FODMAPs?! The Diet That May Eliminate Your IBS Symptoms!

Are you looking for relief from your IBS symptoms?

Symptoms of Irritable Bowel Syndrome include abdominal bloating and distension, excess wind (flatulence), abdominal pain, nausea, changes in bowel habits (diarrhea, constipation, or a combination of both), and other gastrointestinal symptoms.

What are the FODMAPs?

FODMAPs are found in the foods we eat. FODMAPs is an acronym for:

• Fermentable
• Oligosaccharides (eg. Fructans and Galactans)
• Disaccharides (eg. Lactose)Monosaccharides (eg. excess Fructose)
• Polyols (eg. Sorbitol, Mannitol, Maltitol, Xylitol and Isomalt)

This is a collection of molecules found in food, that can be poorly absorbed by some people. When the molecules are poorly absorbed in the small intestine of the digestive tract, these molecules then continue along their journey along the digestive tract, arriving at the large intestine, where they act as a food source to the bacteria that live there normally. The bacteria then digest/ferment these foods and can cause symptoms of Irritable Bowel Syndrome.

Where are FODMAPs found?

• Excess Fructose: Honey, Apples, Mango, Pear, Watermelon, High Fructose Corn Syrup, Corn Syrup Solids
• Fructans: Artichokes (Globe), Artichokes(Jerusalem), Asparagus, Beetroot, Chicory, Dandelion leaves, Garlic (in large amounts), Leek, Onion (brown, white, Spanish, onion powder), Raddicio lettuce, Spring Onion (white part), Wheat (in large amounts), Rye (in large amounts), Inulin, Fructo-oligosaccharides.
• Lactose: Milk, icecream, custard, dairy desserts, condensed and evaporated milk, milk powder, yoghurt, margarine, soft unripened cheeses (eg. ricotta, cottage, cream, marscarpone).
• Galacto-Oligosaccharides (GOS): Legume beans (eg. baked beans, kidney beans, bortolotti beans), Lentils, Chickpeas
• Polyols: Apples, Apricots, Avocado, Cherries, Longon, Lychee, Nectarines, Pears , Plums, Prunes, Mushrooms, Sorbitol (420), mannitol (421), xylitol (967), maltitol (965) and Isomalt (953).

The most common FODMAP is fructose!

What is fructose?

Fructose is a monosaccharide, or single sugar. It is found in three main forms in the diet as:

• fructose in fruits, honey and some root vegetables
• part of the disaccharide, or double sugar, sucrose. Sucrose is made up of glucose and fructose.
• Sucrose is also known as table sugar.
• fructans in some vegetables and wheat. Fructans are short chains of fructose. They are also called inulins and fructo-oligosaccharides.

Fructose is the sweetest of all naturally occurring carbohydrates. For this reason it is often added as a sweetening ingredient in prepared foods. Since it is sweeter than table sugar, smaller amounts of fructose are needed to get the same sweetness.


How do I go on the FODMAPs diet?

During your elimination trial, it is recommended that you eliminate all FODMAPs either significantly or entirely. Most patients will begin to feel significantly better within a few hours and a few days, but will take up to two weeks to feel fully healthy. A minority of patients have reported that it took up to three months to fully recover. After recovery, you can begin to gradually reintroduce foods using the steps outlined at the end of this article.

Many IBS sufferers with generally mild symptoms will find that a general reduction of fructose intake alone significantly relieves them of their symptoms. Other individuals will find that they must significantly reduce their intake of all FODMAPs to experience relief. You may find over time that eating certain FODMAPs does not bother you.

Finally, it should be noted that fructose – the ubiquitous simple sugar – is often allowed in “safe foods” if the food also contains a glucose-to-fructose ratio greater than one. This is because research shows that ingesting glucose at the same time as fructose (and in the same quantities as fructose) eases fructose absorption.

Is it dangerous to limit fructose intake?

In short: no. While carbohydrates are an essential source of energy, refined sugars are anything but and current research shows that fructose may be best ingested in strict moderation.

Further, some sources report that a modern diet contains upwards of ten times the amount of sugar humans ingested for much of evolution. This may help to explain why fructose malabsorption is found in up to 40% of inhabitants of western countries. You will still be ingesting a significant level of glucose and other carbohydrates. Overall, limiting your fructose intake will likely be beneficial to your health. But when in doubt, listen to your body (and, of course, doctor). It is also not inherently dangerous to limit other FODMAPs, but missing out on whole food groups could easily lead to a diet missing in nutrients and lacking in vitamins.

Which foods contain FODMAPs?

The best way to determine the fructose content of a given food is to use publicly available USDA data.

To save you some time, and to bring your attention to foods which contain non-fructose FODMAPs, the list below names some foods that you will definitely want to avoid at least initially. .

Fruits

Most fruits which are excluded are excluded due to excessive fructose content, or greater than a 1:1 Fructose:Glucose ratio. Also, some contain Polyols.

• Apples
• Apricots
• Cherries
• Mango
• Pears
• Nectarines
• Peaches
• Pears
• Plums and prunes
• Watermelon
• High concentration of fructose from canned fruit, dried fruit or fruit juice

Grains

• Rye
• Wheat

Lactose-Containing Foods

• Custard
• Ice cream
• Margarine
• Milk (cow, goat, sheep)
• Evaporated milk
• Condensed milk
• Milk powder
• Soft cheese, including cottage cheese and ricotta
• Yogurt
• Greek yogurt

Legumes

• Many legumes contain Galacto-Oligosaccharides (GOS).
• Baked beans
• Chickpeas
• Lentils
• Kidney beans

Sweeteners

• Sweeteners which end in -ol are excluded because they are fermentable polyols.
• Fructose
• High fructose corn syrup
• It should be noted that HFCS actually only contains marginally more fructose than glucose as compared to refined sucrose. It is included in this list only because it was found on another list (better safe than sorry), and because it still has a F:G ratio greater than 1. The accuracy of this entry will be checked soon for validity.
• Corn syrup solids
• See above
• Palm sugar
• Honey
• Agave nectar
• Isomalt
• Maltitol
• Mannitol
• Sorbitol
• Xylitol

Vegetables

• Vegetables may be on this list for containing fructans.
• Artichokes
• Asparagus
• Avocado
• Beets
• Broccoli
• Brussel sprouts
• Cabbage
• Cauliflower
• Garlic
• Garlic is possibly okay to consume, but should not be ingested in large quantities.
• Fennel
• Leeks
• Mushrooms
• Okra
• Onions
• Onions have recently been reported to be especially troublesome. It is best to completely avoid them.
• Peas
• Radiccio lettuce
• Scallions (white parts)
• Shallots
• Sugar snap peas
• Snow peas

So, what’s safe to eat?
It’s best to obtain your calories principally from a source that is indisputably fodmap-friendly (such as rice or meat). In moderation, however, the following foods are safe to eat on a low-FODMAP diet.

Fruits

• Banana
• Blueberry
• Grapefruit
• Grapes
• Honeydew melon
• Kiwi
• Lemon
• Lime
• Mandarine oranges
• Orange
• Raspberry
• Strawberry

Sweeteners

• Artificial sweeteners that do not end in -ol
• Glucose
• Maple syrup
• Sugar (sucrose)

Lactose Alternatives 

• Butter
• Hard cheeses
• Brie (exceptional cheese)
• Camembert (exceptional cheese)
• Lactose-free products, such as lactose-free ice cream and yogurt
• Gelato
• Rice milk
• Sorbet

Vegetables

• Bok choy
• Carrots
• Celery
• Corn
• Eggplant
• Green beans
• Lettuce
• Parsnip
• Scallions (green parts only)
• Tomato
• Reintroducing foods/Moving beyond the elimination phase

Once you are symptom-free, you may attempt to reintroduce foods in order to determine exactly what was causing your symptoms. There are really no established guidelines on how to best do this – it varies from individual to individual. Key concepts, however, follow:

1. Write it down! Be scientific. Keep a food diary. Your future self will thank you.
2. Only reintroduce one food at a time.
3. Wait ~72 hours for symptoms to reappear before moving on to the next food

Balancing Your Brain Chemistry: Testing and Treating Neurotransmitter Imbalances

Neurotransmitters are molecules that regulate brain function. They are chemicals which relay messages from nerve to nerve both within the brain and outside the brain. They also relay messages from nerve to muscle, lungs, and intestinal tracts.

They can accentuate emotion, thought processes, joy, elation and also fear, anxiety, insomnia and that terrible urge to over indulge in food, alcohol, drugs, etc.

In short, neurotransmitters are used all over the body to transmit information and signals. They are manufactured and used by neurons (nerve cells) and are release into the synaptic clefts between the neurons.  

These brain chemicals communicate information throughout our brain and body.  They relay signals between nerve cells, called “neurons.”  The brain uses neurotransmitters to tell your heart to beat, your lungs to breathe, and your stomach to digest.  They can also affect mood, sleep, concentration, weight, and can cause adverse symptoms when they are out of balance. Neurotransmitter levels can be depleted many ways.  As a matter of fact, it is estimated that 86% of Americans have suboptimal neurotransmitter levels.  Stress, poor diet, neurotoxins, genetic predisposition, drug (prescription and recreational), alcohol and caffeine usage can cause these levels to be out of optimal range.

There are two kinds of neurotransmitters – INHIBITORY and EXCITATORY.  Excitatory neurotransmitters are not necessarily exciting – they are what stimulate the brain.  Those that calm the brain and help create balance are called inhibitory.  Inhibitory neurotransmitters balance mood and are easily depleted when the excitatory neurotransmitters are overactive.  

Inhibitory Neurotransmitters

• SEROTONIN is an inhibitory neurotransmitter – which means that it does not stimulate the brain.  Adequate amounts of serotonin are necessary for a stable mood and to balance any excessive excitatory (stimulating) neurotransmitter firing in the brain.  If you use stimulant medications or caffeine in your daily regimen – it can cause a depletion of serotonin over time.  Serotonin also regulates many other processes such as carbohydrate cravings, sleep cycle, pain control and appropriate digestion.  Low serotonin levels are also associated with decreased immune system function.
• GABA is an inhibitory neurotransmitter that is often referred to as “nature’s VALIUM-like substance”.  When GABA is out of range (high or low excretion values), it is likely that an excitatory neurotransmitter is firing too often in the brain.  GABA will be sent out to attempt to balance this stimulating over-firing.
• DOPAMINE is a special neurotransmitter because it is considered to be both excitatory and inhibitory.  Dopamine helps with depression as well as focus, which you will read about in the excitatory section.

Excitatory Neurotransmitters

• DOPAMINE is our main focus neurotransmitter.  When dopamine is either elevated or low – we can have focus issues such as not remembering where we put our keys, forgetting what a paragraph said when we just finished reading it or simply daydreaming and not being able to stay on task.  Dopamine is also responsible for our drive or desire to get things done – or motivation.  Stimulants such as medications for ADD/ADHD and caffeine cause dopamine to be pushed into the synapse so that focus is improved.  Unfortunately, stimulating dopamine consistently can cause a depletion of dopamine over time.
• NOREPINEPHRINE is an excitatory neurotransmitter that is responsible for stimulatory processes in the body.  Norepinephrine helps to make epinephrine as well.  This neurotransmitter can cause ANXIETY at elevated excretion levels as well as some “MOOD DAMPENING” effects.  Low levels of norepinephrine are associated with LOW ENERGY, DECREASED FOCUS ability and sleep cycle problems.
• EPINEPHRINE is an excitatory neurotransmitter that is reflective of stress.  This neurotransmitter will often be elevated when ADHD like symptoms are present.  Long term STRESS or INSOMNIA can cause epinephrine levels to be depleted (low).  Epinephrine also regulates HEART RATE and BLOOD PRESSURE.

How do we measure neurotransmitters?
Normally the neurotransmitter is released in response to an electric signal. After binding to the receptor site on the second neuron, the chemical is then recycled. However, only about 60% of the neurotransmitter is recycled. The rest is carried away in the blood stream and excreted in the urine. We can measure urinary levels of neurotransmitters, and get a good idea of their levels within the body.

We measure neurotransmitters directly. It has been found that blood and saliva levels are not particularly useful. Some of the neurotransmitters, epinephrine in particular, have wildly fluctuating levels depending on the person’s sate of mind. (If we are approaching them with a needle to draw blood, the levels will be very high within a few seconds, so blood levels do not give us a picture of the person’s rising neurotransmitter levels. )

Urine levels seem to be representative of what is actually going on in the system.

When we see low urinary levels we can be sure that the body’s stores are low. When we see high urinary levels, the issue is more confusing. In over 90% of cases we can be sure that although levels are apparently high, this only relates to biological activity of the hormone. In actual fact, the total body stores are almost certainly low.

We see this particularly in people who are taking antidepressant medication, especially serotonin reuptake inhibitors like Prozac, Paxil, Wellbutrin. These medications prevent the nerve cells from taking Serotonin back out of the system (hence the name, re-uptake inhibitors).

However, since the levels are high at the synaptic junction, the body thinks that the levels are high overall, and makes every effort to get rid of as much serotonin as possible. Since the neurotransmitters are excreted in the urine, we therefore see high urinary levels. Not only does the body try to get rid of the neurotransmitters, it also stops making them, in an effort to reduce the levels at the synaptic junction. In the long run, total body stores are depleted, and eventually the urine levels will fall.

Highly depressed moody people are extremely low in serotonin and norepinephrine, but will probably have high urinary levels because they are losing so much at any given point in time.

If they have insomnia, it is likely that their dopamine and/or PEA levels is high.

Highly agitated anxious irritated people will probably have high epinephrine, norepinephrine and dopamine, and relatively low serotonin levels. They may also have markedly elevated PEA levels.

In addition, the sex hormones influence multiple neurotransmitters. Estrogen has an anti-dopamine effect, in addition to inducing the formation of new synapses.

Progesterone increases the effect of GABA and reduces neurotransmitter activity. Estradiol decreases the level of the enzyme which inactivates the serotonin and dopamine (monoamine oxidase, MAO), thus effectively increases the effects of serotonin and dopamine, where progesterone decreases their effects.

DHEA enhances the effect of serotonin and norepinephrine, thus it enhances cognitive function and reduces depression. Cortisol inhibits the release of catecholamines, and increases the effect of GABA, thus reducing anxiety.  

TREATING NEUROTRANSMITTER IMBALANCES:

1 - We can increase our dietary intake of tryptophan. American diets tend to be high in carbohydrate and low in protein. Foods high in tryptophan are mostly high protein foods:

• Cottage cheese (dry) 450 mg per cup
• Cottage cheese (creamed) 336 mg per cup
• Fish and other seafoods 800-1300 mg per pound
• Meats 1000-1300 mg per pound
• Poultry 600-1200 mg per pound
• Peanuts, roasted with skin 800 mg per cup
• Sesame seeds 700 mg per cup
• Dry, whole lentils 450 mg/cup
  

2 - We can increase our amount of exercise. Exercise leads to more efficient use of insulin, thus reducing insulin resistance and decreasing the amount of food which is stored as fat. When the cells process nutrients better, they make neurotransmitters better.
3  Reduce our intake of caffeine and alcohol. Caffeine makes the body think is it under stress, which raises the cortisol level, raises the insulin level, and causes carbohydrates to be deposited as fat.  Alcohol will deplete seretonin levels over time
4 - Make sure that blood chemistry is in balance.

MIMICS OF DEPRESSION:

• Hypothyroidism can cause a picture similar to depression, and is easily correctable.
• Vitamin B12 and folate deficiencies can also cause a depression like mimic.
  

5 -  We can supplement the needed amino acids and cofactors,so that the body can make the required neurotransmitters.

Remember that neurotransmitters are all over the body and that they are interdependent. We cannot change one level without causing a ripple effect in all the other neurotransmitters. We can start with serotonin, but we need to add support for all the other neurotransmitters whose levels are not optimal.


6 - Dr Carnahan will retest the urine levels every 6-8 weeks, until they are optimal.

Call today for more information on how Dr Carnahan can help you balance your neurotransmitters #303-443-9590

Dr. C's Spinach Berry Smoothie

photo courtesy of www.freedigitalphotos.net

 Spinach Berry Smoothie Recipe

• Approximately 1 cup ice cubes
• 1 ripe banana (frozen sliced works best – slice and freeze your ripe bananas for smoothies)
• 1 cup frozen organic berries (blueberries are my favorite!)
• 1-2 cups organic spinach leaves or other leafy greens
• 1 scoop of Thorne Research Vegalite Vanilla protein (pea-rice combo)
• 1-2 TBSP of finely ground flaxseed or Chia (I use Salba)
• 1tsp ground cinnamon powder
• Optional sweetner: 5-10 drops of pure liquid stevia for desired sweetness.  
• Enough water, coconut milk, almond milk, or rice milk (no dairy, please) to cover all the other ingredients – more or less depending on thickness desired.   

*use water for lower calorie option OR ½ water and ½ coconut milk or almond milk

For my smoothie, I also add 50billion cfu's probiotic, 6grams of l-glutamine powder and free amino acids.

Process everything in heavy-duty blender until you get thick velvety smooth milkshake and enjoy!

Makes a great breakfast or post-workout meal!