bellatrix nutrition

talk to me about FODMAPS

In GAPS diet, must read blog posts, paleo, topics on July 13, 2012 at 4:44 pm

UPDATE 9/16/12: You must listen to this podcast that SCD Diet did with Dr. Allison Siebecker on FODMAPs: You can download the MP3 file here

FODMAPs-SIBO relationship

The acronym FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols.  The term FODMAPs was coined by Australian researchers Susan J. Shepherd and Peter R. Gibson; they found that a low FODMAP diet helped up to 75% of their IBS patients. A low FODMAP diet avoids foods containing certain sugars and fibers capable of causing diarrhea, constipation, gas, bloating and abdominal pain in people with IBS.

 
Common examples of FODMAPs

  • Fructose: a single sugar which naturally occurs in fruits, honey and some vegetables. It is thought that 30-40 per cent of IBS sufferers, and also 30-40 per cent of the general population, suffer from fructose malabsorption (although symptoms can vary widely in how much discomfort they cause).
  • Fructans: a chain molecule of many fructose sugar units joined together, naturally occurring in wheat, onions and many other foods. Because fructans are combined fructose molecules, people who suffer from fructose malabsorption should also avoid these foods.
  • Polyols: often used as an artificial sweetener in gums and confectionery (usually with the warning ‘excess consumption may have a laxative effect’), and naturally occurring in some fruits and vegetables.
  • Lactose: a double-sugar which is contained in the milk from cows, sheep and goats.
  • Galactans: a chain molecule of many single sugar units joined together, commonly found in legumes, baked beans, kidney beans, chickpeas and lentils.

 
FODMAPs  can be poorly absorbed during the digestive process. They are rapidly fermented by the bacteria that live in your gut. They can alter the fluid balance in your gut. Together, these effects can lead to bouts of IBS symptoms within hours of eating a high FODMAP meal or snack. By reducing the overall dietary load of these carbohydrates, you can often reduce your troublesome GI symptoms, but that might not be enough.

Symptoms can include: bloating, wind, abdominal distension,discomfort, abdominal pain, inconsistent or excessive bowel movements, lethargy, and even psychological symptoms such as anxiety or depression.

I know these symptoms well. And stress only makes it worse.

 

 
According to Chris Kresser, L.Ac.,

These short-chain carbohydrates are incompletely absorbed in the gastrointestinal tract and can be easily fermented by gut bacteria.  These sugars also exert an osmotic effect, increasing fluid movement into the large bowel.  The fermentation and osmosis caused by these undigested sugars are a cause of major IBS symptoms such as gas, pain, and diarrhea.

There are many common foods that are high in FODMAPs that can potentially contribute to IBS symptoms, even if they are considered healthy by most standards. Lactose from dairy products, fructose from certain fruit, coconut products, and sweeteners, fructans from fibrous vegetables, and polyols from fruit and sugar alcohols are all rich in FODMAPs and can be difficult to digest for people with functional gut disorders. These foods can cause serious and painful symptoms in those with IBS and Crohn’s disease.

While most IBS patients are FODMAP intolerant, consuming FODMAPs does not actually cause IBS; it simply exacerbates symptoms.

 

 

Treatment includes:
1) Addressing intestinal bacterial imbalance is key; even if you don’t have IBS, gut dysbiosis can lead to poor digestive function as well as contributing to FODMAP intolerance. This is where a Paleo diet, GAPS diet or Specific Carbohydrate Diet comes in, with a  focus on gut healing protocol that includes taking probiotics to increase the numbers of healthy bacteria in the gut.
2) Eliminating FODMAPS from your diet.
3) Removing Gluten from your diet also helps heal the gut.

 

 

Many people wonder what FODMAPs have to do with the Paleo diet. After all, we are eliminating all processed carbohydrates and packaged foods. But according to Chowstalker, while meat and fats are fine on a low FODMAP diet, there are several fruits and vegetables that can cause problems:

Fructan is one kind of oligosaccharide and wheat is the biggest source for most people.  Not only does following a Paleo diet keep the gluten out of your gut, but a lot of fructan as well.  But fructan is also found in many vegetables such as garlic, onions, leeks and asparagus.

The other type of problematic oligosaccharides is galactans, found in many legumes.  We don’t do beans.  But galactans are also in veggies like cabbage and Brussels sprouts…and coffee.   Eek. The FODMAP that may be the worst offender is excess fructose and HFCS isn’t the only source.  Other “excess fructose” foods include apples, pears, peaches, almost all dried-fruits, honey and coconut milk.  Yes, coconut milk.  Shut the front door.

Further evidence that this is a highly individualized issue, is for many people it isn’t a certain food or even category of FODMAPs; it’s the total consumption of FODMAPs.Small amounts of any high FODMAP food may not trigger IBS.  A cup of coffee with coconut cream may be fine OR some fruit but if both are consumed within a small time-frame, then that may be enough to trigger symptoms.

SCD Diet suggests:

Step 1 in testing FODMAP intolerance is to removing foods with high FODMAP content, which includes:

Fruits: apple, apricot, avocado, blackberry, cherry, lychee, nashi, nectarine, peach, pear, persimmon, plum, prune, watermelon and dried fruits

Vegetables: asparagus, artichoke, beetroot, bell pepper, broccoli, Brussels sprouts, cabbage, cauliflower, eggplant, fennel, garlic, leek, mushroom, okra, onion, shallots, sweet corn

Sweeteners: honey, corn syrup, sorbitol, mannitol, isomalt, maltitol, xylitol

Legumes: all beans, chickpeas and lentils

Dairy: milk from cow, goat, sheep, custard, ice cream, yogurt, soft unripe cheese

Grains: wheat, rye, barley

 

And on his blog, Chris Kresser, L.Ac. says that,

While a “Paleo” or “Primal” diet may eliminate many of these culprits, there are a few Paleo-friendly staples that can worsen FODMAP intolerance symptoms. I’ve written about coconut milk causing digestive distress in some individuals, and coconut milk is an unfortunately high source of FODMAPs. Many fruits such as apples, peaches, mangoes, and watermelon are FODMAP rich, and dried fruits are especially problematic for those with intolerances. Even certain vegetables that are normally quite healthy can be problematic for those suffering from IBS; asparagus, brussels sprouts, broccoli, garlic, and onions are just a few of the vegetables that could be exacerbating symptoms.

 
That is certainly the case for me. I could never be a vegetarian because I suffer so badly with abdominal distension, bloating and just feeling totally and completely crappy. Coconut milk and meat (including dessicated coconut, coconut cream, and coconut flour) also cause my digestive system distress. I am fine with raspberries, but many other fruits cause varying degrees of gut issues for me. This is totally separate to my oral allergies.

The best visual I’ve come across so far to help those affected by FODMAPs was shared by Aglaée the Paleo Dietitian: Paleo low-FODMAP diet food list
 
According to this list, taking into consideration my oral allergies, and going by my symptoms, I am able to eat small amounts of cooked green beans, carrots, parsnip, spinach, tomatoes, kale, sweet potato, as well as grapefruit, raspberries, lemon and lime.

 
UPDATE 8/3/12:  Today I came across a new blog post by Chris Kresser, L.Ac.:   How following mainstream advice to eat 6-8 servings of vegetables a day could hurt your gut where Chris explains that:

Vegetables (as well as some fruits) are often high in insoluble fiber. While soluble fiber can be soothing for the gut, consuming large amounts of insoluble fiber when your gut is inflamed is a little bit like rubbing a wire brush against an open wound. Ouch.

Vegetables that are high in insoluble fiber include: Greens (spinach, lettuce, kale, mesclun, collards, arugula, watercress, etc.), Whole peas, snow peas, snap peas, pea pods, Green beans, Kernel corn, Bell peppers, Eggplant, Celery, Onions, shallots, leeks, scallions, garlic, Cabbage, bok choy, Brussels sprouts, Broccoli, and Cauliflower

The vegetables that are high in soluble fiber, but lower in insoluble fiber (and thus tend to be safer for those with gut issues) include: Carrots, Winter squash, Summer squash (especially peeled), Starchy tubers (yams, sweet potatoes, potatoes), Turnips, Rutabagas, Parsnips, Beets, Plantains, Taro, and Yuca

Chris recommends:  Eating less veggies, especially while your gut is healing. Eating a single steamed or roasted vegetable as a side dish per meal. Not eating insoluble fiber foods on an empty stomach (always eat them with other foods that contain soluble fiber). Removing the stems and peels (i.e. from broccoli, cauliflower and winter greens) from veggies (and fruits) high in insoluble fiber. Dicing, mashing, chopping, grating or blending high-insoluble fiber foods to make them easier to break down. Well-cooking any insoluble fiber foods (e.g steamed thoroughly, boiled in soup, braised, etc)

 
 

Recommended Reading:

Gut and Psychology Syndrome: Natural Treatment for Autism, Dyspraxia, A.D.D., Dyslexia, A.D.H.D., Depression, Schizophrenia

IBS: Free at Last! Change Your Carbs, Change Your Life with the FODMAP Elimination Diet, 2nd Edition

Breaking the Vicious Cycle: Intestinal Health Through Diet

 

Resources: 

http://www.healthyfood.co.nz/articles/2010/march/are-you-intolerant-to-common-foods

http://www.cassandraforsythe.com/blog/Low+FODMAP+diet+has+been+great+for+my+gut/

http://chriskresser.com/fodmaps-could-common-foods-be-harming-your-digestive-health

http://www.ibsgroup.org/brochures/fodmap-intolerances.pdf 

http://cassandraforsythe.com/blog/Complete+FODMAP+List+For+a+Happy+Gut

http://www.ibsfree.net/ibsfree_at_last/2012/07/hello-fodmaps-nice-to-meet-you.html

http://www.eat-real-food-paleodietitian.com/paleo-diet-and-fodmap.html

http://followingmynose.com/2012/03/fodmap-paleo-what/

http://www.greenmedinfo.com/blog/avoiding-fodmaps-because-gluten-free-diets-are-not-enough

http://bodyecology.com/articles/ibs-and-digestive-issues-5-categories-of-fodmap-trigger-foods-could-cause-countless-symptoms

http://www.todaysdietitian.com/newarchives/072710p30.shtml

http://scdlifestyle.com/2012/09/dr-siebecker-explains-the-art-and-science-of-the-fodmap-diet-podcast-45/

http://scdlifestyle.com/2012/09/fodmap-diet-a-fad-diet-or-helpful-for-everyone/

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