Fodmap diet shows promise taming stomachs
Slow Diffusion The diet has gained popularity in the U.S. since Gibson and Shepherd spoke on the topic at the American College of Gastroenterology annual meeting a year ago, said Patsy Catsos, a dietitian and author in Portland , Maine , who keeps a list of more than 90 dietitians who feel comfortable delivering the diet. Nutritionists here in the U.S. are thrilled with the diet, happy to have something to offer their patients that has scientific backing and good results, said Barbara Bradley Bolen, a clinical psychologist in Farmingdale and Northport, New York , who has written two self-help books on irritable bowel syndrome. Some gastroenterologists are recommending the diet to their IBS patients, Bolen said.This is a big deal, as traditionally, mainstream medicine has downplayed the role that diet has played in IBS, she said. Theres a slow diffusion of knowledge among physicians about food intolerance, said Peter Green, director of the Celiac Disease Center at Columbia University in New York. Green, a physician, typically tries to rule out gluten, fructose and other intolerances, as well as bacterial overgrowths, he said. If theyre excluded, well say, Theres this new diet thats come out of Australia, and well give them the Fodmap diet, Green said. Typical Meals A typical days meals might include a poached egg with spinach plus a banana for breakfast, followed by a ham and salad sandwich on gluten-free bread for lunch, and a dinner of grilled chicken, baked potato with sauteed spinach and capsicum, seasoned with the green part of a spring onion, salt, pepper, olive oil and pine nuts. Lactose-free yogurt with blueberries, or peanut butter on a celery stick may serve as suitable snacks, according to the Digestive Health Foundation in Melbourne . Because it avoids foods with high-fructose corn-syrup, it can be difficult to procure appropriate products in the U.S. where the ingredient is widespread, he said, in everything from jelly to ketchup. Laden With Fodmaps Usual diets here in the U.S. are laden with Fodmaps, Portland dietitian Catsos said. Doctors have pushed high-fiber diets and fiber supplements almost across the board for IBS patients.
A Low FODMAP Diet: Help for IBS
In her early 20s, the dietitian invented a food regimen to relieve symptoms of bloating and stomach cramps. It’s now being adopted internationally, changing the way doctors manage a set of digestive troubles known as irritable bowel syndrome. She found even those without the condition felt better when they avoided the grain-protein and foods containing certain sugars named “Fodmaps,” an acronym for potentially tough-to-absorb molecules. Shepherd’s diets low in gut irritants have spurred an $8.3 billion market, encouraging the likes of Abbott Laboratories to introduce products devoted to food intolerance. “This approach has really revolutionized the way we treat a common condition,” said Jason Tye-Din, a gastroenterologist at the Royal Melbourne Hospital and celiac researcher at the Walter and Eliza Hall Institute. “The significance has been realized around the world.” Screening for celiac disease in Australia alone has increased 25 percent over the past four years, according to Tye-Din, who runs two of Australia’s four celiac disease clinics. That’s bolstered demand for gluten-free foods and other products for so-called functional gastrointestinal disorders. “Gluten-free food is flourishing,” said Ewa Hudson, head of health and wellness food and beverages research at London-based Euromonitor International, who predicts retail sales of food intolerance products will reach $10.5 billion worldwide by 2017, especially as more grocery chains carry them. The market in developed nations “has undergone a revolution,” Hudson said in an email. “Prior to that, gluten-free had been the preserve of pharmacies and specialist health-food stores.” Abbott and Mead Johnson Nutrition have about 7 percent each of the global food-intolerance market by value, according to Euromonitor. Abbott, which sells intolerance products under the Vital and Ensure labels, introduced a limited-ingredient, gluten-free nutrition bar called Perfectly Simple in June. “We expect to launch an additional 20 products and formulations this year and have more than 30 clinical studies,” Abbott said Oct. 17, when it reported third-quarter earnings. Shepherd said she’s sold almost 200,000 copies of her eight cookbooks, which include “Irresistibles for the Irritable,” that help people choose bowel-friendlier foods. The recipes avoid sugars that aren’t well-absorbed in some people’s bowels, found in products ranging from onions to yogurts.
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A Low FODMAP Diet: What the Science Says The first clinical trial on FODMAPs was published in 2006 by Australian researchers. They put 62 people with IBS who were fructose intolerant on a low FODMAP diet for an average of 14 months and found that 74 percent of participants saw an improvement in abdominal symptoms. More recent studies have had similar results. One published in 2013 in the International Journal of Clinical Practice followed 90 people with IBS as they ate a low FODMAP diet. Most participants saw improvement in abdominal pain, bloating, flatulence, and diarrhea. The concept isnt all that new, however. Doctors have known for a long time that patients who avoided almost all carbohydrates those who went on a high-protein Atkins diet, for instance would see a significant reduction in symptoms in the short-term, said Pankaj Jay Pasricha, MD, chair of the American Gastroenterological Associations Neurogastroenterology and Motility Section and director of the Center for Neurogastroenterology at Johns Hopkins University School of Medicine in Baltimore. Low FODMAP Diet: What to Avoid A low FODMAP diet is all about avoiding the foods that are likely to make IBS symptoms act up. Fruits and sweeteners high in fructose: fresh apples, mangos, watermelon, pears, nashi (Asian pears), and juice made from these fruits; canned fruit; dried fruit; foods with sweeteners made with fructose or high fructose corn syrup; and honey. Dairy products containing lactose: milk from cows, goats, and sheep ; custard; ice cream; yogurt; and soft cheeses such as cottage cheese, cream cheese, mascarpone, and ricotta. Foods with fructans: vegetables such as onions, garlic, leeks, fennel, shallots, spring onions, artichokes, asparagus, beetroot, broccoli, Brussels sprouts, cabbage, eggplant, and okra; cereals, breads, and baked goods containing wheat and rye; couscous and pasta; fruits such as custard apples, persimmons, and watermelon; and chicory root, dandelion, the food ingredient inulin, and pistachios. Legumes containing galactans: baked beans, chickpeas, kidney beans, lentils, and soybeans. Fruits, vegetables, and sweeteners containing polyols: fruits such as apples, apricots, avocados, blackberries, cherries, longons, lychees, nashi, nectarines, peaches, pears, plums, prunes, and watermelon; vegetables such as cauliflower, green bell peppers, mushrooms, and sweet corn; and sweeteners such as sorbitol, mannitol, isomalt, maltitol, and xylitol found in diet soda and diet drinks. Low FODMAP Diet: What to Eat Next, put together a meal plan from foods low in FODMAPs that shouldnt trigger IBS symptoms. Fresh fruits or a small amount of dried fruits: bananas, blueberries, boysenberries, cantaloupe, cranberries, durians, grapes, grapefruit, honeydew, melons, kiwis, lemons, limes, mandarin oranges, passionfruit, papayas, raspberries, rhubarb, cantaloupe, strawberries, and tangelos.