MEDIA UPDATES

5 Low FODMAP Swaps

Fox News features dietitian, Tanya Zuckerbrot and her take on some simple Low FODMAP swaps. Try these Low FODMAP foods that are just as satisfying (and delicious) as their high FODMAP counterparts

• Eat blueberries instead of apples: blueberries are a convenient Low FODMAP option for anyone with a low tolerance for fructose.
• Switch out artichokes for eggplant: increase your veggie intake by adding eggplant to your diet. Eggplant is low in fructans which is a carbohydrate found in artichokes, garlic, and onions.
• Try spaghetti squash instead of pasta: instead of reaching for a wheat-free pasta try making spaghetti squash. It’s a low-fructan option for anyone following the Low FODMAP diet, and it’s simple to prepare.
• Nibble on mozzarella cheese instead of cottage cheese: switch your high lactose dairy products like cottage cheese for harder cheeses such as mozzarella or cheddar.
• Enjoy lentils instead of kidney beans: kidney beans are high in fructans, so swapping them out for lentils is a great way to increase fibre while on the Low FODMAP diet.

What is the Low Residue Diet?

Longevity magazine recently wrote a great piece about the low residue diet. The low residue diet excludes foods high in fibre and foods that move quickly through your gut (i.e. prune juice or dairy products). The goal of the diet is to decrease symptoms such as bloating and frequency of bowel movements. Foods you would typically limit on a low residue diet include: whole-grains, nuts, seeds, raw vegetables, and dried fruit. The word ‘residue’ refers to the undigested food that makes up your stool.

Your doctor or dietitian may recommend a low residue diet if you have IBS or  IBD, have had recent surgery to your digestive tract or are having upcoming surgery to your digestive tract (i.e. colonoscopy). It allows your gut to rest and may help alleviate symptoms. A low residue diet is not meant to be used as a long-term solution for symptom relief.

The best way to determine what is and isn’t working for you is to start a food and symptom journal. You can track which foods trigger your symptoms, as well as the time of day symptoms seem to strike. A dietitian can help you through this process to help you identify patterns and to ensure your nutrient needs are being met. Here are 5 tips to help you follow a low residue diet:

How to Follow a Low Residue Diet

1. Understand your fibre tolerance: Everyone responds differently to fibre so it’s important to discuss with your doctor or dietitian about your tolerance and requirements.
2. Cook your vegetables: Cooking your vegetables helps break down the fibre, making it easier for your stomach to digest.
3. Select the right fruit: Some fruits are higher in fibre than others, look for fruits that allow you to remove the skin/rind and avoid the seeds like bananas or avocado.
4. Focus on starchy vegetables: Many of the carbohydrates you can eat on the low residue diet are highly refine (i.e. white bread). Select complex carbohydrates like squash to meet your nutrient needs.
5. Watch out for dairy: Dairy does not contain fibre, but it can still trigger symptoms, especially for those who are lactose intolerant.

 

RESEARCH UPDATES

What Causes IBS

The exact causes of IBS are unknown, but over the years, researchers have determined several factors that predispose someone to developing IBS. These factors include: genetics, sudden infections, stress, and an imbalance in gut bacteria. For instance, a sudden infection caused by C. difficile or C.jejuni may alter gut bacteria, resulting in the development of IBS.

Additionally, there appears to be a link between antibiotic use and IBS. A study conducted by Maxwell and colleagues found that 30% of people with IBS had taken antibiotics over an extended period of time prior to their symptoms appearing. Since antibiotics don’t discriminate between the beneficial bacteria in your gut and the pathogen that’s causing your infection, it is thought that the decrease in gut bacteria caused by antibiotics may increase a person’s susceptibility to developing IBS.

The increased awareness of the impact our gut bacteria has on our overall health has led to a growing body of research investigating the gut microbiota. With this new information, we are discovering that the gut bacteria of people with IBS isn’t as diverse as otherwise healthy people. We don’t yet know enough to determine whether the chicken or the egg came first, that is, whether or not a bacterial imbalance is the cause of IBS, or just an effect.

Strategies to Treat IBS

Researchers James Pearson and Peter Whorwell conducted a review of the most recent research investigating different forms of therapy that alter gut bacteria. Published in the Current Opinion in Gastroenterology January edition, the purpose of the review was to summarize what we currently know about these therapies. Strategies reviewed included the Low FODMAP diet, prebiotics, probiotics, antibiotics, symbiotics, and fecal transplants.

Low FODMAP Diet and Gut Bacteria

Individuals following a Low FODMAP diet are likely to have a decrease in the amount and diversity of bacteria in their gut. This is due to the restrictive nature of the diet, specifically certain types of carbohydrates which our gut bacteria like to use for food. That’s why we recommend staying on the elimination phase of the diet for no longer than 8-12 weeks. Recently, a low FODMAP rye bread has been developed to increase the amount and variety of fibre which can be tolerated on a Low FODMAP diet.

Prebiotics and IBS

Prebiotics act as food for the bacteria in your gut. However, some prebiotics are also high in FODMAPS so individuals with IBS need to be careful. One prebiotic, guar gum, has been shown to increase a certain type of bacteria (Lactobacilli) that is associated with decreased bloating.

Probiotics and IBS

There have been numerous studies looking at the effects of using probiotics to manage IBS symptoms. It is hypothesized that certain strains of bacteria may work better for different subtypes of IBS. Pearson and Whorwell concluded that probiotics are beneficial for people with IBS but their impact on symptoms is determined by the strains of bacteria present in the supplement and how the probiotic is prepared. The research also warns that people may not see benefits right away, since it takes some time for bacterial colonies to establish themselves in the gut. In the future, it’s possible that we might see probiotic formulas with customized strains of bacteria that target specific symptoms.

Antibiotics and IBS

The role of antibiotics in the treatment of IBS is controversial. They may increase the chances of developing IBS for some people, but they may also provide relief for others. Rifaximin is a commonly prescribed antibiotic for IBS, but its benefits may not outweigh potential costs. With increased risks of C.difficile infection and possibility of microbial resistance, an antibiotic prescription should remain a last resort after all other strategies have been exhausted.

Symbiotics and IBS

Symbiotics are a combination of a probiotic and a prebiotic that work together to improve gut health. Studies have yet to support their use in improving symptoms, but they do seem to increase the diversity of gut bacteria.

Fecal Microbiota Transplants and IBS

The data on fecal transplant for treatment of IBS symptoms is limited, but it’s an exciting new area of research. One study found that for people with IBS-D, fecal transplant resulted in relief from their symptoms. These results were long-lasting, with participants reporting symptom relief up to one year following the transplant.

Altering Gut Bacteria to Treat IBS

There’s a growing body of evidence exploring treatments targeted at altering the bacteria in the gut. We are just scratching the surface in terms of our understanding of the gut microbiome and how to harness its power to improve our digestive health, but things are looking promising, and we hope to see better treatment options for those with IBS in the near future.

 

Written by Adi Hazlewood, News and Culture Editor

 

References

1. Pearson JS and Whorwell PJ. Progress with treating the microbial dybiosis associate with IBS. 2017. Current Opinion in Gastroenterology.
2. Zuckerbrot T. Fox News.  Low FODMAP swaps anyone can digest. 2017.
3. Wildt M. Longevity Live. When do you need to follow a low residue diet? 2017.