The Low FODMAP Diet

As promised in my last post I am going to write about my experience on the low FODMAP diet.

First a DISCLAIMER: Although I wish to share my experience on this diet and I hope that you can share your experiences, I strongly encourage you to see your doctor to get tested and diagnosed with IBS before you start this diet, because you may miss important diagnoses like celiac disease. AND I really encourage you not to take on this diet alone, it involves cutting out a number of different foods, and although you can still eat a balanced diet I think you do need the help of a registered dietitian experienced in the low FODMAP diet because it can get frustrating and you can get hungry if not following it properly.

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Ok now to the fun stuff.

FODMAP stands for
Fermentable
Oligosaccharides
Disaccharides
Monosaccharides
And
Polyols

Basically, these are sugars that are not well absorbed by some people’s guts so they travel along our digestive tract to the colon where they act as food for bacteria and when the bacteria digest/ferment the food it produces symptoms of gas, bloating, diarrhea, constipation and abdominal discomfort. The low FODMAP diet starts by eliminating FODMAPs for 2-6 weeks and then slowly introducing one group at a time to test tolerance/intolerance to a certain sugar group.

The diet was created by Sue Shephard and the team at Monash University in 1999 and is gaining popularity by doctors who are starting to prescribe it to their patients. The Monash team is constantly working to expand the list of FODMAPs and has a great iphone app that can be purchased here, it is $9.99 but all the proceeds from the app go to doing more research and finding more FODMAP foods to add to the list.

So what are the FODMAPS?

Oligosaccharides – water soluble fibres found in: wheat, garlic and onion in large amounts, rye and barley in large amounts, and inulin (added to some foods to increase fibre).

  •          Appropriate foods include: gluten free products (*check labels to ensure they don’t contain other FODMAP food), the green parts of onions, psyllium, gluten free flours
  •          Because IBS is not an allergy to gluten, small amounts of wheat and oligosaccharides can usually be tolerated like bread crumbs and the amount of wheat in sauces like soy sauce

Disaccharides – lactose: found in milk products like, ice cream, milk, most yogurts, some soft cheeses like cream cheese, custard

  • Hard or cured cheeses like mozzarella, brie, feta and cheddar are low lactose and usually well tolerated
  • Small amounts (1-2TBSP) of cream cheese or other soft cheeses like ricotta may be tolerated by some

Monosaccharides – foods with excess fructose like: honey, apples, mango, pears, watermelon, high fructose corn syrup and other foods that contain more fructose than glucose

  • Low FODMAP fruits: bananas, oranges, kiwi, pineapple, grapes, strawberries, tomatoes, papaya, lemons and limes.
  • Keep fruit to 1 serving per meal (separate by 2 or more hours). 1 serving = 1 medium orange or banana, 1/2 cup berries, melon or other fruit
  • Suitable sweeteners: sugar, brown sugar, maple syrup, molasses, cane syrup, most jams in small amounts
  • Sugars should all be consumed in small amounts as high amounts promote weight gain, cavities and excess unneeded calories.

Polyols – sugar alcohols found in foods like pears, plums, cauliflower, mushrooms and artificial sweeteners like sorbitol and malitol (commonly found in mints and sugar free gum).

  • Low FODMAP polyols: bananas, blueberries, gum sweetened with sugar, aspartame, cantaloupe

FODMAPs all cause distension in the colon in the same way so eating them in combination at meals increases the effect of symptoms in an additive form. For example if you don’t tolerate lactose and also have difficulty with wheat and you had shredded wheat cereal with milk for breakfast you would be more likely to have symptoms than if you had just a small amount of cheese on gluten free bread. This is why the low FODMAP diet concentrates on the amount of FODMAPs consumed per meal.

The low FODMAP diet divides foods into high, medium and low FODMAP foods. Low FODMAP foods are best tolerated by most people, but as I said before the sugars are cumulative so the amount of each food eaten will affect your symptoms. This is particularly the case with fruits or the Fructose group as you shouldn’t have more than half a cup serving per meal.

I am currently on the Low Fodmap diet phase and have been cutting out any foods I think could be potential triggers, stay tuned for posts about the struggles and achieves of this phase of the diet and my long awaited reintroduction phase.

Below I’ve listed my references and some great resources for dietitians and others trying to follow this diet.

Resources:

Kate Scarlata’s blog:  her blog is fantastic and she offers a lot of information and answers questions and comments.  Her shopping guide is currently posted on my fridge and I recommend anyone trying to start the diet download a copy (it’s FREE!).

Sue Sheppard Low FODMAP Diet: get information direct from the source, she was part of team of researchers who developed the diet.

Monash University website: always new and updated information on low FODMAP foods again direct from the source. Also a link to the app if you want to download it.

Stephanie Clairmont: her webinar is what got me actually inspired to start the diet myself and she also has some really great information online as she follows the diet herself

 

 

Having Bowel Troubles?

I have been struggling with GI issues for years now and no one has been able to diagnose it. I’ve gone to my doctor numerous times and just been told I had gas. And although it was true I was having gas and bloating and stomach pain I wanted to know why. After 10 years of dealing with the symptoms with no diagnosis I finally decided to take matters into my own hands. I’ve tried cutting out random foods, I’ve been tested for celiac disease, I’ve had ultrasounds, I’ve been referred to a GI specialist (my appointment is in the Fall a short 6 months from now!!!) and I still haven’t figured out what’s causing the GI symptoms. All my doctor ever tells me is that I’m healthy and it’s likely just IBS (Irritable Bowel Syndrome).

Anyone who can say it’s just IBS has never had IBS symptoms before; which include gas, cramping, abdominal pain, abnormal bowl movements including sudden onset diarrhea and constipation.

Commonly IBS has been diagnosed based on elimination, basically if doctors couldn’t find anything  wrong with your gastrointestinal tract they diagnosed you with IBS. It is now typically defined as symptoms of gas, bloating, abdominal discomfort, that persists for more than 3 months (doesn’t need to be consecutively) without any specific disease diagnoses and abdominal pain is usually relieved by having a bowel movement.

The Rome III Diagnostic Criteria define IBS as

Recurrent abdominal pain or discomfort at least 3 days/month in the last
3 months associated with two or more of the following:

  • Improvement with defecation
  • Onset associated with a change in frequency of stool
  • Onset associated with a change in form (appearance) of stool

IBS, although uncomfortable if not managed properly, does not increase one’s risk of developing colon cancer or inflammatory bowel disease and does not specifically damage the intestinal tract.  Symptoms can start at any time but can be triggered by an infection in the intestinal tract, a significant life event or extreme stress.

If you are experiencing IBS symptoms you should speak with your doctor and have your IBS properly diagnosed before trying to treat symptoms on your own. You should also have a colonoscopy to check for any intestinal inflammation or diagnosis of celiac or inflammatory bowel disease. Celiac disease and lactose intolerance are commonly associated with IBS.

IBS is frequently treated by diet, stress relief and sometimes medications (like antidiarreal agents). One of the most widely used and well researched diets to relieve symptoms of IBS came from the Monash University in Australia, the low FODMAP diet. I will be posting my experiences on this diet which I started on Monday. I encourage you to trial this diet if you have been diagnosed with IBS since 75% of people find symptom relief with the diet.  I am a Registered Dietitian therefore I can ensure my diet is balanced all by myself, I encourage you to seek help and advice from a registered dietitian experienced in the low FODMAP diet to help you with proper meal planning as the diet involves eliminating a large amount of foods.

Stay tuned for more posts about what the low FODMAP diet is and my experience on it including some of my trialed recipes including a vegetarian quiche, sheppards pie and even desserts 🙂