IBS and a Low FODMAP DIET

IBS And a Low FODMAP DIET If you are one of the 10-20% of the population with IBS (Irritable Bowel Syndrome) and you haven’t heard of the low FODMAP diet, you are not alone. I only heard about it 2 years ago and was fortunate enough to hear a live talk about it this year by Kate Scarlata, RD at the Greater New York Dietetic Association’s Annual Meeting. The information is so valuable to people suffering from IBS, myself included, that I decided to take the elimination challenge and can now speak first hand, how life- changing this could be. Let me start with what FODMAP stands for: Fermentable Oligo-, Di-, Mono-saccharides and Polyols. It’s basically a bunch of short-chain carbohydrates that are poorly absorbed in the small intestine and pass into the large intestines where there are fermented by the bacteria that live there. They may also pull water into the large intestine. Both of these actions may cause symptoms such as abdominal pain, gas, bloating, diarrhea and/ or constipation. The list of permitted foods is very specific so while certain groups will be easily identifiable, for others you may need to consult with a list while getting started. After a certain amount of time (usually between 2-6 weeks) if you are seeing/ feeling relief from the elimination part, you can add back certain foods, with one of the FODMAP groups at a time, in small amounts, to see what you are most sensitive to. This I would recommend doing methodically with a Registered Dietitian who also has experience with other Nutritional and Medical concerns. There is a good chance that after the challenge you may be able to add back and tolerate a certain amount of a food you are sensitive to in a given day, or at a particular meal, but this will vary with individuals. I will go through the dietary carbohydrates and some of the foods that contain them, but definitely consult with a complete list from a reliable source. Try the institution that developed this diet, the Monash University in Australia, listed below, or other variations available on the internet. Fructose: a natural fruit sugar found in many fruits, honey, high-fructose corn syrup and agave can be a problem either due to the lack of an enzyme in the body or the ratio of glucose to fructose in a fruit. Fruits with a high glucose: fructose ratio are generally well tolerated, such as blueberries, strawberries, cantaloupe, honeydew and ripe bananas, but those with a high fructose: glucose ratio such as apples, watermelon and mangoes may not be. Lactose: a carbohydrate found in dairy products can be a problem due to a partial or complete lack of the enzyme lactase which digests lactose. Foods such as cow’s milk, yogurt and ice cream are lactose containing foods. Fructans: are carbohydrates that are completely malabsorbed because the intestine lacks an enzyme to break their fructose bond. Wheat accounts for most of people’s fructan intake, which can be found in breads, cereals, and pasta, but they can also be present in onions, garlic and other vegetables. This is not to be confused with Celiac Disease, or a gluten sensitivity which is related to the wheat protein, gluten. Galactans: are carbohydrates that are also malabsorbed because the intestine does not have the enzyme to break them down. Beans, peas, and lentils are primary examples. Polyols: also known as sugar alcohols, are found naturally in some fruits and vegetables and also added to sugar-free gum, mints, and cough drops. The names of some of these artificial sweeteners end in ol- like sorbitol, xylitol, mannitol, and malitol. Apples, pears, stone-fruits, mushrooms, and cauliflower would also be high sources of polyols. It may seem like a lot of foods will be “off limits”, but keep in mind this is only during the elimination phase and hopefully you will be able to add back some of your favorite foods, or other versions of them. This article is intended as an introduction to the low FODMAP diet and is not a complete or instructional guide to the Elimination Diet/ Carbohydrate Challenge. Always consult a doctor or medical professional for diagnosing medical conditions and treatment options. If you are interested in learning more or participating in a free Virtual Group please contact me at: carena@carenalowenthal.com Carena Lowenthal, MS, RD, CDN (917) 882-5033 Here are a few recipes and resources to learn more: med.monash.edu: Monash University, where the FODMAP diet was developed. blog.katescarlata.com and KateScarlata.com: the IBS and FODMAPs expert the Monash University LOW FODMAP diet App for your iPhone Summer Squash Salad: 2 small zucchini squash (washed and trimmed), 1 small summer squash (washed and trimmed), 3 T. fresh lemon juice, 2 T. olive oil OR garlic infused oil, 1-2 t. Dijon mustard (no onion), 1/3 cup crumbled feta cheese, fresh herbs: parsley, mint, basil as desired, ¼ c toasted pine nuts, salt and pepper to taste. In a medium bowl, combine the zucchini and summer squash. Whisk the lemon juice, olive oil, mustard, salt and pepper and drizzle over the squash. Toss in the feta, pine nuts and herbs. Serve immediately. Greek Turkey Burgers with Tzatziki Sauce: 1 pound ground white meat turkey, 1 pound ground dark meat turkey, ½ c fresh chopped dill, ½ c pitted Kalamata olives, juice of ½-1 lemon, 1 c reduced- fat feta cheese. Tzatziki Sauce: 1 c plain Greek yogurt (or lactose free yogurt if you are doing the elimination diet), juice of ¼ lemon, ¼ c diced cucumber, 2 T. chopped fresh dill. Combine all ingredients for the burgers and mix well. Form into 10-12 burgers and grill until the internal temperature reaches 165 degrees F. Can freeze leftover cooked or raw patties for later use. For Tzatziki Sauce, combine all ingredients and place a bit on top of burgers to serve. (Recipes adapted from blog.katescarlata.com)