IBS--Free at Last!

Q. 3 and 4 of #fodmapchat Fiber, Recipes

Question 3: Any tips for getting enough fiber on a low FODMAP diet?

Question 4. Any reliable sources for low FODMAPs recipes?

 

Chocolate--I can't put it off any longer!

Questions about whether chocolate is OK on the FODMAPs elimination diet top the list! I have been stalling on writing a post about this while I try to locate a primary source of data for the fructan or galactan content of cocoa and chocolate, but so far I have not been successful. I've decided to just post about my current thinking on chocolate, even though it isn't possible to have the "last word".

Chocolate has a lot more fiber than most of us give it credit for! For example, 100 grams of cocoa powder has 33 grams of fiber in it--about 1/3 of it is fiber! Dark chocolate has 11 grams (or more) of fiber per 100 grams.  Do we know what KIND of fiber this is? No, and none of the chocolate company reps I've spoken with have been able to point me to any more details about whether the fiber in chocolate is highly fermentable and osmotically active (FODMAPs) or not! 

How much would be in a typical serving? It varies, of course, but it might be quite a lot! One bar of 70% dark organic chocolate I have here in the office has 4 grams of fiber in a single serving (35 gram bar).If these are FODMAPs fibers, then chocolate clearly flunks the cutoff I use for the elimination diet, that foods allowed on the elimination phase should have less than .5 grams of fructans per serving. This may be part of the reason that chocolate is an oft-suspected villain as an IBS trigger!

My current thinking is that chocolate does not have a place on the elimination phase of the FODMAPs restricted diet, unless you can figure out how to have such a small portion that there is less than .5 grams of fiber in your serving.

I would appreciate any leads to primary sources of detailed nutrient composition data for chocolate from anywhere in the world. Thanks!

What's the word on rye?

The sources I used to create the allowed food lists for the FODMAPS elimination diet suggest that in clinical practice rye seemed to be reasonably well tolerated and is not considered problematic, although it does contain fructans. A more recent publication by the same work group puts rye on the "problem" list (Gibson PR, Shepherd SJ, Evidence-based Dietary Management of Functional Gastrointestinal Symptoms: The FODMAP Approach. J Gastroenterol Hepatol 2010;25(2):252-258). This is creating some confusion, and a lot of questions from sharp-eyed readers and dietitians!

After doing some extra digging around, I conclude that this is an excellent example of the importance of cultural context in  In the US, for example, rye consumption is rare and in minor quantities. Even most rye breads in the US have more wheat flour in them than rye. This makes rye not "problematic" here, as in Australia.

In Scandanavian countries, on the other hand, rye may be eaten daily, and in larger amounts. According to a paper I recently read (Karppinen S, Dietary Fibre Components of Rye Bran and Their Fermentation In Vitro, VTT Technical Research Center of Finland, 2003) rye is the number one source of dietary fiber in the Finnish diet. That paper also reports that the fructan content of rye is significantly higher than that of wheat (typographical error corrected 8/18/10). Put those two facts together and you HAVE got a problematic food, at least in some parts of the world.

Looks like rye should be removed from the allowed food lists for the basic elimination diet, and added to the fructans challenge list. When all is said and done, most people will be able to eventually include rye in their diets in small quantities.

Remember, rye contains gluten. People with celiac disease shouldn't eat rye at all, even in small quantities.

Getting Enough Fiber on the FODMAPS Elimination Diet

Fiber is a good thing, right? Yes, in general, although some food fibers are considered FODMAPS and aren't tolerated well by some individuals with IBS. How can a body get enough fiber on the FODMAPS-elimination diet? Here are some FODMAPS-friendly foods to help boost fiber intake:

• brown rice and rice products
• corn products
• oatmeal
• potatoes and with skins
• all allowed vegetables
• nuts and nut butters (except pistachios)
• seeds and seed butters

Updated 9/19/2011

FODMAPS in Coffee?

According to the USDA Nutrient Database for Standard Reference, coffee does not contain fiber, and would therefore FODMAPS-friendly. However, I have just become aware of some recently published details about the nutrient composition of coffee (J Agric Food Chem, 2007, 55, pgs 1999-2003).

According to this report, the average 9-ounce "cup" of filtered coffee contains 1.3 grams of fiber. Most of the fiber is a fermentable type, and would be defined as FODMAPS, in the galactans category. People who drink three "cups" of coffee a day could be consuming about 4 grams of fiber, equal to the amount in 1/4 cup of cooked beans. Who knew?

Many people, including me, would find it very difficult to give up coffee entirely for even a week or two, to do a completely FODMAPS-free elimination phase. I'm going to suggest, instead, that people undertaking the FODMAPS elimination diet cut back on coffee somewhat, but not to the point that would cause caffeine withdrawal symptoms, during the elimination phase.

If you decide to be a purist, you could wean yourself off coffee over a week's time--watch out for rebound caffeine-withdrawal headaches if you do this. Then, after the elimination phase of the diet, you could add de-caf coffee back during the galactans challenge. Challenge with decaf to avoid confusion about the impact of caffeine itself on bowel habits.

Once in a while someone who is apparently a good candidate for the FODMAPS elimination diet doesn't improve much during the elimination phase. Before calling the experiment a failure, it might make sense at that point to completely wean off coffee and see if any further improvement takes place.

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.