The Low FODMAP Diet 101 (what you should know)

If you’ve been hanging around with me for a little while now, either through my blog, email letters, or over on social media, you may have noticed I’ve been dropping the F-word quite a bit.

No, not that F-word. (I’m much classier than that ;))

I’m talking about FODMAPs.

Don’t worry…if you’re not sure what that word means you’re most definitely not alone.

In this post I’m giving you a brief overview of the Low FODMAP Diet, what exactly it is and how it works, and what you should know before you begin one.

But first…

What the heck is a FODMAP?

FODMAP is actually an acronym for a group of short-chained carbohydrates (certain sugars and fibres) that are poorly digested and absorbed in the small intestine, and as a result, lead to unpleasant digestive symptoms in some individuals who have a sensitive gut – typically associated with Irritable Bowel Syndrome (IBS) and other gut-related conditions, such as Small Intestinal Overgrowth (SIBO).

These poorly absorbed FODMAPS travel to the colon largely intact where they become food for the microbes (healthy or otherwise) that naturally reside there. As a by-product of this “break-down” or fermentation process, these microbes produce gases that can contribute to bloating, abdominal distension, pain, and cramping.

Furthermore, these undigested FODMAPs also have an osmotic effect, meaning they draw water into the intestines – which can contribute to further bloating and distention. And if you’re somebody who already has fast motility to begin with, this can equate to loose stools and diarrhea.

Overall, this lovely little combo of gas and water can lead to altered and unpredictable bowel motility – both constipation and loose stools.

Enter…

The Low FODMAP Diet as a Tool for IBS Sufferers

The Low FODMAP diet is a dietary regimen that was designed by researchers at Monash University in Australia to help minimize the GI (Gastrointestinal) symptoms associated with IBS.

Research has shown that up to 75% of IBS sufferers experience relief when following a low FODMAP diet.

With up to 15% of the world population suffering from this functional gut disorder and its associated symptoms of bloating, abdominal pain, distension, excess gas, and altered bowel motility (constipation and/or diarrhea), the ramifications of these findings is quite significant.

Although each person’s experience of IBS can greatly differ within the known range of symptoms, for many people it’s a debilitating condition that can severely affect their quality of life.

 

FODMAP stands for:

Fermentable (carbohydrates easily broken down by gut bacteria)

Oligosaccharides (Fructans and Galacto-oligosacchardies aka GOS)

Disaccharides (Lactose)

Monosaccharides (excess fructose)

And

Polyols (sugar alcohols such as sorbitol and mannitol)

As you can see it’s quite a mouthful, so let’s just stick with the acronym, shall we?

 

High FODMAP Foods

Here’s a brief sampling of some high FODMAP foods by their respective categories. It’s important to note that foods can contain more than one group of FODMAPs.

Fructans: wheat, barley, rye, onions, garlic, nectarines, dried figs, inulin (added to many packaged goods)

GOS: legumes, cashews, pistachios

Lactose: milk, yogurt, cottage cheese, ice cream

Excess Fructose: apples, pears, mangos, asparagus, honey, agave nectar, high-fructose corn syrup

Polyols: apples, apricots, blackberries, mushrooms, cauliflower, snow peas, sweeteners like xylitol, sorbitol, and mannitol

 

Low FODMAP Foods

This is by no means a complete list, but some of the foods considered to be low FODMAP include:

Grapes, oranges, blueberries, strawberries, bell peppers, bok choy, carrots, eggplant, most leafy greens, cucumbers, brown and white rice, quinoa, polenta, almond milk, goat cheese, feta, cheddar, lactose-free yogurt, chia seeds, hazelnuts, pumpkin seeds, walnuts, beef, chicken, eggs, fish, firm tofu, tempeh, butter, olive oil, coconut oil, apple cider vinegar, soy sauce, peanut butter, maple syrup, dark chocolate, stevia (w/out inulin, FOS, or chicory root), most spices (except onion and garlic powder), black, green, and white tea, peppermint tea, coffee.

Keep in mind that FODMAPs are a type of carbohydrate, so if the food contains no carbohydrates, such as the case with many animal proteins and pure fats (i.e. oils), it’s safe to assume that it wouldn’t contain any naturally occurring FODMAPs.

 

Size Matters (BIG TIME)

When following this diet it’s not enough to just eat from a list of low FODMAP foods and avoid lists of high FODMAP foods, because in many cases the portion size matters.

Some foods that are considered low FODMAP can quickly become high FODMAP when eaten in larger quantities, just as some foods that are considered high FODMAP can be considered low FODMAP (and enjoyed) in a smaller portion size (i.e. 1 tbsp. vs ½ a cup).

A great reference guide for portion sizes is the Monash University Low FODMAP Diet app that can be downloaded to your smartphone. I highly recommend it as it’s continually being updated with the latest FODMAP research. (see resources below).

 

How the Diet Works (3 Stages)

1) Elimination Phase. For 2 – 6 weeks all high FODMAP foods are restricted. The point of the elimination period is to get GI symptoms under control and to assess whether or not these foods might be contributing to your symptoms.

2) Reintroduction/Re-challenge Phase. Each group and subgroup of high FODMAP foods are methodically tested one at a time and in varying portion sizes to see which ones might be potential culprits. You may discover that you can handle a small serving size of some foods, but a larger quantity triggers symptoms. And it’s not uncommon to find that only 1 or 2 categories of FODMAPs are problematic for you.

3) Personalization Phase. Based on your findings you can customize your diet to your unique needs and preferences. Once you know which foods trigger your symptoms, you can continue to either limit them or modify the portion size to suit yourself. Since FODMAPs have a cumulative effect, you may be able to eat small amounts of your “trigger foods” as long as your total overall FODMAP load is low.

 

What You Should Know Before You Begin

Before jumping into the diet here are some important considerations to be aware of:

It’s a Temporary Diet. After you complete the Elimination phase of the diet, the goal is to only avoid (or reduce) those foods that trigger your symptoms while adding back in all of the others foods that don’t and that you enjoy. It’s not about eliminating all high FODMAP foods forever.

Don’t Equate FODMAPs with Unhealthy. As you likely noticed from the food lists above, many foods high in FODMAPS are actually quite nutritious and considered part of a sustainable healthy diet. Remember, the idea is to find out which foods trigger your symptoms (and in what quantities) and then introduce them back into your diet in a way that you can enjoy them without suffering and having to police every bite.

(Of course there are some that you can ditch for good if you please. I’m *looking* at you high-fructose corn syrup.)

It’s One Piece of the Digestive Health Puzzle. While some people experience a significant reduction in their symptoms when following this diet, there may still be other factors that need to be considered alongside a low FODMAP diet such as overall diet quality, eating behaviours, hydration, stress, intestinal infections, and other potential non-FODMAP food sensitivities.

It’s NOT the First Place to Start. As you’ve likely gathered by now, this diet can be quite restrictive. While a little sacrifice upfront in the short-term can mean long-term freedom and empowerment if you can pinpoint food culprits, there are still many other factors that should be addressed first (i.e. diet, eating habits) that can potentially provide a significant relief in symptoms without having to be so restrictive from the get-go.

Seek Guidance. If you’re seriously considering following this diet fully (as in ALL in), at the very least download the Monash University app as mentioned above. Better yet though, consider working with a Certified Nutritionist or natural health practitioner who is well-versed with this diet and can guide you through each phase while keeping you accountable. 

 

Final Thoughts: Is a Low FODMAP Diet Right for You?

If you suffer from IBS, or another functional gut disorder, and the associated symptoms of abdominal pain, constipation, diarrhea/loose stools, bloating, and/or distention, then it’s definitely worth considering. Although to reiterate the point mentioned above under the list of considerations, it’s definitely not the first place to start.

It also goes without saying that it’s always important to see your medical practitioner first to rule out more serious GI diseases (i.e. Celiac Disease, Inflammatory Bowel Disease) and some gynecological conditions, which can have similar symptoms to IBS.

With that said, individuals with Inflammatory Bowel Disease (i.e. Crohn’s) or Celiac Disease can have IBS-like symptoms occur at the same time, so in conjunction with the standard treatments for these conditions (i.e. a gluten-free diet for Celiac Disease), a low FODMAP diet may provide further relief.

 

Sources/Resources

Monash Low FODMAP Diet app: https://www.monash.edu/medicine/ccs/gastroenterology/fodmap/education/iphone-app

https://aboutibs.org/facts-about-ibs

http://fodmapmonash.blogspot.ca/

 

Heal Your Gut in 5 Steps (Part 5 of 5)

Note from Elaine: This is the final part of our 5-part series on Gut Health

You can access Part 1, Part 2, Part 3, and Part 4 via the links below.

Part 1: https://www.elainebrisebois.com/healyourgut-part1/

Part 2: https://www.elainebrisebois.com/healyourgut-part2/

Part 3: https://www.elainebrisebois.com/healyourgut-part3/

Part 4: https://www.elainebrisebois.com/healyourgut-part4/

We’ve made it all the way to the final part of the series! If you’re still here with me please know that I humbly salute you for sticking around right until the end.

I realize this is a lot of information to cover, but given how many people I consult with who struggle with digestive problems (not to mention the population at large), I believe this information is critical to understand.

Moving on to step-5 of the protocol…

Step #5: Rebalance

Admittedly, this final step of the series is often the most overlooked in favor for the other parts – namely the diet and supplements aspect.

Truthfully though, you can be following the perfect diet and supplement regime and still have digestive problems if you don’t take into consideration this final point. In other words, don’t discount it for being too easy (it’s not), or something to put off until later.

You might recall from part 3 that our gut is home to our enteric nervous system, commonly referred to as our “second brain” – the part of our nervous system that controls our gastrointestinal tract.

Our brain and gut are connected by an extensive network of neurons (nerve cells) and a “highway” of neurotransmitters and hormones. This highway is known as our “gut-brain-axis” and it continually provides feedback about how hungry we are, whether we’ve eaten something disagreeable, or whether or not we’re feeling anxious or stressed.

Those butterflies you get in your stomach before a big presentation that perhaps have you running for the bathroom? That’s your gut responding to your emotional state!

Re-balance refers to all of those other lifestyle factors that impact our gut health, such as proper stress management, daily physical activity, and getting adequate sleep.

You know, all of those things that you know are important but don’t always happen because “life” gets in the way.

Deep breathing, yoga, meditation, positive affirmations, getting outside in nature, spending time with loved ones, and making time for play can all influence the release of hormones and neurotransmitters that help us to relax and reduce the effects of stress in our lives, positively affecting our gut health and our bodies at large.

I’m not saying that you have to drastically overhaul your lifestyle overnight, but consider the small changes you can create in your daily routine that ensure you’re not neglecting this area.

Perhaps it’s starting with just a few small tweaks such as:

  • Switching your cellphone into airplane mode at 9 pm to ensure a restful sleep
  • Creating a morning routine that allows you to start your day off relaxed rather than frenzied and rushed, and actually makes you excited to get out of bed (yes, it’s possible!)
  • Listening to an inspiring podcast on your morning commute to help alleviate the frustration of traffic or a jammed-packed train or subway car
  • Going for a walk outside on your lunch break or before dinner to decompress from work
  • Scheduling a weekly yoga class or massage
  • Limiting television/Netflix time to the weekend so you free up time
  • Making regular dates to connect with family and friends

Keep in mind: Progress, not perfection.

There you have it! I hope you enjoyed this series on Gut Health. If you ever feel you could use some help or guidance putting all 5 of these steps into practice in your own life, I invite you to consider one of my 1-on-1 nutrition programs.

Much love,

Elaine

 

References:

The Good Gut: Taking Control of Your Weight, Your Mood and Your Long-Term Health, by Justin Sonnenburg and Erica Sonnenburg, PhDs.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4367209/

Heal Your Gut in 5 Steps (Part 4 of 5)

Special Note: This is the fourth part of a 5-part series on Gut Health.

I’ve included the link for Part 1, Part 2, and Part 3 below, and I suggest reading those first before jumping into this 4th step.

Part 1: https://www.elainebrisebois.com/healyourgut-part1/

Part 2: https://www.elainebrisebois.com/healyourgut-part2/

Part 3: https://www.elainebrisebois.com/healyourgut-part3/

Step #4: Repair

The fourth part of the 5-step protocol involves repairing and nourishing the gut lining through the use of select nutrients, herbs, and functional foods.

Recall, I already discussed antimicrobial, digestive aids, and probiotics/fermented foods in the previous steps so I won’t be mentioning them again here.

Furthermore, be absolutely sure to address (at the very least) step 1 and step 2 before implementing step 4, otherwise you won’t be getting to the root of your digestive problems.

When it comes to gut repair there are many great supplements on the market that you could potentially use. When I work with my clients I like to make things as simple as possible and we always begin with a gut healing diet first before introducing any gut repair supplements. Once the diet is in place, then I’ll introduce supplements as needed.

Below I’ve listed some of my top choices for gut healing.

Many of the supplements can be found in combination via targeted gut healing formulas available on the market. I suggest consulting with a natural health practitioner or nutritionist who specializes in this area to find the appropriate formula and dosages best suited for you.

Gut Healing Supplements

L-Glutamine
A building block of protein, l-Glutamine is the most abundant amino acid in the body. It’s considered “conditionally” essential because although our body can produce it naturally, during times of stress it’s required in greater amounts. It also happens to be the primary fuel source for the cells of the gut, and when taken therapeutically can help maintain the integrity of the gut wall, or “heal and seal” the lining. If you’re buying it on its own, I suggest getting the powder over capsule form since it’s easier to get a therapeutic amount without having to swallow a handful of capsules.

Demulcent Herbs: Slippery Elm, Marshmallow Root, and Deglycyrrhized Licorice (DGL)
These herbs are all mucilaginous which means they produce a slimy substance that coats, soothes and protects the lining of the GI tract. They can be particularly helpful for calming inflammation and soothing digestive discomforts. These herbs can be taken in powder, tea, capsules, and lozenge form. Foods high in mucilage that you can add to your diet include: flax seeds, chia seeds, and okra.

Zinc Carnosine
A unique combination of the essential mineral zinc, well known for its antioxidant and immune support role, but also its critical involvement in tissue repair. When bound to the dipeptide carnosine, it’s been shown to protect and stabilize the mucosal lining of the gastrointestinal tract, support healthy gastric microbial balance, and relieve gastric discomforts such as heartburn, bloating, nausea, and stomach upset.

Hydrolyzed Collagen Powder
The main structural protein in connective tissue, collagen is abundant in cartilage, tendons, ligaments, marrow, and bone. When collagen is cooked it becomes what we know as gelatin. Collagen and gelatin have similar healing properties and both are rich in amino acids (particularly glycine and proline) that help to rebuild the intestinal wall. You can supplement with both through good quality grass-fed sources. I personally like the collagen powder over gelatin powder since it’s cold and hot soluble, and can be easily added to a smoothie or a warm drink without it clumping up. The gelatin powder is better for recipes where you want that “Jello effect”. You can also consume gelatin through nourishing, homemade bone broths.

Other gut-healing options include:

  • NAG (N-acetyl glucosamine)
  • Omega-3 fatty acids (particularly those found in fish and the algae they feed on)
  • Quercetin
  • Turmeric (and Curcumin)
  • Colostrum
  • Gamma Oryzanol
  • Vitamins A, C, E

As I mentioned above, you can find many of these compounds in various “gut healing” formulas on the market, although some, such as omega-3 oils for example, would be best taken as a stand-alone product.

Stay tuned later this week for part 5—the final installment in this series!

Heal Your Gut in 5 Steps (Part 3 of 5)

Special Note: This is the third part of a 5-part series on Gut Health.

I’ve included the link for Part 1 and Part 2 below, and I suggest reading those posts first before jumping into Part 3.

 Part 1: https://www.elainebrisebois.com/healyourgut-part1/

Part 2: https://www.elainebrisebois.com/healyourgut-part2/

Step #3: Reinoculate

Imagine a beautiful, lush garden growing in your backyard…or maybe on your balcony if you’re a city gal like me.

(Go with it for a second)

This garden is home to a diverse range of exotic plants and colorful flowers, all with a uniqueness of their own.

You planted the seeds and lovingly tended to its needs, paying special attention to ensure hospitable conditions for its nourishment and growth. As a result, you’ve watched it flourish to the beautiful garden it is today.

Now imagine a garden in your gut, but instead of plants and flowers, it’s made up of trillions of microbes containing at least 1000 different known species.

Welcome to your gut microbiome, also commonly referred to as your gut microflora.

It’s interesting to note that these bugs actually out number our cells 10 to 1, so it’s not unfair to say that we’re actually more microbe than we are human!

But before you get squeamish at the thought of trillions of bugs crawling around your insides, know that the majority of these microbes are actually harmless, and in fact, many benefit our health in a number of ways.

These healthy microbes are referred to as probiotics—which literally translates to “pro-life”.

Consider them the cheerleaders and support system of your gut, working on your behalf to crowd out pathogenic microorganisms and break down harmful toxins.

Health Benefits Include

  • Enhancing our immune system and making us more resistant to infection (Note: improved immune system function can reduce symptoms related to food allergies, eczema, arthritis, and many other conditions)
  • Assisting in digestion and better absorption of nutrients
  • Synthesizing important vitamins such as some of the B Vitamins and Vitamin K (necessary for utilization of calcium and blood coagulation)
  • Producing protective substances such as short-chain fatty acids that support colon health
  • Helping to correct diarrhea and constipation associated with infection or certain gut disorders like Irritable Bowel Syndrome (IBS)

Another exciting and growing area of research is the effect of probiotics on our mental health. Our gut is home to our enteric nervous system, lovingly referred to as our “second brain”, and this includes our gut microbiome. There’s growing evidence that suggests our gut microbes actually talk to our brain through our hypothalamus-pituitary-adrenal (HPA) axis, a feedback loop that regulates mood, stress, digestion, immune function, and more.

Really though this is just the tip of the iceberg when it comes to the potential health effects of probiotics!

Modern Day Dilemma

Here’s the problem though. Most people living in this day and age don’t have a gut microbiome that’s flourishing with an ideal ratio of healthy microbes.

This is because our gut flora is extremely delicate and very easily disrupted by our environment, food choices, sugar, alcohol, medications (notably antibiotics and birth control pills), and stress.

Probiotics: Food and Supplementation

The two most common ways to introduce more probiotics to your gut is through diet and supplementation.

Eating foods that are naturally rich in probiotics is the easiest method. These include foods that are cultured or fermented and contain “live” or “active” bacteria. Many of these foods are ones that our ancestors regularly consumed, but over the years fell out of fashion in favor of quicker food preparation methods. With that said, many of these foods have made a comeback in recent years and are more readily available in the marketplace, so you don’t necessarily have to prepare them from scratch yourself.

Some of these foods include:

  • Sauerkraut
  • Kimchi
  • Pickles
  • Kvass
  • Kombucha
  • Miso
  • Natto
  • Kefir (plain, unsweetened)
  • Yogurt (plain, unsweetened)

While these foods make a great addition to your diet, the best way to get a therapeutic amount of probiotics to your gut is through a good quality supplement—particularly if you’ve been ill, fighting an infection, and/or on antibiotics.

When it comes to purchasing a quality supplement it can be a bit overwhelming as there are many different types on the market.

Here’s a few pointers:

  • Not all probiotics are created equal. Choose one from a trusted brand that uses clinically tested strains.
  • Probiotics are classified by genus, species and strain. For example: Lactobacillus acidophilus La-14. In this case Lactobacillus is the genus, acidophilus is the species, and La-14 is the specific strain.
  • The most common genera used in supplements are Lactobacillus and Bifidbacterium with each containing many different species and strains, although there are other genera. One notable mention is a probiotic called Saccharomyces Boulardii, a non-pathogenic yeast that exerts a probiotic effect in the body, and is clinically effective in the treatment of gastrointestinal orders such of antibiotic-associated diarrhea and traveller’s diarrhea.
  • Not all species have the same health benefits, and will be dependent on individual strain.
  • Potency is measured in CFUs, which stands for Colonizing Forming Units.
  • Higher potency doesn’t always equate to better or more effective—more importantly are the individual strains being used.
  • Are the strains resistant to stomach acid and bile? In other words, can they survive the journey down to the gut where they exert their beneficial effect?

As I mentioned, there are a lot of different formulas on the market. Some of them include many different strains, while others include just a few key ones. Some formulas are great for everyday health maintenance and some are actually formulated to prevent or treat specific conditions such as symptoms associated with IBS or traveller’s diarrhea.

And because each of our gut microbiomes is so unique, a supplement that works great for somebody else might not be the best one for you. You might find one product that serves you well for a while, and then switch to a different one to introduce other strains into your gut. I actually encourage experimenting with different products!

A Word on Prebiotics

Prebiotics are fermentable fibres that are essentially fuel for the healthy microbes in your gut, and help them flourish—kind of like the fertilizer you add to your garden to make it grow! Oftentimes they’re added to a probiotic formula in the form of fructooligosaccharides (FOS) or inulin. You’ll see them listed on the label.

You can also get prebiotics through your diet. Rich sources include raw foods such as garlic and onions, leeks, dandelion greens, Jerusalem artichokes, chicory root, and under-ripe bananas.

One word of caution. Some people with certain gut issues such as Irritable Bowel Syndrome (IBS) can actually find that prebiotics make their symptoms worse (i.e. gas, bloating). If this is the case for you, you might want to consider a supplement that is free from these added prebiotics, or work your way up slowly either through your diet or through supplementation.

Stay tuned for Part 4 and 5 coming next week!

 

Articles Referenced

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2672.2006.02963.x/full

http://www.johnshopkinshealthreview.com/issues/fall-winter-2015/articles/the-garden-in-your-gut

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3296087/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705355/