Low FODMAP Diet

Who can the low FODMAP diet help?  Reportedly, the low FODMAP diet can help those suffering from IBS and other functional gastrointestinal disorders.  Most recently I heard that it *may* be helpful for those with gastroparesis or funtional dyspepsia.

What does FODMAP mean?  FODMAP is an acronym that stands for: Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols.  These are names for a collection of molecules found in foods that cause digestion issues for some people.

What foods have FODMAPS?  

• Fructose: Honey, Apples, Mango, Pear, Watermelon, High Fructose Corn Syrup, Corn Syrup Solids.
• Fructans: Artichokes (Globe), Artichokes(Jerusalem), Asparagus, Beetroot, Chicory, Dandelion leaves, Garlic (in large amounts), Leek, Onion (brown, white, Spanish, onion powder), Raddicio lettuce, Spring Onion (white part), Wheat (in large amounts), Rye (in large amounts), Inulin, Fructo-oligosaccharides.
• Lactose: Milk, icecream, custard, dairy desserts, condensed and evaporated milk, milk powder, yoghurt, margarine, soft unripened cheeses (eg. ricotta, cottage, cream, marscarpone).
• Galacto-Oligosaccharides (GOS): Legume beans (eg. baked beans, kidney beans, bortolotti beans), Lentils, Chickpeas.
• Polyols: Apples, Apricots, Avocado, Cherries, Longon, Lychee, Nectarines, Pears , Plums, Prunes, Mushrooms, Sorbitol (420), mannitol (421), xylitol (967), maltitol (965) and Isomalt (953).

Why do these foods cause problems?  Since some people have trouble digesting the above mentioned foods, and the molecules travel past the small intestine to the large intestine.  Upon their arrival, they act as a food source to the bacteria that live there normally.  The bacteria digest/ferment the FODMAPS, which in turn causes unpleasant IBS-like symptoms.

Source for foodlist and information above:  http://shepherdworks.com.au

Low FODMAP Resources:

• About the low FODMAP diet
• Low FODMAP books
• Long list of FODMAP foods
• Foods to Avoid & Why
• Low FODMAP Shopping List
• When Everyday Foods Are Hard to Digest
• List of FODMAP friendly dieticians
• Symptom rating worksheet
• Food Diary
• FODMAP Diet Recipes
• The FODMAPS Approach
• Fructose Malabsorption & FODMAPS
• Recipes for low FODMAP dressings
• LowFODMAP.com

Next week I will feature a list of FODMAP friendly recipes, in addition to my own recipes.  I am only a few weeks into this diet, but I've found that a bit of creativity has kept in manageable so far.  I should also probably mention that I do NOT have IBS, but rather an undiagnosed functional GI disorder than I am in the process of figuring out.  It surfaced after a case of food poisoning, so there is some speculation as to what is causing the persistent symptoms (ie. a parasite, a newly developed food intolerance, post infectious gastroparesis, functional dyspepsia, etc.).

Gastroparesis Series - Part IV: Nutrition Helpers

During a flare (or if you have a consistent case of severe GP) your body may become depleted of essential nutrients.  Adequate nutrition is a fundamental component of healing, and I've found some of these products to help me meet my needs:

• Coconut Milk - this is the base for my smoothies.  My nutritionist recommended the coconut milk because it has a bit of fat in it (about 5g) and she said that would help "carry me longer".  If you can't tolerate fat, rice milk and almond milk are healthy alternatives.
• Organic Rice Protein Powder - this is a necessary addition to my morning smoothie.  I am generally too nauseated to eat solids in the morning, so this helps add protein to my morning meal which helps give me the fuel I need to start my day.
• Fish Oil or Flax Oil - while this might sound strange, these oils do contain small amounts of fat (about 2-5 g) and can help get some "healthy fat" in you without having to eat a large portion that'll make you feel overly full.  There are certain kinds out there (ex. lemon flavored by Metagenics) that reduce the yucky "fish burp" side effect.  The flax oil by Barleans comes in a delicious strawberry banana flavor and can be easily added into a smoothie.
• Nano Greens - I have yet to be able to eat and/or digest green vegetables, so I've found this product to be a life saver in getting nutrition from veggies without actually having to eat them.
• Coconut Water - this is a great thing to have on hand if you can't keep much down or if you're dehydrated.  It contains 5 essential electrolytes, making it an excellent source for hydration purposes.  Additionally, it contains more potassium than a banana and is 100% natural- not to mention it tastes very refreshing!
• Sublingual Vitamin B Complex and D - these vitamins are essential for proper immune and neurological function.  They're extra easy to keep down since they're sublingual.

You might be wondering why I didn't add Boost or any of the more commonly known nutritional shakes out there to my list.... The primary reason for this is that I have an inflammatory condition that demands that I follow a dairy-free, sugar-free, low gluten, all-natural diet.  While it is a very diet to follow, I believe it has allowed my body to improve it's healing abilities.  Many of the commercially available drinks are very necessary for some people so I am not suggesting you shouldn't use them, but I avoid them because they have ingredients that are not consistent with my diet (ex. sugar, dairy, artificial colors and flavors, etc.).  

I'm sure I'll make more discoveries as time goes on and add more to this list- check back for updates!

*Just a reminder - I am NOT a doctor and this is not intended to be medical advice.  This information is based solely on my own personal experience and the information I have come across while dealing with my GP. *

Gastroparesis Series - Part III: Resources

Books:
Sadly, there are not many helpful books out there for the GP community.  Of the few that exist, these are the only two that had consistent good reviews.

• Eating for Gastroparesis: Guidelines, Tips, and Recipes by Crystal Zaborowski Saltrelli
• Living (Well!) with Gastroparesis by Crystal Zaborowski Saltrelli

Websites:
Websites for more information, resources, Q & A, and videos.

• G-PACT
• UVA Nutrition Series: Diet Intervention for Gastroparesis
• GICare
• Living Well With Gastroparesis

Online Support Groups and Communities:
Share your story and get feedback from others.

• MDJunction Gastroparesis Support Group
• Inspire (type in "gastroparesis" or "GI motility disorders"
• G-Pact on Facebook
• Living with Gastroparesis Community on Facebook

Diet Log for Tracking Possible Food Intolerance:

This can be a helpful step in figuring out "trigger foods" or subtle intolerances.  It could also be helpful to fill out this form if you are planning to see a dietician or nutritionist in the near future.  

• Food Diary from SheperdWorks

Gastroparesis Series - Part II: Natural Remedies

For my GP, I use a combination of the following herbs, supplements, and lifestyle changes to get me through the day.  On tough days, pharmaceuticals are sometimes the only thing that help, and on really tough days even they don't do the trick.  Luckily, my GP is usually pretty well behaved and I can manage it with only minimal discomfort when I use the natural methods listed below.

• PEPPERMINT - peppermint is known to stimulate digestion and ease abdominal discomfort.  I usually drink a cup of Traditional Medicinals Organic Peppermint Tea each night after supper, and I generally take a few peppermint capsules between meals throughout the day.
• GINGER - ginger is a well known anti-nausea remedy and anti-inflammatory.  You can take this in the form of a tea, pill, or even a lozenge.  Personally, I like to drink a cup or so of Traditional Medicinals Ginger Aid Tea each day, and I also take a few Ginger/B6 Capsules (by Karuna).  There is some research that suggests that ginger in high doses (greater than 1200 mg) can help stimulate digestion.  Read more about ginger, here.
• DIGESTIVE ENZYMES - there are many to chose from, although I take a pretty basic chewable papaya enzyme.  Here is a similar formula, with a nice description of how the enzymes work.  
• DGL - this is licorice, with the glycyrrhizin component (that is known to raise blood pressure) removed.  It is said to be a great stomach soother and many people report great results for indigestion and upset stomach.  I use Enzymatic Therapy's unsweetened formula.  Read reviews of this formula on Vitacost.
• ALOE - I use the formula from Nutrametrix, in the strawberry-kiwi flavor and it is delicious!  This may be due to the fact that my first bottle of aloe juice from the Vitamin Shoppe tasted and smelled like a raw aloe plant, so I really had nowhere to go but up after that experience.  The formula from Nutrametrix is more like a juice and goes down quite easy.  I take a 2 oz "shot" on an empty stomach in the afternoon.  This product was recommended to me by my nutritionist.  I have not done an extensive amount of research on aloe, although she cautioned that many products have a laxative effect because they contain latex.  This product does NOT.  
• YOGA - there are several yoga poses that can help stimulate the digestive tract.  I love the Gaiam DVD, "Yoga Remedies for Natural Healing" because it contains an 8 minute chapter that includes yoga poses for indigestion.  Watch it for free on Hulu.  You can also check out the article "10 Yoga Poses to Improve Your Digestion" on Care2.  There are pictures and descriptions to help explain the poses.
• MEDITATION & RELAXATION - stress has a nasty effect on your GI function, so it is very important to try to find some balance in your life.  I know that chronic pain can cause a vicious cycle of stress and anxiety, but it is important to try to do what you can to lessen your stress.  In some scenarios, this may just mean accepting that there is nothing that you can do and going into survival mode until a flare comes to an end.  In other scenarios, this might mean doing daily guided relaxations or meditating daily to keep the stress levels low.  Do what's right for you at the time.  For a list of free podcasts that are great for helping with pain and providing nice guided relaxations, check out this old post. 
• WALKING - I try to take a walk at least once a day.  This is a great way to get a little exercise, some fresh air, and to get that digestive tract stimulated.

While I know it is far from a cure, I hope that this information is helpful for some of you suffering from GP!

Gastroparesis Series - Part I: The Basics

What is gastroparesis?
Gastroparesis is a condition that reduces the ability of the stomach to empty its contents, despite the fact that there is no mechanical blockage. (1)  When you have GP, the stomach muscles don't work properly so food is not propelled through your digestive tract like it should be. In many cases, it's assumed that this results from damage to the vagus nerve. (2)

How do you get gastroparesis?
The vagus nerve can be damaged by stomach surgery, or diabetes.  Other causes or risk factors for developing GP include infection, eating disorders, sclerodoma, Parkinson's, hypothyroidism, certain cancer treatments and certain medications.  In many cases people develop idiopathic gastroparesis, meaning that the cause is unknown.

What are the treatments for gastroparesis?
The most common treatment for GP is the use of motility drugs, such as Reglan or Motilium.  It is also often recommended that GP sufferers eat a low fat/low fiber diet and consume several small meals throughout the day.

There are more invasive options out there that are usually reserved for those with the more severe cases of GP.  These options include surgery, botox injections, or the use of a stomach pacemaker.  Many GP patients also need anti-emetic drugs (to help control the frequent nausea that often accompanies GP) and pain management drugs (to help control the pain that frequently is associated with GP). (2)
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In part II of this series, I will be discussing some natural alternatives that can help to manage symptoms of gastroparesis.

*Note: I am NOT a doctor.  I am sharing information that I've found from my own research and/or personal experience.  Nothing listed here is intended to be or replace medical advice from your doctor.


Sources:
1) http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001342/
2) http://www.mayoclinic.com/health/gastroparesis/DS00612