IBS--Free at Last!

FODMAP Twitter Chat Thursday 1/19/12 7 pm

Hope you've got Thursday's FODMAP twitter chat on your calendar! The chat will be moderated by Kate Scarlata. Jaci Barrett and I will be there too, and we've come up with some great questions to get the ball rolling. Open to all. Not sure how? On Thursday 1/19/12 at 7 pm Eastern Standard Time (US), go to your twitter home page. Click on the #discover button at the top of the page. Enter #fodmapchat in the box and you are in business. See you then!

New Year's Resolution? Check for Lactose in Prescription Drugs

Are you lactose intolerant? Prescription drugs are an under-recognized source of lactose. Lactose is used as a filler or coating in approximately 20% of prescription drugs and 6% of over-the-counter drugs. Ironically, this is true even for drugs meant to treat gastrointestinal diseases and disorders! Examplesinclue: certain antispasmodics; anti-diarrheal tablets such as Imodium; IBD drugs such as mesalazine, budesonide and prednisolone; pancreatin enzymes. People who take multiple medications  or many capsules and tablets a day might be consuming quite a bit of lactose this way.

While many people may be able to tolerate a gram or two of lactose each day in meds, others may be unable to do so. Do not stop taking prescribed medication if you are concerned about lactose. Ask your pharmacist to help you figure out how much lactose is in your medications, then discuss alternatives with your prescribing physician.

For more information see http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2008.03889.x/pdf

Any Absolute Avoids?

Are their any foods one must absoutely avoid post-challenge phase of the FODMAPs elimination diet? No. That is the whole point of this program. You can eat any foods that you tolerate, in the amount that work for you. (Of course, keep in mind the dietary requirements of your other health conditions and goals.)

Love garlic, hate FODMAPs?

It's easy to get the flavor of garlic into your favorite dishes without eating a load of FODMAPs.  Prepare this easy recipe for garlic oil, then use it as a cooking or seasoning oil in any FODMAPs-friendly recipe that would benefit from a shot of that incomparable garlic flavor:

Garlic Oil

1/2 cup olive oil
3 large cloves of garlic, wash, peeled and slightly crushed

Pour olive oil into a small, heavy saucepan. Add the slightly crushed garlic. Heat oil until small bubbles rise vigorously from the garlic. Remove from heat. Garlic will continue to cool. Allow the garlic and oil to cool for a few minutes, then pour them into a freshly washed glass jar with a lid. Store in the refrigerator for up to a week. Remove the garlic before using the oil. Olive oil will sometimes get a little cloudy or solidify when it is refrigerated, but it will quickly melt back to its familiar form when you remove a spoonful. Use this as a cooking or flavoring oil to modify any recipe in your collection that calls for garlic.

Note: To make sure your garlic oil is safe to eat, do not store it on the counter at room temperature, and do not eat it it if it has been in the fridge for a month! Garlic oil can go bad like any other fresh food.

Why not just used garlic powder, dried or dehydrated garlic? Although a small pinch of these certainly would not have as much fructans as would eating a few cloves of fresh or roasted garlic, they still have some. Garlic-infused oil is the better option.

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

Can FODMAPs Elimination Help my GERD?

Theoretically it might offer some indirect relief. The large bowel (colon) wraps all the way around the abdominal cavity and passes close by the stomach in the upper abdomen. If the colon is distended with fluid and gas due to FODMAPs ingestion, it could put some physical pressure on the stomach. The upward pressure might encourage reflux of the stomach contents into the esophagus, as it does during pregnancy. We might guess this effect would be more likely in people with a lot of abdominal body fat or short-waisted body types.

Lactose-Free Milk Really is Lactose Free!

Consumerlab.com recently tested three brands of U.S. fat-free, lactose-free milk: Lactaid, Land O Lakes and Organic Valley. All three brands had no detectable lactose! So, when at home, use these products to keep your protein and calcium intake up.

 

How strict must I be when following the FODMAPs diet?

It is one thing to be strictly following an elimination/challenge protocol, and it is another thing just to eat "low FODMAPS".

An “elimination diet” is a strict, temporary, learning diet that we do to learn what foods or food categories trigger symptoms. A FODMAPs-restricted (or low FODMAPs) diet is what we do going forward after we learn what our problem areas are, with the ultimate goal of the most liberal, varied diet possible. Sometimes a low FODMAPs diet is the way to go from the outset, when doing the whole elimination/challenge enchilada isn't practical or medically appropriate.

Please be clear with yourself which one you are doing. While a particular food might not meet the criteria for the strict elimination phase of the diet, it might be perfectly fine in real life, later on, while just trying to balance everything and eat low FODMAPs overall. This will help you evaluate whether is OK to eat foods that contain borderline amounts of FODMAPs. Remind yourself of your "elimination v restricted" status as you review confusing or seemingly contradictory information. While it is not recommended to eat raisins or green beans during the initial stage of a FODMAPs elimination diet, for example, going forward you may find you are perfectly well able to tolerate small, controlled portions of these foods.

If you are doing a the elimination diet and challenge process described in my book, you will learn much more if you follow the protocol strictly for the few weeks it takes to complete the process. After that, you only need be as strict as it takes to manage your symptoms; you can eat whatever you can get away with given your new-found knowledge.

Intolerance to a Single Food; Don't Overgeneralize.

This question comes up frequently: If you know you react to a food within a group (eg wheat/fructans) can you assume that you will react to all foods within that group.. in other words could you react to some fructans but not others?

Good question. Remember with FODMAPs we are trying to assess tolerance to a type of carb (ex. fructans) in our food rather than out tolerance to individual foods. If you do an organized challenge process, the outcome might be that you learn you do not tolerate fructans in general very well. But you cannot assume that just because you react to a single food in a group that you will react to others.

Here are a few reasons why: You might be allergic to that food; you might have celiac disease or non-celiac gluten intolerance(in the wheat example you gave); other foods in the same group might have much less fructans per serving than the one that bothers you; your portion size of other foods in that group might be much smaller, the specific type of fructans in the food might be more or less rapidly fermentable than others, etc.

It's important not to overgeneralize, because its a nutritional mistake to unecessarily restrict your diet.

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.