Beating IBS with the low-fodmap diet
No, its not some strange military maneuver or a new food map (ha); its the latest, cutting-edge treatment for irritable bowel syndrome, or IBS. Basically, the FODMAPs approach is a diet, a way of eating. Eating a low FODMAP diet means avoiding certain foods that can cause gas, bloating, constipation and all of the other lovely symptoms those of us with IBS know so well. But whats with the weird name? FODMAPs stands for Fermentable Oligo-, Di- and Mono-saccharides, and Polyols. The name was created by Australian researchers who realized that a low FODMAP diet helped up to 75% of their patients, says Patsy Catsos, MS, RD, LD, a registered dietitian with a private practice focused on gastrointestinal health. She is the author ofIBSFree at Last! Second Edition(2012) and the editor of http://www.ibsfree.net . Patsy explains that examples of FODMAPS include: Lactose (also known as milk sugar, found in milk, yogurt and ice cream) Fructose (also known as fruit sugar, found in fruit, high-fructose corn syrup, honey and agave syrup) Sorbitol, mannitol, and other -ol sweeteners (found in certain fruits and vegetables as well as some types of sugar-free gums and candies) Fructans (a type of fiber found in wheat, onions, garlic and chicory root) GOS (a type of fiber found in beans, hummus and soy milk) Catsos adds that the novelty of the FODMAP approach is recognizing how the big picture [of overall diet] can be used to create a strategy for managing IBS symptoms.I struggle with IBS myself, and I first became aware of the diet by reading the healthy living blog Hungry Hungry Hippie . Its author (and fellow IBS sufferer and nurse),Elise Dieden, says she was hesitant to treat her IBS with medication: After a few months of looking into FODMAPs, I decided to give it ashot. The symptoms certainly matched mine and everything I read feltlike it was personally directed at me. She continues: I did a two week elimination phase (no FODMAPs) inSeptember 2011andsince then Ive been maintaining (with a low FODMAPs plan).
Gut Week 2013 encourages us to pay more attention to our digestion and what it’s telling us – particularly if you have symptoms of Irritable Bowel Syndrome Print Gut Week 2013 may not be something to celebrate exactly, but it’s aimed at getting people thinking about talking about their guts. And if your digestion is a constant source of struggle, help is at hand. IBS affects up to 20 per cent of the population, causing painful, embarrassing and uncomfortable symptoms. It has no cure but learning how to manage your diet and recognising your trigger foods can transform your life. Bloating, abdominal pain, diarrhoea and constipation can all be IBS symptoms [REX] One of the latest methods of doing this is using the FODMAP diet. This NHS-approved programme is gaining in popularity, but changes some of our thinking on what ‘good’ foods for us are. Because of this it’s recommended you only start the diet with the help of a dietician or your GP. [The facts about IBS] Dr Gill Hart, Scientific Director at YorkTest Laboratories, which specialises in food intolerance testing and has created a new diet programme specifically to combat IBS explains: “IBS varies hugely between individuals so it’s never a case of one diet fits all, which is why it’s really important to be supervised if you decide to remove FODMAP foods from your diet.” “In trials we’ve run at YorkTest, we saw a significant improvement in symptoms in patients who stuck to their prescribed diet. “Many people with IBS just aren’t aware that with a little help, they can often find simple dietary solutions to ease their symptoms.” Though packed with nutrients, broccoli can cause problems for IBS patients [REX] What is FODMAP? Standing for the rather complicated Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols, FODMAP foods contain types of carbohydrate and sugars that are not successfully broken down and absorbed by the small intestine. This means they are badly digested and arrive in the large intestine, where they act as a food source for bacteria, soak up water and produce gas, leading to pain, bloating, diarrhoea and/or constipation – classic IBS symptoms. The idea of removing FODMAP foods is to take away these carbs and sugars that your body has trouble digesting, and it’s been found to make a difference in 70 per cent of cases. [Stretches to improve digestion] FODMAP foods Fruits: Apples, apricots, avocados, blackberries, cherries, concentrated fruit juices, dates, dried fruits, figs, lychees, mango, nectarines, peaches, pears, plums, prunes, tinned fruit in natural juices, watermelon. Alternative fruits: Banana, bilberries, blackcurrants, blueberries, cantaloupe/honeydew melon, cranberries, grapefruit, kiwi fruit, oranges, pineapple, strawberries, raspberries. Vegetables: Asparagus, beetroot, broccoli, brussel sprouts, cabbage, cauliflower, garlic, mushroom, onion, leeks, sweetcorn. Alternative vegetables: Carrots, celery, cucumber, lettuce, peas, peppers, olives, spinach, tomatoes, courgettes, parsnips, squashes, sweet potato.
Beating IBS – could the FODMAP diet be the answer?
In addition, they are added to most sugar-free chewing gums. If you chew sugar-free gum that contains polyols as a sweetener you may well be causing a massive buildup of abdominal gas – from the fermentation of the polyols in your chewing gum and from swallowing air when you chew. Try cutting out chewing gum for a week or so to see if this does not relieve the flatulence. The pros and cons Prof Slavin was careful to point out the following: The various compounds that are classified as fodmaps have different physiological effects and should not be lumped together If you suffer from IBS, do not try cutting out all the fodmaps from your diet because you may only be sensitive to one of the categories If possible, get the help of a registered dietitian to help you figure out which one of the fodmap categories you are sensitive to and what steps you need to take to prevent deficiencies if you do need to cut out a whole food group such as milk and dairy Keep in mind that even if you are sensitive to one category of fodmaps that the other categories may have very beneficial effects and should not be cut out (see below). Fodmaps have many beneficial properties which Prof Slavin listed for us: Reduced energy values (4.2 to 14.7 kJ/gram) compared to sucrose (17 kJ/gram) Low GI Don’t cause tooth decay Prebiotic effects (i.e. prebiotics such as inulin are used by the beneficial microorganisms in the colon as a food source) The most serious negative effect of a blanket ban on all fodmaps in the diet is that this could result in reduced intake of the above mentioned prebiotics and therefore also affect the beneficial microorganisms in the gut (Slavin, 2013). It is, therefore, important to get professional help from a registered dietitian when you start trying to identify which fodmaps you need to avoid and also not to cut them all out of your diet indiscriminately. Fodmaps may well be the answer to IBS, but the concept must be carefully and circumspectly applied if the patient is not going to do more harm than good. (References: Hijova E, Chmelarova A. 2007. Short chain fatty acids and colonic health. Topical Review. Bratisl Lek Listy; 108 (8): 354 358; Slavin JL, 2013. Beyond Belly Aches: The implementation of fodmaps in clinical practice. Paper presented at: Nutritional Solutions CNE, Johannesburg 11 April 2013.) Dr Ingrid van Heerden (DietDoc) Dr Ingrid van Heerden is a registered dietician and holds a doctoral degree in Nutrition and Biochemistry.