IBS and the low-FODMAP diet

Irritable Bowel Syndrome is a common GI problem which troubles up to 15% of the

population and it is manifested primarily by abdominal pain associated with a change in bowel habits or change in stool frequency. It is a diagnosis of exclusion in that it can only be diagnosed after previous testing has failed to identify any underlying source of gastrointestinal pathology. Patients typically suffer from either chronic diarrhea or constipation; however, alternating between these two bowel patterns is also common. Other common complaints with this condition include nausea, excessive gas, bloating and chronic fatigue. The cause of this condition remains unexplained, but current theories from my research attribute the collection of symptoms to altered gut motility, visceral hypersensitivity involving the nervous system to the gut, and alteration of the normal intestinal bacteria. Current treatment strategies include the use of pharmaceuticals, psychological therapy, high fiber diet, probiotics, and certain dietary and lifestyle modifications.

FODMAP

The role of dietary factors contributing to distressful gastrointestinal symptoms has long been recognized, and certain dietary components including gluten, fat, dairy, caffeine, and alcohol have frequently been implicated. FODMAPs (Fermentable Oligo-, Di- and Mono-saccharides and Polyols) are short-chain carbohydrates.  These carbohydrates are poorly absorbed in the small intestine and are highly fermentable which subsequently leads to increased fluid in the intestinal tract, as well as increased gas production. 

A low FODMAP diet is eliminating fermentable oligo-,di- and mono-saccharides and polyols. The FODMAPs in the diet with some examples are fructose (large servings of fruit, fruit juice, honey, high fructose corn syrup), lactose (dairy), fructans (wheat, onion, garlic), galactans (beans, lentils, legumes), and polyols (sweeteners containing sorbitol, mannitol, xylitol, maltitol, stone fruits such as avocado, apricots, cherries, nectarines, peaches, plums.) The most common FODMAP is fructose; however, it will appear as allowed in low FODMAP foods where the glucose to fructose ratio is greater than one, as research has shown ingesting glucose at the same time as fructose eases fructose absorption. If you follow the low FODMAP diet nutrition plan you are still incorporating glucose and many other carbohydrates.

Trying the low-FODMAP diet

If you have IBS, the low FODMAP diet may be helpful for you. While I don’t personally have IBS, I hear about it from my friends all the time. I like to experiment with different diets (healthfully) so I followed the low FODMAP for about a month. It’s challenging to really dissect the foods you are eating. I constantly was referring to my food source charts. While it takes time to adjust to tolerance, you can reduce the FODMAP load of your meal or snack by choosing lower FODMAP alternatives or reduce the portion size of the FODMAP containing ingredient. I attached some helpful charts and links:

 http://stanfordhospital.org/digestivehealth/nutrition/DH-Low-FODMAP- Diet-Handout.pdf  http://www.webmd.com/ibs/features/finding-right-diet-ibs?page=2

Low FODMAP grocery list:

GRAINS

Oats, Oat bran, Polenta, Quinoa, Rice: Brown and White, Rice bran, Gluten-free pasta and corn

PROTEIN

Beef, Chicken, Fish, Egg, Pork, Tofu, Canned tuna, Turkey, Egg, Egg whites, Lamb, Cold cuts 

NUTS/SEEDS (allow one handful per sitting)

Almonds, Chia seeds, Flax seeds, Macadamias, Peanuts, Pine nuts, Pumpkin seeds, Sesame seeds, Walnuts

CHEESE

Cheddar, Swiss, Parmesan, Brie, Feta, Camembert, Mozzarella

MILK

Lactose free, Coconut milk, Rice milk, Almond milk

YOGURT/KEFIR

Green Valley lactose free yogurt, Lifeway kefir (plain only)

VEGETABLES:

Alfalfa sprouts, Arugula, Bamboo shoots, Bean sprouts, Beets (limit to 4 slices), Bok choy, Bell peppers, Broccoli (limit ½ cup), Brussel sprouts (limit ½ cup), Butternut squash (<1/4 cup), Carrots, Common cabbage, Corn (half a cob), Celery (1/4 stalk), Chives, Cucumber, Eggplant, Endive, Ginger, Green beans, Kale, Lettuce, Olives, Parsnips, Pears (<1/4 cup), White potato, Radish, Rutabaga, Scallions (green part only) , Spinach, Summer squash, Sweet potato (limit to ½ cup), Swiss chard, Turnips, Tomato, Water chestnuts, Zucchini

FRUIT (limit to one serving per meal)

Banana (small), Blueberries, Cantaloupe, Dragonfruit, Grapefruit (1/4 only), Grapes, Honeydew melon, Kiwifruit, Lemon, Lime, Orange, Papaya, Passion fruit, Pineapple, Raspberries, Rhubarb, Starfruit, Strawberries, Tangelo

My sources:  Horowitz BJ, Fisher RS. The irritable bowel syndrome. N Engl J Med 2001

Heizer WD, Southern S, McGovern S. The role of diet in symptoms of irritable bowel syndrome in adults: a narrative review. J Am Diet Assoc 2009
Shepard SJ, Gibson PR. Fructose malabsorption and symptoms of irritable bowel syndrome: guidelines for effective dietary management. J Am Diet Assoc. 2006. 
Mahan L, Escott-Stemp S, Raymond J. Krause's Food and the Nutrition Care Process. 2012