A small, quiet life

Reflecting on 10 years on a therapeutic diet

As of earlier this year, i reached ten years on a modified low-FODMAP diet. Stated like that, it seems so...straightforward? Clear-cut? Misleadingly simple, at any rate. Which it decidedly was not, especially in the beginning.

In 2015, when i was first diagnosed with IBS (rather than a disease or fixable physical condition) the low-FODMAP diet was still fairly new. The scientific research was centered in Italy and Australia, and there were only a handful of registered dieticians talking about it online. There were also no dieticians near me who were familiar with this protocol. So i pieced it together from the scientific literature, advice from my PCP, and the only reputable book i could find that included details on the tolerance testing process. I became diligent about reading ingredient lists, created a few meal plans, and dove in.

Today, my understanding is that the protocol has changed to be more manageable. Then? Six weeks of a highly restrictive diet, followed by months of slowly testing tolerances alternating with "rest" periods in between. Including some false starts and re-testing, it took a good eight months before i had a handle on where my problems were coming from.

Looking back, it boggles my mind that i was able to do that while simultaneously dealing with a still-new, much more difficult job and a failing relationship. I'm even more boggled that i was able to transition into that new job while simultaneously dealing with crippling levels of brain fog. It had been such a long, slow slide that i had no idea what was going on until a week into the initial restrictive diet. Having the fog clear, along with the drastic reduction in gut pain, was an absolute revelation.

The trick with the modified, ongoing version of low-FODMAP, though, is that it's a constantly evolving thing. It can feel like you're done once the testing phase is complete--and you're certainly over a big hurdle! But bodies adjust and change and, frankly, are outright assholes sometimes. I've re-tested a few times over the years, when it seemed like my baseline might have changed.

There's also the social aspect. That ex took it all very personally when i made my own food rather than eating what they'd cooked, despite many explanations. Colleagues expected me to continue going out to eat at the drop of a hat, regardless of what was on the menu. Extended family did the same. There were only four people who were exceptions. It felt very lonely at the time, with so few people willing to meet me where i was.

This is one way in which the COVID-19 closures helped me immensely. Even after spending 2018 and 2019 re-testing and working with a low-FODMAP-certified nutritionist to find the cause of continued relapses into pain and brain fog, we were only marginally closer to an answer. After one month of not eating out at all at the beginning of the lockdowns, i realized that despite every precaution i could make, i'd still been ingesting foods from the "absolutely not" list. (Onion and garlic hide in a lot of places!)

Even now, it's an ongoing process. Last year, after a suggestion from my PCP, i realized that it isn't lactose that's the problem--it's cow milk. (Did i immediately go buy a giant chunk of manchego? Why yes, yes i did!) And since i'll always prefer to skate the line of "safe" in order to keep as much dietary variety as possible, it isn't like the problems are gone entirely. They are manageable, though.

Despite the complexities of living with a gut with so many intolerances, i'm incredibly grateful for the researchers who started down this path and developed the protocol. Their work made a huge difference in my life.

#low fodmap