IBS--Free at Last!

Coconut and FODMAPs

There are many foods in the world that aren't mentioned, for lack of data, in my book, IBS--Free at Last! There does not seem to be much lust for information about swiss chard or kumquats, but everyone wants to know about coconut!

I've spent the afternoon sifting through all the available nutrient composition data on coconut products and comparing it to the guidelines I use to decide whether foods are allowed or not allowed on the FODMAPs elimination diet. Here are my best  thoughts, to be revised as better data becomes available, as always:

• coconut water--allowed; we can add this to the list of FODMAPs-friendly electrolyte replacement fluids! The 14 oz. bottle of zico coconut water I am holding contains 160 mg of sodium and 569 mg of potassium, as well as some calcium, phosphorus and magnesium. Hmm...but does it contain poyols? I'll revise this if I find out it does.
• coconut milk, 1/4 cup--allowed
• coconut cream, 2 tablespoons--allowed
• coconut meat--not allowed
• coconut oil--allowed

The main problem with coconut products appears to be the fiber content (presumably fructans). In general there does not seem to be excess fructose, there is no lactose, and if NUTTAB is presenting accurate data, no polyols.

Lots of conflicting data for these products going back to 1961--the carbohydrate details are affected by the variety of coconut, maturity, growing conditions and analytical techniques. Data in some nutrient tables is weak, imputed (calculated based on assumptions) rather than actually measured in a lab.

It's 95 degrees and humid here in Maine this evening--rather tropical! My bottle of coconut water is cool and refreshing. Hard to believe those aren't palm trees I see out the window.

Need to Gain Weight? High-Cal, Low-FODMAPs Foods

Some people with IBS are in the very difficult position of needing to gain weight, yet having to limit food choices and portion sizes to avoid setting off their IBS symptoms. Believe me, people who are underweight get plenty tired of cracks about how lucky they are. It isn't funny; it can be scary to be underweight, and even harder to gain weight for some people than it is for the rest of us to lose it.

High calorie intake may be needed for weight gain, or to support high levels of activity such as training for a marathon or working a demanding physical job. One memorable patient of mine was a tall, slightly underweight 18 year old male college student who had a very physical summer job, played soccer for a couple hours after work most nights, and had a lovely mom who prepared mostly vegetarian food (read: beans) at home, and plenty of it. He had to consume thousands of calories a day to support his calorie needs--how to do it, without blowing up!?

It is helpful to recall that oils do not contain any FODMAPS carbohydrates. Oils contribute 9 calories per gram, versus only 4 calories per gram from protein and carbohydrate. So the #1 weight gain strategy for FODMAPs sensitive individuals or those on the elimination phase of the diet is to EAT MORE HEALTHY FATS, such as olive oil, canola oil, any kind of nut or seed oil, peanut or almond butter. I know, I know, you've always read that people with IBS shouldn't eat too much fat, but is that really true for you? Try it and see for yourself, before you limit your fat intake unnecessarily, based on over-generalized advice. You might be able to tolerate more healthy fat than you think. There is a huge difference between a tablespoon of olive oil (13.5 grams of fat) and a Bloomin' Onion (134 grams of fat--ouch). Just because fried foods make you feel sick, doesn't mean you can't put olive oil on your salad, or drizzle your roasted veggies liberally with oil. If you have to limit fat intake because of another medical condition, you will need the assistance of a registered dietitian to help you plan your weight gain.

Foods high in protein are the next best low-FODMAPs source of calories for weight gain, again because they are automatically low in both sugars and fibers. If you need to gain weight and you don't have any other health issues such as kidney stones or kidney disease that would make it inadviseable to eat more protein, you might try eating bigger portions of foods in the Allowed Meats/Milk section of the elimination diet, for example:

• Beef
• Pork
• Chicken
• Fish
• Seafood
• Lactose-free milk
• Lactose-free yogurt or kefir
• Lactose-free cottage cheese
• Hard Cheeses
• Eggs
• Puddings and custards made with lactose-free milk, eggs, and granulated sugar

You must try these things for yourself to see if you tolerate them. Don't over-restrict based on one-size-fits-all advice that people with IBS shouldn't eat red meat, for example.

There are a few commercial weight gain products that look FODMAPS-friendly based on their ingredients and would be worth trying:

• Boost
• Carnation Instant Breakfast (bottled, not the powdered mix)

Please comment on this post with your weight gain suggestions for other readers. Thanks!

Don't hold the mayo

FODMAPS-friendly mayonnaise for those early-summer potato salads turns out to be rather easy to find. Most of the full-fat, real mayo on your grocer's shelf will work quite well! Always double check ingredients when you buy, in case they've switched sweeteners when I wasn't looking, but at the time of this writing, the following brands appear suitable for the FODMAPS elimination diet: Hellman's Real Mayonnaise, Cains Mayonnaise, Spectrum Organic Olive Oil Mayonnaise, Smart Balance Light Mayonnaise, even Miracle Whip.

Many of the fat-free mayos I checked were sweetened with high-fructose corn syrup, so read those labels carefully. Remember that regular corn syrup is OK on the FODMAPS elimination diet.

What about soybean oil?

Soybean oil is allowed during the elimination phase of the FODMAPS Elimination Diet.  The nutrient of concern is the type of carbohydrate in the soy bean, not the fat.  Soybean oil is 100% fat;  there are no FODMAPS carbohydrates in soybean oil, so it is not prohibited during the elimination or any other phase of the diet.

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