Agave, Aspartame And The Low FODMAP Diet

Hi again Fodmappers

This week I had a message from a friend who, having been advised by her doctor to try a low-fodmap diet, was concerned at some of the things she had read online. She was particularly worried about some of the information she saw regarding Agave and Aspartame ..

'I was disheartened to see that agave was on the bad food list and aspartame was on the good food list.... this has made me lose hope and confidence in fodmap even before starting.'

I should say that my friend, like many of us, tries to eat as healthily as possible, opting for fresh fruit and vegetables and avoiding unnecessary additives as far as possible - so I could completely understand her concerns regarding Aspartame, and her doubts on seeing this recommended as part of a low-fodmap diet. So this post is dedicated to my friend, in the hope that it addresses her concerns.

But before I talk about Agave and Aspartame I want to say a little about Fructose in relation to a low-fodmap diet.

The Low-Fodmap Diet

As regular readers will know, the low-fodmap diet is a process by which a person initially eliminates all high-fodmap foods, later reintroducing them one at a time to identify their personal triggers. (If you're new to the low-fodmap diet, it would be worth you visiting 'What are FODMAPs' before reading on).

Fructose

Fructose is a Monosaccharide (the M in FODMAP) a type of carbohydrate which is poorly absorbed by people with IBS. Though it isn't possible to avoid fructose altogether, it is possible to choose foods which are low in fructose and other fodmaps, and by doing so gain some control over IBS symptoms.

Agave.

Agave has become popular as a 'healthy' alternative to sugar and has been promoted as 'natural' and low G.I. (1) alternative to sugar. It has long been used as a sweetener in South America where it is also used in the production of Tequila. However Agave syrup should be avoided on a low-fodmap diet due to it's very high fructose content.

'Most agave syrup has a higher fructose content than any commercial sweetener -- ranging from 55 to 97 percent, depending on the brand, which is FAR HIGHER than high fructose corn syrup (HFCS), which averages 55 percent.' (2)

Most Fodmappers would realise that high fructose corn syrup is to be avoided, but many people might not realise that fructose is harmful, whether you have IBS or not.

'Your body metabolizes fructose in a much different way than glucose. Fructose is broken down in your liver just like alcohol and produces many of the side effects of chronic alcohol use, right down to the "beer belly".' (2)

Aspartame

Aspartame, an artificial sweetener, is generally chosen by people wanting a low-calorie sweetener, but many fear it is carcinogenic. However, 'the US National Cancer Institute conducted a study of nearly half a million people, comparing those who consumed drinks containing aspartame with those who did not. Results of the 2006 study found that aspartame did not increase the risk of leukaemia, lymphoma or brain cancer.' (3)

But the reason that Aspartame might be included on a low-fodmap diet has nothing to do with whether it is carcinogenic or not, and everything to do with the fact that, unlike Agave, it is low-fodmap and therefore unlikely to trigger symptoms of IBS.

When you see Aspartame included on a list of low-fodmap foods, it isn't that it is recommended that you do include it, it's just that it would be preferable to high-fodmap sweeteners such as Agave.

Other low-calorie options such as Xylitol and Sorbitol are high-fodmap and best avoided for that reason.

Honey vs Sugar

While we're talking about sweeteners I think it's worth mentioning honey and sugar. I think it's fair to say that many of us would presume that honey is healthier than sugar. But from a fodmap perspective, honey should be avoided due to it being high-fodmap. Like Agave it is also high in fructose. Sugar, on the other hand is low-fodmap. Interestingly honey and sugar are listed on the current Monash App (4) but neither Aspartame or Agave are.

If you wish to avoid sugar - Stevia, maple syrup and rice syrup are suitable low-fodmap options.

So, what can we conclude from all this? It certainly throws some of our 'knowledge' of what is healthy and what is not into question. I think we have to remember that a low-fodmap diet is a way to address a specific medical condition. Just as we are used to the idea that many other health problems (such as diabetes, raised cholesterol, coeliac disease and obesity) benefit from certain dietary restrictions, so people with IBS can benefit from changes in what they eat. What is 'healthy' for one person, may not be for another.

But as for Aspartame, I have to say I'd rather go without. Even with evidence to the contrary I'd rather not risk my health, which means I'll probably continue to use sugar (in small amounts) despite the known health hazards! However, I won't be using Agave either.

And maybe that's the answer to this concern? If in doubt, leave it out.

'Til next time Fodmappers - Stay Fabulous. x

1. http://www.nhs.uk/chq/pages/1862.aspx?categoryid=51
2. http://www.huffingtonpost.com/dr-mercola/agave-this-sweetener-is-f_b_537936.html
3. http://www.nhs.uk/Livewell/Goodfood/Pages/the-truth-about-aspartame.aspx
4. http://www.med.monash.edu.au/cecs/gastro/fodmap/iphone-app.html

Can A Gluten Free Diet Help IBS?

And how is that different from a low-fodmap diet?

Hi again Fodmappers

I've noticed that there seems to be a lot of confusion surrounding gluten and whether going gluten-free can help reduce the symptoms of IBS, so that's what I want to talk about today. I also want to look at why you need to avoid wheat, barley and rye as part of a low-fodmap diet, and, finally, why some gluten-free products are not suitable for a low-fodmap diet. But first lets look at the difference between gluten and FODMAPs.

Gluten vs FODMAPs

Gluten is a protein (or more accurately a combination of two proteins) found in grains, particularly so in wheat but also in rye and barley, and it is this which gives dough it's stretchy quality. If you have bought flour for baking bread you will probably have bought a 'strong flour' as this type contains more gluten than the flour you might use for cakes or biscuits as bread making needs the elasticity that gluten provides. It's gluten that is a factor in coeliac disease.

Approximately 1 in 100 people in the U.K have coeliac disease. 'Coeliac disease is not a food allergy or intolerance, it is an autoimmune disease. In coeliac disease, eating gluten causes the lining of the small intestine to become damaged.' (1) People who have coeliac disease need to avoid ingesting even the smallest amount of gluten as to do so can cause further damage to the lining of the gut.

Fodmaps, on the other hand, are a group of carbohydrates found, not only in grains, but also in fruit, vegetables, nuts, pulses and dairy produce. 'Current research strongly suggests that this group of carbohydrates contributes to IBS...' (2)

IBS is much more common than coeliac disease, affecting between 1 in 4 and 1 in 10 people at any given time. (3) Though it is a chronic condition, it is a functional disorder. That is to say, the problem is in the way the gut functions, rather than in any damage to the gut itself.

Though wheat, barley and rye contain gluten they are also high-fodmap, and this seems to be where the confusion arises.

If you have IBS you may have discovered that you feel better if you eat gluten free products rather than wheat-based breads, biscuits, cakes, pastas and cereals. However, this is likely to be because, by choosing gluten free, you are also removing high-fodmap grains (such as wheat, rye and barley) from your diet.

A Gluten Free Caution

But if you have IBS, you do not need to avoid gluten, you need to avoid fodmaps. In fact fodmappers need to be careful when choosing 'gluten-free' as these products are designed for people with coeliac disease not IBS. Just because they are gluten-free doesn't mean they are necessarily low-fodmap. Remember fodmaps are found in more than just grains, and gluten-free products may also contain soya flour, apple fibre or inulin (from chicory) all of which are high-fodmap.

So the short answer to the question, 'can a gluten free diet help IBS?', is yes. But it has nothing to do with gluten. I hope that's cleared things up a bit?

'Til next time Fodmappers - Stay Fabulous. x

1. https://www.coeliac.org.uk/coeliac-disease/myths-about-coeliac-disease/
2. http://www.med.monash.edu/cecs/gastro/fodmap/
3. http://www.aboutibs.org/site/what-is-ibs/facts/

Protein in the Vegetarian Low-FODMAP diet

 

The question is - are you getting enough?

Hi again fodmappers. 

A couple of times lately I've been asked how I manage to get enough protein on a vegetarian low-fodmap diet. It's a good question because, as you probably know, many of the usual vegetarian protein sources (legumes and some nuts) are off limits. Though I felt intuitively that I do get enough, it never hurts to do a bit of research and check. So that's been my project this last week.

I soon realised that, before looking at whether I was getting enough, I had to find out how much protein I should be having. That seems obvious I know, but when you constantly see ads for protein shakes, bars and protein based weight-loss programmes, the suggestion seems to be that none of us are getting enough, let alone anyone on a restricted diet!

The first figures I came across were that a sedentary man needs 56g a day and a woman needs 46g. Those figures weren't working for me for a simple reason, and that is that our need for protein must differ according to our body size, age and health, as well as our activity levels. After a while I tracked down a suggested intake of 0.66g of protein per kg of body weight for both men and women. (1) For me that works out at 31.43g of protein per day - much less than the average guidelines.

My next task, of course, was to find out how much protein there is in the food I eat. (A summary of just one day is at the end of today's blog). It's surprising what contains what!

I've recently converted to using cups as a way of measuring dry and liquid ingredients, but if you don't have these handy little measuring devices you might like to know that 1 cup is the same as 250ml. Simply find something in your kitchen that holds 250ml and you're away.

Dairy and Milk Alternatives

• 1 large egg = 6g
• 1 cup of grated cheddar cheese = 28g
• 1 cubic inch of cheddar cheese = 4.2g
• 1 cup of crumbled feta cheese = 21g
• 1 cubic inch of feta = 2.4g
• 1 cup of lactose free milk = 9g
• 1 cup of almond milk = 1.25g
• 1 cup of oat milk = 2.5g
• 1 cup of oat milk = 0.25g

Nuts and Seeds

• 1 cup of walnuts = 18g
• 1 cup of brazil nuts = 19g
• 1 cup of hazelnuts = 20g
• 1 cup of sunflower seeds = 29g
• 1 cup of sesame seeds = 26g
• 1 cup of dried pumpkin seeds = 39g
• 1 tbsp of peanut butter = 4g
• 1 tbsp of almond butter = 3.35g
• 1 tbsp of tahini/sesame seed paste = 3g

Grains

• 1 cup of cooked buckwheat = 6g
• 1 cup of cooked quinoa = 8g
• 1 cup of cooked brown rice = 5g
• 1 cup of cooked white rice = 4.2g
• 1 cup dry oatmeal/porridge oats = 6g

Fruit and Vegetables

• 1 medium banana = 1.3g
• 1 medium kiwi fruit = 0.8g
• 1 cup of spinach = 0.9g
• 1 large potato (baked with skin) = 7g
• 1 red or yellow bell pepper = 1g
• 1 small courgette = 1.4g
• 1 cup of shredded lettuce = 0.5g
• 1 medium tomato = 1.1g
• 1 cup of cubed butternut squash = 1.4g

Bread and Crackers

• 1 slice of Genius triple seeded bread = 2.1g
• 1 slice of Genius brown bread = 1.2g
• 1 slice of Genius spicy fruit bread = 1.2g
• 1 Kallo Organic unsalted rice cake =  0.6g
• 1 Nairns oat cake = 0.8g

Pasta

• 100g Orgran buckwheat spirals = 11.2g
• 100g Orgran corn and vegetable spirals = 6.9g

Other

• 100g of Tofu = 8g
• 100g of canned chick peas = 4.3g

I could include much more ....

So, back to the question of whether I am getting enough protein. The only way this was going to be accurate was if I added it up as I went along. So one day last week I met a friend for a cuppa (Hi Jacqui) and kept notes.

My breakfast that day was 1 banana (1.3g) and a bowl of porridge made with half a cup of oats and 1 cup of lactose free milk (12g). Mid-morning I had a gluten free coconut and raspberry slice (4g). And lunch was a kiwi fuit (0.8g), a peanut butter sandwich on Genius fruit bread (6.4g) and a small savoury muffin (6g). The recipe for the muffin (and it's really easy) can be found here.

If you've been counting you'll know that comes to 30.05g of protein (remember I need to aim for 31.43g) and at that point I have to confess I stopped counting.

But this has been an interesting issue to explore. I had never realised what a difference there is in the protein content of the low-fodmap milks, for example, and how something as simple as a bowl of porridge can give a real protein boost to the start of your day. It's an exercise that's definitely worth doing.

And it's been reassuring. The low-FODMAP diet is complicated enough, especially for vegetarians and vegans, without worrying about protein too.

So a big thank you to those of you who have asked, you know who you are. It's been an eye-opener putting this list together, and an education. If there are any other topics you'd like me to explore, please let me know.

1. http://www.nal.usda.gov/fnic/DRI/DRI_Tables/recommended_intakes_individuals.pdf

Chocolate Gets the Green Light

I love to share good news and, if you like chocolate, I have some very good news indeed. Dark chocolate is low-FODMAP!! (Doing a little happy dance right now - feel free to join in).

When I wrote about Rainbow Drops I promised I'd seek out more fun foods for you, and I just love chocolate so it had to be next. Well it seems Monash University (who we have to thank for coming up with the low-FODMAP diet) have kindly delved into this topic for us and the results are as follows.

Marked according to their traffic light system, one 30g serving (approx 5 squares) of dark chocolate, gets a green light. This means that it's low FODMAP and safe to enjoy as part of your diet. Right now I'm imagining dark chocolate chips in yummy low-FODMAP muffins. Mmmmmm.

However, the same size serving of both milk and white chocolate are given an amber light. This indicates that these contain a moderate amount of FODMAPs due to the lactose content. Depending on how well you tolerate lactose will depend on whether you can enjoy these too.

But a word of caution is probably called for before you dash off to buy the very best (and darkest) chocolate you can find, and that is to say that it's vitally important to stick to the serving size. FODMAPs are cumulative - the more you eat the more you increase your FODMAP level, and the higher the FODMAP level the greater the risk of tummy upsets.

Also Monash advise sticking to small portions as "Chocolate is high in fat, and when consumed in excess can affect gut motility and may trigger symptoms." (1)

Having said that, I think this still counts as good news and I hope it's brought as big smile to your face as it has to mine. I've always been partial to a nice bit of dark chocolate and don't we all deserve a treat now and then?

I think FODMAP just got a little more fabulous!

1. http://www.med.monash.edu.au/cecs/gastro/fodmap/diet-updates/chocolate.html

Buckwheat - The Wheat You Can Eat

 

Don't panic Fodmappers! If you haven't already discovered Buckwheat I have a surprise in store for you. Buckwheat isn't wheat - which means you can eat it as part of a low-FODMAP diet.

Buckwheat is something which is called a 'pseudocereal' (1) because, though it isn't a grass (which wheat is) it can be used in much the same way as grains which are. Buckwheat flour can be made into bread, pastry or pancakes (though when making pancakes remember to use a lactose-free milk) or bought as pasta or noodles. The grains can be toasted and then cooked in twice the volume of water (one cup of grains to two cups or water) to make a nice and nutty change from rice. Alternatively they can be sprouted in just a few days and added to salads, breads or breakfast cereals.

Sprouting Buckwheat couldn't be easier. Of all the grains I've sprouted over the years, this is definitely one of the quickest to grow. I use the Bio-Snacky jar but you could also use an ordinary large jar and a piece of muslin. Simply put a couple of tablespoons of grains into the jar, rinse well, soak for about 30 mins and then strain. Rinse and strain twice daily until the grains develop little tails - which in warm weather might be as quickly as 2 days.

Alternatively you could just use a sieve, like this guy does here. Take it away chef!

If you're still not convinced you might be interested to know that Buckwheat is incredibly good for you! (2) It is high in zinc, copper, potassium and manganese and also high in protein. Protein can be a bit of a challenge for vegetarian and vegan fodmappers as many of the usual sources (such as lentils, chick peas, soya and tvp) are high-fodmap and therefore to be avoided. Buckwheat can replace some of the lost protein. It is also a good source of soluble fibre.

As you can see from the sneaky peek into my kitchen above, I've rather taken to Buckwheat. You might even notice that the label on the taller jar reads 'Buckwheat - Yum'. To be honest, unless it's toasted it doesn't have a strong taste at all, which means it will pretty much go with anything you fancy. Right now I fancy cake. I found this recipe on 'A Clean Bake'. Mmmm - Buckwheat cup-cakes. Got to try that.

'Til next time Fodmappers. 

1. http://en.wikipedia.org/wiki/Pseudocereal

2. http://nutritiondata.self.com/facts/cereal-grains-and-pasta/5681/2

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/