IBS—Free at Last!

Welcome to IBSFree.net

Ibsfree.net is your resource for low-FODMAP living: frequently asked questions about FODMAPS (use the search box in the upper right hand corner of the page), product reviews, recipes, and more. The editor is Patsy Catsos, a registered, licensed dietitian in private practice, and author of IBS--Free at Last! Available from Amazon.com, IBS--Free at Last! Second Edition includes a step-by-step elimination diet, menus, shopping list, and label reading tips to help you learn to manage your irritable bowel syndrome. Please use the "comments" link at the bottom of each blog post to ask questions so that everyone can benefit from the discussion that follows. Follow Patsy Catsos on Twitter (see sidebar) or "like" IBS--Free at Last! on Facebook to be notified about new posts and other interesting tidbits. Thanks for visiting!

FODMAP-Friendly Protein Powders and Supplements

Most people can easily meet their protein needs through food alone on a low FODMAP diet,  but sometimes a little extra help from special products is needed. Athletes in training or underweight patients often ask what products are suitable, so I have reviewed the available options. Protein supplements are not right for some people, so please seek advice from your health care provider if you have any other medical conditions besides your IBS. These products are NOT meant to be sole sources of nutrition. They are used in addition to a wide variety of low FODMAP foods and beverages.

The following protein supplements do not appear to contain FODMAPs based on the list of ingredients and the nutrition info provided by the manufactureres as of today. Always double check list of ingredients before you buy:

• Nutribiotic Vegan Rice Protein Powder Vanilla
• Dr. Sears Zone Protein Powder
• Jarrow Brown Rice Protein Concentrate Vanilla Flavor (does contain a gum, gums are not FODMAPs but are close enough to be poorly tolerated by some people)
• Nestle Benecalorie (special order at pharmacy)
• Nestle Beneprotein (special order at pharmacy)
• Bi-Pro Whey Protein Isolate (online only)

 If those are not available, the next lowest FODMAP supplements would be:

• Solgar Whey to Go Whey Protein Powder Natural Vanilla Flavor (less than 1 gram of lactose per serv)
• Biochem 100% Whey Protein Powder Natural Flavor (packages claim 99% lactose free, other marketing from company says lactose-free, does contain xanthan gum). 
• Ensure Clear ("suitable for lactose intolerance" per Abbott Nutrition--not the same as lactose-free, but presumably very low lactose to support this claim)

Note that other flavors by the same companies and in the same line of products may contain FODMAPs such as fructose.

Please comment if you'd like to suggest other products. Also, please share how you consume your protein powder--low FODMAP smoothie and shake recipes are welcome!

If I have fructose intolerance must I avoid all fructose?

Should a person with fructose intolerance avoid any and all sources of fructose? The answer to this question depends on what type of fructose intolerance the person has.

Hereditary fructose intolerance (HFI) is a genetic disorder, and is not the type of fructose intolerance that some people with IBS commonly have. Individuals with HFI should not consume any fructose at all, no matter how small the amount. Many individuals with HFI are diagnosed in infancy or childhood, when caregivers not the child is violently ill after ingesting anything containing fructose, such as table sugar, fruit, or honey. Rarely, adults have undiagnosed HFI; they have an absolute aversion to sweet food of any kind, going back to chilhood. The "dislike" of sweets may run in the family.

If you have HFI or suspect you may have HFI, there are some foods on the FODMAP Elimination Diet you should not consume. Instead of proceeding with the protocol in IBS--Free at Last! you should consult your healthcare advisor for an evaluation.

Dietary fructose intolerance (DFI) is a term that describes the symptoms that some people get when they have fructose malabsorption (FM). To cleary distinguish their condition from HFI, many affected people prefer the term fructose malabsorption (FM) over dietary fructose intolerance. In my opinion it isn't as medically accurate to do so, since not everyone who malabsorbs fructose experiences uncomfortable symptoms. But still, if a patient tells me they have FM I know what they mean. Most people with DFI/FM can tolerate some amount of fructose.  With the help of the FODMAP Elimination Diet, you may be able to figure out how much is too much for you.

More information about HFI is available from the U.S. National Library of Medicine.

Can Digestive Enzymes Help my IBS?

Wouldn't it be great if you could just take a pill to help with carbohydrate digestion and absorption? Are there such pills that could promise no more trouble with FODMAPs?

The answer depends on which particular FODMAPs are your problems. To figure that out, I recommend you follow the protocol in my book, IBS—Free at Last! Second Edition, now available as a Kindle book or a paperback. I don't recommend using digestive enzymes during the Elimination Phase of the diet. Later, after you've identified the problem carbs, you can go on to consider whether digestive enzymes might help. The short answer is, if you are lactose intolerant, try using lactase enzyme pills. For all the other FODMAPs, there are no magic bullets, but some intriguing possibilities. If you like nitty-gritty details, here are some of my thoughts:

• Lactose. Digestive enzymes probably will help to some degree. Most people are lactose intolerant because they don't product enough of the enzyme lactase. It makes sense, then, that using the enzyme lactase when you eat or drink foods that contain it will probably help you manage your symptoms. Beware of lactase pills that are sweetened with other FODMAPs--check the ingredients (mannitol--ackk!!) Read a previous blog post about lactase pills here.
• Fructose. Insufficient enzymes are not the cause of fructose malabsorption. Fructose does not need to be "digested." It is already the smallest possible sugar unit. That makes it unlikely that taking an enzyme will improve absorption. Still,there is one product on the market in Europe (Fructosin®) that claims it can convert fructose to glucose for absorption. We will all be watching to see whether this type of product will be of any use; way to soon to tell.
• Polyols. I am not aware of any available enzymes that claim to help polyol digestion or absorption.
• Fructans. Fructans are chains of fructose molecules. Humans don't produce enzymes to break the bonds of those chains. That is the normal state of affairs. It seems to me that taking such an enzyme might be of limited value; it would release a flood of free fructose into the gut, with no net decrease in the FODMAP load, perhaps worsening the plight of people with fructose malabsorption. However, certain individuals may absorb fructose well but not tolerate fructans; they might benefit from experimenting with enzymes.
• Galactans. Again, humans normally don't produce enzymes to break down galactans.The enzyme alpha-galactosidase, found in some over-the-counter enzyme products such as Beano® and Digest Spectrum®, is reported to break galacatans/GOS apart into galactose molecules which can then be absorbed by humans. Beano, in particular, has been around for years, and many people report it helps them tolerate foods high in galactans. There has been little published research to back this up; most information available has been provided by the company that makes Beano. This enzyme should be used with caution by people with galactosemia or diabetes.

Most of these enzymes are produced industrially by the mold aspergillis niger, so they should be used with caution by people with allergy or sensitivity to molds.

If you have used any of these supplements, please share your experience with others by leaving a comment!

Paperback Launches: IBS—Free at Last! Second Edition

I am thrilled to announce the release of IBS—Free at Last! Second Edition. Change Your Carbs, Change Your Life (2012 Pond Cove Press)!

IBS should not make you skip a beat—get your groove back!

Tired of missing the fun because of your irritable bowel syndrome (IBS)?

Confused about what to eat?

Think you’re the only one who feels miserable while eating healthy foods like fruits, vegetables, beans, and yogurt?

You are not alone. IBS affects up to 15% of teens and adults. If you have IBS, you might be missing more than a good time. Although not a hot topic around the water cooler, IBS is the second leading cause of missed work and school, after the common cold. If you could get your groove back in just a few days by trying a new kind of diet, would you do it?

High-fiber diets for IBS are old school. You deserve to have the latest information on how the foods you eat might be causing your IBS symptoms. It’s time you learned about FODMAPs!

Registered dietitian Patsy Catsos spells out a diet program to help you find your FODMAP food triggers. Thousands of readers of the first edition of IBS—Free at Last! (Pond Cove Press, 2008) were the first to benefit from her program. Now it’s your turn.

What readers are saying about IBS—Free at Last!

“IBS—Free at Last! is a must-read for anyone with IBS who thinks they have tried it all. Many books about IBS claim they are revolutionary; this one truly is life-changing.  As a registered dietitian, I have observed first-hand how reducing FODMAPs in the diet can really work to reduce IBS symptoms quickly. My well-worn copy of IBS—Free at Last! is my go-to reference for the FODMAP diet; now Ms. Catsos brings us a second edition that is even better than the original, with expanded menu ideas, travel tips and all new Frequently Asked Questions from her readers. Her practical advice and realistic approach to the FODMAP Elimination Diet is inspiring and empowering; it offers the IBS-sufferer something that is so often elusive—hope!”—Niki Strealy, R.D., L.D., Author of The Diarrhea Dietitian: Expert Advice, Practical Solutions and Strategic Nutrition

“I was just stunned—within two days on your FODMAP Elimination Diet I felt relief. I can’t believe that I’ve been miserable all these years and not one doctor asked me anything about my diet. I had every test in the book and ‘eat more fiber’ drilled into my head. I was trying to be a good patient and it was just making me worse. It’s been two months and I feel like I’ve died and gone to heaven.”—C.F.

“The book is full of great information on a new way to treat IBS through diet. It is easy to read, goes through each step of eliminating, then reintroducing, FODMAP carbohydrates, and explains the science behind it. My IBS symptoms improved dramatically after restricting FODMAPs in my diet…The book really changed my life and health!—CA Dietitian

“Your book, IBS—Free at Last, is a dream come true for my whole family!”—C.D.

Ms. Catsos translates the science of FODMAPs into practical information. This book contains your game plan for a FODMAP Elimination Diet:

* Menus

* Shopping list

* Label reading tips

* Lists of low- and high-FODMAP foods

* A few recipes to get you started

What’s New in the Second Edition?

* Updates based on the latest research

* More on coping with FODMAP intolerance and how to enjoy your favorite foods again

* Answers to over 100 of the best reader questions

*Free downloads for readers on www.IBSFree.net

What Can Glucose/Dextrose Tablets Do to Help IBS?

As you may know, fructose is absorbed more effectively when an equal or greater amount of glucose is present in the food. This begs the question: "Why not just eat some extra glucose (a.k.a. dextrose) when I eat to help my IBS?" This might help in some limited situations if, and only if:

• You have fructose malabsorption
• You are eating a food containing excess fructose but no other FODMAPs

Since most people with FODMAP intolerance have trouble with multiple FODMAPs, and since many foods contain multiple FODMAPs, that really narrows down the potential for help from this trick. An apple, for example, contains sorbitol in addition to excess fructose. Still, some of you may find it worth trying.

Rolls of glucose/dextrose tablets are sold with diabetes supplies at the pharmacy. Some hard candies like Smarties are mostly dextrose.

Please comment if you've tried this technique and share whether it worked for you!