Irritable Bowel Syndrome and FODMAP approach for relief

By Dr. Harold Gunatillake - Health Writer

Irritable Bowel Syndrome (IBS) is quite a common gastro-intestinal disorder accompanied by Gastric discomfort, bloating, nausea with change of bowel habits, and occurs in mild to severe forms for most people with aging. IBS, functional diarrhoea, and functional nonspecific abdominal bloating are also classified as functional gut disorders (FGDs).

The research team at Monash University developed a diet control gastro-intestinal upsets associated with IBS and other gastro-intestinal disorders.

The researchers focused on a group of carbohydrates referred to as FODMAPs (Fermentable Oligo-saccharides, Disachcharides, Mono-saccharides and Polyois)

These fermentable saccharides are poorly absorbed in the small intestine. These are insufficiently digested and poorly absorbed short chained carbs. Stagnation of such indigestible carbs tends to ferment by the gut bacteria to produce gaseous distension. These carbs when converted into sugar through gut enzymes exert an osmotic effect, increasing the fluid content and movements of the large bowel. So, it is believed that these undigested or incompletely digested carbs cause major IBS symptoms such as gas, pain and diarrhoea.

These groups of short chained carbohydrates referred to as FODMAPs are found in a wide range of foods.

There is growing evidence that a low FODMAP Diet would be the solution in most cases of FGDs.

Most high FODMAP diets are healthy though they contribute to IBS symptoms. It is ironical that healthy foods become ‘unhealthy’ and intolerant for those having this gastro-intestinal disorder.

The common foods in high FODMAP diets are lactose producing dairy products, fructose from certain fruits, coconut products and sweeteners, fructans from fibrous vegetables and polypols from fruit and sugar alcohols. These foods are responsible for the serious and painful symptoms in those with IBS and Crohn’s disease.

Majority of people can tolerate high FODMAP foods causing no food digesting disorders, but it is the smaller numbers that are intolerant consuming high FODMAPs and present with the symptoms.

Further analysing to find out what causes IBS, it is assumed that small intestinal bacterial overgrowth may be contributing to the development of FGDs: Certain pathogenic bacteria in the gut can cause excessive fermentation of these stagnant short chained carbs, resulting in increased production of gas, and further proliferation of these specific pathogenic bacteria.
In other cases the syndrome can be caused by lack of adequate enzymes that digests these carbs and may not be due to bacterial causes.

Of course emotion and physical stress may be contributing to the development of FGDs. It is known that stress can alter the gut flora significantly and could be the reason why stress can cause food intolerance linked to IBS and other functional nonspecific disorders.

Unfriendly and friendly FODMAPS
Onions and garlic are two very bad triggers and should be avoided as best as you can. What it means is that normal home cooked curries are trigger factors, as onions and garlic are liberally used in the preparation of spicy curries. If you need to eat curries you may have to restrict to a minimum.

Processed foods and meat can triggers for IBS and other food disorders. Wheat products such as white bread and Asian foods like hoppers, indiappans, rotties and pittus may trigger abdominal discomfort. One has to through elimination check on your favourite foods. Also check on the labels and check on the ingredients before you purchase.  Fruits must be restricted to one portion per day.

If you wish to eat onions and garlic they could be infused in oil. You could use garlic cloves and sauté with olive oil for 20 minutes, medium to high temperature should be used immediately. Same with onions. (Uncooked garlic placed inside oil can cause a bacterium Clostridium Botulinum to breed which can cause botulism poisoning.)

High FODMAP food to avoid /reduce
Vegetables and Legumes

  • Garlic – avoid entirely if possible:Onions – avoid entirely if possible
  • Artichoke Asparagus, Baked beans, Beetroot, Black eyed peas, Broad beans, Butter beans, Cauliflower. Celery, Kidney beans, Leeks, Mange Tout, Mushrooms, Peas, Savoy Cabbage, Soy beans, Split peas, Scallions / spring onions (bulb / white part) Shallots

Fruit – fruits can contain high fructose

  • Apples, Apricots, Avocado, Blackberries, Cherries, Currants, Dates, Grapefruit, Lychee, Mango, Nectarines, Peaches, Pears, Persimmon, Plums, Prunes, Raisins, Tinned fruit in apple / pear juice, Watermelon

Cereals, Grains, Breads, Biscuits, Pasta, Nuts and Cakes

  • Wheat containing products such (be sure to check labels): Biscuits, Breadcrumbs, Cashews, Cakes, Egg noodles, Regular noodles, Pastries

Pasta made from wheat, Udon noodles, Wheat bread, Wheat cereals
Wheat rolls, Barley, Bran cereals, Couscous, Pistachios, Rye, Semolina

Low FODMAP food (good to eat food)
Vegetables and Legumes

  • Alfalfa, Bean sprouts, Bok choy / pak choi, Broccoli – avoid large servings, Brussel sprouts, Butternut squash – 1/4 cup, Cabbage, Carrots, Corn / sweet corn- if tolerable and only in small amounts – 1/2 cob, Courgette, Chick peas – 1/4 cup, Chilli – if tolerable, Chives, Cucumber, Eggplant / aubergine, Fennel, Green beans, Green pepper (green bell pepper), Ginger, Kale, Leek leaves, Lentils – in small amounts, Lettuce, Okra, Olives, Parsnip, Parsley, Red peppers (red bell pepper), Potato, Pumpkin, Scallions / spring onions (green part), Spinach, baby, Squash, Sweet potato – 1/2 cup, Tomato – avoid cherry tomato, Turnip, Zucchini

Fruit

  • Bananas, Blueberries, Boysenberry, Canteloupe, Cranberry, Clementine, Dragon fruit, Grapes, Honeydew and Galia melons, Kiwifruit, Lemon including lemon juice, Lime, Mandarin, Orange, Passion fruit, Paw paw, Papaya, Pineapple, Raspberry, Rhubarb, Strawberry

Meats, Poultry and Meat Substitutes

  • Chicken, Beef, Lamb, Pork, Quorn, mince, Turkey, Cold cuts / deli meat / cold meats

Fish and Seafood

  • Canned tuna, Fresh fish e.g., Salmon, Cod, Haddock, Plaice, Trout
  • Seafood (ensuring nothing else is added) e.g. Crab, Lobster, Shrimp, Mussels, Oysters

Cereals, Grains, Breads, Biscuits, Pasta, Nuts and Cakes

  • Wheat free or gluten free breads, Bread made from oats, rice, corn, and potato flours, Wheat free or gluten free pasta, Buckwheat noodles, Rice noodles, Porridge and oat based cereals, Cornflakes – 1/2 cup, Rice bran, Rice Krispies, Almonds – max of 15, Amaranth, Buckwheat, Crispbread, Corncakes, Coconut – milk, cream, flesh, Hazelnuts – max of 15, Macadamia – max of 10, Millet, Oats, Oatcakes, Peanuts, Pecans – max of 15, Pine nuts – max of 15, Polenta, Potato chips, plain, Pumpkin seeds – max of 1 – 2 tbsp, Quinoa, Rice cakes, Rice crackers, Sesame seeds – max of 1 – 2 tbsp, Sunflower seeds – max of 1 – 2 tbsp, Sorgum, Tortilla chips, Walnuts – max of 10, White rice, Wheat free rye

Drinks

  • Alcohol – is an irritant to the gut, limited intake advised:
  • Beer – limited to one drink
  • Clear spirits such as Vodka
  • Gin
  • Whiskey
  • Wine – limited to one drink
  • Fruit and herbal tea – ensure no apple added
  • Lemonade – in low quantities
  • ‘Sugar’ Fizzy drinks (i.e. not diet/sugar free version) – such as lemonade, cola
  • Soya milk
  • Water

Dairy Foods and Eggs

  • Butter, Cheese, brie, Cheese, camembert, Cheese, cheddar, Cheese, cottage, Cheese, feta, Cheese, mozzarella, Cheese, ricotta – 2 tablespoons, Cheese, swiss, Dairy free chocolate pudding, Eggs, Gelato, lactose free milk, Lactose free yoghurt, Oat milk, Parmesan cheese, Rice milk, Sorbet, Soy protein (avoid soya beans), Swiss cheese, Tempeh, Tofu, Whipped cream

Ref: www.ibsdiets.org/fodmap

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