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By Dr. Maiko Ochi, N.D., L. Ac.
Many of my patients with irritable bowel syndrome symptoms (episodes of abdominal pain and discomfort, gas and bloating, and altered bowel habits ranging from diarrhea to constipation or even altering between the two but with no abnormal pathology) do not have celiac disease, an autoimmune condition where eating gluten triggers destruction of their small intestine cells. However, they feel much better when they avoid gluten-containing grains. Some even notice that when they cut out grains completely, i.e. follow a Paleo diet, their health improves tremendously.
However, a few notice that they still have symptoms even when they avoid gluten and other grains. These individuals do well by avoiding FODMAPs, which stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. These are sugars from various grains, fruits, vegetables, and dairy products. They can be poorly digested by some and be fermentable food for gut bacteria, which causes gas and other abdominal symptoms. They can draw water into the intestine to cause diarrhea.
FRUCTOSE is a sugar that is abundant in fruits such as apples, pears, watermelon, mangoes, grapes, blueberries, and dried fruit. It is also common in vegetables such as tomatoes, sugar-snap peas, and sweet peppers. High-fructose corn syrup and foods that contain it, such as jams, salad dressings, and drinks, as well as other sweeteners like honey and agave syrup, has high amounts of fructose.
LACTOSE is a sugar in dairy products, including not just cow, but goat and sheep milk. It is high in in ice cream, soft cheeses, sour cream, and custard. Those with lactose intolerance are unable to make an enzyme that digests lactose.
FRUCTANS are a type of fiber found in garlic, onions, and leeks, as well as artichokes, asparagus, and beets. They are also in bananas and grains like wheat and rye.
GALACTANS are carbohydrates that are present in the gas-producing vegetables such as cabbage, broccoli, and Brussels sprouts, as well as dried peas, beans, and soy.
POLYOLS are sugar alcohols in stone fruit (avocadoes, cherries, peaches, plums, and apricots). They include isomalt, mannitol, sorbitol, and xylitol. Sugar alcohols are used as low-calorie alternative sweeteners in packaged foods.
If you suspect you may be sensitive to FODMAPs, or have IBS symptoms despite cutting out gluten and other grains, avoid foods that are high in these sugars for several weeks. This will entail meticulously reading all labels on packaged foods – this may surprise you and can be very educational. I have a lot of patients report that they had thought they ate a very “clean” and healthy diet, but were surprised at what they were unwittingly consuming in the few packaged foods they included in their diet.
A complete list of foods low in FODMAPs and tips can be found at http://stanfordhealthcare.org/programs-services/nutrition-services/resources/low-fodmap-diet.html. Also look in your probiotic supplement, as many of these now contain prebiotics such as fructooligosaccharides (FOS), oligofructose and inulin to serve as food for intestinal bacteria.
After several weeks of avoidance, introduce each food individually and see if your symptoms return.
Be aware that a diet low in FODMAPs can be low in fiber and certain nutrients, as you are avoiding certain grains, fruits, and vegetables. You may need to take certain supplements to make sure you are getting all your nutrients.