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Fructose Malabsorption

Digestive Health | Last Active: Jul 2 9:43am | Replies (288)

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@lelia

Are you doing this in person with the Mayo nutritionist or remotely? I looked online and couldn't find the Mayo Clinic FODMAP Eating Plan. How do they determine the order of food reintroduction? What if you can't tolerate a food? Is that it for that category or do you just try each food separately regardless? For example, if you can't tolerate cabbage, do they then assume you can't tolerate cruciferous vegetables so you don't try them? How long do you wait before introducing a new food? Thanks. I'd appreciate any info you could give.

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Replies to "Are you doing this in person with the Mayo nutritionist or remotely? I looked online and..."

I see a nutritionist face to face every two to three weeks and can access her by email if I have a question. I don’t work with the Mayo Clinic. Another major medical center in another city. Even though my insurance does not cover the sessions, the $92.00 I pay for these sessions is the best money I have ever spent, and I am not exaggerating. I went from being an emaciated 105 pound person who experienced diarrea several times per day to a much healthier, functioning adult. Have not experienced diarrhea in nearly two months and gained ten of the 20 pounds I lost. I am a fairly intelligent person, but the whole reintroduction aspect of the diet and what to eat and not eat and the amounts were too hard for me to do on my own. These diets have to be individualized, as we are all different. My efforts to implement this low FODMAP diet on my own were a disaster. I had no clue until I met with a professional. Can’t emphasize this enough. Neither my general nor my GI doctor were of any help. Both encouraged me to eat “normal” and eat high calorie foods to gain weight. Therefore, I kept relapsing while eating wheat toast, rice, jello and baked potatoes. All the typical bland foods you are supposed to eat for colitis and diarrhea. Once I knew I needed nutritional help, I kept asking, insisting and making phone calls until I found someone. Every GI practice should have a nutritionist on staff. Sadly, not the case.

I see the Mayo nutritionist in person.
After my tests, my Mayo GI initially gave me the Mayo Clinic Fructose Malabsorption Eating Plan and recommended seeing the nutritionist, which I did. She then gave me the FODMAP Eating Plan (20 page booklet). I don't know if it is available online or how you get it if not a patient.

There are no firm rules about which foods you start with or the order but the Plan highly recommends you follow their rules/ recommendations if you want to figure out which foods caused your symptoms. You reintroduce 1 FODMAP group at a time and 1 food at time. My nutritionist gave me the order of FODMAP groups to work. The groups (in the order I'm working) are Galactans, Polyols, Fructans, then Fructose (I don't have an issue with Lactose; if so, they would be a group as well).

Within each group there are a a list of foods. You start at the bottom of the list and work up (from lowest FODMAP to highest). What she has me doing is 1 new food every 3 days. Eat the (last) food on the list for day 1, 2 and 3. If on day 1, I don't feel well then wait until I feel better (maybe 3 days) and then try the next food on the list. I then know that I cannot tolerate (or eat) that food. I can always try again in smaller amounts.

If I can tolerate that food, then I wait a day and start with the next food in the same group. As I work myself 'up' the list for the food group, if I find 2-3 in a row that don't work for me, then I probably won't be able to tolerate anything else higher in that food group list.

Once complete a group, go back to basic diet before starting next group and stop eating foods from the first group. Wait about 3 days before starting the new group. Etc.

It is very tedious, but the whole goal is to figure out what you can eat.

There is a website she recommended: http://blog.katescarlata.com/tag/fody-foods/
It contains a Low FODMAP grocery list.

Plus http://www.fooducate.com to get label information of lots of different types of groceries.
And http://www.fodyfoods.com for low fodmap foods you can purchase. They have a really good snack bar (since my old favorite protein bars weren't making my stomach happy!)

Also, for gaining weight there is Nestle ProNourish digestive wellness drink (gluten free, suitable for lactose intolerance, low FODMAP).