitivity to tyramine? There’s all these different ways that we have to look at food and see how it’s interacting with the body, so part of my work is asking these questions, figuring out the trends, and seeing if there’s any kind of patterns and then seeing if we need to do any kind of testing.

LARAH: Yes, great. Thank you, Erin, for clarifying that because that’s a question that I’ve seen or a comment that I’ve seen quite often. People getting confused between lactose and having an issue with dairy in general. And so that hopefully clarifies and that’s also why it is important to be seen by a specialised health professional, specialiaed dietitian, a nutritionist that can really guide you through what your individual issues are with the specific food.

ERIN: Yes, for sure.

LARAH: Yes, because some people may just cut out all dairies when there is no need to. If they don’t like it, fair enough, that I love dairies so whatever I can have to have it.

ERIN: Yeah, I really do my best to prevent the development of a food fear or a food phobia because that’s not a fun way to live. You want to feel safe with your food and you don’t want to live a life of restriction. We use these diets short term to treat something, to medically improve a condition, but they don’t always have to be used forever, and there has to be some kind of a maintenance approach.

LARAH: Yes, and that’s what we say that as well every time I interview a professional. They always say that a low FODMAP diet is only for a short time. You should not follow a low FODMAP diet for life. It is for a few weeks until you’ve worked out what your intolerance and sensitivities are and then reintroduce the foods that you’re okay with and then keep on trying and testing as time goes by and you feel better.

ERIN:  Yeah, yeah. That’s great advice.

LARAH: Okay, another question. If you have the knowledge, or if you have experience with probiotics with using them for your clients and if they worked or haven’t worked for your clients that suffer from IBS, do you know if we have enough evidence that probiotics can help those like us suffering from IBS?

ERIN: Yeah. And probiotics, they’re so trendy and everyone’s on them these days. They’re at every grocery store and we can find them even at the drugstore. So they’re very popular, but there is so much to beat because they’re so variable.

There are so many different kinds and formulation; then different strains and species; then they’re for different populations and so it’s a confusing world, and yes, we could probably have a whole podcast just on probiotics. But they have been shown to be helpful for people with IBS. I found a couple mini analysis which is where they take a bunch of studies that all have been done on probiotics on the same IBS type of population and assessing, are they helpful? And so, overall, yes, they can definitely be helpful but it’s not clearly understood like specifically one strain or one type, or how long to take them, or which exact product to take. All of that is still not clearly understand. I don’t think it’ll ever be understood because we know everyone so different, everyone’s microbiome is very different and maybe needs different things.

I always say, start with a diet, and once you’re through with the FODMAP elimination, make sure you’re getting enough fermentable fibre, or these prebiotics — making sure you’re eating fermented foods and things like yogurt, kefir, sauerkraut, kombucha — all these things with funny names, right? And they naturally are going to contain a wide variety of these good beneficial bacteria. And then you can also work in a probiotic, but I do think you don’t have to be on it forever. Maybe switch it up —  try one for a month and see if you feel any different. Play around with the different brands.

There’s big differences in the quality, and then see what happens when you go off of it. In some cases, people only need it for a couple of weeks, or maybe a couple months, and then they seem to be in better balance and their symptoms are more in remission. They don’t need it forever. So I think if you’re going to spend money on supplements, use it wisely and always consult with a doctor or a dietician just to make sure you’re on the right track with that.

LARAH: Yeah, perfect. And I have to say that I do have, from time to time, the fermented sauerkraut that are very expensive at the health food store. I could probably just buy normal sauerkraut — I’m not sure. They’re fancy and are in fancy jars and I usually have a scoop here and there with my salad. And things like Kombucha — I do like them. Are there actually these things low FODMAP as well or should we still be a bit careful of things like sauerkraut, kefir, kombucha, and all that?

ERIN: Well, it depends on the exact product you are choosing, right? So if you have the sauerkraut, yeah you’re right. There’s all these trendy, fancy, gourmet sauerkrauts, but if it has like garlic and onions in it for flavouring, obviously, that wouldn’t combine with low FODMAP. So you just have to find one that has the appropriate ingredients. But even like yogurt, we know that there are so many benefits of eating yogurt and I think  people get a lot of fear of dairy and the harms of dairy. But again, if you’re going to get an organic, plain is the keyword — not flavoured or not low sugar with sugar alcohol in it — just the plain yogurt, and maybe add some low FODMAP fruit to it. You can get a lot of benefit from that, and of course, you get the probiotic but you also get a good healthy snack, you get calcium, vitamin B, lots of minerals, a good source of protein. So, I say, if you can work these foods in, go for it. If for some reason they don’t agree with you — there can be a lot of reasons — then avoid them. But even something like Kombucha you can make from home. You can make any of these things at home very cheap and you can be more careful like what are the flavours you’re adding to it? What are the actual ingredients?

LARAH: Yes and also with I think kefir, maybe instead of using normal cow’s milk, maybe it works with other milks as well, or lactose free milk?

ERIN: You can’t do lactose because the bacteria ferment the lactose so it’s like you need the lactose in it initially to then work and become that product. But yeah, there’s like sheep’s milk, goat’s milk, there’s even like coconut and even water kefir. So there are all kinds of ways that you can add a culture into something—

LARAH: Yeah.

ERIN: It doesn’t just have to be milk. .

LARAH: Yeah, yeah, okay, great. Great tips. Okay, was there anything else that we haven’t covered that you would like to share?

ERIN:  Well, I know that we covered a lot of material and a really wide range of topics and so I just don’t want people to feel overwhelmed. I think that, in general, there’s a lot of information available to people online, on podcast, on blog, in magazines and TV. So I think it can feel a little bit stressful, actually, and so I just want people to be able to know that there are trusted resources out there and it’s just a matter of kind of processing it and make sure the information you are finding is accurate and appropriate for you. So working with someone one on one or talking with your doctor is very important step as well.

LARAH:  Yes, thank you. And also, if people have recently been diagnosed with IBS or you’ve recently been asked to be on a low FODMAP diet, they’re very fortunate because 10 or 15 years ago they would have struggled to find information. The research wasn’t so advanced so—

ERIN: Yeah.

LARAH: — in a sense that they’re lucky if they get diagnosed now.

ERIN:  I know what you mean, yeah.

LARAH: Okay. My last question is how can people get in touch with you? Would you like to share your website and your social media or anything you think it might be useful?

ERIN: Sure. So my website nutritionbyerin.com and that’s also where you’ll find the blog. We have recipes and articles and videos that are all free for you to access as well as I can schedule appointments and work with people one-on-one. That’s all done through the website. I do have social media, of course, so my Facebook page is Nutrition by Erin and I have Twitter, I have Instagram, Pinterest. So, yeah, you can use just type Nutrition by Erin and it should pop up.

LARAH: Perfect. Thank you, Erin. I will be putting those links unto the transcript, the show notes for this episode so that people can get in touch with you from there as well and as well as they are direct links to the article or to the sign in for the tips regarding acid reflux that we’ve discussed.

ERIN: Alright, it sounds good.

LARAH: Okay. Well, I thank you so much, Erin, for being such a wonderful guest and answering all those different questions. It has been a pleasure to have you here in the podcast.

ERIN: Thank you so much. This was a great time and I’m happy to help however I can.

LARAH: Thank you, Erin.

Thank you so much for listening to this episode with dietitian Erin Peisach. I hope you found it useful. Below you can find the links to Erin’s site and all the links to her social media

Please feel free to contact me via my contact page and ask me all the questions that you would like me to discuss on one of the future episodes.

One last thing, before you turn off your smartphone, I would really appreciate if you would take a couple of minutes of your time to go to iTunes and leave a review for the show, if you are enjoying the show I’d love to receive your feedback. To leave a review, you can go from the Podcast app and do a search for the low FODMAP diet & IBS podcast. When it shows up in the search, click on it and then click on Reviews and you can write a review right there. I’d like to thank you from the bottom of my heart for doing that.

Anyway, this is all for today and until next time, I hope you keep healthy and happy. Lots of love to you and has a great day or a great night if it’s night time when you’re listening to this podcast. Thanks again. Goodbye.

Links and Resources Mentioned in this Episode:



About Larah

I have been suffering from Irritable Bowel Syndrome for many years, but it took a longtime to get a diagnosis, since then I have been following a low FODMAP diet, which has changed my life for the better. This is my story and experience with IBS and the low FODMAP diet.