IBS & SIBO Management

Health can be improved without a focus on weight. As a registered dietitian nutritionist who practices through the weight-neutral lens of Health at Every Size, I can help you work toward your health goals in ways that are not restrictive.

This means I do not provide rigid meal plans, food rules, or guidance on weight loss.

Instead, I help guide you towards an eating pattern that is flexible and sustainable for you.

This also means I will never judge you for your current or past eating habits, nor do I judge you if you desire weight loss.

Instead, we talk about what has felt hard about eating and being in your body, and how you can feel better around food and your body in the long-term.

Health will mean something different to each person depending on their life circumstances, and our work together will also include defining health on your terms.

FODMAPs (FOD rhymes with cod) is a two-syllable acronym that stands for:

Fermentable

Oligosaccharides

Disaccharides

Monosaccharides

And

Polyols

FODMAPS are specific types of carbohydrates that may be poorly absorbed and, as a result, can cause digestive discomfort. Humans do not contain enzymes to break down some FODMAPs. Others pass through the intestinal tract too quickly and are not absorbed. As a result, some FODMAPs remain intact as they travel through the gut. They can be fermented by bacteria along the way and put off gas, or they can attract water into the gut. In someone with sensitive intestines, gut nerves overreact to the presence of gas or excess water, resulting in issues such as diarrhea, abdominal pain, cramping, excessive bloating or constipation.

Oligosaccharides include two types of FODMAPs: fructans and galacto-oligosaccharides (GOS). These tend to create gas. Oligosaccharide-containing foods include the following: wheat, rye, barley, onions, leek, shallots, white part of spring onion or leeks, garlic, legumes, lentils, artichokes, chicory, artichokes, inulin, cashews, chamomile, and oolong tea.

Disaccharide refers to the lactose molecule. Lactose tends to create gas and may pull water into the gut. Lactose-containing foods include the following: milk, evaporated milk, yogurt, cottage cheese, some soft cheeses, custard, and ice cream.

Monosaccharide refers to the fructose molecule. Fructose may pull water into the gut, causing diarrhea. Fructose-containing foods include: asparagus, honey, mango, watermelon, apples, pears, high fructose corn syrup, and agave.

And

Polyols include a few types of FODMAPS called sugar alcohols: sorbitol, mannitol, maltitol, and xylitol. These can pull water into the gut. Foods that contain polyols include: apples, apricots, avocados, cauliflower, mushrooms, nectarines, peaches, pears, plums, sugar-free products like gum and some sweetener alternatives like Truvia or stevia with added sugar alcohols.

People with irritable bowel syndrome (IBS) and/or small intestinal bacterial overgrowth (SIBO) or intestinal methanogen overgrowth (IMO) are extremely sensitive to FODMAPs and experience significant, sometimes debilitating intestinal distress as a result of consuming them.

IBS is an alteration in bowel habits accompanied by significant abdominal pain and changes in the frequency or consistency of bowel habits. The cause of this is unknown, but IBS may be linked to the gut-brain interaction, genetics, stressful early life events, certain mental disorders, food sensitivities, eating disorders, food poisoning, and bacterial infection or overgrowth.

SIBO (small intestinal bacterial overgrowth) is a condition that occurs when bacteria overgrow in upper parts of the small intestines where there are usually very low bacterial levels.

IMO (intestinal methanogen overgrowth) is a condition where methane-gas producing microorganisms overgrow in parts of the small or large intestines.

The are various risk factors for SIBO and IMO, including chronic constipation, changes in motility, intestinal surgeries, and chronic PPI use.

Everyone has a FODMAP “bucket”, and some people’s buckets are smaller than others, especially those with IBS or SIBO. The effects of FODMAPs are cumulative so that as you eat more FODMAPs over the course of the day, the bucket fills up. Smaller buckets overflow more quickly than larger buckets. When an overflow occurs, a person may experience symptoms from the gas emitted by bacteria as they ferment the FODMAPs, or from water being drawn into the gut by FODMAPs.

Currently, the low FODMAP diet is indicated for IBS and SIBO patients. There may also be indications for those with inflammatory bowel disease, such as ulcerative colitis and Crohn’s disease.

I do not recommend the low FODMAP diet unless you have been diagnosed by a doctor with IBS and/or SIBO. FODMAPs contain prebiotics, which are fibers that feed beneficial gut bacteria. Excluding FODMAPs for long periods of time can actually reduce microbial diversity, which may have long-term health implications.

The low FODMAP diet is a three-phase, short-term dietary intervention that is designed to provide relief from debilitating digestive symptoms and help you identify food triggers of these symptoms.

The end goal is to establish as varied and balanced of a diet as you can tolerate for the long-term.

It is not a diet in the traditional sense as there is no calorie restriction. Instead, you are encouraged to honor your hunger and find snacks and meals that satisfy you and do not leave you feeling deprived.

Here is a breakdown of the three phases:

• Phase I eliminates FODMAPs for 2-6 weeks to reduce symptoms. This helps you establish a baseline that is as symptom-free as possible and makes it easier to judge sensitivity to FODMAP tests that occur in Phase II.
• Phase II entails reintroducing one FODMAP group at a time to figure out which FODMAP(s) overflow your “bucket” and cause intestinal distress. This stage can last 6-8 weeks, depending on the number of FODMAPs you want to trial, how those trials progress and accommodating any travel plans or special events you may have.

Phase III is about personalizing a dietary pattern that incorporates FODMAPs that you can tolerate.

You will continue to re-test poorly tolerated FODMAPs over time (tolerance can change!) and you will learn how to manage symptoms when they pop up.

Anywhere from 50-75% of people may find relief in their symptoms from this short-term intervention. If you do not find relief within six weeks, please get back in touch with your dietitian and gastroenterologist for further evaluation.

The low FODMAP diet can be very daunting to tackle alone. Working with a registered dietitian reduces stress around the diet and makes you feel like you have a partner in the process. There are ins and outs to the diet, so working with a registered dietitian who has experience ensures you have the most up-to-date, evidence-based care.

I do not recommend self-diagnosing. If you experience periods of prolonged intestinal distress that impact your quality of life, please get evaluated by a gastroenterologist. A gastroenterologist will help rule out any serious medical issues that must be considered during workup for IBS or SIBO. 

For anyone with a history of chronic dieting, disordered eating or an eating disorder, the low FODMAP intervention is often a last resort. If you have an active eating disorder or history of an eating disorder, the goal is to balance symptom relief and your mental wellbeing to prevent a relapse into disordered behaviors. There are several non-restrictive avenues we can first explore. If you eventually decide to try the low FODMAP diet, I will have ongoing conversations with you to ensure the process is not triggering disordered thinking and behaviors. You will feel safe and supported as you become more attuned to your body’s sensitivities and needs.

No, you don’t! The low FODMAP diet is quite restrictive and many people have difficulty sticking with it. You can come in to discuss non-restrictive and non-food interventions that may provide you with as much or more relief than the low FODMAP diet alone.

As a dietitian who practices through the weight-inclusive lens of Health at Every Size, I do not provide guidance on weight loss. While I can certainly help you explore your desire for weight loss and find ways to feel more peace in your body at its current size, our sessions together would not focus on weight loss efforts.

There are many reasons I have shifted my practice away from a focus on weight loss:

• Our society has unrealistic beauty standards that harm people of all ages and unfairly tie our worth with our looks
• Our society has a narrow definition of what health and healthy mean
• Our society equates weight with health, which can be harmful
• Weight loss is not sustainable for the vast majority of people
• Chronic patterns of weight loss and weight regain are not only emotionally distressing, they can harm physical and mental health in the long-term.

To learn a little bit more about how I can help you move away from defining your worth by your size and towards more body peace, please visit my intuitive Eating page.

Sessions occur on a biweekly or every three-week basis depending on the level of support you feel is needed.

Sessions take place by secure video.

Every person is different and it has hard to predict exactly how many sessions you will need. Session frequency will depend on how complicated your digestive struggles are and figuring out what interventions work best for you.

I tell people to expect a minimum of 4 sessions to start, and depending on your progress, we can go from there.

Managing chronic digestive issues requires trial and error to figure out what interventions work best for your body and your life. Every person is different and what works for one person may not work for another.

During the first session, we will discuss your eating history, digestive health, lifestyle factors, how you feel about your body and any other relevant information you feel comfortable discussing. Depending on what your concerns are in session, we will discussion possible interventions we can start to explore.

In follow-up sessions, you are free to discuss any successes or challenges since the previous meeting. We will explore the efficacy of the previous interventions, and try something else if it's necessary.

Several insurers have recently decreased their reimbursement rates for dietitians. Because of this, I have made the difficult decision to stop accepting insurance. 

I offer various package and payment options that we can discuss.

Please contact your insurer to inquire about out-of-network coverage using the questions in this out-of-network form. I will provide you with a superbill after each session to submit to your insurer for possible reimbursement.

Yes! If you are exploring whether my approach is right for you, single initial consultation sessions are available. After our initial meeting, we can discuss various package options I offer.