Monday, January 30, 2017

Eating for IBS: The FODMAP Diet

This is a re-post from a few years ago. This topic is getting continued interest so I thought I would re-visit it! 

            As a registered dietitian, I have been counseling patients with a variety of medical needs for years. The condition that has always left me empty handed when it comes to patient advice is irritable bowel syndrome (IBS). Most of our nutrition texts simply state “the patient has to figure out for themselves what foods they can and cannot tolerate”. Big help huh? Well, after a little searching, I found a little-known diet based on a little-know hypothesis that may help with IBS.

            First, a little background on IBS:

IBS is one of the most common disorders that doctors diagnose.

Ø  As many as 20% of Americans have IBS.
Ø  The good thing about IBS is that it is not a dangerous disease. There is no damage to the intestines with IBS and no risk of any long-term complications. Other intestinal diseases like celiac disease or Crohn’s disease where the intestine is actually physically damaged.
Ø  The bad thing is that IBS can wreck your life. People who have it experience bloating, abdominal discomfort, and can alternate between diarrhea and constipation. And there really isn’t a cure for it.
Ø  But the good news is that some people may respond well to a diet called the “Low FODMAP” diet.

           The idea behind it is that foods from 5 different groups tend to ferment in the intestine and contribute to the symptoms of people with IBS. The idea was developed and studied by an Australian nutritionist. While more research is needed to find out if it really works, it can’t hurt to try it. The foods are abbreviated by the acronym FODMAPS: Fermentable Oligo-, Di-, Mono-saccharides and Polyols. High FODMAP foods tend to ferment in your intestines and cause the symptoms of IBS. High FODMAP foods include prunes, apples, milk, watermelon, asparagus, avocado, corn, and wheat. But there are many more.

            You don’t have to completely eliminate all of the foods on the list – you may be able to handle some in small amounts. You may be more sensitive to some than others. So, if you are struggling with IBS, I recommend that you eliminate the FODMAP foods for several days to a week. If you find that your symptoms subside, then you can add back individual foods (one at a time) from the list to see which are more problematic for you. Obviously, keeping a detailed food record will be very important for sleuthing out the foods you need to ditch from your diet.

            I do recommend that you work with a registered dietitian to help you develop your own healthy, low FODMAP diet! You don’t need to simply eliminate all high FODMAP foods. In fact, cutting them all out could be bad for your diet. However, here is a list from Barbara Bolen, PhD, a leader in this research: 

Beth Kitchin, PhD, RDN
Assistant Professor, Nutrition Sciences
University of Alabama at Birmingham 

Tuesday, January 17, 2017

Brain Food

The MIND diet was one of U.S. News and World’s top diet picks in last week’s big reveal of the best 2017 diets. Some studies show that following the MIND diet is associated with a lower risk of Alzheimer’s disease and better cognitive function.

How good is the research? The data is really preliminary – observational studies that can’t show cause and effect, just associations or correlations. So, what you’re reading is likely over-hyped. But what isn’t overhyped in nutrition news? However, if you’re interested in the MIND diet, it is a healthy, plant based diet that does not cut out large categories of foods. Even if it doesn’t live up to the hype, you could end up with benefits such as weight loss, heart health, and lower blood pressure because it is basically a combo of the Mediterranean diet and the DASH diet. These two diets have stronger research to support their benefits.

Let’s take a look at foods that supposedly give your brain a boost, and the foods you should limit.

Supposedly Brain Healthy Foods:

1.     Green Leafies (think kale, romaine lettuce, spinach) every day
2.     Other Vegetables – at least one a day in addition to the green leafies
3.     Berries – particularly blueberries and strawberries – a half cup several times a week
4.     Nuts & Seeds on most days
5.     Starchy Beans – every other day
6.     Olive Oil – use it as your primary cooking oil
7.      Whole Grains – like brown rice, whole grain breads and cereals – 3 servings a day
8.     Wine – a glass a day - but if you're a non-drinker, just             skip this one! 
9.    Fish at least once a week
10.  Poultry twice a week

Supposedly Brain Unhealthy Foods:
1.     Butter – less than one tablespoon a day
2.     Red Meat – 3 servings or fewer servings a week
3.     Cheese – fewer than 1 serving a week (undoable for cheese lovers and probably not             necessary to cut it out anyway)
4.     Fried Foods/Fast Foods – no more than once a week
5.     Sweets – 5 or fewer a week

Here’s a sample one day MIND meal plan:

3/4 cup bran flakes with ½ cup blueberries
1 slice whole grain toast with 2 tsp peanut butter

1/3 cup cashews
1 cup strawberries

      2 slices whole-wheat bread
3 ounces chicken
      1 teaspoon Dijon mustard
     1 cup romaine lettuce
     ½ cup raw vegetables
     1 tablespoon sunflower seeds
     Olive Oil Dressing


      1/2 cup romaine lettuce
1/2 cup baby spinach
1 tablespoon olive oil vinaigrette
3-ounce salmon cooked in olive oil
1/2 cup brown rice 
1/2 cup zucchini and asparagus spears
1 cup lima beans
5 ounces red wine

1/2 cup sliced almonds

Now, let me tell you what I don’t like about this diet.  Some of the restrictions are reasonable – others are not:

·For us cheese lovers, eating less than one ounce of cheese a week is crazy. And it’s probably not even necessary. And, yes, I have bit of a bias about cheese! I love it and will never give it up! 
·No mayo on your sandwich? For some that’s fine, others it’s not.
·I think the red meat guideline is pretty good – eating several servings a week is not too rigid.
·But I think with sweets, you can have a small amount every day to satisfy your sweet tooth. We should definitely limits sweets – but if you’re like me – I need a little chocolate every day!

So, here’s what I recommend. Start by focusing on the “brain healthy” foods like berries, nuts and seeds, olive oil, fish, and lots of green leafies. Find olive oil based salad dressing that you like or make your own and dress up your salad with nuts and seeds, tuna, chicken, and yes, a little cheese if you like it.  You don’t have to eat all your green leafies in salads. For instance, you can sautee spinach and kale in olive oil. Berries can be expensive – so look for frozen blueberries and strawberries and add them to yogurt or smoothies.  

Check out the U.S. News and World’s evaluation of this diet and many more:

Make sure you go to the “Expert Reviews” section for a good analysis of the claims the diets make.  

Beth Kitchin, PhD, RDN
Assistant Professor, Nutrition Sciences
University of Alabama at Birmingham