Friday, January 27, 2012

An Apple A Day May Not Keep Bloat Away

Ladies and gentlemen, children of all ages (nope, not talking about the circus) all have unpleasant changes in their bowel movements bloating or gassiness from time to time. For some, these GI symptoms are a daily struggle. I’ve had clients who have dabbled in lactose free or gluten free with little improvement. A couple of years ago, I learned of the Low FODMAP diet. FODMAP stands for Fermentable Oligo-, Di- and Mono-saccharides, and Polyols. God bless the acronym.

The science: high FODMAP foods are poorly absorbed in the small intestine which leads to bacterial fermentation in the colon and then bloating, pain and gas in susceptible individuals. So what foods are these? Fruits such as apples and pears, many vegetables including onions, garlic, asparagus, wheat (because of it’s fructan content not the gluten), most artificial sweeteners and legumes.

It’s generally suggested to first eliminate all high FODMAP foods and then be sure to keep total FODMAP content in your diet low. There’s a threshold effect so a little bit may be fine but in combination…. watch out. A recent Wall Street Journal article talked about the low FODMAP concept, which originated in Australia, gaining support in the US.  The results from the studies done are impressive with figures around 75 to 80 percent of participant’s symptoms improving. I have introduced the FODMAP system to many clients but have a nutrition colleague, Gina Casagrande aka The Candid RD, who is not only a fantastic supermarket nutritionist but also a low FODMAP follower herself.  Gina’s blog has been one of my favorites since I started this one.

Who should try the FODMAP system? 
I think anyone who feels like they are constantly bloated, gassy, or who has chronic constipation and diarrhea (on and off). However, I wouldn't suggest anyone doing it without a dietitian to guide them, as it's easy to fall short in certain nutrients if you aren't careful (so many vegetables and fruits aren't allowed!).

How long until you felt it was "working"
Honestly, within a couple days.  Prior to starting the diet, I was eating garlic and apples every single day. These are two foods that give me my worst symptoms, so when I took them out of my diet I felt amazing (as in, I didn't have gas and bloating).

I'll admit I hadn't heard of FODMAPS until the last couple of years, why do you think it’s gaining ground (WSJ article etc.)? 
Because it works.  More and more people are trying it out of desperation and realizing that it's helpful.  More research is being done too, which means more widespread knowledge and education.

Is this something you have to do 100%? Do you ever cheat? 
Oh yes, I cheat, but only if the food or drink is worth the pain. Actually I've found that certain "bad foods"  (like beans) that don't cause me a lot of problems unless I eat a lot of them.  Then there are foods (like garlic) where if I eat just one bite I have a problem.  I have been doing this diet for three years now, so I sort of know my limits.

What food(s) do you miss the most?
 I miss apples, a lot.  I miss garlic and onion too, but mainly because it's difficult to cook without those. 

What resources you'd suggest?
 I encourage anyone to get in contact with me if they have questions. Also the booklet from the Monash University in Australia (where most of the research has been done) has been a lifesaver for me.

Thanks Gina, this is not an easy protocol to follow because there are items in each food group to avoid. On the other hand, if it's a way to figure out triggers for pain and discomfort it's well worth it.Have you heard of FODMAPS before? Do you know anyone who has tried this approach? And because we’re “going there” what are your GI issues?
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  1. LOVE IT!
    Great job LAuren. Thanks for the kind words too.
    As I just wrote you on Twitter, mention BEANO if you can, it's the only way I can still enjoy my beans and broccoli! Also, Gas-Ex has their own "Beano" now, that is cheaper.

  2. I read the Wall Street Journal article and thought it might help my husband's symptoms. He'd done the same elimination diet I did which helped me learn of my dairy allergy and left me feeling great. It didn't help him. Sure enough, FODMAP did. Cooking is a whole new challenge though.

  3. I had heard of FODMAPS through Gina's blog too. I really should try this since I struggle often with gas and bloating. TMI!? ;)

  4. Do these issues change as we age?

  5. I am pretty sensitive in the GI department. This is fascinating as I had never heard of FODMAPS. I will experiment. Thanks!

  6. Thanks for the information Gina and Lauren...I totally know that certain healthy foods do not agree with me! It's frustrating but in the grand scheme of things I am okay not eating things like lentils too often. There are worse things, right?

  7. Ameena, yes the irony is that many FODMAP foods are "healthy" good point. Cameo, if you haven't heard of many people haven't worth testing out. Especially with fruit we can all skew in the low FODMAP direction. The veggies are tough. Caron, yes digestive issues can change and sensitivities can develop. I had to stop wheat 2 years ago and before that my symptoms weren't there or were much more subtle. Kristin, not TMI here gas, gas, gas :) FODMAP cooking has to be hard, GIna has some great recipes and modifications.

  8. Thank you Gina and Ameena I also know that certain foods are not healthy for me..I appreciate the information :)

  9. Glad you posted this Lauren, and shared Gina's expertise. I love her blog too, and she has some great FODMAPs resources, plus personal experience to share! I have used this approach with a few clients and they have had really good results. Another good resource for FODMAPs is Kate Scarlatta, RD. She has a lot of great information as well.

  10. FODMAP was totally new to me until Gina mentioned it. I should read more about it because yes to apples and onions causing me stomach pain/bloating!
    Great info =)

  11. Although FODMAP is frequently used for those with IBS I think we may all be vulnerable to certain foods. EA- does Katie Scarlatta have a site? Blog? Ayala, sorry there's no "poetic" way to talk gas/bloating. Forgive me.

  12. Hmm this is interesting and I really understood it. I think part of the reasons why is that I don't experience a lot of bloating with 'real' foods. I have horrible reactions to fake sugars/processed foods in the bloating dept.

  13. I did not realize that there was a specific diet delineating these foods. But it makes sense. I am always bloated after apples and pears, and its hard to reconcile that with the fact that they are healthy.

  14. I'm on a low FODMAP diet and have starting blogging about it as it's been beyond *fab* for my Dad and I. Great that it's becoming more and more known! It'll sort out everyone's' rumbly tums in no time!x