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Health & Food

Three Years After Starting the Low FODMAP Diet….

…..it’s become more popular than ever! Last month even the Wall Street Journal wrote an article about it. And of course, my all-time favorite dietitian magazine, Today’s Dietitian, wrote an article about it several months ago.

And I recently found this study that was published in the Journal of Human Nutrition and Dietetics, which compared symptoms of those with IBS who followed a “Standard IBS diet” with those who followed a low FODMAPs diet. Here is the abstract;

Background:  Emerging evidence indicates that the consumption of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) may result in symptoms in some patients with irritable bowel syndrome (IBS). The present study aimed to determine whether a low FODMAP diet is effective for symptom control in patients with IBS and to compare its effects with those of standard dietary advice based on the UK National Institute for Health and Clinical Excellence (NICE) guidelines.

Methods:  Consecutive patients with IBS who attended a follow-up dietetic outpatient visit for the dietary management of their symptoms were included. Questionnaires were completed for patients who received standard (n = 39) or low FODMAP dietary advice (n = 43). Data were recorded on symptom change and comparisons were made between groups.

Results:  In total, more patients in the low FODMAP group reported satisfaction with their symptom response (76%) compared to the standard group (54%, P = 0.038). Composite symptom score data showed better overall symptom response in the low FODMAP group (86%) compared to the standard group (49%, P < 0.001). Significantly more patients in the low FODMAP group compared to the standard group reported improvements in bloating (low FODMAP 82% versus standard 49%, P = 0.002), abdominal pain (low FODMAP 85% versus standard 61%, P = 0.023) and flatulence (low FODMAP 87% versus standard 50%, P = 0.001).

Conclusions:  A low FODMAP diet appears to be more effective than standard dietary advice for symptom control in IBS.

Here are some important points about the low FODMAP diet from the article in Today’s Dietitian;

What are FODMAPs?

They are short-chain carbohydrates that are often malabsorbed in those with IBS. The acronym stands for:

  • Fermentable
  • Oligosaccharides
  • Disaccharides
  • Monosaccharides
  • And
  • Polyols

Why are these foods considered “trouble foods” for those with IBS?

The short-chain carbohydrates typically end up undigested in the colon, where gut bacteria happily ferment them and thus produce the side-effect of gas and bloating. Not fun.

What are some foods that contain FODMAPs?

If you peruse the internet you will find hundreds of different lists of foods that contain FODMAPs. The lists all seem to be different, and it can get very confusing. The article in Today’s Dietitian, as well as the booklet I will discuss below seem to be very consistent and accurate. I have stuck with these lists.

FODMAPs exist in some very commonly consumed foods, which is why many people with IBS have trouble figuring out the exact cause of their discomfort (I’ve heard this before, “everything I eat causes a problem!!”). Here are some examples of problem foods (NOTE: This is not all-inclusive. Download the Monash University phone app for a more complete list, as well as appropriate serving sizes);

Fruits: Apples, pears, peaches, mangoes

Vegetables: artichoke, asparagus, brussels sprouts, broccoli, onion, beetroot, chicory root (Inulin), beans and soy products (don’t want to give up your beans, broccoli, Brussel sprouts, and soy? BEANO can help with these, but not 100%)

Grains: Mainly wheat and rye

Dairy: Any dairy products with lactose are off-limits, or should be limited (unless you aren’t lactose intolerant)

Sweeteners: Sorbitol, mannitol, xylitol, maltitol, HFCS, agave, honey

Spices: Garlic (garlic is hard to avoid, especially if you love to cook. I have found that garlic-infused olive oil works great as a replacement).

What are some foods that those with IBS can enjoy instead of some of their favorite fruits, veggies, grains, and dairy products?

Fruits: Berries (no blackberries), cantaloupe, oranges, bananas

Vegetables: Squash, spinach, kale, sweet potatoes (in limited quantities), tomatoes, eggplant (although eggplant does give me some problems…), carrots

Grains/Starch: Quinoa, rice, oats, popcorn

Dairy: Lactose-free dairy products like aged cheese, Lactaid products, and for some people yogurts are well-tolerated (because the bacteria break down the lactose, and uses it as food!), especially Greek yogurt (because it has been strained of excess liquid, and thus lactose).

Sweeteners: Stevia, sugar, brown sugar, molasses, maple syrup

Spices: Cinnamon, pepper, salt, cumin

Much of the research on FODMAPs started (and continues) at the Monash University in Australia. Visit this link to order the booklet and learn more about their app. This has been the most accurate information on the low FODMAPs diet I have found. The booklet and app also contain some great recipes and grocery lists.

After three years of being on this diet, I still struggle to stick to the plan 100%, but I feel better than ever and my quality of life has skyrocketed. Please feel free to ask me any questions about my journey adapting to the low FODMAPs approach to IBS management, or any other questions you might have!  Also, read this latest post for more helpful resources.

QUESTION: Do you know someone who is following the low FODMAPs diet? Do you think you could benefit from it yourself? Have you ever had to drastically change your diet?If you’re wondering how my celiac test went on Wednesday, it didn’t happen. As it turns out my visit on Wednesday was just a doctor visit to see which tests I needed. On the 16th I am getting my blood tests done, as well as an upper GI series. I have to fast all morning and afternoon and I am NOT looking forward to it! I’ll keep everyone updated.

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