In Part 1 of this series you learned that your diet can be modified to help you combat digestive complaints including constipation, excess (embarrassing) gas and diarrhea.
None of these symptoms are anything to laugh at, because for some people, they can cause them much pain, discomfort and extreme frustration. Instead of just excess gas, they can be scared to leave the house because they can’t get themselves to the bathroom fast enough, or fear that their next gas bubble might turn into a “shart.”
Before you self-diagnose, and decide that you can combat these more extreme symptoms with diet alone, make sure you consult with a well-respected Gastroenterologist who can rule out any more serious issues such as Crohn’s disease or Colitis. Even have yourself checked for food intolerances that may be contributing to your problems – one that I highly recommend is the ALCAT food intolerance testing company: www.alcat.com
However, if/when these intestinal diseases, inflammation and intolerances have been assessed and found not to be the sole cause of your issues, your doctor will probably suggest a dietary approach.
If your doctor doesn’t, you might have to look for one on your own instead of feeling even more frustrated and embarrassed.
As you learned in Part 1, a diet that is low in FODMAP foods might be the solution to your ailments.
I personally have been following a low FODMAP diet for 4 years (with some flexibility as my gut health has improved and irritation was removed) and have very little issues at all. I do still struggle with constipation at times (slow gut motility), but if I use a magnesium blend every night, I am much more comfortable (one I love is ColonRx by Designs for Health).
What are FODMAPs?
FODMAPs stands for: Fermentable, Oligosaccharides, Disaccharides, Monosaccharides & Polyols.
(Don’t worry. There won’t be a test at the end to remember all these words!)
They include:
Galacto-Oligosaccarides:This includes legumes such as baked beans, lentils, & chick peas. These have chains of galactose, which end in fructose & glucose.
Lactose (Disaccharide):A sugar that naturally occurs in milk products. A Lactose Breathe Test determines whether you have lactose intolerance. The test measures the production of methane or hydrogen produced by bacteria in the large intestine.
Fructans (Disaccharide):These are a chain molecule (a fructose chain with glucose as a final molecule). Main sources are wheat products, & some vegetables (onion, garlic, and others). There is no gas test to determine fructan intolerance, other than by an elimination trial.
Fructose (Monosaccharide):A single sugar found in all fruit & other foods. A Fructose Hydrogen Breathe Test determines whether you have fructose intolerance. The test measures the production of methane or hydrogen produced by bacteria in the large intestine.
Isolmalt, Xylitol, Maltitol, Sorbitol, & Mannitol (Polyols): This includes sugar alcohols, occurring in some fruits & vegetables and many “sugar free,” “low carb,” “diet,” and “artificial sweetener” products.
Look for additives such as sorbitol (420), mannitol (421), isomalt (953), & xylitol (967). There is no test for intolerance to these, but excessive consumption has a laxative affect that can worsen diarrhea condition & symptoms.
Be wary of products labeled “sugar free” as the sweeteners can be substituted with sugar alcohols that can be tough on the gut.
Before following a low FODMAP diet, I used to think that eating an apple a day would keep the doctor away, and that avocados were a good source of dietary fat for me.
I was wrong. Both these foods are very high in FODMAPs. I also chewed a lot of sugar-free gum and cooked with onions and beans. Well, needless to say, I wished I lived on an island during this time.
This diagram explains easily the connection between your diet (FODMAPs) and digestive issues you might be struggling with:
Figure 1 from Barrett JS and Gibson PR, 2007
What Foods Should You Avoid?
Before you stress out while reading through the table of FODMAPs below, keep in mind that every person is unique and what bothers me or your friend, might not bother you.
You have to listen carefully to your body and determine what really sets your gut bacteria off and what you can tolerate in small or large doses.
Also, some foods that affect you might not be listed below so, you need to evaluate your own diet and pay attention to what you currently eat and discover for yourself what might be the issue.
For a more comprehensive list, and a handy app you can install on your phone, check out the Monash University: http://med.monash.edu.au/cecs/gastro/fodmap/
FRUITS TO AVOID
VEGETABLES TO AVOID
Excess Fructose fruit:
Apple
Mango
Nashi fruit
Pear
Persimmon
Rambutan
Watermelon
Excess Fructan fruit:
Persimmon
Rambutan
Watermelon
Excess Polyol fruit:
Apple
Apricot
Avocado
Blackberries
Cherries
Longon
Lychee
Nashi Fruit
Nectarine
Peach
Pear
Plum
Prune
Watermelon
Excess Fructose vegetables:
Sugar snap peas
Excess Fructan vegetables:
Artichokes (Globe & Jerusalem)
Asparagus
Beet
Brussel Sprouts
Cabbage
Chicory
Dandelion leaves
Fennel
Garlic
Leek
Legumes
Okra
Onion (red, white, yellow, Spanish, etc.)
Peas
Radicchio lettuce
Scallion / Spring onion (white portion)
Shallot
Excess Polyol vegetables:
Avocado
Cauliflower
Mushrooms
Snow peas
Some grain products can be problematic for people, as these are high in fructans:
Biscuits, sweet & savoury
wheat based
Bread & wraps
white, wholemeal, multigrain, sourdough, pita, & many ryes
Breakfast cereals
containing wheat, excess dried fruit, or fruit juice
Cakes & baked goods
wheat based
Others
semolina, couscous, bulger
Pasta & noodles
regular, two minute, spelt, egg noodles, hokkien, & udon
Pastry & breadcrumbs
wheat based
It’s really important to note that onion is one of the greatest contributors to bloating, gas and motility changes. Strict avoidance is recommended.
SPECIAL NOTES ON VEGETABLES
Avoid:
Onion (all varieties), onion powder, white part of scallions and spring onions
Leeks, shallots, garlic
There is undeclared onion hidden in many processed foods including, chicken salt, vegetable salt, vegetable powder, dehydrated vegetables, stocks, gravies, soups, marinades, & sauces.
This may or may not affect you, but if you are really struggling, you need to keep it out of your gut.
Alternatives:
Chives
Green part of spring onion
Asafoetida powder (contains gluten)
Basil, coriander, chili, ginger (fresh or dried), lemongrass, marjoram, mint, parsley, oregano (Greek, Italian, or Mexican), thyme, rosemary, etc.
SPECIAL NOTES ON WHEAT/ FRUCTANS
A low FODMAP diet allows oats & barley which are not high in fructans.
Wheat-free rye is tolerable for most (assess individually)
Small amounts of wheat, such as breadcrumbs, may be tolerable
Those with diagnosed Celiac disease or gluten intolerance should eliminate gluten from their diet
Gluten-free foods do not contain wheat fructans
Trace amounts of wheat ingredients, such as soy sauce, should not be a problem
Many wheat-derived products such as, wheat starch, wheat thickeners, wheat maltodextrin, wheat dextrin, wheat dextrose, wheat glucose, and wheat colored caramel are fructan-free glucose chains. They may be safe to eat.
Alternatives to wheat grains/fructans:
Rice
Corn (not for everyone – assess individual tolerance)
Potato
Amaranth
Tapioca
Quinoa
Millet
Sorgum
Buckwheat
Arrowroot
Sago
Alternatives to wheat products:
Gluten-free bread, 100% spelt bread, wheat-free rye
Rice noodles, wheat-free buckwheat noodles
Porridge, wheat-free muesli, rice bubbles, corn flakes, & gluten-free cereals
Corn thins, rice cakes & crackers, ryvitas, & rye cruskits
Gluten-free cakes, flourless cakes, biscuits
Gluten-free pastry mixes, & bread crumbs
Polenta, cornflake crumbs (corn)
Buckwheat, millet, sorghum, sago, tapioca, rice, & corn flours
SPECIAL NOTES ON FOODS CONTAINING FRUCTOSE &/OR FRUCTANS
Alternatives to foods containing fructose and/or fructans:
Golden syrup
Treacle
Molasses
Maple syrup
White, brown, raw & castor sugar (sucrose), eaten in moderation
Tea, coffee, & herbal teas
Nuts & seeds (moderation)
Oat bran
Barley bran
Psyllium
Rice bran
Low calorie sweeteners (stevia)
Other foods (containing fructose and/or fructans) to avoid:
Baked beans, lentils, & chick peas
Honey
Corn syrups, corn syrup solids
Fruisana
Chickory
Dandelion tea
Inulin
Artificial sweeteners (watch out for sugar-free gum!)
Sugar-free or low carb sweets, mints, & dairy desserts
SPECIAL COMMENTS
Dairy: is often a big problem for people with IBS – best to avoid! Small amounts of organic yogurt (PLAIN) may be ok for some people, but assess individual tolerance. Fluid milk and cheese are usually not good.
Limit alcohol intake: Avoid alcohol which is high in indigestible carbohydrate, such as beer. Clear spirits (e.g., vodka and gin) served with water or soda, flavored with suitable fresh fruit, is preferable.
Always try to:
Drink plenty of water
Eat in moderation
Chew your food well
Limit processed foods (hidden FODMAPs & irritants)
Limit or avoid processed meats (hidden FODMAPs & irritants)
But, What Can I Eat?
I know, I know. Reading this list can make it feel like there’s nothing to eat, but that’s not the case! There are still plenty of foods you can eat!
They include everything that is not on the lists above. Assess your own diet to see what those foods are, and discover new foods you may have not tried before that are not high in FODMAPs.
Also, remember the list above is just a guide. There may be some FODMAP foods that don’t bother you after you’ve given the full diet time to work.
For example, I sometimes enjoy a crisp fall apple, or have beans on my salad. I just don’t do it every day.
You might find that after cutting out these foods, you still have issues. You will have to then look carefully at if there are hidden FODMAPs in something you are still putting in your mouth (like chewing sugar free gum, or using a whey protein powder that has lactose in it).
Following a low FODMAP diet doesn’t mean an end to delicious food. There are plenty of tasty and healthy options to eat daily
Here is an example diet to see what a low FODMAP approach could look like for you:
Breakfast:
2-3 scrambled eggs cooked with fresh baby spinach
1 medium banana (if you struggle with diarrhea, bananas can help reduce this significantly) or clementine
Snack:
1.5 oz walnuts
Sliced cucumbers and zucchini
Lunch:
Spinach salad with 1 can chunk light tuna + olive oil + rice wine vinegar + tomatoes, cucumbers and bell peppers + sunflower seeds
Snack:
Pea protein powder (PurePea by Designs for Health) smoothie:
Berries + rice milk + pea protein + ½ banana + baby spinach
Dinner:
Baked or pan-fried salmon (in extra virgin olive oil)
Baked sweet potato
Steamed red swiss chard
Evening Snack:
Air popped popcorn (lightly salted)
What Else Can I Do?
If diet isn’t helping, you also may have to employ a round of antibiotics to obliterate the bad bacteria and give you a fresh start.
Make sure you follow up with a solid course of good probiotics to replenish the good and fully eradicate the bad. (See resources below for more info.)
Going forward, your daily supplement routine should still involve a probiotic. I use Probiotic Supreme by Designs for Health and FloraMyces by the same company. I take these each morning. You can take them before you eat or with food.
If you struggle with constipation, a good magnesium product taken at night before bed will not only help you sleep better, but will allow you to have a bowel movement when you wake up the next morning. As I mentioned above, I like ColonRx by Designs for Health.
Make sure you have ruled out any structural issues, food intolerances, or allergies with your doctor or gastroenterologist (such as gluten intolerance or celiac disease, which often exist at the same time) if you really have a lot of problems.
Finally, check your stress levels and how you treat your body. If you have a very stressful job or family life and follow up each evening with a bottle of wine, your belly is not going to be happy no matter what you eat or don’t eat.
Flat Belly Again!
Once the bloat is gone and your bowels are moving normally, you’ll find that you can button your pants more easily and enjoy your non-distended once again.
As I said at the beginning, no woman likes to feel bloated, and now you don’t have to. Following this dietary approach can help you feel much, much better.
If you would like more help with your FODMAP approach, contact me at cassandraforsythe@gmail.com for dietary coaching.
References:
Barrett JS and Gibson PR, Clinical Ramifications of Malabsorption of Fructose. Practical Gastroenterology, August 2007.
Sartor RB, The intestinal microbiota in inflammatory bowel diseases. Nestle Nutr Inst Workshop Ser. 2014;79:29-39. Epub 2014 Sep 5.
Lakhan SE, Kirchgessner A. Gut microbiota and sirtuins in obesity-related inflammation and bowel dysfunction. J Transl Med. 2011 Nov 24;9:202.
VSL#3 is an outstanding probiotic: http://www.crohns.net/)
FODMAP recipe book: http://www.strandsofmylife.com/low-fodmap-menu-cookbook/http://www.strandsofmylife.com/low-fodmap-menu-cookbook/