How to Manage your Irritable Bowel Syndrome with the Low FODMAP Diet

Hi guys, I’m really excited to announce that I was asked to write an article about fructose malabsorption for Suggestic, a website that deals with nutrition, food intolerances and restaurant suggestions. Well, apparently I was a little enthusiastic – I didn’t want to miss anything – so I needed to split the article in two. I have already shared part one, so here goes part two:

Last week I talked about fructose malabsorption, its link to irritable bowel syndrome (IBS) and the similarities it shares with non-coeliac gluten sensitivity (NCGS). This week, I will expand on the “fructose friendly” dietary management strategy for fructose malabsorption – the complete low FODMAP diet – that is gaining traction as the frontline dietary method for combating IBS symptoms.

IBS is generally understood as a long-term or recurrent disorder involving the function of your gastrointestinal system, usually due to imbalances of intestinal motility, function and sensation, leading to symptoms of digestive distress. It is a common occurrence in Western countries, with up to 30% of the population being affected at some point in their lives, women generally more-so than men.

What are FODMAPs?

FODMAPs” is an acronym that stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols and describes a group of readily fermentable carbohydrates that are not well absorbed in the small intestines of some people; if these carbohydrates are not broken down and/or transported through the intestinal wall and into your blood stream, they continue down into your colon, where the resident gut bacteria digest them, leading to a build-up of certain gases and short chain fatty acids, which can alter the water content of your large intestine. These products of fermentation are the causes for the wind, bloating, abdominal cramps/pain and altered bowel movements that you associate with your fructose malabsorption, lactose intolerance or IBS.

The list of FODMAPs includes:

  • Monosaccharides (single sugar units) – fructose (when consumed in excess of glucose) and galactose.
  • Disaccharides (double sugar units) – lactose.
  • Oligosaccharides (multiple sugar units) – fructans (FOS, inulin), galactans (galactooligosaccharides or GOS)
  • Polyols (sugar alcohols) – sorbitol, mannitol and other sweeteners ending in “-tol.” Some polyols, such as sorbitol and erythritol, have the added effect of decreasing the rate of fructose absorption in the small intestine even further when consumed in large enough amounts.

There are hydrogen/methane breath tests that can check whether you malabsorb fructose, lactose and/or sorbitol but the other FODMAPs must be properly eliminated and then tested with a reintroduction trial (outlined below) to know whether they are causing your symptoms…”

Read more at Suggestic.com

Once again, let me know what you guys think! I sincerely hope I didn’t miss anything out – I’m planning on writing more about the links between carbohydrate malabsorption and nutrient deficiencies soon, when I have some time over the holidays.

Thank you for taking the time to read it! Have a great weekend guys – and stay tuned for the easy to make chocolate peanut butter cookie ball recipe that’s very coming soon.

Natty xo.

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Could Fructose Malabsorption be the Cause of your Irritable Bowel Syndrome Diagnosis?

Hi guys, I’m really excited to announce that I was asked to write an article about fructose malabsorption for Suggestic, a website that deals with nutrition, food intolerances and restaurant suggestions. Well, apparently I was a little enthusiastic – I didn’t want to miss anything – so I needed to split the article in two. Here goes part one:

“So you’ve gone gluten free. You had coeliac disease ruled out first – as you should – but you still felt that wheat was a big trigger for your irritable bowel syndrome (IBS). You feel better off wheat – less bloated, more energy – but you’re not quite 100 %. What could it be?

I’m sure that many of you have by now heard of the study behind the media storm that apparently refutes the existence of non-coeliac gluten sensitivity (NCGS). Gluten is a protein that is common to the grains wheat, barley and rye. Contrary to what many of those journalists would have you believe, the researchers did not say that people who identify with NCGS are imagining it; rather, that it might actually be a different component of wheat, other than gluten, or in combination with it, that is causing them to experience IBS-like symptoms, including digestive distress, bloating and others, such as fatigue.

What then could be the culprit behind your wheat-triggered IBS? The answer: it might be fructans (also known as fructooligosaccharides or FOS). Fructans coincidentally happen to be found in large enough amounts to cause symptoms in the gluten containing grains, which includes all varieties of wheat, barley and rye; and they, along with fructose, made my first year of university… let us just say, “interesting.”

Growing up, I always had a fussy gut. When I was going through the last two years of secondary school, it got a little worse but not bad enough for me to really take notice, other than joke about it with friends. It was not until I was in my first year of university that it really got going, dictating not only the parties I could go to but things as seemingly insignificant as which seat I would take in the lecture theatres and what I could wear (think room for bloating). Luckily, my mum had an eye on me and about half way through the year (after end of semester exams really took their toll on my IBS) she read an article about coeliac disease. Digestive distress, nausea, fatigue, brain fog… I ticked most of the boxes, however, I did not have active coeliac disease. My gastroenterologist (since retired) had a game plan though and the next thing I knew I was being sent off to have hydrogen/methane breath tests to check for both lactose and fructose malabsorption*.

I had heard of lactose intolerance before, but fructose malabsorption? Well, fructose malabsorption was my answer and explained why the gluten free diet that my GP had advised me to trial earlier had helped significantly – but not completely…”

Read more at Suggestic.com.

Let me know what you guys think and please share – as awareness of fructose malabsorption spreads, it is more likely that people will be correctly diagnosed and the variety of food choices for us will increase, both at restaurants and in supermarkets.

Read part two here.

Have a great night!

Natty xo.

Creamy Roasted Pumpkin and Sage Soup – Low FODMAP, Fructose Friendly, Lactose Free & Gluten Free

Creamy Roast Pumpkin and Sage Soup - Low FODMAP, Fructose Friendly and Gluten Free, with a vegetarian option

The leaves are finally starting to change in Seattle, huzzah!

I’ve always loved soups in Autumn – okay, okay, “Fall” – and pumpkin soup was a firm favourite of mine growing up; it was one of the dishes that my Mum had nailed (another being Spanakopita – I can’t believe I haven’t posted that one yet).

Well, just my luck to marry a guy who isn’t a pumpkin fan… or a spinach fan, either, for that matter. Hmm… I kid. It’s not that he dislikes them, there’s just plenty of other foods he’d rather eat, like a spicy chili or a really spicy Szechuan dish. I like those things, too, so mostly I don’t mind the compromise but every now and then, well, once or twice each pumpkin season, I make this soup.

The recipe below isn’t exactly my Mum’s recipe, as Ev hates nutmeg. The poor soup, it just can’t win. Instead, I went for a mix of oregano and sage, as we have a handy dandy supply of those in our herb garden. I love the traditional mix of the pumpkin and sage and the addition of a little bacon and Worcestershire sauce (see notes) really brings it all home. Top nosh. Although, be warned, this soup might look light and innocent but it is definitely filling. If you’re serving it as a first course, keep the servings small. Just FYI.

PS. Apologies for the lack of “during” photos, both my camera and phone batteries had carked it.

FODMAP Notes

  1. Butternut pumpkin/squash is low FODMAP in 1/4 cup serves but is given a moderate rating for GOS and mannitol in 1/2 cup serves. Jap/Kent/Kabocha pumpkin (squash) is low FODMAP in 1/2 cup (60 g) serves, with all green lights and no upper limit listed. If you are sensitive to GOS and mannitol, go for the Jap pumpkin but otherwise, use either or a combination of both.
  2. Garlic infused olive oil is considered low FODMAP, as carbohydrates are water soluble, so the FODMAPs can’t leech into the oil, like it would into a water based dish. Either use store bought or saute garlic cloves with the oil and bacon (or butter) at the beginning and discard before the other ingredients are added.
  3. Bacon is low FODMAP, as long as no spices like onion or garlic powder are added into its cure.
  4. Green leek tips are low FODMAP in 1/2 cup servings. Beware the white bulb, which is high in FOS.
  5. Worcestershire sauce is FODMAP friendly in 2 tbsp. servings, despite the onion and garlic that might appear at the very end of the ingredients list. The 1/4 cup called for in the recipe, divided by many servings, is a very small amount and should be tolerated. If you are concerned, or cannot tolerate even a few dashes of Worcestershire sauce, sub in Balsamic vinegar to taste, 1 tbsp. serving of which gets a green light from Monash. This will alter the flavour a little but will still taste delicious.
  6. If you want to make this paleo, use unsweetened almond milk instead of the cream and Balsamic vinegar instead of the Worcestershire sauce.

Roasted Pumpkin and Sage Soup

Serving size: 1/2 to 1 cup (125 – 250 ml).

  • 2 kg approx. Butternut or Jap/Kent pumpkin (works out to 1 large Butternut)
  • 2 tbsp. garlic infused olive oil
  • 1/2 cup diced bacon (replace with 1 tbsp. butter for vegetarian version)
  • 1 cup diced green leek tips
  • 1.0 L of fructose friendly chicken or vegetable stock
  • 1/4 cup fresh oregano
  • 1/4 cup fresh sage
  • 1/4 cup Worcestershire sauce (or Balsamic vinegar if required)
  • 2 tsp. kosher salt (or more to taste)
  • 2 tsp. fresh ground black pepper
  • 1/2 cup cream (lactose free or almond milk if required)
  • 1 cup water (maybe a little more)

Preheat your oven to 200 C/400 F.

Cut the Butternut/Jap pumpkin in half, scoop out the seeds and go to town (carefully!) stabbing it with the knife, to facilitate even cooking. Lay the halves skin side down on a baking tray and sprinkle with salt. Bake in the oven for approx. 90 minutes, until a fork will easily penetrate the flesh. Remove from the oven and allow to cool until it’s comfortable to touch. Alternatively, refrigerate it until required, for up to 2 days.

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In a large saucepan, heat the garlic infused olive oil and fry the bacon until crispy. Meanwhile, scoop out the cooked pumpkin flesh. Remove the bacon and set it aside for later. Add in the diced green leek tips and saute til translucent, then throw in the pumpkin flesh, chicken or vegetable stock, oregano, sage, Worcestershire sauce, salt and pepper. Bring to the boil for 1 minute, before reducing to a simmer for 30 minutes, with the lid on.

After 30 minutes, use your stick/immersion blender to puree the mixture until it’s completely smooth. Then, add in the cream and 1 cup water and stir through – if it needs a little more fluid, add in a bit more water.  Play with the salt and pepper, until the seasoning suits your tastes. Simmer for a further 20 minutes with the lid on, before serving warm with the bacon bits sprinkled on top or keeping it on a low heat until it’s required.

I like to serve with a dollop of sour cream and some finely minced chives. A fresh slice of crusty ryce bread (or your favourite low FODMAP/gluten free bread) also goes down a treat. Dig in!

This soup, like most, is better the next day and it lasts in the fridge for five days, so you can divvy it up for weekday lunches. Alternatively, it also freezes well.

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Travel Series – Managing Fructose Malabsorption While Staying at Resorts

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As the warm weather and summer holidays are just around the corner, I thought I’d write a post about managing resort-based holidays while following a FODMAP friendly diet.

Last summer, Ev and I, along with a few friends, flew down to Cabo San Lucas in Mexico for the 4th of July long weekend. It was pure bliss, even if we did get a little bored on the second last day (thanks for the rain, weather man!). We spent four days relaxing and exploring downtown Cabo, not having to worry about cash at the resort, as everything was included.

I was initially concerned about what I would eat but, given that corn and avocados (I’m okay with polyols) are staples in every Mexican restaurant I’ve ever been to, I thought it shouldn’t be too bad. Luckily, I was right.

The following will outline how to successfully manage a resort-based holiday with fructose malabsorption.

Step 1: Can the resort cater for your dietary requirements?

From the beginning, when you’re browsing websites, many will state specifically whether they can cater for certain diets and will ask you to list dietary requirements when you book your stay. If they don’t, you can always call or email and double check.

However, as FODMAPs and fructose malabsorption are still such unknowns, you might choose to contact the resort and ask anyway. If the resort cannot cater for you, it’s up to you to decide whether you will go and supply your own foods (if possible) or you will find somewhere else.

Step 2: Make some safe food flash cards

If you don’t speak the language, flash cards listing the ingredients you can and cannot consume in the language spoken at the resort will help prevent a lot of confusion.

In fact, even if you do speak the local language, flash cards might still be a good idea as the idea of fructose malabsorption is still so novel that the apparently random list of ingredients that you cannot consume might overwhelm the staff and create an unwanted fuss.

Make sure the lists are clear and concise as to what you can and absolutely cannot consume – perhaps even just handing them the “Can Eat” list might be easier.

Step 3: Plan ahead

If at all possible, pack an emergency food supply (for transit and when you’re out on the town exploring) and bring a stash of fructose-remedies, just in case. This won’t be possible everywhere you go, due to customs regulations and the like – it’s one extra point to research before you go.

Pack any dietary supplements and take them with you if customs regulations allow it. This may include:

  • A good probiotic.
  • A multivitamin.
  • Digestive enzymes.
  • Apple cider vinegar (apparently FODMAP friendly in 1-2 tbsp. servings).
  • bicarb soda etc.

Good emergency foods include:

  • Non-perishable foods, or at least foods that will keep well for a few days in warm weather in a freezer bag (so no yoghurts or cheeses).
  • Foods that won’t tax your gut too much, especially if you plan on being tempted by local delicacies that you haven’t tried before – give yourself the best chance for success.
  • A variety of foods for different meal times.
  • See Road Tripping with Fructose Malabsorption (step 3) for a complete list of foods that may be suitable.

Handy fructose remedies could be:

  • Paracetamol (acetaminophen in the USA) – ibuprofen is a known gastric irritant, so I personally don’t take it. I’m not recommending that you do take paracetamol but it’s my preferred method of choice for helping to ease intense cramps, which aren’t fun even when you’re not on holiday. At home I might try another method first (such as water or tea) but when I’m away from home I’ll go straight to the Panadol.
  • Dextrose – to help offset any excess fructose that you may have ingested, swallowing dextrose (glucose-glucose) ASAP will help to even out the glucose/fructose ratio and potentially prevent a reaction. This all depends on how much fructose you consumed, how much glucose you followed it with and your gut’s own behaviour.
  • Water and lots of it. Not only is it healthier for your gut and body to remain hydrated but if you have to take a tablet, it’s a lot easier to take it with water than dry. Water is also useful for washing things… and on that note,
  • Wet wipes/baby wipes, in case of an emergency cleaning situation.
  • Any other methods that you can take with you that is feasibly going to be useful in case of a reaction. Something along the lines of Buscopan or Beano might be suitable but I do not recommend relying on a product you haven’t tested before to stop a reaction unless you have no other choice.
    • Buscopan contains sucrose, so is listed as inappropriate for those with “fructose intolerance.” I am assuming that they mean HFI here (as we know sucrose is safe for FM) but use your discretion when deciding whether or not to try it – it might help some with IBS but it might not help at all or even worsen your symptoms.

Step 4: Good buffets (and the staff) are your friend

At the Riu Santa Fe in Cabo, if worst came to worst, I could have lived off potatoes, avocado, eggs and corn chips. The buffet was amazeballs.

Using your flash cards (or a friend who happens to speak the language fluently), double check the ingredients with the staff for anything that could potentially hide some FODMAP bombs and decide what is safe for you. For example, the guacamole: is it just avocado, salt, olive oil and lemon juice or did they throw in some garlic, too?

Stay AWAY from the doughnuts at the breakfast bar, no matter how tempting they look – they’re just not worth it. Instead, I opted for a healthier breakfast of hard-boiled eggs, guacamole, sauteed veggies (if safe), baked potatoes and plantains in maple syrup for the sweet note. Plantains are like a cross between a banana and a potato – I don’t know for sure if they’re low FODMAP but they’re really good! The juice bar luckily had fresh squeezed OJ, so I could drink a bit of one of the pre-poured glasses. All the other juices looked phenomenal, including a really healthy (and delicious, according to Ev) green juice but of course it contained apple.

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Step 5: Relax!

Research (and experience) shows that stress is a major trigger for many with IBS style symptoms. Do yourself a favour and take a break from the stress while you’re on holiday and it could go a long way towards reducing reactions. In fact, many people report that they are able to tolerate foods on vacation that they normally could not eat back home – though I’m not sure whether this is due to lack of stress or the quality of foods they’re eating, or maybe a combination of the two.

All the steps above, especially planning ahead (and not just for the eating side of things), will help you to relax while you’re actually away and make the most of your well-earnt break.

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If you have any new suggestions for managing resort travel with dietary restrictions, please let me know in the comments section below.

Cheers and happy holidaying.