IBS--Free at Last!

What about vinegar?

Sprinkling your own oil and vinegar on salad is the FODMAPS-friendly way to dress it, since most commercial salad dressings have one or more ingredients that are not allowed during the elimination phase of the diet. I am often asked which vinegars are OK to use? The answer is that any filtered vinegar will do, in a 1 tablespoon portion. Filtered vinegars include white vinegar, white or red wine vinegar, champagne vinegar, rice or rice wine vinegar, and most flavored vinegars.

Unfiltered cider vinegar does retain some sugar in it, and it has an excess of fructose, so it is probably not appropriate during the elimination phase unless it is a minuscule portion. You can recognize unfiltered cider vinegar because it is cloudy in appearance, not transparent, like filtered or distilled vinegars are.

Balsamic vinegar has a 2 grams of sugar in a 1 Tb. portion, but luckily for us balsamic lovers, there is more glucose than fructose in it, so it is allowed on the elimination phase. For more information about the role of the fructose to glucose ratio, click here.

Sucrose, By Any Other Name...

Sucrose--good old table sugar--is one of the few allowed sweeteners on the elimination phase of the FODMAPS diet. In an effort to be more specific, more exotic or healthier-sounding, manufacturers use a great many different words on the food label that all mean essentially the same thing: sucrose. Here is a list of allowed sugar names you might see in recipes or the ingredients section of a food label:

• sugar
• cane sugar
• confectioner's sugar
• granulated sugar
• superfine sugar
• naturally milled organic sugar
• sugar syrup
• cane syrup
• evaporated milled cane juice
• organic cane syrup
• organic sugar
• beet sugar
• bar sugar
• berry sugar
• castor sugar
• icing sugar
• refined sugar
• cane juice crystals
• invert sugar

Raw, unmilled, unrefined or darker colors of sugar have not had the molasses removed, and have an excess of fructose, so should be avoided on the elimination phase of the diet.

Remember, even if sweetened with sucrose, your treat shouldn't have more than 40 grams of sugar per serving during the elimination phase of the diet.

To learn more about the sweeteners named above, start with one of my favorite sites, Cook's Thesaurus.

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.

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Agave

Agave nectar and agave syrup are the hot new sweeteners of the day. How do they fit into the FODMAPS elimination diet? Are they capable of causing IBS symptoms?

In my opinion, agave nectar and syrup products are sources of FODMAPS carbohydrates. I would not recommend using them during the elimination phase of a FODMAPS elimination diet.

According to the USDA, cooked agave plant has far more fructose than glucose in it. This is a set-up for fructose malabsorption and may cause symptoms for people with IBS. Also, cooked agave is about 10% dietary fiber. The type of fiber in agave is mostly inulin, which is defined a FODMAPS carb in the “fructans” category, and could also cause IBS symptoms.

The USDA nutrient database doesn't include agave nectar or syrup, so we don't have an authoritative source for nutrition information on these items. From what I gather, agave nactar and syrup are not standard products. Depending on how they are processed, the type and amount of sugars they contain can vary a great deal. The information I have seen on agave industry web sites indicates that agave nectars and syrups are high in fructose and osmotically active; these are described as selling points for the product.

I suggest holding off on agave sweetened products until the challenge phase of the diet; you could include during your fructose challenge.

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Cough Drops

What if you have a cough while on the FODMAPS elimination diet? Can you use cough drops? To answer that question, I bought a selection of cough drops at the local pharmacy the other day, so I could study the list of ingredients in detail. I found several good options.

Halls Mentho-Lyptus Strawberry:  Active ingredient: Menthol. Inactive ingredients: FD&C red no. 40, flavors, glucose syrup, sucrose, water. These sweeteners are not FODMAPS, so this one is OK, although I wish they wouldn't put food dyes in the product.

Halls Naturals Wild Cherry: Active ingredient: Menthol. Inactive ingredients: citric acid, elderberry juice, flavors, ginger, glucose syrup, lemon grass, sage, sucrose, water, white thyme.

Ricola Natural Lemon Mint: Active ingredient: Menthol. Inactive ingredients: citric acid, extract of lemon balm and Ricola's herb mixture (elder, horehound, hyssop, lemon balm, linden flowers, mallow, peppermint, sage, thyme, wild thyme), natural color (beta-carotene), natural flavors (lemon oil, peppermint oil), starch syrup, sugar. Starch syrup = glucose syrup, so no FODMAPS here.

If you are considering different flavors of the above brands, be sure to check the ingredients, as each one is a little different. For example, the Halls sugar free product I checked was sweetened with isomalt, which is a FODMAP. Ingredients to avoid: honey, high fructose corn syrup, isomalt and sugar alcohols (sorbitol, mannitol, xylitol, maltitol, or lactitol), maybe pectin (I am still looking into this one).

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"Healthy" is in the Eye of the Beholder and Other Disclaimers

"If those are healthy recipes, sign me up!"  Readers are psyched to have old favorites such as "No-Bake Chocolate Cookies" blessed by a dietitian! Butter, sugar, peanut butter, chocolate, yum!

Perhaps this would be a good time to offer some disclaimers: 

• Recipes for holiday meals and gatherings are party foods. We all need party food sometimes, even if we're on a special diet. One of the first questions clients ask when I am teaching them the basics of the FODMAPS elimination diet is, "What about chocolate?" Clearly, it's an important concern! So,I have offered some low-FODMAPS party food recipes for your consideration, not that I would recommend them for everyday fare.
• When it comes to nutrition, "healthy" is sometimes in the eye of the beholder. By this, I mean that we all have unique diet and nutrition priorities, depending on our medical, family, genetic, diet and exercise histories. What appears to be healthy for one person may not be appropriate for the next, and vice versa. The recipes presented on this blog are designed for those whose highest dietary priority is reducing IBS symptoms due to intolerance of FODMAPS carbohydrates such as lactose, fructose, fructans, galactans and polyols. In the portion sizes suggested, these recipes will fill that bill.
• If, in addition to IBS, you have other medical diagnoses, take prescription medications or have other health issues such as over- or under-weight, you should consult a registered dietitian to assist in designing an appropriate diet. Do not diagnose yourself with IBS. If you have gastrointestinal symptoms suggestive of IBS, consult your physician to rule out other serious medical conditions and to receive a proper diagnosis. This web site does not provide medical advice, and is not a subsitute for personal medical care provided by a qualified health care professional.

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