Are the foods you are eating making you sick? Have you tried all the latest fad diets with minimal to no relief?

For many people suffering from Irritable Bowel Syndrome (IBS), it is a constant struggle to figure out which foods are contributing to the relentless gas, bloating, pain/discomfort, diarrhea and/or constipation that define this condition. IBS is widespread and affects an estimated 10-15% of the U.S. population with female predominance^1,2. The severity of symptoms can range from mild to debilitating and for many, significantly disrupts everyday life. In fact, IBS is credited as the 2^nd leading cause of missed work days, behind the common cold.³

In recent years, it is increasingly common for patients to seek more natural remedies as opposed to medications to treat health problems, especially digestive issues. Researchers at Monash University in Australia have designed a dietary approach called the low FODMAP diet that is effective in reducing gastrointestinal (GI) symptoms in up to 75% of people suffering from IBS.^4,5 This approach also helps pinpoint the specific problem foods in the diet through the two part elimination and reintroduction process.  

The word FODMAP is an acronym for Fermentable Oligosaccharides Disaccharides Monosaccharides And Polyols. In short, FODMAPs are a group of poorly digested, nonabsorbed and highly fermentable short-chain carbohydrates found in everyday foods. These carbohydrates travel through the small intestine and because they are not digested or absorbed, reach the colon where they are fermented by the natural bacteria that normally live there. Fermentation of these carbohydrates produces gas and organic acids. For people with a sensitive gut, this can cause unpleasant symptoms including bloating, cramps, gas and, in some cases, significant abdominal discomfort. FODMAPs also can have an osmotic effect, which means they pull water into the intestines, contributing to loose stools or diarrhea.

F: Fermentable (creates gas)

O: Oligosaccharides (fructans and galacto-oligosaccharides)

D: Disaccharide (lactose)

M: Monosaccharide (fructose)

A: And

P: Polyols (also known as sugar alcohols, including sorbitol and mannitol)

FODMAPs are found in a variety of foods, even some healthy fruits and vegetables. Here is a look at some of the foods that are highest in FODMAPs:

Lactose: Milk, yogurt, ice cream, soft cheeses (cottage and ricotta)

Fructose: Apple, pear, mango, watermelon, asparagus, sugar snap peas, honey, agave, and high-fructose corn syrup

Fructans/galacto-oligosaccharides (GOS): wheat, rye, barley, onion, garlic, inulin/chicory root, artichokes, grapefruit, legumes, pistachios, cashews

Polyols: stone fruit (peaches, apricots, cherries, plums/prunes, nectarines), blackberries, cauliflower, mushrooms, sugar-free gum and candy

FODMAPs tend to have a gradual and cumulative impact on symptoms; therefore, small amounts may be tolerated fine, but increasing quantities throughout the day may trigger symptoms in IBS patients. The best approach to see if you are sensitive to these foods is to eliminate them from your diet for 2-4 weeks and see if your symptoms improve. The next step is to reintroduce the high FODMAP foods back into your diet one group at a time to identify which groups cause symptoms so that you learn which foods you should limit or avoid.

So, what can you eat on a low FODMAP diet? Not to worry; It is still possible to eat a balanced and nutritious diet made up of low FODMAP foods, and remember, it’s only for 2-4 weeks. There are plenty of fruits and vegetables, whole grains, nuts and lean proteins that are FODMAP friendly and will make you feel great! It is important to understand that this is not a low carb diet, but only restricts certain types of carbohydrates. For instance, the high FODMAP grains, wheat, rye and barley can be replaced with rice, oats, corn, quinoa, and some gluten-free products. Low FODMAP fruit options include bananas, oranges, cantaloupe, grapes, kiwi, papaya, pineapple, lemon and most berries. Many vegetables are acceptable on a low FODMAP diet, though some are restricted in portion size. Some of the choices are bell peppers, zucchini, lettuce, tomato, cucumber, carrots, green beans, corn, spinach and eggplant. Animal proteins and seafood do not contain carbohydrates and are therefore FODMAP-free, as are oils. Dairy foods that are high in lactose can easily be replaced with lactose-free alternatives (lactose-free milk, yogurt, ice cream, and cottage cheese) and there is no need to avoid butter and hard/aged cheeses as these are naturally low in lactose. While vegans will naturally be more restricted, protein requirements can be met with nuts (other than cashews and pistachios), canned lentils and chickpeas in small portions, firm tofu, tempeh, quinoa and other whole grains. For more details on which foods are FODMAP friendly, check out the resources at the conclusion of this article.

A delicious low FODMAP sample one-day menu is below:  

Breakfast: oatmeal with blueberries and walnuts

Lunch: sandwich with roasted turkey, cheddar cheese, lettuce, tomato, mustard (without FODMAP ingredients) on gluten-free bread and 1 cup of grapes.

Snack: 1-2 cups of popcorn

Dinner: grilled chicken with lemon, roasted potatoes with rosemary, and side salad w/lettuce, tomato, cucumber, shredded carrots and oil/vinegar dressing.

Dessert: ½ cup lactose-free ice cream topped with strawberries

Because this is a complex diet, individuals are likely to have better success when working with a registered dietitian (RD) who has expertise in the low FODMAP diet, rather than trying to learn about and implement this diet on their own. In working with a dietitian, you can expect to receive comprehensive food lists showing you what you can and cannot eat during the elimination phase and learn how to read labels for hidden FODMAPs in processed foods. You will also get personalized meal and snack suggestions, and low FODMAP cooking tips that are tailored to your lifestyle and cooking skills. After completing the elimination phase, the RD will guide you through the reintroduction process with the goal of achieving the most varied diet possible while keeping symptoms at bay. Ultimately, working through the low FODMAP diet with an RD will help you gain confidence that you can eat a nutritionally balanced diet that tastes great and sooths your gut.  For a referral to a dietitian, speak to your gastroenterologist or visit www.eatright.org to find a dietitian specializing in digestive disorders near you. WF

Further Reading

Suggested resources on the low FODMAP diet:

www.ibsfree.net

www.blog.katescarlata.com

The Complete Low-FODMAP Diet: A revolutionary plan for managing IBS and other digestive disorders by Sue Shepard and Peter Gibson (found at amazon.com and major book retailers)

References

1. Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol. 2012;10(7):712-721 e4.
2. Chey WD, Eswaran S, Kurlander J. Management of Irritable Bowel Syndrome. JAMA, 2015;313(9):949-958.
3. Cash B, Sullivan S, Barghout V. Total costs of IBS: employer and managed care perspective. Am J Manag Care. 2005;11(1suppl):S7–S16.
4. Spencer M, Chey WD, Eswaran S. Dietary renaissance in IBS: Has food replaced medications as a primary treatment strategy? Curr Treatment Options Gastroenterol 2014;12:424-440.
5. Halmos EP, Power VA, Shepherd SJ, et al. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology. 2014;146(1):67-75.

Lauren Van Dam, R.D., and William D. Chey, MD, AGAF, FACG, FACP, are affiliated with the Division of Gastroenterology at the University of Michigan Health System, Ann Arbor, MI.

NOTE: The statements presented in this column should not be considered medical advice or a way to diagnose or treat any disease or illness. Dietary supplements do not treat, cure or prevent any disease. Always seek the advice of a medical professional before altering your daily dietary regimen. The opinions presented here are those of the writer. WholeFoods Magazine does not endorse any specific company, brand or product.

Posted 4/20/15