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.

Nutrition Facts Panel and FODMAPs (U.S. only)

You can sometimes use the Nutrition Facts panel on a food package to figure out whether something has FODMAPs in it or not. Let's use Kikkoman Soy Sauce as an example.

First place to check is the list of ingredients at the bottom of the panel. If the product has added sugars, fibers, or polyols, or food ingredients that contain them, you will see them listed in the ingredients. This sauce contains water, wheat, soybeans, salt and sodium benzoate. Hmm. Suspicion is raised because it contains soy and wheat. But does it really contain FODMAPS?

Next place to check is total carbohydrates per serving of the food. All FODMAPs, by definition, are carbohydrates. "Total carbohydrates" on the Nutrition Facts Panel is the sum of the sugars, fibers, sugar alcohols and "other" carbohydrates (usually starches). If the total carbohydrates are zero, then one serving of the product is likely to be fine to eat on the FODMAPs elimination diet.

• Lactose and fructose would show up on the nutrition facts as "sugars".
• Fructans and galactans would show up on the nutrition facts as "fiber".
• Polyols (sugar alcohols) are harder to spot. If the product makes a claim on the label about sugar, and sugar alcohols are present in the food, they must be listed on a separate line. If not, they are lumped in with "other carbohydrates" which are often not listed on the food label at all.

In our example, the total carbohydrates listed on the food label are "zero". One serving of this food contains little or no FODMAPs, less than .5 grams of total carbohydrate according the FDA Rounding Rules. Is that low enough? It's low enough to slip under the guidelines for everything but polyols. If the food really did have .49 grams of polyols per serving it might be enough to trigger symptoms for some people. 

How can we make an educated guess whether or not this food might contain polyols? Polyols enter our diet as natural components of certain fruits and vegetables, and sweeteners added to food. Let's have one more look at the ingredients. There are no added sweeteners and no fruit or vegetable ingredients.

I conclude it is a very safe bet that this brand of soy sauce can be eaten during the elimination phase of the FODMAPs diet. You can use the same reasoning for other foods. Please comment if you have any brand name foods you can recommend to the rest of us!

2011 Book Update: Meats and Milk

There are blessedly few changes to the list of Meats and Milk allowed on the elimination phase of the FODMAPS elimination diet. On page 52 of the book you can add two items:

• lactose free yogurt
• lactose free kefir

Most commercial yogurt is not lactose-free. Modern yogurt manufacture does not allow the yogurt fermentation to continue long enough to break down all the lactose. So far, I know of exactly one commercial lactose-free yogurt (Green Valley Organics, available at Whole Foods) but I'm hoping this will be a 2011 food trend (you heard it here first)! Please share if you know of any other brands of lactose-free yogurt! You can, of course, make your own lactose-free yogurt at home.

Green Valley kefir is also lactose free. Lifeway kefir is widely available and it is 99% lactose free (close enough for most people). Kefir is a cultured, creamy milk drink similar to yogurt but pourable. It's really delightful! Try it, you'll like it!

 

New Products added to FODMAPs-Friendly Brand Name Guide

I've added several dozen new products to my FODMAPS-Friendly Brand Name Guide (US). Check the update list here, or select the link in the sidebar, under Resources for Readers and Clients.

The Role of Lactaid Pills

I am often asked whether it is OK to just take a Lactaid pill with milk products during the elimination phase of the diet. No, it isn't.

Lactose is "milk sugar". It is broken down to simpler, absorbable sugars by the enzyme lactase. For various reasons, some people don't produce enough lactase, or maybe the contents of the small intestine are rushing through too fast for lactase to do its job. Though most people who don't produce enough lactase can tolerate a few grams of lactose here and there, other people are exquisitely sensitive and can't tolerate even small amounts. During the elimination phase of the diet, you should not make assumptions about this, even if your impression is that sometime milk products don't bother you. You will learn so much more if you follow the plan and have no lactose during the elimination phase.

Commercial lactose free milk products are treated with the lactase enzyme before they are packaged. Mixing is thorough and complete before the product is packaged, and the product is rendered 100% lactose free. When you take a lactaid pill, the mixing is not as thorough and complete in your body as it is at the dairy plant! The pill may knock the grams of lactose in the product down somewhat, but it will not render it lactose free.

So, during the elimination phase, use only pre-treated, lactose-free milk products, or those that are naturally lactose-free, like hard cheeses. There are lots of brands of lactose-free fluid milk to choose from. Lactaid is the only brand of lactose-free cottage cheese I have seen so far, and Green Valley Organics is the only brand of yogurt I have seen so far.

P.S. After you have completed the elimination diet and challenge phases, there may yet be a role for Lactaid pills. If you discover that you need to limit your lactose consumption, you can use pre-treated products at home, but carry some Lactaid pills with you in case you are unexpectedly "forced" to eat some ice cream or chowder while away from home;) It may help you handle it, even if it doesn't do the whole job.

Mayo, Jam and Peanut Butter

No, not all on the same sandwich!

New FODMAPS-friendly products added today to the brand name guide:

Mayonnaise: Hellman's, Duke's, Trader Joe's Organic

Jams, Jellies, Marmalades: Hero, Smucker's Orchard's Finest, Stonewall Kitchen, Bonne Mamman (flavors made with allowed fruits)

Peanut Butters: Smucker's, Krema, Skippy, Teddie

Remember to double check the label before purchasing, in case the manufacturer has made changes to the product.

Brand Name Guide Update: Breyer's Lactose-Free Vanilla Ice Cream

My new FODMAPS-Friendly Brand Name Guide (U.S.) is getting a lot of hits, and suggestions are starting to come in. I will double check the suggestions as time allows, and when I've added them to the Brand Name Guide List I'll let readers know with a blog post. I always share blog posts via Twitter, so if you want to get the updates, follow me on Twitter!

Brand Name Guide--a Beginning

I've posted a short FODMAPS-friendly brand name guide, something a number of readers have suggested. The list is posted in the sidebar under the heading "Resources for readers and clients."This list is in its infancy, and I welcome your comments and additions. If you have a nationally distributed (U.S.) food or beverage that you would suggest adding to this list, please leave a comment. I will update the entire list from time to time, and with your input, this will be an excellent resource for us all!

Have You Tried Udi's Bread Yet?

One of the most difficult things for many people on the elimination phase of the FODMAPS diet is the difficulty of finding a decent bread. Actually, I usually recommend steering around bread for short duration of the elimination diet, but if your lifestyle demands sandwiches or toast, ya gotta have bread.

You may be lucky enough to find a good millet and potato bread in your area. Those I have tried are pretty good, but I don't know of any national brands to recommend.

At last, however, most of us in the U.S. have access to a FODMAPS-friendly bread: Udi's White Sandwich Bread Loaf. It's delicious, has a typical wheat bread texture, and keeps well in the bread drawer. No need to freeze this loaf. Use the store locator on the company web site to find out where you can buy it.

Green Valley Organics Lactose Free Yogurt

Yes, that's right! Lactose-free yogurt is now available from Green Valley Organics! This is great news for folks on the FODMAPS elimination diet, as well as anyone with lactose intolerance. People do love their yogurt, and with good reason--it is a great source of protein, calcium, phosphorus and other important nutrients! Many of my clients have been disappointed to learn that commercial yogurts are off limits on the FODMAPS elimination diet; although they are touted as having less lactose than the milk they are made from, they do contain enough lactose to cause symptoms in some people. Until now, only homemade yogurt made from lactose-free milk (or cultured for 24 hours from regular milk) was allowed. No more! That market niche has now been filled in a very delicious way--plain, vanilla, blueberry and strawberry flavors are FODMAPS friendly, according to the ingredients listed on the web site products page (always check the label before purchasing any product in case the ingredients have changed)! This brand is available at Whole Foods Markets across the country.