IBS—Free at Last!

Planning ahead for FODMAPs-friendly Thanksgiving

This year, Thanksgiving dinner doesn't have to be a gut-buster. You can follow all of the suggestions on my menu for a very low FODMAPs dinner. Or, you can follow MOST of the suggestions, and splurge on one or two higher FODMAP treats in small portion sizes. Personally, I can't imagine Thanksgiving dinner without a scoop of my mother-in-law's sausage stuffing; I'll be leaving plenty of room in my "bucket" for that by going low FODMAPs on everything else. Click on the link below to download a pdf of the menu. Enjoy, and let us know what FODMAPs-friendly thanksgiving treats you have planned.

Download FODMAPs-Friendly Thanksgiving Dinner Menu

What are Probiotics? Microwarriers!

A picture is worth a thousand words... or a trillion microbes! "Probiotics" is a difficult and wordy concept to explain: "live microorganisms which when administered in adequate amounts confer a health benefit on the host." Huh?

What if you had an entertaining and factually accurate DVD that could do the job for you? You could teach (or learn) about probiotics the easy way, watching lively graphics and hearing the story of probiotics directly from world-class experts! Health Point Productions has recently released just such a DVD: Microwarriers. The Power of Probiotics. You can learn a lot just by watching the trailer:

See what I mean? The movie really brings the miniature and powerful world of our microbial life-partners up to a size that anyone can see and understand. The experts interviewed in the movie are the real deal. I heard two of them, Dr. Mary Ellen Sanders and Dr. Martin Floch, speak just last month at the Yale Workshop on Advances in Probiotic Use.

If you want to learn more about the relationship between humans and bacteria, and about the manufacture and use of probiotic foods and supplements, you might like to own this 53-minute movie. If you are a health care provider or an educator, this movie makes a great teaching tool, and would be an excellent addition to your professional media library.

Margaritas?

Here in the northeast we're having a heatwave, and a thirsty reader has sent a question about whether tequila and margaritas are allowed!

Tequila as a distilled spirit, and is allowed on the FODMAPS elimination diet. Those margaritas are lookin' good so far.

The potential problems in a margarita are the triple sec, the sweetener, and the type of fruit juice. Let's look at the options:

Margarita from scratch--a standard recipe for margaritas contains triple sec. Scratch margaritas are not allowed because it is impossible to find out what triple sec is sweetened with (proprietary information).

Margarita premixed in a bottle--these seem to all have high fructose corn syrup, triple sec, or both, so these products are not allowed. Let me know if you find a brand that works.

Margarita that you make at home from a mix--if you read the label on the mix and find the product is sweetened with sugar or corn syrup (not high fructose corn syrup), and all the juices in the product are OK (lime, lemon, orange), then you've got the makings for an "allowed" margarita! Here's one to consider: Nantucket-Off-Shore-Simple-Margarita.  Bar-Tenders-Instant-Margarita-Mix looks OK. Another mix that looks OK is Lt-Blenders-Margarita-in-a-Bag.

Always check the label before you purchase, in case ingredients have been updated or changed.

Note the portion sizes are VERY small. Even sweetened with allowed sugars, you should consume 40 grams of sugar or less in your drink(s) follow the rule of thumb for the FODMAPS elimination diet. Hey, this will help you drink responsibly!

Clear Liquids

Has your health care provider asked you to drink clear liquids to prepare for a procedure or for bowel rest? Here is a list of some clear liquids that are FODMAPS/FM-friendly.

• homemade or commercial lemonade made with lemon juice concentrate (no pulp) and sugar or real maple syrup
• tea, regular or herbal (watch out for chicory root in the herbal teas)
• gelatin dessert (like Jello) made from powdered mix (double check label--dextrose is OK)
• soft drink (like Kool-Aid) made from powdered mix (double check label--dextrose is OK)
• diluted white grape juice
• homemade chicken or beef stock
• water, of course
• ice chips
• Frozen lemonade or limeade, sugar sweetened (single serving section of freezer), such as Minute Maid
• lemon sorbet sweetened with sugar or corn syrup (not high-fructose), such as Haagen-Dazs
• pulp-free orange juice (w/OK from physician--sometimes this is not considered a clear liquid)

Now, if the next step to get ready for your procedure is to consume laxatives, there is nothing I can do to save you from diarrhea, since that is pretty much the point. But at least the first day of your prep might be reasonably comfortable if you stick to the above liquids. Remember, if you are preparing for a colonoscopy, you should avoid products with red or purple food dye in them.

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.

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 malabsorption. 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, both during the test and at other times.

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.

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

Click here for more complete info on lactose content of foods and beverages.

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