Prebiotics, FOS and a Low-FODMAP Diet

I was speaking to someone recently who told me her doctor had suggested a low-FODMAP diet and a probiotic - with the emphasis on her taking a probiotic which included a pre-biotic. This struck me as a bit of a contradiction, and hesitant as I was to dismiss her doctor's advice, I explained what I knew about prebiotics. But maybe we need to say a little about probiotics first? (Feel free to skip this bit if it's something you already understand).

Probiotics

Probiotics are supplements you will have come across I'm sure. They are sold in various forms such as capsules, powders, liquids and added to foods such as yogurts and yogurt drinks. They are often described as 'friendly bacteria' and advertised as a remedy for bloating. The aim of taking a probiotic is to rebalance the bacteria of the gut after a course of anti-biotics, for example, or where an excess of 'bad bacteria' has resulted in IBS type symptoms.

There seems to be general (if cautious) acceptance for the benefit of probiotics in helping manage IBS symptoms, such as this from NHS Choices;

"Probiotics may help reduce abdominal bloating and flatulence in some people with IBS, and they may help relieve pain and provide general relief. [...] however, we don't yet know the extent of the benefits, nor the most effective probiotic species and strain." (1)

Prebiotics

Prebiotics (FOS) are often included in probiotic supplements to provide a food source for these good guys, which seems reasonable, but it's possible they also feed the bad bacteria. As I found out, most of the studies into the benefits of prebiotics for gut health have been carried out on healthy people, not people with IBS.  In fact, Kevin Whelan of King's College, London reports that "in Crohn's disease and irritable bowel syndrome there is evidence that some prebiotics in high doses worsen functional symptoms." (2)

Well, as you can see in the photos below, the amount of prebiotics in supplements varies drastically. In fact I was surprised by just how much they vary. The first picture is of a bottle of probiotic capsules containing 100mg of FOS per capsule, whereas the  second picture is of a psyllium husk (fibre) supplement which contains 1620mg per serving. Quite a difference yet you might notice that the probiotic content of each is pretty similar.

 

FODMAPs

And here's that contradiction - the prebiotic Fructo-Oligosaccharides (FOS) are high FODMAP. Surely if you are reducing your FODMAP intake by limiting your diet to 'safe' foods, it doesn't make sense to add them back via prebiotic supplements, especially at the higher doses? Chances are that you are already getting sufficient prebiotics through everyday (low-FODMAP) foods anyway.

"If you are following a strict low–FODMAP diet, you can obtain prebiotics from non–FODMAP foods such as bananas, kale, chard, brown rice and oatmeal." (3)

Having discovered that I am sensitive to Fructo-oligosaccharides (including wheat, onions, garlic and cashews) I'm inclined to steer clear of probiotics which have added FOS altogether. Of course, if you can tolerate FOS (something you will discover from your low-FODMAP diet) then prebiotics probably aren't going to cause you problems either.

1. http://www.nhs.uk/Conditions/probiotics/Pages/Introduction.aspx#IBS 

2.  http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8952695&fileId=S0029665113001262

3. http://www.totalhealthmagazine.com/articles/digestion/hidden-carbs-that-can-hurt-your-gut.html

Ripe or Not? IBS, Bananas and FODMAPs.

Anyone else confused about whether bananas should be ripe or unripe (or maybe inbetween) on a low-FODMAP diet? I must admit this has been fascinating me as I remember reading some years ago that bananas benefit some people with IBS while being problematic for others. Could this be why? But then when I started reading up on it I found the info out there was more than a little bit confusing! Well, I've done a bit of digging and I think I've got it. So here goes.

It seems to me (if I've understood it correctly) that the issue with bananas is not just limited to the fructose/glucose content but also to something called 'resistant starch'. As you may already know, the fructose/glucose content of a banana varies according to how ripe or unripe it is.

'At harvest, when bananas are green and unripe, the fruits are 20 percent starch and 1 percent sugar. As the bananas ripen over 21 to 28 days, the starch turns into several types of sugars. Sucrose forms first but remains at a constant amount as fructose and glucose content increases. A fully ripe banana, which is yellow with some brown spots, is 14 percent fructose, 20 percent glucose and 66 percent sucrose, note researchers from a study published in "Food Chemistry" in May 2005.' (1) So as the glucose content is higher than fructose a ripe banana is fine. As for the sucrose, Monash University explains 'Sucrose is a disaccharide (2 sugar units) made up of equal parts of glucose and fructose. Sucrose is broken down and absorbed efficiently in the small intestine.' (2) So Sucrose isn't an issue.

But as for the starch content ...

Unripe bananas are difficult to digest as they contain something called resistant starch. 'In many ways, resistant starch is similar to and behaves like fermentable fiber in the digestive tract.' (3) And as we know 'Fermentable' is not good. Resistant starches are categorised according to four groups. Unripe bananas are classified RS2 (resistant starch type 2). 'RS2 – Is intrinsically resistant to digestion before cooking. RS2 includes unripe bananas, uncooked potatoes, along with many other foods.' (ibid).

So there you have it - two reasons to opt for ripe bananas. Hope that clears things up a bit.

1. http://www.livestrong.com/article/520165-fructose-bananas/
2. http://www.med.monash.edu/cecs/gastro/fodmap/faq.html
3. http://digestivehealthinstitute.org/2013/05/10/resistant-starch-friend-or-foe/

Low-FODMAP Veggie Summer Salad

This salad has become a firm favourite in our house this summer. I don't think it needs a recipe as such as I'm sure you can see most of the ingredients (sweet peppers, cucumber, tomatoes, radishes, olives, salad leaves and feta) and it's fun to adapt it to your own tastes. The one thing you can't see from this pic is the Quinoa base.

Quinoa is still a bit of a recent discover for me. It's low-FODMAP (of course) and gluten free so it can be eaten by people with IBS and also those with Coeliac disease. It is a complete protein and high in magnesium and iron and contains both soluble and insoluble fibre for good digestion. It also contains calcium so is a great addition to a vegan diet. I'm vegetarian, rather than vegan, so I get to enjoy a bit of both the feta and the quinoa.

The salad is dressed with a splash of olive oil and a sprinkle of sea-salt - but a squeeze of lemon juice could work well instead.

Enjoy. 

Managing IBS - A Solution Focused Approach

After being reminded recently what a miserable experience IBS can be, I wanted to share with you something a little different which I am experimenting with. This is based on the Solution Focused (SF) approach which was something I had some training in a few years ago but, so far, I haven't seen applied to IBS. Rather than focusing on your symptoms and difficulties, this approach encourages you (us) to look instead at what is already working for you - even when it feels like nothing is!

Essentially, SF explores a problem through asking questions like the ones below. These are not particularly difficult questions but are aimed at helping you recognise your strengths and coping strategies. And yes, you are strong and you are coping!

I encourage you to have a go at answering some of the questions below, and maybe making notes as you go along to reflect on or to add to later. If you can't answer them all, that's fine, go with those that you can answer fairly easily and jot down any that you might like to come back to another time. (Don't forget to bookmark this page so you can find your way here). Also if you feel you want to re-word the questions so that they better apply to you, please do so.

Just one suggestion. When answering the questions try not to use statements such as 'I wouldn't feel bloated' and instead focus on what the positive aspect of that would be, for example 'my clothes would fit comfortably' or 'I'd be able to sleep comfortably' or whatever is true for you. 

I hope you find this helpful - let me know how you get on.

1. How do you cope with your IBS?
2. What are the most effective ways you've found of managing your symptoms?
3. List 5 different ways in which you already manage your IBS.
4. If your IBS was better controlled, how would things be different for you?
5. What would tell you that your IBS problems were becoming more manageable?
6. What would you notice about yourself?
7. What would you be doing differently?
8. What would others notice about you?
9. Bring to mind a time recently when your symptoms have been (even relatively) under control. What else was different about that time?
10. What were you doing that was different to other times?
11. What was it about your diet (if anything) that was different to other times?
12. What do you think made the biggest contribution to how you felt?
13. How will you manage your symptoms better in future?
14. If you knew of one small thing you could do that would make a difference for you, what would that be?
15. What encouragement could you give yourself?
16. What have you learned from thinking about this?

A Cure for IBS?

A cure for IBS? Wouldn't that be nice? No more pain or bloating. No more planning your day around visits to the loo. No more uncomfortable nights' sleep. No more days missed off work or college. No more feeling lousy. Is it possible? I'm beginning to think so.

A few months ago I realised I'd had trouble with IBS for the best part of 20 years and quite frankly, I'd had enough! I decided it was time to get to get to grips with it once and for all. So I started another food diary and kept note of everything that passed my lips.

I'm guessing if you're reading this, you'll know what I mean when I say that it seemed like everything I ate made me ill? I instinctively felt it was food that was making me feel so awful but I was eating a healthy vegetarian diet so where was I going wrong? Determined to find a solution I scoured the net - and then I discovered FODMAPs. I also discovered that a large part of what I was eating was making it worse.

But the good news is that after just a couple of months on the low-FODMAP diet I can honestly say I feel better than I have in years. And, even though it IS a very restricted diet, I'm probably eating even healthier than before.

It's early days for me still, and I have to be honest, a low-FODMAP diet isn't really a cure but  sometimes it really does feel that way. I'm sure there will still be difficult days but I feel I am finally beginning to understand what and why certain foods cause me trouble. I know that there is more to beating IBS than FODMAPs but managing what I eat around a low-FODMAP diet has been a big step in the right direction. And now I am determined to discover what else could help.

So, if you have IBS or other digestive problems, and especially if you're a vegetarian or vegan, then this blog is for you. (A low-FODMAP diet is a bit harder for us veggies but it IS do-able.) I shall be adding lots of info on FODMAPs as well as other tips for digestive health, plus yummy veggie recipes so you can look forward to enjoying food again. I hope you'll join me.