Dietitian Laura Manning and author Karen Frazier enlighten IBS sufferers through their book The Flexible FODMAP Diet Cookbook, which offers over 100 tasty and nutritious FODMAP friendly recipes, that can be customised depending if you are prevalent IBS-D or IBS-C and can also accommodate other food intolerance, in addition to FODMAPs (GERD, SIBO and more).
Quote by Karen Frazier: “I don’t think there’s any one diet for any one person. I think there’s the diet that works for you, and my mission in life is to just make it taste good for people.”
In this episode, you’ll learn:
- Why did Karen keep on putting on weight despite following a very healthy diet?
- Which health issues does Karen suffer from?
- Why was Laura truly enlightened when the low FODMAP diet came about?
- How Karen and Laura’s cookbook differ from most other low FODMAP cookbooks?
- Reasons why a lot of IBS sufferers lose weight.
- What is hypermotility and how can it affect your day-to-day activities?
- What is dysbiosis of the gut?
- Tips on how to reduce bloating.
- How to adjust low FODMAP recipes to help with other health issues?
- Why planning and preparation are so important to be successful on a low FODMAP diet?
- How to avoid the fear of starting a low FODMAP diet.
- Karen and Laura’s favourite recipes from the book.
- What are the main struggles for IBS sufferers’ starting a low FODMAP diet?
- And much more!
LISTEN OR DOWNLOAD THE LOW FODMAP DIET & IBS PODCAST EPISODE 36 HERE
Can’t listen to this episode right now? Read the transcript below
Hi, and welcome to the Low FODMAP Diet and IBS Podcast! My guests on today’s episode are Karen Frazier and Laura Manning. These two ladies have collaborated to create a fantastic book called The Flexible FODMAP Diet Cookbook.
Karen Frazier is a nutrition and fitness expert who specialises in recipe development for restricted diets and has written several cookbooks for people with various health conditions including the Acid Reflux Escape Plan, the Hashimoto’s Cookbook and Action Plan and the Gastroparesis Cookbook. Diagnosed with celiac disease and an acute dairy allergy, Karen understands the challenges of eating a restricted diet that is both healthful and satisfying.
Laura Manning is a registered dietitian in the department of gastroenterology at the Mount Sinai Medical Center in New York, where she has worked since 2001 with patients diagnosed with irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), celiac disease and other disorders of the GI tract. She has also contributed to the Huffington Post, Fitness Magazine, Everyday Health, She Knows and Mind Body Green. So, here they are, my two lovely guests, Laura and Karen.
LARAH: Hi. How are you?
KAREN: Hello. I’m well, thank you.
LAURA: Hi, I’m doing good.
LARAH: Thank you so much for accepting to be on my podcast. We’re going to talk a lot about your book which I have a copy of and I can see being so useful for IBS sufferers and for people following a low FODMAP diet. We will see details of why it is so useful. First of all, I would like to ask if you could tell us a little bit more about yourselves and how you came across the low FODMAP diet; starting from Karen first, as you’ve been suffering from digestive issues since your early twenties. Could you please tell us what these issues are and what symptoms you suffer from? Can you also talk about the tests you had to do to get a diagnosis and how you eventually came across the low FODMAP diet?
KAREN: Sure. Well, in my early twenties, one day I got up and it was like somebody had flipped a switch. I was feeling well; I was a competitive body builder; I was an aerobics instructor; I counselled people on nutrition, and one day it was like somebody had turned on a light switch — or turned off a light switch — and I woke up and I felt terrible and spent the next 25 years chasing a diagnosis to find out what was wrong with me. And so I went from doctor to doctor.
The other thing that happened at the same time, is that I started gaining a ton of weight really quickly, in spite of being as active as I was — and I was incredibly active. Unfortunately, what happened to me as I gained the weight, when I would go to doctors to try to get diagnosed, I would be diagnosed with ‘fatness’, essentially, as opposed to anything else, and it was never really productive. But over the years, I’ve had diagnoses of IBS, IBD, Chronic Fatigue Syndrome…you name it, they’ve diagnosed it as far as gastrointestinal things. So, I’ve eaten a lot of ways over the years including eating vegan and, back in the eighties, when low fat/low calorie was in, that’s what I did. So, I really sought nutritional solutions for what was going on with me for years, and it wasn’t until about within the last 10 years I finally found a doctor who said, “Okay, let’s unravel this one thing at a time.” And they did the one where you swallow the camera — the test — and I was diagnosed with celiac disease, and that was kind of the turning point for me was realising that gluten was the cause of all of my symptoms, as far as my bowels. And then, I also was diagnosed with Hashimoto’s thyroiditis, which was the weight part. So, just with all of the years of chasing diagnosis and trying to advocate for myself and trying to eat in a way that was nutritious and helpful for me, I learned how to make really restrictive diets taste good. So that is my mission now in life, as you mentioned — a lot of different diets; I don’t think there’s any one diet for any one person. I think there’s the diet that works for you and my mission in life is to just make it taste good for people.
LARAH: Yes, thank you, Karen. And that’s absolutely incredible what you had to go through for 25 years before being able to even be told that you’re celiac which is just a fairly simple test nowadays, just to rule it out.
LARAH: So how you are feeling now? Are you feeling okay?
KAREN: I feel fantastic. I actually lost 145 pounds about 4 years ago.
KAREN: I feel fantastic. For years, I was unable to exercise or do any of the things I loved, and now I dance 4 days a week. I danced shortly before I came on the air with you as a matter of fact. I run, I do yoga, so I feel better than I’ve felt since I was in my twenties — and I’m 51.
LARAH: Oh… that’s fantastic. I’m so happy to hear that.
LARAH: Alright. Let’s go now to Laura. So, Laura, you are a very experienced dietitian, so could you tell us as well about your interest in helping people suffering from disorders affecting the GI tract and how you found out about the low FODMAP diet and eventually realising that it was a good diet for your patients suffering from IBS?
LAURA: Sure. So being a dietitian you have many opportunities to work in different areas. You can work with diabetes; you can work with kidney disease. There are so many different opportunities, and where I was working at Mt. Sinai in Manhattan, I found that there was an opening in gastroenterology and that was my opportunity to really see how the body metabolises nutrition in the purest form. It was really something that I had a true interest in and I took the opportunity and have been with gastroenterology for over 15 years. When we work with patients, we always try to figure out different ways that will help the bowels move. We’ll regulate that in different ways using food, using medication, and it’s a team effort. Very often, we would add foods in, to track fibres and want to have the person feel better.
There were so many different trial and error that would go on with each patient. And then, about 10 years ago, the low FODMAP diet came around and it was truly enlightening to utilise that as a tool to help patients. The patients that have IBS have a lot of trial and error, but with the low FODMAP diet, there was a clear-cut way of helping patients to learn how to eat, to find what their trigger foods are, and to be able to manage IBS symptoms. It has been an absolute joy to work with patients and to use the diet.
LARAH: Thank you so much, Laura, for introducing yourself and explaining what you’ve been able to do for all of your patients. Talking about the book that you just mentioned, Karen, would you like to tell us how you met each other and when the idea of creating this book came about?
KAREN: Well, actually, we work with a little different publishing model, so our publisher connected us. I’ve done a few low FODMAP cookbooks for them now and they liked what I did, so they contacted me for this one. They said we would like you to hook you up with Laura, who is a dietitian. I learned a lot from her, actually, about the different ways to adapt recipes for acid reflux — and I have written acid reflux cookbooks too — but especially for IBS-C and IBS-D where that was something I’d worked with before. So, it was really helpful to have that opportunity to meet and talk to somebody who said, “Hey, you need to adjust these recipes this way for people who present in different ways.”
LARAH: Yes, thank you, Karen. That was quite incredible that your publishing agent put you in contact and you’ve been able to produce this really fantastic book. Yes, well done to them.
So, Laura, I was reading that you have a few malnourished patients with a GI condition. As we talked about, you helped them, and also you helped them to gain weight in a healthy way. Can you please explain why a lot of people that have this condition, like IBS, tend to lose weight and how they can be helped?
LAURA: Certainly. When you have IBS, very often people will be afraid to eat and so that could be the number one reason why patients will lose weight. They want to avoid eating so that they can be in social situations, get to work on time, and very often, when these people eat, they will have to immediately go to the bathroom — and maybe multiple times — and it may prevent them from trying to get to their destination. Not eating is one of the ways that they will prevent this from happening. And, of course, if you don’t eat, then you’re going to lose weight, and that could become a vicious cycle.
So that is one thing that can happen with people. Another can be that the food may go through you rapidly. People with IBS may have a few extra nerve endings in their bowels creating more contractions and food will go through them a little bit more quickly. It’s called hypermotility and it could be very disturbing and difficult to have your day-to-day activities. That’s truly one of the ways that we see patients losing weight. So what we have to do is we have to look at the types of foods that they are eating. We also have to look at the texture of the foods — maybe they’re too abrasive; maybe there’s too much fibre, which is also not good. And we have to maybe have small, frequent meals so that the body can hold it — less pressure on the bowels — and be able to absorb the nutrients from the foods that they are eating. So, small, frequent meals; maybe changing the amount of fibre or different types of fibres because there’s soluble fibre, there’s insoluble fibres, and each person, we all need fibre in our diet then maybe one type will work better for another person. So, there are definitely reasons why people could lose weight while having IBS.
LARAH: So, in terms of losing weight, do you think that more people suffer from IBS-D that they have the issues with the weight, or is it people with the constipation as well?
LAURA: I really see an exact division of 50-50 between IBS with constipation or diarrhea. They’re really isn’t more of one over the other.
LARAH: Okay. Yeah, that’s interesting because personally, I have the opposite problem. I put on weight, so my diet it’s pretty good. I mean, sometimes it may not be perfect, but generally, it’s pretty good. I watch what I eat and I essentially eat healthy food — mainly low FODMAP because of my IBS-D. But I put on quite a bit of weight in the last few years, so that was about 20 kilos or 44 pounds that I had in extra weight, which with really careful eating supervised by a dietitian and lots of exercise, I managed now to get rid of it. I was wondering how much IBS can affect the weight loss, or weight gain. So you’re saying that 50% usually put on weight and 50% lose the weight? And I’m sure there will be people that just stay the same and they just have the symptoms — or is it just putting on weight or losing weight? What do you think?
LAURA: There’s this theory that when patients have IBS, there could be something called dysbiosis of the gut. And that means that the gut flora may be off where there could be an overpopulation of one particular bacteria or an under population of another. Bacteria can communicate with other types of systems within the body, and it has been shown to impact insulin resistance and create potentially more inflammation within the body and also increase fat cell production. This is what we called as being having dysbiosis. So we want a lot of different bacteria. We want a good diversity within our GI tract, and again, what the low FODMAP diet can do, is it can help to reset the gut flora. You can start out the bad and good and then help repopulate with the good bacteria. There needs to be a lot more of research done on this topic and they are doing a lot to look at the gut bacteria and how it influences our weight status.
LARAH: Yes, thank you. I have another question for you, Laura. One of your articles is about tips on how to reduce bloating. We just talked about one of the symptoms of IBS. Would you be able to share some of those tips on how to reduce bloating?
LAURA: Sure. There are many ways that we can prevent bloating from occurring and when I work with a patient, I try to look at many different aspects of the person’s lifestyle and, of course, how they eat. But I will look at how often they’re eating, the types of foods that they’re eating, whether they are multitasking during a meal or that they are swallowing a lot of air, while they’re eating and if there’s a lot of carbonation in their beverages. So, there can be little minor details that can add to bloating, but the best way to reduce bloating is certainly by implementing the low FODMAP diet. And what that will do, it will eliminate any fermentable carbohydrates that are in the diet for a short period of time — get everything to relax and calm down, and then slowly increase foods back in that you were eating before. People feel excellent when they do the low FODMAP diet, because they find out what those trigger foods are and they gain that information and can decide when and where they want to eat those foods in the future. And bloating can be a thing of the past.
LARAH: Perfect! And as you said, the low FODMAP diet, again, is not a one size fits all and that’s what I really like about your book. Now I’m going to go back to Karen and talk about the book which I read and I went through quite in detail and I think it’s really fantastic. It’s a cookbook, but not your usual recipe book. People can customise the meal plans based on their symptoms or based on what they can and cannot eat. For each recipe, you actually provide the 4 types of meal versions which are A, B, C and D. Would you be able to explain the differences between each meal plan, Karen?
KAREN: Sure. So we have meal plans for people who have just kind of the alternating type of IBS –the constipation and diarrhea alternating– and that’s kind of the base meal plan. It doesn’t have any special twists. There’s a meal plan for people who have acid reflux because let me tell you, I had acid reflux for a long time, when I was struggling with my issues, and for me, that was worse than anything else. That took precedence over anything. I would have done anything to get rid of that acid reflux. So we do have plans that have acid reflux. And acid reflux is a little bit of a different animal even though it’s often co-occurring with IBS. There’s different things you have to do to control acid reflux and there’s some crossover, but it’s a little different. And then, we also have texture adjustments for people who have IBS-C or IBS-D.
LARAH: Thank you, Karen. I really like the way that you created this book and I can see it being useful for most people following a low FODMAP diet, just because that difference between, ”Can you have dairy,” or “Can you have a little bit of fructose or can you have none of it?” It’s really good.
Karen, would you like to share one of your favourite recipes from the book?
KAREN: Well, I am a sucker for anything roasted — vegetables especially. I think that one of the things that happens when you have to be on a restrictive diet out of necessity, is that you feel like you have to sacrifice flavour. And so when you roast things, especially vegetables, you can add a lot of flavour into them because the roasting process adds this really delicious caramelisation to the outside of the vegetables that brings the natural sugars to the surface and it gets all brown. So, actually, one of my favourite recipes in the book is just really simple. It’s a potato hash that you do on the stove top where you leave it in contact with the pan. So it’s just oil in your pan add some potatoes. Let them cook for 8-10 minutes in the oil, stirring them every once in a while. You don’t want to stir a lot because you want to leave them in contact with that pan so that they caramelise, and then push them to one side. You crack an egg and let it cook for a minute or two, flip it, let it sit for 30 seconds and put it on top of the potatoes. You can add some herbs. If you do okay with chives, you can add some chives. I like to use the garlic oil, if you don’t have the gerd, where you cook the garlic in the oil, because it just adds extra flavour. Anything that adds layers of flavour like that, I think really helps make the diet delicious and sustainable. And that’s what I’m all about because otherwise you feel deprived.
LARAH: Thank you, Karen. Yeah, that sounds like a simple recipe but quite comforting, so it’s like healthy comfort food kind of thing.
KAREN: Yes, I love my comfort foods.
LAURA: And what about for you, Laura? What’s one of your favourite recipes from the book?
LAURA: One of my favourite recipes in the book was the Ginger Melon Smoothie, and that is because I’ve been suffering from a lot of acid reflux lately and it has been one of the most soothing drinks that I use to start my day off. I don’t have a lot of reflux all the time, but I think that there was one particular point a couple of weeks ago where I was just like constantly not feeling good and this was the best way that I started my day and it was a low acid and very easy to tolerate drink. It was a really wonderful way to get some wonderful nutrients in a very low acid way without causing any gas and bloating additionally. Thank you, Karen that was a good one.
KAREN: Yeah, I like that too. I don’t get reflux very often, but when I do it’s I usually will have some kind of a fruit smoothie with ginger in it because ginger is amazing for acid reflux, isn’t it?
LAURA: Yes, it is.
LARAH: Yeah, I’m a big fan of smoothies as well. I often have them for breakfast or like a mid-morning or a mid-afternoon snack just to get a little bit of the sugar from the fruit and then I’ll add some vegetables and some proteins in it. It’s really nice.
Another question for you, Laura. Based on your experience and knowledge, what do you think the main struggles are for people starting on a low FODMAP diet?
LAURA: Some of the main struggles are that a lot of people will feel very overwhelmed by it and they feel that they’re going to have to cut out all these different foods and become very restricted in how they eat. What people need to do is they need to be able to have the right information mapped out for them in the most user-friendly way. There’s a lot of information on the Internet about how to do the low FODMAP diet and it can be very overwhelming if they’re not reading the correct information.
The first thing people need to do is make sure that they’re getting the correct information; they need to be able to make sure that they’re doing the diet in the most nutritional way and not excluding large food groups; and they need to be given a lot of different options and ideas. With all of that information, they need to be organised as well. You cannot say that you’re going to start this diet the next day, if your kitchen is not setup correctly and if you don’t have a plan. If you are organised and you do have a plan, you can implement the diet extremely efficiently and with a lot of ease and without stress. Stress is a big factor. Stress does affect the bowels. If you’re going to do the diet and you feel very stressed about it, then you’re probably not going to get the best results. So, as organised as you can possibly be before starting the diet is truly the key to success for it.
LARAH: Yes, perfect, Laura, and I agree with you. I always say, even on the podcast, that you should not really attempt the diet before having seen a dietitian, who is specialised on the diet because it’s so complex and it needs to be individualised for your needs, especially when the reintroduction part starts.
I guess your book can be a really good companion to that visit to the dietitian to help you with the recipes and help you to know what food you can combine together to make sure that you don’t go over the limit of your threshold.
Karen, could you tell us where the book can be found?
KAREN: So the book is The Flexible FODMAP Diet Cookbook and it is available where books are sold. You can find it online at Amazon.com. You can find it at Barnes and Noble. You can enter ‘flexible FODMAP’ and it will pop right up there towards the top of the results usually.
LAURA: Okay, great, and I will put the links in the show notes for all these places where the book can be found. And I also wanted to tell the listeners that if you would like to enter for a chance to win one of the few copies I have of the book to give away, please look at the end of these show notes and you’ll find the details over there.
Alright, well, thank you so much for all this information. And is there anything else that you would like to share or we haven’t covered?
KAREN: So, I just wanted to mention, as someone who has had to drastically adapt my diet, even though I don’t have to do the FODMAP diet, I do understand when you’re standing at the edge of the cliff and looking down and thinking, “Oh my God. I can never have this again. Oh my God, I can never have this again,” and how easy it is to slide into what I’d like to call The Long Goodbye to food. Laura’s probably seen the long goodbye to foods in some of her patients where, “Well, I’m going to eat anything I want today and I’ll start tomorrow.” And then tomorrow comes and you think, “Well, since I’m starting tomorrow, I’m going to eat anything I want today.” And so, I would really encourage your listeners, who haven’t taken the step yet to alter their diet and try something different to go do the shopping, stock your pantry, get rid of all of the stuff that you’re not going to eat over the next few weeks, and give this a try and then start to customise it. Instead of doing the long goodbye to food, just make the choice and do it. Because it can still taste good and it still can be really great and feeling better is, to me, way better than eating onions.
LARAH: Yes, absolutely. You can’t eat onions anyway. But, yeah, it is so true. When I first got the list of the food I couldn’t eat during the elimination phase I wanted to cry. But you can adapt so quickly and you learn how to use herbs and spices in the right way. Garlic infused oil and onion infused oil are a great help, and there is really not much that I missed that I can’t have anymore in a substitute form on a low FODMAP version of it. So, yeah.
LARAH: It is not as bad as it sounds like at the beginning, let’s say.
KAREN: Right. I’ve discovered that because I thought I could never give up bread, pie, cake and pasta. You can.
LARAH: Or you can have a low FODMAP version that is not going to cause you symptoms.
LARAH: So, what about for you, Laura? Do you have anything else that you would like to share?
LAURA: I would like to mention that it’s important to meet with a dietitian if you’re truly going to embark on doing the low FODMAP diet and also to know that everybody is an individual on how IBS affects them. When you do the low FODMAP diet there may be some very little changes that are needed to be made from one person to another. And that’s one of the things that is important with the cookbook, is to know that if you have IBS with constipation, there are certain foods that will make you feel better. They may have a little bit extra fibre in them. If you have IBS with diarrhoea, you may need to cook more of your vegetables and not have a lot of harsh roughage in the day. There’s very simple little changes that each person probably could benefit from, and I think that the cookbook really has a smart way of guiding the person for implementing the diet in the smartest way. The diet is also temporary, and it’s important that people know this because what happens is that you may feel excellent, and you may want to stay that way and not make any re-introductions back in the diet. There hasn’t been enough evidence to show what the long-term effects of being on the low FODMAP diet is, so we need to probably not do it longer than 8 weeks maximum and start to bring foods back in back that were generally healthy and help to feed our microbiome and give us that good gut flora that we all need. So make sure that when you do the diet that it’s temporary. Use it to your advantage to learn what are the foods that work best for you so that you can always have that information moving forward and to be able to decide when and where you want to eat certain foods.
LARAH: Yes, thank you, Laura. And this is so very true. When I did my elimination phase back in 2013, it was for 6 weeks, but I’ve now seen it recommended even as short as 2 weeks for some people. So, of course, if you are seeing a dietitian, she/he will guide you through it and will tell how long you will need it for and everything else. That’s why it’s important not to really attempt it yourself if you want to be successful with it.
LARAH: Okay, we just need you to share your website for people to get in touch with you if they need to. Would you like to start first, Laura?
LAURA: I would like to have people reach me by contacting me at www.lauramanningrd.com .
LARAH: Okay, that’s great, and your contact information will obviously be on the page so people can get in touch through that and I will have that link on the show notes as well.
LAURA: Yes, that’s correct.
LARAH: Thank you, Laura. What about for you, Karen?
KAREN: I have a website: KarenFrazier.com. You can find me on Facebook @authorKarenFrazier or on Twitter @authorKarenFrazier although I am not very good at Twitter so I don’t use it very often.
LARAH: That’s okay.
KAREN: Every once in a while I remember I have Twitter, but I’m very active on my Facebook page.
LARAH: Yes. Okay, so the Facebook page will be the best way to reach Karen and, of course, her website. And, again, congratulations on your book and thank you so much for coming on the podcast. Thank you for your time.
LAURA: Alright. Thank you so much.
KAREN: Thank you.
LARAH: Okay, thanks. Bye!
Thank you to all the listeners of the podcast for all the emails and feedback. Please keep on sending me the questions that you would like me to ask my featured guests and any other feedback or suggestions you might have. As mentioned, I have 5 copies to give away to my listeners of the eBook version of The Flexible FODMAP Diet Cookbook — Customizable Low FODMAP Meal Plans of Recipes for a Symptom Free Life which is the book written by my guests Karen and Laura. That’s the eBook version and if you would like to get hold of one of the copies, please contact me before the end of June 2017 and let me know how the low FODMAP diet has improved your symptoms. I will then select five people, who will be receiving a copy of the eBook.
As usual, I leave you with my best wishes of good health and happiness and I hope you will join me the next time. Goodbye!
Links and Resources Mentioned in this Episode: