By Darlene Endy
If you suffer from the gas, bloating, constipation and/or diarrhea common to irritable bowel syndrome, you are not alone. According to a Philadelphia gastroenterologist Dr. Jenifer Lehrer, studies have shown that 10 to 20 percent of the population suffers from IBS. Current treatments include increasing dietary fiber intake, taking a medication to reduce gastrointestinal spasms or practicing relaxation or hypnosis to manage symptoms, but often these are ineffective.
A new dietary approach involves limiting groups of highly fermentable carbohydrates in the diet, which are slowly absorbed and often fermented by bacteria found in the small and large intestine, causing excess gas and bloating. They also attract fluids into the bowel. Both the extra fluid and gas cause distension, leading to constipation, diarrhea or both. The "guts" of people with IBS are much more reactive to these side effects.
The acronym FODMAPs stands for fermentable oligosaccharides (fructans and galactans), disaccharide (lactose), monosaccharide (fructose) and polyols (sugar alcohols). Foods that contain a lot of one of these short-chain sugars are grouped together. For example, foods high in fructose are apples, coconut milk, dried fruit and fruit juices, pears and watermelon. Fructans are chains of fructose found in wheat, asparagus, beer, garlic and onions. Eliminating just one food from a group is not sufficient to reduce symptoms, but avoiding all sources of that type of carbohydrate can reduce symptoms in up to 75 percent of those people who try it.
Foods that contain FODMAPs are naturally very nutritious and should not be avoided if you don't have symptoms. If you do, it is important to restrict your diet systematically instead of just excluding all fruits or vegetables, because this could contribute to a nutrient deficiency.
Begin by keeping a food and symptom diary to identify problem foods and describe your "normal" bowel behavior. Then remove all FODMAPs from your diet for a period of six to eight weeks. If FODMAPs are a cause of your symptoms, you should find relief very quickly. (If not, return to your usual eating habits). Next, gradually add back one group of foods at a time and observe for symptoms. You may be able to tolerate a small amount of some foods but none of others. Keeping a careful record is important so that you don't exclude foods unnecessarily.
Be sure to work with a registered dietitian to help you to plan meals to exclude problem foods and still get all the nutrients you need to stay healthy, as well as provide resources to make meal planning and grocery shopping easier. You can also consult references by registered dietitians, such as, "The Complete Idiot's Guide to Eating Well With IBS" by Kate Scarlata, or "IBS-Free at Last" by Patsy Catsos.
Darlene Endy is a registered dietitian in Manlius. Learn more about her through her website, nutritionbydarlene.com.