IBS--Free at Last!

Enter to win the ibsfree.net FODMAPS-friendly recipe contest!

Every few days I review the site statistics for this blog, and I've learned that many visitors are especially interested in the recipes posted here. I'd like to build the recipe collection with your help! Do you have a FODMAPS-friendly recipe you'd be willing to share?

Here is the process:

• Review your recipe to make sure it is FODMAPS-friendly. This will be easier if you have read IBS--Free at Last! Those who haven't read the book yet can also submit recipes, but if the recipe contains FODMAPS, your entry won't qualify for the $25 best recipe prize. No purchase is necessary to enter this contest!
• Download the contest guidelines from the Resources sidebar of this blog. Please take the time to review these guidelines and the sample entry form.
• Download the entry form, use your word processor to type in your entry information and recipe, and send it to me at patsycatsos@gmail.com as an email attachment.
• If you prefer, download the pdf version of the entry form, fill it in by hand, scan it, and send it back to me as an email attachment.
• That's it! Suitable entries may be posted in the ibsfree.net recipe collection or in my upcoming cookbook.
• There is a $25 Whole Foods gift certificate for the best recipe submitted by February 28, 2010.
• When the cookbook is published, I will draw 10 names from those who submitted recipes, and will send those 10 people free cookbooks, postage paid (sorry, continental U.S. only--if you are elsewhere, I will contact you to make arrangements for shipping).
• If you have questions about the contest, please ask via the "comments" link, below.

I can't wait to hear from you!

Fructans 101

Fructans are a group of food fibers. As you might guess from the name, fructans are chains of ring-shaped fructose sugars. Humans don't have what it takes to break these chains apart, so the fructose in the chains is not absorbed in the small intestine where other sugars are absorbed. When these dietary fibers reach the large intestine, they are fermented by the bacteria that live there, producing gas. This is no problem for many people, and sometimes fructans are even deliberately added to foods or probiotic supplements for the specific purpose of feeding the "good" bacteria. But for some people with IBS, the gas causes painful bloating.

By far the largest source of fructans in the Western diet is wheat.It accounts for 70% of our fructans intake. The second biggest source is onions, followed by garlic and unripe bananas. You can recognize added fructans in your food or supplements by the names "inulin" or "FOS".

It is important to note that even though wheat happens to be the primary source of fructans in our diets, intolerance of this kind has nothing to do with the wheat protein, gluten, which those with celiac disease must avoid. For a more complete discussion of fructans intolerance versus gluten intolerance, please see my recent guest post on the Kitchen Therapy blog.

My Guest Post on Kitchen Therapy

My friend, Linda, invited me to write an article for her KitchenTherapy blog, and it was published today! The article is entitled "Wheat-Free, Gluten-Free, FODMAPS-Free" and explores the FODMAPS concept from the point of view of those who have a gluten-free lifestyle. Kitchen Therapy is one of my favorite blogs, with inspiring posts about gluten-free cooking, recipes, gardening, and more. Pop on over there, visit, and be sure to comment on my article for a chance to win one of my books, IBS--Free at Last!

Fructose 101

Fructose is known as "fruit sugar". It is present in fruits, some vegetables, honey, granulated sugar, agave syrup and high-fructose corn syrup. In the past, the human diet was lower in fructose than it is today--think of how hard it was to get honey in the wild, for example, or what a treat it would have been in the past to have fruit out of season, much less a never-ending supply of ketchup, cookies, candy and other sweets. Now it seems as though fructose is everywhere in our food supply.

Our capacity to absorb fructose is easily overwhelmed; it is almost considered normal to experience abdominal pain, flatulence, bloating or diarrhea when we overdo the amount of fruit or fruit juice we consume--many people have experienced this phenomenon. But some of us experience symptoms with much smaller intakes of fructose. And most of us overlook the impact that large portions of sugary sweets, baked goods and soft drinks can have. And what about those honey or fruit juice concentrate-sweetened energy bars? Interestingly, apples are part of the traditional BRAT diet sometimes recommended to fight diarrhea. Umm...maybe apples and apple juice aren't such a good idea for some people with diarrhea.

Diagnostic dietary fructose intolerance tests are available, but are not ordered as frequently in the US as they are elsewhere. If you suspect you don't tolerate fructose very well, try cutting back on soft drink and other sweets. Limit tomato paste. Choose small portions of fruits that are lower in fructose, such as kiwi, berries, citrus fruits, and bananas. Read labels, and avoid or limit portion sizes of foods sweetened with honey, fructose, high-fructose corn syrup, agave syrup and fruit juice concentrates.  See if you feel better!

Fructose malabsorption can occur on its own, or it can be part of the larger IBS picture.The FODMAPS elimination diet in IBS--Free at Last! can help you figure out how fructose fits into your IBS scenario.

It is important to distinguish dietary fructose intolerance, described in this posting, from hereditary fructose intolerance, which is a serious, hereditary disorder requiring a truly fructose-free diet.

Click here for more details about dietary fructose intolerance and how it causes GI symptoms.

Buy IBS--Free at Last!

What If I've Tested Negative for Lactose Malabsorption?

If you've tested negative for lactose intolerance, how does that fit into the FODMAPS picture?

First of all, let's review the test for lactose intolerance. The patient consumes a known amount of lactose. If the lactose is poorly digested and absorbed in the small intestine, it continues "down the line" to the large intestine, where it is fermented by the resident bacteria. They produce hydrogen gas as they ferment the lactose. Some of this gas is absorbed into the patients blood stream, where it travels to the lungs and is exhaled. If there is a sharp rise in the amount of hydrogen exhaled after the patient consumes the lactose, that is considered "positive" for lactose intolerance. One thing to keep in mind is the fact that approximately 20% of us are not colonized by hydrogen-producing bacteria; instead, our resident bacteria many produce other types of gas such as methane or hydrogen sulfide (bad breath, anyone?).  Lactose-malabsorbing individuals in this category will falsely test negative for lactose intolerance on a hydrogen breath test alone, but might be positive if tested for both hydrogen and methane exhalation. The results of the lactose test really need to be viewed together with the patient's history of symptoms after consuming lactose.

If someone has tested negative for lactose malabsorption AND doesn't particularly have a history of symptoms after ingesting milk products, it is pretty safe to say that individual is not lactose-intolerant and other FODMAPS carbs are likely to be having the major impact on symptoms.

However, even adults who tolerate lactose well in general do have limits to how much lactose they can handle. Because the effects of FODMAPS carbohydrates are additive, excessive lactose intake could put you over the top, and contribute to symptoms mostly caused by the other FODMAPS.

How much lactose is "excessive"? The answer to that question varies from one person to the next, but to put things in perspective, check out these generalizations about the lactose content of milk products:

Fluid milk: 11-14 grams per cup

Lactose-free milk: 0 grams per cup

Evaporated milk: 24 grams per cup

Yogurt: 5 grams per cup

Ice cream: 12 grams per cup

Butter: trace per 1 tsp

Most cheeses: 0-2 grams per ounce

Whey protein concentrate: varies

Whey protein isolate: trace per serving

To learn more about lactose intolerance and the FODMAPS elimination diet, visit www.ibsfree.net

Make Your Own Lactose-Free Yogurt

Yes, it is possible to make your own lactose-free yogurt. There are a couple of ways to accomplish this:

1) Make yogurt with any recipe and equipment; make sure to age the yogurt for 24 hours before chilling it to stop the fermentation process. The bacteria in the yogurt culture will have time to eat up all the lactose in the milk, rendering it lactose-free.

2) Make yogurt with lactose free milk; age the yogurt only as long as convenient, until set.

I purchased an inexpensive, 1-quart yogurt maker on Amazon.com (less than $20.00). Bought the yogurt starter in the dairy case at Whole Foods. Followed the directions on the yogurt starter package--easy. The milk I used was lactose-free. The results were absolutely delicious and FODMAPS-friendly.