What drew you to the field of gastroenterology?

Shilpa Ravella, M.D.: At the core of practicing medicine is this idea that you’re helping people with their most valuable possession, their health. No matter how small a part we play in that, it was something that I felt compelled to do. … And as the years went on, everything I was interested in learning about nutrition and lifestyle and the gut microbiome was so directly relevant to gastroenterology. I just fell in love with the field.

How did you become interested in inflammation?

SR: As I went through my fellowship, I saw a lot of patients who struggled with inflammatory gastrointestinal disorders. They were coming into the clinic and asking, “Is there something I can do with my diet and lifestyle to decrease inflammation?” At that time, folks in Western medicine would think of [an anti-inflammatory diet] as a hoax. I had a lot of questions: Is there a true anti- inflammatory diet? Moreover, what is low-level inflammation, and can it be a root cause of disease? … During the early years of my fellowship, someone very close to me was diagnosed with a devastating autoimmune disorder, and that also compelled me to want to know more about this topic.

What are the top foods that you recommend cutting to reduce inflammation?

SR: Ultraprocessed foods are truly insidious. They’re made in laboratories by companies who want to make them addictive. So you don’t just eat one chip— you’re eating bag after bag after bag and bypassing your body’s regulatory systems. They’re mostly made of whole-food derivatives and additives that we are finding more and more problematic, including artificial sweeteners and some oils that are very inflammatory. So the first step is going back to real foods. Even if you can’t make the shift to a [completely] plant-based diet, make the shift to whole foods.

What have you learned working with patients in Hilo, Hawaii?

SR: At the government-funded rural health clinic [in Hilo], we see a proportion of native Hawaiians and Pacific Islanders, and this particular population experiences the highest rates of death from any type of cancer compared with other racial and ethnic groups of the same age, and the highest incidence of heart disease and stroke and diabetes. … We’re seeing a lot of cancer in young folks here. Part of the problem is that the “local” diet has taken over—a lot of fried foods, very meat-heavy. By contrast, the ancestral Hawaiian diet is largely plant-based. It involves a variety of vegetables, like ulu (breadfruit), which can be prepared in so many different ways, taro (a starchy vegetable), and seaweed. A return to this type of diet is what I push for my patient population. I try to put it in that cultural context: This is the diet that your forefathers followed, and this is a diet that can help you thrive.

Can anti-inflammatory foods cancel out the effects of processed foods?

SR: To an extent, you can indeed dull the inflammatory spikes you get from junk foods by pairing them with something healthy. For example, there are studies that show if you add berries or nuts to processed breads and cereals or some spices to your chicken dinner, you see less of an inflammatory spike as opposed to if you’ve eaten those foods on their own.

I think the biggest problem with that outlook is the opportunity cost, because the goal is not just to prevent inflammation but also to reverse it so that your body has greater potential to heal. Someone who is 90 years old and eating a highly plant-based diet, exercising regularly, breathing clean air, drinking clean water is going to have more potential to resolve the inflammation from, say, an infection, and a more robust immune response as well.

Stamping Out Myths About Inflammation

We asked Ravella to break down some of the most common myths she encounters about inflammation.

Myth #1: Plant foods promote inflammation.

“Certain plant foods or components of plant foods, like nightshade vegetables, gluten, or lectins, are often demonized for being inflammatory,” Ravella says. “However, evidence to date shows that these foods are actually anti-inflammatory and beneficial for human health.”

Myth #2: All inflammation is bad.

“We need some inflammation in our bodies to fight off infections and keep us healthy in other ways. And in fact, increased bodily inflammation is a natural part of aging. It’s when inflammation becomes excessive or deployed without reason that problems arise.”

Myth #3: Anti-inflammatory diets are expensive.

“A true, evidence-based anti-inflammatory diet does not rely on expensive foods or supplements,” Ravella says. “Anti-inflammatory, plant-forward diets—such as traditional Mediterranean, Okinawan, African, Latin American, Native American, Asian, and Hawaiian diets—are rooted in ancient traditions and arise from humble origins.”

The post What We’re Getting Wrong About Inflammation: Gastroenterologist Shilpa Ravella Explains appeared first on Forks Over Knives.

Every year in the U.S., nearly 90,000 people are diagnosed with Parkinson’s, a progressive neurodegenerative disorder characterized by motor symptoms like tremors and muscle rigidity, along with non-motor issues such as cognitive decline and mood disorders.

The Gut-Brain Connection: How Parkinson’s May Begin in the Digestive System

Within the past decade, research has indicated that Parkinson’s begins in the gastrointestinal tract and spreads via the vagus nerve, a long cranial nerve, to the brain. This may explain why many patients report gastrointestinal symptoms, such as constipation, years before receiving a Parkinson’s diagnosis.

In light of these discoveries, physicians are increasingly recommending dietary changes as part of Parkinson’s treatment, in addition to prescribing medications. In a new study, published in December 2024 in Neuroscience, researchers compared the neuroprotective effects of various diets—including Mediterranean, vegan, carnivore, paleo, and ketogenic—with regards to Parkinson’s disease.

The study found that the largely plant-based Mediterranean diet showed the greatest promise, correlating with a slower disease progression and lower rate of Parkinson’s occurrence. The vegan diet also appeared beneficial.

How a Plant-Based Diet May Slow Parkinson’s Progression

As noted in the new review, plant-rich diets may help protect against neurodegenerative diseases by lowering oxidative stress and inflammation. Oxidative stress, an imbalance of free radicals and antioxidants in the body, can lead to cell damage and contribute to neuron loss. Meanwhile, inflammation can damage the nerve cells that control movement.

The paper sheds further light on growing awareness of the gut microbiome’s important role in this progressive disease, something even neurologists had not considered until recently, explains Sergio Ramirez-Salazar, M.D., MPH, a cognitive neurologist at Dartmouth Health Medical Center who was not involved in the study.

“Definitely, the diet has a direct role,” Ramirez-Salazar says. “We’ve found that through the vagus nerve, there is a direct connection between the brain and the gut in Parkinson’s.” He adds, “It’s interesting, because [before], we didn’t know the microbiome was playing an important role in not only neurological conditions, but other types of diseases.”

Healthy vegan diets and Mediterranean diets emphasize higher consumption of fruits and vegetables, which are rich in antioxidants, such as vitamins C and E, polyphenols, and carotenoids. These help reduce oxidative stress and support healthy cell function, particularly in the mitochondria, where energy is produced. Additionally, plant-based foods contain compounds that can reduce inflammation, further lowering the risk of cell damage linked to Parkinson’s. Researchers noted that historically, in regions where plant-based diets are common, such as East Asia and sub-Saharan Africa, there are lower rates of Parkinson’s disease.

“What recent studies have shown is that green, leafy vegetables, nuts, seeds, and also tea can help a microbiome prosper,” Ramirez-Salazar says.

On the flip side, the study authors noted that consuming more red and processed meat is associated with an increased incidence of metabolic syndrome, which has been linked to a higher Parkinson’s disease risk. High-protein, meat-heavy diets can interfere with the absorption of carbidopa and levodopa, key medications that help increase dopamine levels and reduce Parkinson’s symptoms like stiffness and tremors.

Furthermore, meat lacks fiber, which is critical for gut motility and microbial balance. As such, constipation, already common among Parkinson’s Disease patients, may be more prevalent among heavy meat eaters.

“I would say every single movement disorder specialist would say try to stay away from a huge carnivore diet because that is going to affect the absorption of the medication,” Ramirez-Salazar says.

Ramirez-Salazar, along with the Parkinson’s Foundation, recommends a whole-food, plant-based diet for individuals who wish to reduce their risk of Parkinson’s and those who have been diagnosed with the disease.

He also emphasizes that diet is just one piece of the puzzle—exercise, sleep, and other lifestyle factors also play a crucial role in managing Parkinson’s. “It’s an interplay,” he says.

The post New Study Finds Vegan, Plant-Forward Diets May Help Prevent and Slow Parkinson’s appeared first on Forks Over Knives.

In 2005, a few weeks after giving birth to my son, I was diagnosed with ulcerative colitis, a form of inflammatory bowel disease (IBD). It was a challenging time, becoming a new mother and suffering from painful symptoms. I was exhausted.

On a Mission to Find Answers

I’m a radiation oncologist, and patients often ask me what lifestyle changes they can make to improve cancer outcomes and quality of life. Four years ago, on a quest to find answers for them, I was researching complementary therapies and came across The China Study, by T. Colin Campbell, Ph.D. After that, I read articles and listened to podcasts about plant-based diets. I could not believe all the evidence connecting plant-based nutrition with better quality of life, better cancer outcomes, and decreased risk of multiple diseases. I was sold: I switched my diet overnight and convinced my husband to join me. I also enrolled in the plant-based nutrition certificate program through eCornell.

Full of Energy, Free of IBD Symptoms

It’s been four years since my plant-based awakening. I’ve never looked back—honestly, the hardest part of this lifestyle change has been to forgive myself for not doing it sooner. Since changing my diet, I’ve not suffered a significant recurrence of ulcerative colitis; I am completely asymptomatic. I wonder sometimes if I might be cured. My skin is better, too. I used to suffer from rosacea, but I’ve had no episodes since changing my diet. I am very active physically: I run, cycle, spin, do yoga, walk, and hike. I feel so energized.

My husband has stuck with this lifestyle and is feeling good, as well. We eat overnight oats every morning. I love to make bowls with sweet potatoes, tofu, and spicy peanut sauce. He makes a great vegan chili that we serve with avocados—delicious! We enjoy snacking on baked kale chips; crispy chickpeas; and hummus with carrots and celery. I love apples, too. I don’t miss any of the foods I used to eat.

Encouraging Others to Eat More Plants

In the beginning, I found it hard to have to explain our diet to our extended family, and going out to eat was a challenge. We have now found many restaurants with excellent options, and our family is more open and understanding. Our niece even adopted a plant-based diet after spending a few weeks with us!

On top of transforming my health, this lifestyle has completely changed my approach with patients. I discuss nutrition with each of them and encourage them to introduce more plants into their diets and, ideally, to adopt a completely plant-based diet. I find they’re more receptive than you might expect.

I am so happy about my decision to go plant-based. I feel very good.

Ready to get started? Check out Forks Meal Planner, FOK’s easy weekly meal-planning tool to keep you on a healthy plant-based path. To learn more about a whole-food, plant-based diet, visit our Plant-Based Primer.

The post As a Radiation Oncologist Suffering from IBD, Discovering Plant-Based Nutrition Has Changed My Life appeared first on Forks Over Knives.

In 2015, at the age of 33, I was diagnosed with Crohn’s disease. With two young children, I was desperate to find something that would make me feel better. Of course, I was prescribed plenty of medications, some of which helped a little, but they came with so many uncomfortable side effects and potentially harmful long-term effects that I didn’t want to stay on them for long.

Eventually, I stumbled upon a few books about healing with plant-based nutrition that caught my attention. I didn’t cut out meat entirely, but I ate a lot less of it. For a while, I experienced some relief from my Crohn’s symptoms.

Ready to Throw in the Towel

In 2019, I got really sick and ended up in the hospital a few times. In 2020, a surgeon removed an extremely damaged section of my small intestine. After that surgery, I expected to feel 100% better… but I didn’t. I was frustrated enough that I was about ready to throw in the towel and just take all the scary medications indefinitely.

But I ended up going back to the dietary drawing board one more time. Lent was coming up, so I resolved to eat only fruits, vegetables, beans, and nuts for 40 days. I found that I felt so much lighter. I decided to cut out meat completely. I didn’t really have a taste for it after the surgery, so it wasn’t that hard to do. And at that point, in my quest to eliminate my Crohn’s triggers, I had already cut gluten, dairy, corn, refined sugar, oils, soy, eggs, caffeine, and alcohol from my diet. What was one more food, in the grand scheme of things? So I got to work, researching and planning a whole-food, plant-based (WFPB) diet, as a last-ditch attempt to heal myself from Crohn’s.

Off All Medications

Within a year of going WFPB, I was able to discontinue all medications, and I felt better than I had in 10 years.

It’s been a few years now, and I’ve stayed on a WFPB path. I love to eat lots of fresh fruit, Buddha bowls with quinoa and root veggies, big salads with simple cashew- or tahini-based dressings, potato bowls with roasted veggies, and vegetable curries with brown rice. I return to Forks Over Knives again and again for new healthy vegan recipes.

Things aren’t perfect. I occasionally have small Crohn’s flare-ups, mostly stress-related—but with my healthy diet and lifestyle, I’m able to get past them much easier than in the past. I wholeheartedly believe that I will be completely healed one day, and whole plant foods will be a major key to that healing. Getting plenty of sleep and exercise, managing stress, and keeping a positive mindset are other things I work on every day, as well.

A couple of years ago, I was inspired to get certified as a health coach to help others eat more plants and lead healthier lifestyles. It’s work that I love and look forward to every day. Eating plants has helped me make incredible strides in my own health journey, and now I get to help others improve their health as well—what could be better?!

I feel amazing and excited to live the rest of my life as a WFPB eater.

Ready to get started? Check out Forks Meal Planner, FOK’s easy weekly meal-planning tool to keep you on a healthy plant-based path. To learn more about a whole-food, plant-based diet, visit our Plant-Based Primer.

The post I’m Keeping Crohn’s Disease in Check with a WFPB Diet appeared first on Forks Over Knives.

Humans have been consuming probiotics for thousands of years via fermented foods, but over the last century, supplements have emerged to deliver high concentrations of specific strains, such as Lactobacillus acidophilus and Bifidobacterium bifidum. Probiotic supplements are hugely popular, generating $759 million in U.S. sales in 2020. If you’re looking to improve your gut health, you may have considered taking a probiotic supplement—but experts warn against doing so without the guidance of a gut-health specialist.

“[American College of Gastroenterology] guidelines don’t recommend widespread use of probiotic supplements, even for the majority of gastrointestinal conditions,” says Vanessa Méndez, MD, triple board-certified gastroenterologist. She notes that supplements may be helpful in specific instances—for example, to help treat infections or to restore gut microbiota following a course of antibiotics—but in other instances, they may be ineffectual, at best.

In general, Méndez recommends getting probiotics the old-fashioned way: from fermented plant foods, such as tempeh, miso, and kimchi. A 2016 review published in Critical Reviews in Food Science and Nutrition analyzed a number of studies and concluded that for healthy people, probiotic foods appeared more effective than supplements; the researchers posited that this may have to do with a buffering effect of foods to help probiotics pass through the gut.

But all probiotics, whether from food or supplement, will only take up residence in environments that are hospitable to their strain. Otherwise, they’ll act more like tourists. “Consuming the microbes themselves can have a temporary effect,” says Méndez. The real long-term benefit comes from giving your existing beneficial microbes what they need to thrive and multiply. That’s where prebiotics come in.

Prebiotics: Premium Fuel for a Healthy Gut

Most of what we eat is broken down and absorbed in the small intestine, but fibrous nutrients known as prebiotics move on to the large intestine and serve as food for beneficial microbes. As the microbes break down prebiotics, they release biochemicals that carry out important tasks in the body (more on that below).

While only a few types of resistant starch and fiber have been confirmed to be prebiotic, experts expect the list to grow. “Ten years ago, the entire conversation around prebiotics revolved around inulin, so people started focusing on Jerusalem artichokes and asparagus. But we now know that consuming a wide variety of plants is far healthier than only consuming Jerusalem artichokes and asparagus,” says Will Bulsiewicz, MD, MSCI, board-certified gastroenterologist and the author of The Fiber Fueled Cookbook. “I think the important point is that all plants, without question, contain prebiotic fiber.”

Bulsiewicz and Méndez emphasize that probiotic supplements can be useful in certain medically supervised contexts, and probiotic-rich foods can help bring diversity to your gut microbiome—but prebiotic foods are the bedrock of sustainable gut health.

“The great thing about a whole-food, plant-based diet is that you can be consuming both [prebiotics and probiotics],” says Méndez. “Fill your plate with more fiber-rich foods, and you’re going to be feeding a healthy gut microbiome.”

Food manufacturers are hip to the growing interest in prebiotics. The next time you’re at the grocery store, you’ll likely spot granola bars or sugary cereals sporting claims about prebiotics on their labels. Don’t buy it. “They’re still ultraprocessed foods,” explains Bulsiewicz. He instead advises choosing dietary fiber “in its native state”—i.e., whole plant foods.

What Are Postbiotics?

One of the most exciting developments in the gut-health world is the discovery of postbiotics: short-chain fatty acids (SCFAs) and other biochemical byproducts that gut microbes release as they consume prebiotics. SCFAs such as butyrate, acetate, and propionate carry out important functions throughout the body, reducing inflammation and insulin resistance, killing cancer cells, and maintaining the integrity of the intestinal barrier. They also appear to help synthesize neurotransmitters and influence the brain in other profound ways.

“For a long time, we thought that the intestinal tract was essentially just a hollow tube that churned food and absorbed nutrients,” says Méndez. “Then we discovered that gut microbes are really involved in the process of breaking down fiber. And recently, we’ve realized that they actually do so much more.”

The post Why You Probably Don’t Need a Probiotic Supplement appeared first on Forks Over Knives.

Our everything-you-need-to-know guide is here to help you better understand who the low-FODMAP diet is designed for, how it works, and how to maintain a whole-food, plant-based diet as you heal your digestive issues. Forks Over Knives spoke with gastroenterologist Will Bulsiewicz, MD, MSCI, who offered his best advice on confidently taking control of your health with the low-FODMAP diet.

In this article you’ll learn:

• What Are FODMAPs?
• What Is the Low-FODMAP Diet?
• Are High-FODMAP Foods Bad For You?
• Who Should and Shouldn’t Go on the Low-FODMAP Diet?
• How Long Should You Be on a Low-FODMAP Diet?
• What Else Might Be Causing Gut Health Issues?
• Can You Be Whole-Food, Plant-Based While on a Low-FODMAP Diet?
• Our Favorite Low-FODMAP Recipes

What Are FODMAPS?

The acronym FODMAP stands for “fermentable oligosaccharides, disaccharides, monosaccharides, and polyols,” which are certain types of short-chain carbohydrates that aren’t easily digested.

Most digestion occurs in the small intestine, where food is broken down, nutrients are absorbed into the bloodstream, and waste is then pushed into the large intestine. But the small intestine has trouble absorbing nutrients from FODMAPs, because the human body doesn’t produce the enzymes needed to break down these specific types of short-chain carbs; instead, it relies on the trillions of microorganisms that live in our large intestine to do this task. When the small intestine encounters FODMAPs it pulls in extra water to move these foods to the large intestine, which can cause bloating and other GI issues.

Once the food reaches the large intestine, gut bacteria begin to ferment it and get it ready for excretion. While this fermentation is a natural and healthy process, the bacteria can produce excessive amounts of gas when encountering difficult-to-break-down FODMAPs, leading to all the unpleasant symptoms associated with IBS.

What Is the Low-FODMAP Diet?

While people with healthy gut microbiomes are able to digest FODMAPs without issue, those with sensitive digestive systems have a much harder time. The good news is that your gut can be trained to better tolerate the foods it once struggled with, which is where the low-FODMAP diet comes in.

“The [low-FODMAP] diet is generally reserved for people who are having digestive health problems that include food intolerances,” explains Bulsiewicz. “What that means is that when people consume normal foods in a normal serving size, they have unpleasant symptoms like bloating, abdominal pain, cramping, diarrhea, constipation, and nausea. The [low-FODMAP] diet is an approach that allows them to improve their symptoms and eventually to reintroduce these foods that they have struggled with.”

The low-FODMAP diet is typically broken down into three main stages:

• Eliminating high-FODMAP foods from your diet to establish a baseline.
• Reintroducing high-FODMAP foods one at a time so you can determine which are triggering unpleasant symptoms.
• Customizing your diet by figuring out the specific portion sizes of high-FODMAP foods that are tolerable and integrating them back into your normal diet in those portions.

“A properly constructed low-FODMAP approach involves restriction, but it’s just a temporary restriction,” says Bulsiewicz. “Then it’s all about reintroduction, which can be quite complicated. Generally, I recommend that people do it with the support of a dietitian or someone who’s an expert on the topic.”

Are High-FODMAP Foods Bad for You?

The short answer is no! High-FODMAP foods are not intrinsically bad or dangerous unless you have a specific allergy or condition, such as celiac disease. High-FODMAP foods include fruits, vegetables, and whole grains, which are some of the healthiest foods you can eat.

“The vast majority of FODMAPs are actually prebiotic, meaning that they are good for the gut microbiome,” Bulsiewicz explains. “[By] avoiding high-FODMAP foods, you’re depriving yourself of all of the beneficial nutrients that are found in that food, such as polyphenols and phytochemicals and vitamins and minerals. When we categorically remove these foods, it’s potentially problematic because not only are we getting into a restrictive dietary pattern where you are more likely to have a nutritional deficiency, but you are negatively affecting the gut microbiome.”

So while it can be tempting to blame your digestive woes on the foods themselves, it’s better to look at the low-FODMAP diet as a technique to slowly make friends with these foods rather than a way to avoid them. Creating a flourishing gut microbiome that can tolerate a wide range of foods is key to fewer digestive problems in the long run and better health throughout your life.

“When you’re struggling, it’s because the gut microbes are fermenting [FODMAPS] in a way that’s inefficient and gas producing,” says Bulsiewicz. “Your gut microbes can be trained to do better.”

Who Should and Shouldn’t Go on a Low-FODMAP Diet?

The low-FODMAP diet is not meant to be a weight-loss technique and should only be used by people struggling with digestive issues related to food intolerances. While weight loss may occur on the diet, Bulsiewicz emphasizes that it’s important to get enough calories and nutrients while on this diet.

“People who have a history of disordered eating should not be doing this, especially not independently,” he recommends. “They should only do it with the approval of someone who’s managing their disordered eating so they can be in a good place before moving forward with it. Also, if a person has a complex medical condition, such as active Crohn’s disease, and they’re losing weight, then it’s not the time to do something like this. You have to get your disease under control first before going on a low-FODMAP diet.”

How Long Should You Be on a Low-FODMAP Diet?

The low-FODMAP diet is meant to be temporary, with the goal of resuming more normal eating patterns as soon as possible. Total time spent on the diet will vary from person to person. Typically, the elimination phase lasts two to six weeks and then high-FODMAP foods are slowly reintroduced based on your symptoms and sensitivities. The entire process should only last a few months, says Bulsiewicz.

“Ultimately, we want a diet of abundance,” says Bulsiewicz. “The most important rule for gut health is to eat a wide variety of plants. The advantage of a properly constructed FODMAP approach is that it allows you to, number one, feel better. Number two, understand what the source of your problem is. Then number three, to actually have a strategy to bring that food back on board and tolerate it.”

Bulsiewicz says that you’ll know the low-FODMAP diet has worked once you’re able to enjoy a wide variety of foods free of unpleasant symptoms. Remember, the idea of going on the low-FODMAP diet isn’t to eliminate large categories of food: It’s to slowly retrain your gut microbiome to tolerate the foods that typically trigger it.

“Ease into it and give your body a chance to catch up and adapt to what you’re doing,” Bulsiewicz recommends. “It’s similar to exercise. If you haven’t worked out in a while, you wouldn’t pick up the heaviest weight in the gym. You’d start small and work your way up from there. It’s the same with high-FODMAP foods. As with anything, you’ll get better the more you practice.”

What Else Might Be Causing Gut Health Issues?

There are myriad other reasons for digestive problems besides FODMAP sensitivities. As you work on retraining your gut, it’s likely your physician will also recommend lifestyle changes to help bolster the impact of your dietary changes. Bulsiewicz says there are many aspects of our modern lives that lead to gut issues.

“It’s the lack of sleep, it’s the electronics in the evening before you go to bed, it’s the absence of exercise, it’s the medications, and it’s the large amount of processed foods present in our diet,” he says. “These are all disruptive to the balanced community of microorganisms in our gut.”

Stress can also play a significant role in chronic gut health problems. A 2020 review published in Current Opinion in Behavioral Sciences indicates that the relationship between our mental health, gut microbiome, and dietary choices is deeply interconnected. Depression, anxiety, and other psychological conditions can influence the reactivity of gut bacteria and cause flare-ups of digestive issues. When beginning the low-FODMAP diet, be sure to talk with your doctor about how mental health may be playing a role in your intestinal discomfort.

Can You Eat Whole-Food, Plant-Based While on a Low-FODMAP Diet?

The low-FODMAP diet was created with omnivores in mind, which means it can often be more restrictive for people who follow a whole-food, plant-based diet since meat and dairy are already off the table. Bulsiewicz shared some thoughts on how to get enough calories and nutrients as a vegan who’s traversing the low-FODMAP path.

“I think it’s important to include all of the major [plant-based] food groups,” he says. Don’t eliminate an entire group of food. Instead, opt for low-FODMAP options within that groups. “For example, people may often have issues with whole grains, and those issues are usually specific to wheat, barley, and rye. You can opt for a low-FODMAP option like quinoa.”

While we always recommend going directly to your doctor for health care advice, you can check out this full list of FODMAP foods to get a general idea of what you’ll need to eliminate if you’re exploring a low-FODMAP diet. Bulsiewicz also offers an online class in FODMAP intolerance that includes techniques on reintroduction, healthy recipes, and handy kitchen tricks.

“Be patient, because it takes time,” Bulsiewicz recommends. “It’s not meant to be a quick fix. It’s meant to be about your long-term health and allowing you to have a diet that is sustainable and enjoyable.”

Our Favorite Low-FODMAP Recipes

High-FODMAP foods such as beans, wheat, lentils, and fibrous veggies are some of the healthiest foods on the planet, and diets rich in these foods have been linked to lower rates of heart disease, certain cancers, and Type 2 diabetes. However, should you need to temporarily cut back on these foods to retrain your gut, here are some healthy WFPB recipes you can enjoy on a low-FODMAP diet:

• Sweet Potato Jalapeño Poppers
• Cantaloupe-Cucumber Soup
• Blueberry Farro Grain Bowl
• Jerk Grain Bowls with Air-Fried Plantain Chips
• Berry-Stuffed Breakfast Sweet Potato

The post Everything You Need to Know About the Low-FODMAP Diet appeared first on Forks Over Knives.

As rates of irritable bowel disease and other gastrointestinal disorders have risen in recent years, so, too, has the amount of questionable “gut health” advice floating around on the internet. One prominent voice cutting through the noise is Will Bulsiewicz, MD, MSCI. “Dr. B,” as he’s known to his patients and more than 400,000 Instagram followers, is about as close to a rock star as a gastroenterologist can get. In May 2020, he released his debut book, Fiber Fueled, which explored the fascinating science of the microbiome and broke down why a whole-food, plant-based diet beats fad diets such as Paleo and keto when it comes to sustainable weight loss and long-term health. The book quickly became a New York Times best-seller, highlighting consumers’ hunger for answers to chronic gastrointestinal woes.

Now, two years later, he’s back with The Fiber Fueled Cookbook, a cookbook/guidebook hybrid geared toward helping readers pinpoint their own specific food sensitivities, heal their guts, and develop a repertoire of healthy plant-based recipes they can turn to every day. We spoke with Bulsiewicz about his latest release, the fiber paradox, and the top two foods you should ditch right now if you’re having GI problems. Read on for the full conversation, and check out an exclusive Sweet Potato Shawarma recipe from the new book here.

What made you decide to write this book?

Fiber Fueled was an unexpected success. With that came a lot of enthusiasm from readers, but many came to me saying, “I want to eat the way that you’re describing, but I don’t feel well when I do.” As a gastroenterologist, I understood what they meant, because I see this in clinic all the time—people who suffer with digestive health problems struggling to increase fiber in their diet. I wanted to create a resource that [empowers] people to eat a diet that heals the microbiome—which is a plant-based diet. … Whether you’re healthy or whether you have gut issues and food intolerances, we can share the same common cookbook and pursue a higher level of health together. So that was the goal with this book.

You note that dairy and artificial sweeteners are the first things that you recommend people try ditching when they come to you with gastrointestinal problems. Why?

The reason they cause so much trouble is dairy contains lactose, and 70% of the world is actually lactose intolerant. And artificial sweeteners are what we call polyols: sugar alcohols. Although they may not have calories, they can still be fermented, and they can still be disruptive to our gut microbes. In a person who has bloating or diarrhea, when I remove these things, there’s legitimately a 30% chance that we’re done. And that saves my patient a lot of money, they feel better, and now they’re given an opportunity to replace this part of their diet with something better. And I see no reason to include [dairy and artificial sweeteners] in your diet at all, from a health perspective.

If a fiber-rich diet is the key to a healthy gut, why do so many people experience uncomfortable bloating after adding more fiber to their diets?

In the book, I call this the fiber paradox. Fiber is the nutrient that heals the gut microbiome. But the people who need fiber the most are also the ones who struggle the most [when incorporating fiber], because their gut is in a damaged state. We lack the enzymes as humans to process fiber, which means that we are 100% reliant on microbes [living in our guts] to do it for us. If you take a person who has a damaged gut microbiome, their capacity to process and digest fiber may be impaired relative to a person who has a completely healthy microbiome. That doesn’t mean that they’re not capable of consuming fiber. … You can get functionality back and become fully capable of consuming unlimited amounts of fiber. You just have to go through the proper process to do that.

What does it mean to heal your gut?

Your gut is the most adaptable part of your entire body. Like anything else in life, with practice, your gut microbes can become better; they can become more efficient. They can have enhanced functionality. I’m in no position to run a marathon today. If you give me four months to train, I could do it. Similarly, your gut may not be in a position to process and digest large amounts of fiber today, but if you go through this process with me and you train it, in four months, you can do it. So this is a message of hope that we’re not stuck. We just need to know how to fix it, and that’s what I’m trying to teach in the book.

Could you break down the GROWTH strategy that you outline in the book?

Each letter represents a step in the process of healing your gut. “G” stands for “Genesis”: What is the root cause of your problem? Understanding the problem means that we will be able to create more targeted solutions. “R-O-W” is “restrict, observe, work it back in.” This is the approach that we take to identify food intolerances. A blood test can never tell you what foods you are intolerant to. … If you temporarily remove something and your symptoms improve, and then you add it back in and your symptoms get worse, you have identified a food intolerance. Once we know what we’re treating, we can move to the next step, which is the healing phase: “T,” train your gut, “H” stands for holistic healing.

You write that one of the most fulfilling aspects of your career has been helping patients get the help they need to heal emotional wounds, and then watching their “impossible” gut health problems disappear. Why is mental health important to gut health?

It’s very, very important for people to understand that many times it’s the parts that don’t [directly] involve our digestive system that are negatively impacting us. And people may not make these connections. They may think, “Oh, well, the fact that I hate my job has nothing to do with my digestive health problem,” but that’s not actually true. You are a whole person, so we have to look at the whole person and understand that anything that’s affecting you as a human being could eventually downstream affect your gut health. And when we create plans to treat you as a whole person—addressing any trauma in your life—we actually are providing the best treatment for your gut health.

Who is The Fiber Fueled Cookbook for?

My book was designed to help people enhance the health of their microbiome in whatever way suits them. So it jumps out as being for people with food intolerances…but if a person has a healthy gut, I want them to understand that our gut health is proving to be essential not just for our digestion but also our metabolism, our immune system, our hormones, our mood, our brain health, and our energy levels. This is a precious resource and so important to our health.…We should all be living with intention and supporting this part of our body, starting today, because it’s that important.

This interview has been edited and condensed for clarity.

To learn more about a whole-food, plant-based diet, visit our Plant-Based Primer. For meal-planning support, check out Forks Meal Planner, FOK’s easy weekly meal-planning tool to keep you on a healthy plant-based path.

The post 2 Foods to Ditch if You Have GI Issues, Plus More Expert Advice from Gut Whisperer Will Bulsiewicz, MD appeared first on Forks Over Knives.

Irritable bowel syndrome (IBS) affects as many as 45 million people in the United States. It is the most common diagnosis in gastroenterology practices: 1 out of 3 patients seen are suffering from IBS. More people miss work as a result of irritable bowel syndrome than any other reason other than the common cold. In this article, we’ll review the symptoms of IBS and the scientific research regarding IBS and diet.

What Is Irritable Bowel Syndrome?

IBS is a chronic condition that affects the large intestine, causing symptoms that range from mild to debilitating. It is considered a functional bowel disorder, which means the problem isn’t with the structure of the bowels; it’s with how they work. Because symptoms are present without any visible signs of damage to the digestive tract, it is not diagnosed through testing such as blood tests, X-rays, or endoscopy. Doctors may order tests to rule out other digestive problems, such as celiac disease, but IBS is not a diagnosis of exclusion. Instead, diagnosis is made using a well-accepted set diagnostic criteria called the Rome criteria.

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Symptoms of IBS

According to the Rome criteria, to be diagnosed with IBS, a patient should have abdominal pain and discomfort lasting on average at least one day a week for the last three months. The pain or discomfort should be related to defecation, associated with a change in frequency of bowel movements, and/or associated with a change in stool consistency. Other symptoms of IBS can include bloating, gas, passage of mucus, straining, urgency, or a feeling of incomplete evacuation.

What Causes IBS?

The exact cause of IBS is not known, though we know at the root is a disturbance in the interaction between the gut, brain, and nervous system. “There are millions of neurons in our gut, and the gut and brain are talking to each other all the time through the vagus nerve,” says Dr. Sarina Pasricha, MD, MSCR, a gastroenterologist specializing in gut motility. “The gut, the brain, and the nervous system are like three legs of a stool. If one part is not working properly, the whole thing weakens and falls apart.” 

Two of the biggest factors behind IBS are gut dysbiosis, an imbalance of the bacteria in the GI tract, and stress and anxiety. Studies show that people with IBS have unusually sensitive nerve endings in the GI system and are prone to feeling more intense pain at lower thresholds. This can lead symptoms to flare up in conditions—dealing with a stressful situation or even simply eating a meal—that would not trigger symptoms in those without IBS.

Trigger Foods

“The first thing I usually recommend to my patients is cutting out dairy,” says Pasricha. “Dairy for most people is quite inflammatory. With just that switch alone my patients will have symptom improvement.” Other common triggers include consuming large meals, high-fat meals, caffeine, alcohol, and carbonated drinks. 

It can be helpful for patients with IBS to keep a food diary to uncover their personal food triggers. However, it is important to not jump to conclusions, because foods aren’t the only triggers. “Patients with IBS may be able to eat one food item one day and not have an issue, but the exact same food item on a different day will create an issue,” says Pasricha. “That’s where environment and stress play a role as triggers. It is always worth reintroducing and retrying foods to see if it’s the food or that environment—like eating too quickly that day—causing the issue.”

It is often recommended for people to try a diet low in certain carbohydrates called FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols). FODMAPs are found in dairy products and certain grains, vegetables, and fruits. However, since so many healthy plant foods fall into the FODMAP category, totally cutting them out—while it may reduce symptoms in the short term—will lower the number of healthy microbes in the gut, increase the number of unhealthy ones, and leave you worse off in the long term, says Pasricha. 

“When necessary, the low-FODMAP diet can help reset the gut microbiome, but I only recommend this for 4 to 6 weeks and only for the most severe cases of IBS,” says Pasricha. “After that it is really important that you slowly try to incorporate FODMAPS back into the diet in order to provide the right type of food for your gut microbiome.” 

For severe cases of IBS, Pasricha recommends working with a plant-based dietitian.

IBS and Plant-Based Diets

A whole-food, plant-based diet improves the gut microbiome, which can improve IBS symptoms. “I always recommend a whole-food, plant-based diet for my patients and counsel them that the more variety you can eat in fruits and vegetables, the healthier the gut microbiome will be,” says Pasricha. In 2018, the American Gut Project released the largest study of the microbiome to date and found that subjects who ate more than 30 different types of plants (including whole grains) in a week had significantly healthier gut microbiomes compared with those who ate 10 or fewer types of plants each week, with more beneficial gut microbes and fewer harmful microbes. 

Studies show that compared with people eating an animal-based diet, a plant-based diet increases microbiota diversity in part because it provides more fiber. Fiber is considered a first-line therapy in treatment recommendations for patients with IBS, according to the 2021 American College of Gastroenterology clinical guidelines. “A whole-food, plant-based diet that is rich in fiber helps to produce short chain fatty acids, which is the key to building a robust gut microbiome,” says Pasricha. Fiber adds bulk to stool, speeds up its transit through the colon, and can help regulate bowel movements. A 2018 study found that the more fiber participants consumed, the less likely they were to have IBS. Soluble fiber—found beans, oats, lentils, and certain fruits—may serve as a prebiotic, feeding beneficial bacteria in the gut. Research suggests that insoluble fiber, the “roughage” that whole grains and vegetables tend to be rich in, has a laxative effect that can relieve constipation. 

However, most people with IBS will need to go slowly when beginning a plant-based diet. “I always tell my patients not to go from 0 to 100 really quickly,” says Pasricha. “It’s OK to go gradually, to slowly increase fiber intake and slowly transition to a whole-food, plant-based diet, especially if they experience gas and bloating to begin with. It’s important to counsel our patients that when they are transitioning to a whole-food, plant-based diet they might experience some worsening of their gas and bloating. That is expected. It is not harmful.” As noted above (see “Trigger Foods”), it’s important to keep an open mind and remember that it’s not always food causing the issue. “People will have a symptom when eating an apple or broccoli and assume it’s the food, but it doesn’t mean they have to eliminate it permanently,” says Pasricha. “They need to retry those foods again.”

IBS Treatments

While a change in diet is the first powerful step in alleviating symptoms of IBS, studies have found improvements with a range of lifestyle strategies including exercise, yoga, stress reduction, biofeedback, and psychological therapies such as cognitive behavioral therapy. “IBS requires a multifactorial approach to treatment and management,” says Pasricha. “Mind, body, soul, and gut health care are all important.” 

For people suffering from more severe IBS, treatment may include prescription antispasmodic or antidiarrheal medications, or low-dose antidepressants. “The last resort is medication,” says Pasricha. “We don’t want our patients to be on medications lifelong if they don’t need to be. After transitioning to a whole-food, plant-based diet and making lifestyle changes, many of my patients are able to decrease the dose of medications or come off of them entirely.”

To learn more about a whole-food, plant-based diet, visit our Plant-Based Primer. For meal-planning support, check out Forks Meal Planner, FOK’s easy weekly meal-planning tool to keep you on a healthy plant-based path.

The post Irritable Bowel Syndrome: What to Know About IBS appeared first on Forks Over Knives.

1. Vegans poop more.

It’s true: Vegans poop more. A University of Oxford study of 20,000 people found that vegans poop more than vegetarians who poop more than meat eaters. Eating a healthy vegan diet (i.e., rich in fruits, veggies, and whole grains) makes it easy to exceed the recommended 25 to 30 grams of fiber a day, and it’s not unusual for that to translate into daily poops for vegans—or two or three!

2. It’s about quality, not quantity.

More important than how often you poop is experiencing a sense of total relief afterward, usually a welcomed side effect of eating plant-based. Without this sense of satisfaction, you could be constipated—even if you poop every day or have diarrhea (called overflow). “The goal is to sit on the toilet for less than three minutes and to have a soft poop that comes out without pushing or straining,” says Dr. Sarina Pasricha, MD, MSCR, a gastroenterologist specializing in gut motility.

3. You can be plant-based and still constipated.  

A plant-based diet lays the foundation for healthy poop (especially when it includes flax and chia seeds), but other factors, such as hormonal changes, play a role. Regular exercise and water help move food through the colon. Stress-reduction techniques such as yoga and meditation can help, too. Pasricha diagnoses about 50 percent of constipated WFPB patients with pelvic floor dysfunction, where muscles that are supposed to relax during pooping actually tighten up. The fix? Pelvic floor physical therapy.

4. Look before you flush. 

Consult the “Bristol stool chart” (the poster you’ll find in any GI doctor’s office) and get to know the illustration for Type 4. That’s your shooting star: poop formed like a long, bulky, soft sausage or snake, smooth without lumps. Sixty percent of stool’s weight comes from gut bacteria of the microbiome. When you feed gut bacteria the fiber-rich plant foods they prefer, they thrive and multiply; as a result, you have larger BMs, says Dr. Will Bulsiewicz, MD, MSCI, a gastroenterologist and author of Fiber Fueled. 

5. Treat poop like a vital sign.

When your poop is off, it’s a red flag that your gut bacteria aren’t being treated with TLC. Heed the warning. Since gut health is integral to all health, dysbiosis may manifest into other disease states, says Bulsiewicz. Constipation can precede diagnosis of Parkinson’s disease by as many as 20 years and is common in up to two-thirds of patients. It’s also linked to an increased risk for breast cancer, according to a study in the Cancer Epidemiological Biomarkers, and mood disorders. Tend to your gut microbes with a diverse menu of 30 different kinds of plants per week, and if you see pencil-thin poops or blood, or don’t feel like you’re completely emptying your bowels, call your doc for a workup.  

The post Do Vegans Actually Poop More? 5 Things You Need to Know appeared first on Forks Over Knives.

It’s estimated that IBD, which takes the form of Crohn’s disease or ulcerative colitis, affects 5 million people worldwide. The United States accounts for more than half of that number. In recent years the incidence of IBD has increased in several countries where both Crohn’s disease and ulcerative colitis had previously been uncommon. And that increase, the study’s authors note, seems to coincide with these nations adopting a Western diet.

Previous research connecting diet with IBD had been limited and even conflicting. However, most of those studies involved a small number of participants. The current study drew findings from questionnaires given to 116,087 adults aged 35 to 70 who were enrolled in the global Prospective Urban Rural Epidemiology (PURE) study between 2003 and 2016. After a median follow-up of 9.7 years, 467 participants were found to have developed IBD (90 with Crohn’s disease and 377 with ulcerative colitis).

After adjusting for other potentially influencing factors, researchers found that those individuals who reported a higher intake of ultra-processed foods—such as soft drinks, refined sweetened foods, salty snacks, and processed meats—were much more likely to develop IBD.

Participants were grouped according to their level of ultra-processed food consumption: less than one serving a day, one to four servings per day, and more than five servings per day. Compared with people who had less than one serving of ultra-processed food a day, those who consumed one to four servings daily had a 67 percent greater risk of developing IBD. And those who ate at least five daily servings of ultra processed food were 82 percent more likely to develop IBD than those who ate one serving or less. 

Among study participants, ultra-processed food consumption was highest in North America, Europe, and South America. These regions also logged the highest consumption of processed meat and soft drinks. Participants in North America and Southeast Asia ate the most salty snack foods such as chips, while South American participants consumed the most refined sweetened foods such as chocolate.

Researchers found that unprocessed red and white meat; dairy; and whole foods such as fruit, vegetables, and legumes were not associated with IBD risk, leading researchers to posit that it isn’t the type of food but the way a food is processed that relates to the elevated risk.

“Ultra-processed foods often contain high amounts of many non-natural ingredients and additives such as artificial flavors, sugars, stabilizers, emulsifiers, and preservatives,” said the study’s lead author, Neeraj Narula, MD, MPH, FRCPC, director of the IBD Clinic and associate professor of medicine at McMaster University in Ontario, Canada. “Detergents and emulsifiers that are added to foods may have a detrimental impact on the gut barrier, as some translational science research papers have demonstrated increased intestinal permeability—or ‘gut leakiness’—with consumption of these ingredients.” Narula notes that increased intestinal permeability is thought to play a key role in the development of IBD.

Growing Research

This is not the first time ultra-processed foods have been linked to disease. A 2018 population-based cohort study of 104,980 participants found that a 10 percent increase in the proportion of ultra-processed food in one’s diet raised their cancer risk by more than 10 percent. Another large observational study linked higher consumption of ultra-processed foods with increased risks of cardiovascular, coronary heart, and cerebrovascular diseases. Meanwhile, there is also evidence that eating an ultra-processed diet increases calorie consumption and leads to weight gain, compared with a diet rich in whole plant foods. 

To learn more about a whole-food, plant-based diet, visit our Plant-Based Primer. For meal-planning support, check out Forks Meal Planner, FOK’s easy weekly meal-planning tool to keep you on a healthy plant-based path.

The post More Processed Foods, More IBD: New Study appeared first on Forks Over Knives.