Friday, December 2, 2011

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 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, malitol, 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 breaks 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.

19 comments :

  1. How come your doctor decided to do the upper GI series? I've never had that done and just wondering. I have had the celiac test more than once, and I definitely don't have it. I hope you don't either!

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  2. I haven't been tested for celiac but I know I feel better without eating gluten, so I've just cut it out. Looking at the list of foods off limits with the low FODMAP diet, following that would be so hard for me! Those are some of my fav fruits and veggies. It is all very interesting though and whatever makes people healthy is the way to go!

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  3. Hi lovely lady!

    So... I'm glad you wrote this post because I've been wanting to follow up on FODMAP more and remembered you posted awhile ago. I find it very interesting because IBS seems to be what we get from a doc when they can't really find anything else majorly wrong ( organ, blood etc) BUT don't want to go into further testing because nothing will really show up.

    So, I feel like I was in your shoes exactly one year ago a little bit. I had issues for years and seemed to think it was celiac because I felt worlds better when I cut out grains all together.... except popcorn... and oats seemed ok sometimes... I still had issues though, and I couldn't figure it out! I had 3 rounds of bloodwork, went to a food allergist and got tested, and to the OBGYN who suggested an ultrasound as did my PCP so they luckily worked together and got all they wanted on one ultrasound. I had to drink 32 oz of water in like an hour and hold it all for the longest time!!! They found nothing so then....
    it was off to the Gastroenterologist for a consultation... then it was a gastroscope to see the villa in the SI. He was a GREAT GE ... we had long chats because he knew I had the MS in Nutrition and was considering GE/MD/ PhD etc.

    He found I didn't have signs of celiac but I did have a hernia - and IBS. So for the hernia - I was getting ridiculous nausea, vomitting some, just felt terrible. And, I had the lower GI issues with IBS.

    I find a ton of truth to the list of foods you mention in this giving problems vs. appropriate. I have to stay away from tomatoes and onions, eggplant gives me issues on occasion. I LOVE the veg that is problematic...esp. asparagus... but broccoli def. gives me issues.

    This is really interesting and I'm definitely going to keep looking into it more. Thanks for the link to the more comprehensive brochure!

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  4. I don't know anyone else that has heard of FODMAP and all my co-workers are RD's! Haha. I've tried to adapt my diet by cutting out tomatoes, onions, pasta sauce, limiting other acid-producing foods and limited wheat because it seems to just give me issues. I've always hated unripe bananas but did fine with super ripe - esp. in my banana bread made with oat flour!

    For the "GERD" aspect of the hernia (hiatal) I stick to squash, sweet potatoes, asparagus, kale, spinach, celery and okra the most. I can only have like 1 beer before I have issues, sometimes all it takes is a sip. I seem to do okay with wine and chocolate and coffee...by force probably because I don't want to give those up entirely! haha

    For the IBS- I haven't done much except limit wheat, opt for GF foods when I can and I think now I will limit apples, soy products, broccoli and sweeteners. I will aim for more grapefruit and more quinoa!

    Good luck with the tests on the 16th!

    This weekend my bf is driving down ( today actually!) and we are watching movies and going to the Canes NHL game!

    Have a good weekend Gina!

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  5. this is great! you were definitely the biggest influence on me eliminating a lot of the foods on the fodmaps diet. i don't follow it exactly but i have eliminated cooking with onion and garlic as well as not eating cabbage, etc other things that make me gassssyyyy hahahah thanks lady!!

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  6. wow without even realizing it i have been eating more of the foods that are beneficial for those with ibs! when i have most of the foods from the list that isn't beneficial, i tend to get that horrible bloated feeling and gas :P

    im looking forward to hearing about your results of the gluten testing. it took awhile for me too, mainly just with setting up tests and getting the right timing/bookings etc. it is so helpful though to finally have the results. because im "borderline celiac" i definitely do better without it..even tho i still rebel and have it on occasion. but uno what, right away i feel anxiety and my mood is terrible at night, i get so angry...and i also get insomnia. if i eat wheat for more than 3 days in a row then i start getting small stomach pains. better without the wheat than with it...goes for most people too huh! anyways, fingers crossed for you love.

    xoxo <3

    xoxo <3

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  7. I've been thinking about taking the plunge again, and eating totally FODMAPs free for a while. It does seem like the diet has really been catching on, both around the blogosphere and otherwise. Limiting garlic, apples and onions helps me a lot.

    I hope your Celiac test goes well. I've had the blood test done, and it came back negative. I suppose I'm not surprised since I eat pure wheat gluten (seitan) and haven't had problems.

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  8. I will definitely try that.. I've been procrastinating to start! But I'm also afraid of having to restrict too much. we'll see.

    tonight I'm playing with my new iMac, I'm in love, it's so pretty! And I'm "working" on the +5000 pics from the wedding! :)

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  9. I am so lucky that I can pretty much eat whatever I want. I take that for granted far too much.

    My son has some lactose issues and my daughter has some food allergies.

    I have a friend who is on a restricted diet due to food allergies and gluten issues. I have learned to work around everyone's special dietary issues as I cook for them.

    Knowledge is power and once we educate ourselves possibilities open up and we find ways to make it work.

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  10. So clearly stated, love it. I have to admit when I first started reading your blog, I had no idea about FODMAPS and now I am hearing everywhere. Thank you for keeping us informed. Curious about your tests, good luck.

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  11. This is really interesting, I don't personally suffer from IBS but I have a friend who is wondering if her symptoms are similar... I'll be sure to send her a link to your blog as you explain it so well!

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  12. I still want to get the hydrogen breath test because most of those foods give me the bloat. Brussel sprouts are the worst. I can't eat those anymore! I would like to order their cookbook too. Hope the test goes as well as it can without eating ugh

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  13. I have IBS (10 years now) but have only heard of FODMAP's. I'm confused as some foods on the o.k. list are triggers for me. Do you think if I eliminate the other foods that I'll be o.k. with everything else again?

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    1. Hi angela,
      I think they are still researching these foods and some may be good/bad for others, and not....others. haha, does that make sense? For me eggplant causes problems, but it's not on als the lists. Also, some of the food son the "bad" foods list are fine for me. It's very individual.

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  14. I've felt so much better GI-wise since I cut out wheat last week, and since I started noticing extreme reactions to other foods, I decided to give the FODMAP diet a try. Those symptoms have cleared up considerably as well. The only thing that bothers me is insomnia, which hit me the night after I first cut out wheat. Has this happened to anyone else? I'm wondering if it's withdrawal or a decrease in B vitamins. As far as the latter is concerned, I eat several B-vitamin containing foods, just not everyday and at nearly every meal like I was eating wheat products, and I take an excellent multivitamin, Nature Made Multi Complete, which contains 100% of the RDA of B vitamins. Withdrawal seems more likely, since I was eating so much wheat before, but it would be nice to know others' experiences. Maybe the decrease in B vitamins, while I'm not actually deficient, could be something my body needs to adjust to as well?

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    1. I take a B-complex every single day. I think it helps. I still have problems with insomnia though, so I'm not sure it was a lack of B-vitamins for me (I've always had sleep issues).

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