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FODMAP Diet Therapy for IBS


By Dr. Vince Ziccarelli PhD. MSc. RD ND FICN


The bloating is growing


As more people see me for their digestive woes, the more I seem to be recommending variations of the FODMAP diet. Before I get into the FODMAP diet, let's talk a bit more about why this diet is so relevant today, where it started so to speak. One of the most frustrating dietary issues for many people are those connected with unexplained digestive symptoms; especially bloating, excess gas, irregular bowel patterns, and abdominal discomfort.


After seeing their doctor to rule out an underlying medical cause, and countless medical experts such as the gastroenterologist, they are often told that they are suffering with IBS or some sort of functional gut disorder. Up to 15% of people in the population are diagnosed with IBS, whereby women are more than twice as likely to suffer than men. 40% of sufferers have mild forms, 35% moderate and up to 25% severe symptoms. Many of these digestive sufferers are told to simply live with it, try their best to cope, and hopefully with time, things will get better.


There is a light at the end of the IBS tunnel


Fortunately, there are dietary and natural health solutions that get to the root of most functional gut disorders including IBS. After years of working with many digestive clients, I have come to the awareness that most digestive symptoms are associated with some level of food reaction. The whole idea of food reactions is not a novel concept, as many natural health disciplines pontificate such to be the case. In fact, Hippocrates, the father of modern medicine had once stated thousands of years ago "one person's food is another person's poison", essentially referring to adverse food reactions.


However, the art of identifying the food or foods causing the adverse reactions can be very daunting, such as is the case with IBS. Fortunately, leading researchers in the field of dietetics found a commonality with those experiencing IBS; there appears to be more reactions to foods rich in certain types of highly fermenting carbohydrates (known as fermentable carbs for short). Fermenting simply means they produce excessive gases in the gut.


You see the gut bacteria may be off balance, with more of the unfriendly types of bacteria vs the friendly probiotic types (i.e. the lactobacilli, etc.), that love to feed off of carbs and fibers in many plant foods to thrive and spew off gases that often become trapped. Leading to a cascade of events that throw off the digestive tract, confusing digestive motility in a way that leads to bloating, pent up gas, discomfort and irregular bowel patterns.


At the end of the day people are suffering with major discomfort. In contrast, when limiting fermentable carbs, the symptoms have been found to be dramatically improved. The bloat becomes much more manageable. This is where the FODMAP diet started to shine, as a superstar dietary approach for those with IBS showing a strong light of hope, with progressive registered dietitians leading the way.


FODMAP Fundamentals Made Simple


FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols - which are all various forms of carbs/carb like fibers found in plant foods and added to foods for sweetening and or texture characteristics. Ultimately, these short chain carbs and sugar alcohols include lactose (milk sugar), fructose (fruit sugar), fructans (vegetable storage starch), galactans (legume and lentils), sorbitol (sugar alcohols), xylitol, maltitol, etc. They share three main properties including poor absorption in the small intestine, they are osmotically active (draw water into the intestine), and rapidly ferment gases such as hydrogen.


The gold standard dietary approach to managing IBS and other functional gut conditions is to limit the global intake of dietary FODMAPS. This means that by limiting the overall intake of foods rich in gaseous carbs, you will achieve a more profound effect controlling IBS type symptoms. Sensible FODMAP restrictions have been shown to be effective in well designed double blinded placebo controlled re-challenge food trials - in other words, very high gold standard clinical nutrition trials. These studies have shown that people comply well with the FODMAP diet and their quality of life ratings substantially improve. Other digestive conditions including inflammatory bowel disorders (i.e. Crohn's and Colitis) and ileal pouch may benefit as well.


What to Limit with FODMAPS


Ultimately, after all the science jargon about the in and outs of the FODMAP diet, the take home message is to simply limit foods that contain excess amounts of fructose, fructans, galactans, lactose, polyols. The goal is to limit and establish your unique level of FODMAP tolerance, so you may still enjoy foods that contain these carbs but within limits that will not provoke your symptoms. Following is a summarized list of some of the excess FODMAP foods that should be limited in the diet. Note that whenever limiting it is critical to ensure you are eating suitable food alternates with equivalent nutritional value - to maintain complete nutrition, registered dietitians specializing in elimination diets are best to guide you in this process.


Fructose: apples, pears, clingstone peaches, mango, watermelon, tinned fruit in natural fruit juice, honey, dried fruits and fruit juice.


Lactose: Milk, ice cream, yoghurt, soft and fresh cheese (i.e. ricotta, and cottage).


Fructans and Galactans (Oligosaccharides) : Artichokes, asparagus, beetroot, brussel sprouts, broccoli, cabbage, fennel, garlic, leeks, onions, peas, shallots, wheat, rye, legumes and lentils (i.e. beans, etc.).


Polyols: Apples, apricots, cherries, prunes, plums, sorbitol, xylitol, maltitol, isomaltitol, and any sweetener ending in ol.


However, to achieve these limits it is essential to have a baseline, and to attain this properly and accurately; a systematic elimination FODMAP diet under the guidance of a specialized dietitian or nutritionist would be the ideal. After working with countless patients I have attained some pretty amazing results, some claim life changing. With careful systematic re-introduction of the FODMAP foods the individualized level of tolerance and dietary flexibility is achieved with very good IBS management. This is not a surprise since the science is pretty strong in favor of this therapeutic dietary approach.


Other Natural Medicine Options to help Cope with the Bloat


Fortunately there are many viable natural medicine options that may help people cope better with their dietary reactions, and have more flexibility with their dietary lifestyle. Some of my all time favorites are digestive enzymes. If you peruse the internet or vitamin isle of your organic grocer or health food store you will surely find hundreds of brands of enzyme formulas. They may all have their place but what I usually find works the best is to select a brand with a proven track record, following strict GMP (Good Manufacturing Practices), with a well thought out comprehensive formulation.


One such company is Now Foods. They have some really effective enzyme formulas such as the Digest Ultimate, Fermentable carb and lactose formula. It contains a comprehensive mix of enzymes including meaningful amounts of lactase enzyme, amylase, cellulase, hemicellulase, alpha-galactosidase, protease, bromelain and lipase enzymes. Unlike many other enzymes in the market, it includes therapeutic levels of the alpha-galactosidase, which targets galactans and fructans (oligosaccharides).


Recent studies have shown that this specific enzyme helps improve symptoms for those IBS sufferers that are more sensitive to wheat, legumes and lentils. So the use of a comprehensive enzyme supplement containing alpha-galactosidase would be an ideal enzyme support for coping with symptoms, especially during those times when it may be difficult to limit those foods. Thus, sensible use of dietary enzymes may help many cope better and allow for occasional indulgences. As is the case with any natural health product, always double check with your health care practitioner to ensure that there are no contra-indications for your specific medical history, as some of these enzymes may aggravate ulcers for some people, or have the potentials to thin the blood.


Take Home FODMAP Dietary Message


After all that has been said, although the science of the FODMAP diet appears complex, with some time, energy, self discipline and effort to do the detective work, it is very possible to reap some amazing benefits for your IBS symptoms and finally ease the discomfort. Be heartened by the fact that there are also natural health products such as a well formulated comprehensive dietary enzyme, that when used sensibly, may help you enjoy more indulgences with less of the bloat. Finally, the ideal way to optimize your FODMAP lifestyle and results - is to seek the direction of a registered dietitian experienced with elimination diets.