Poop. Bowel movements. Diarrhea. Constipation. Bloating. Gas. Cramping. Emergency bathroom stops. Courtesy flushes. Hemorrhoids. These words themselves are taboo subjects for anyone to talk about (women especially) and, yet, here I am coming out of the closet -- the water closet, that is.
In my case, blood test for celiac: negative. Endoscopy and colonoscopy showed everything to be "normal" with no signs of Crohn's or ulcerative colitis. My doctor had no other choice but to tell me I have irritable bowel syndrome (IBS) and that there's no medical treatment for it. The worst thing to hear when you're in an incredible amount of pain every day is that there's no cure for it.
It wasn't until a planned trip to Mexico a few months ago that my motivation really kicked into high gear. To get in the mood for my trip, I treated myself to some homemade guacamole, tortilla chips and a Corona. Within an hour, I looked like I was seven months pregnant. A few days later, when I wasn't any better, I went to my gastroenterologist to find out if I was dying (naturally). The doctor told me I had gas and it would go away soon. I'd have considered the doctor visit a complete wash had his next words not been: "You should look into a low-FODMAP diet."
Um, FODMAP... what's that?
In short, FODMAPs are dietary sugars that can be poorly absorbed in the small intestine. This organ is responsible for breaking down and absorbing nutrients from the foods you eat. When FODMAPs are not absorbed here, they travel to the large intestine, whose role it is to absorb water and prepare undigested food for "the deed."
It's there that millions of bacteria feed on the unabsorbed fiber and sugars. The FODMAP diet essentially cuts out the food supply for the large intestine bacteria that create the liquid, gas and bloating.
When these FODMAPs aren't properly absorbed by your intestines, they have a reverse reaction in the gut and a rush of water comes through the bowel. This can lead to farting, bloating, nausea, cramping, and overall discomfort and is followed by either diarrhea or constipation.
Understand that FODMAPs are poorly absorbed in all people but they primarily affect people with intestinal disorders (such as IBS).
How to eat a low-FODMAP diet
Going low FODMAP is a commitment. During the elimination period, you begin by cutting out all foods that are considered high FODMAP (listed below) and must be consistently mindful of your portions of low FODMAP foods. Because FODMAPs accumulate, eating a lot of low FODMAPs, say, over the course of a day, could make you react later on at night. It's all about the balance.
You'll learn more about your body and its intolerance as you go because now you'll really be paying attention. Once you start to feel better (or whenever you're comfortable) you can start testing foods to see how you react and what you can tolerate. Every person has different thresholds, and the FODMAP diet is used to specifically discover what it is for particular foods.
Learning to read ingredient labels is going to be the biggest challenge in the beginning. Read: Eat natural, whole foods that are low FODMAP and stay away from processed foods, dressings and marinades and certain snacks.
FODMAP is an acronym for...
Fermentable (rapidly broken down by bacteria in the bowel)
Oligosaccharides (fructans and galacto-oligosaccharides) -- This includes fructans that naturally occur in some vegetables, specifically onions and garlic. Important: Even if you test negative for a gluten allergy, it's the natural fructans in the wheat that might be giving you your "issues." Galacto-oligosaccharides are in legumes like beans, lentils and chickpeas (I had a memorial service for hummus).
Disaccharides (lactose) -- Lactose is the sugar in milk products. Not many people who have IBS are lactose intolerant, so reducing lactose intake might not minimize your symptoms unless you've been diagnosed. A lactose-free diet doesn't mean a dairy-free one. There are many cheeses that have very little lactose in them and according to the research done on FODMAPs, most people do OK with small amounts anyway.
Monosaccharides (fructose) -- Fructose is a simple sugar that's found in all fruits and added to many foods and drinks in the form of -- drumroll -- high-fructose corn syrup. Quick anatomy lesson: Fructose is easily absorbed in the small intestine when it links up with glucose, which is what carries it down through the intestine. This transportation fails when there's too much fructose and results in fructose malabsorption. On a low FODMAP diet, you're eating specific fruits that have equal amounts of glucose and fructose. And keep in mind that the amount you eat is just as important as what you eat.
Polyols (sorbitol, mannitol, xylitol and maltitol) -- Polyols are the sweeteners that are in candy, gum and "sugar-free" products. Inulin is another polyol (added to yogurt, snack bars, etc.), but it comes from vegetable root, as opposed to being man-made like the others.
High-FODMAP and low-FODMAP foods
The foods themselves are being tested at Monash University in Australia, where the FODMAP diet was born. Download the Low FODMAP app from iTunes for the most up-to-date information on specific foods.
(Some) foods you can eat -- Bananas, blueberries, raspberries, strawberries, maple sugar and table sugar, most types of lettuce, bell peppers, carrots, cucumber, potatoes, zucchini, gluten-free bread, gluten-free pasta, potato and corn chips, quinoa, almonds, peanuts, mozzarella, cheddar, feta and other hard cheeses.
(Some) foods you cannot eat -- Garlic and onion are our enemies. Apples, cherries, watermelon, peaches, asparagus, artichoke, mushrooms, cauliflower, avocado, chickpeas, fennel, beets, wheat, rye, spelt, honey, high-fructose corn syrup, isomalt, maltitol, mannitol, sorbitol, xylitol. Read those labels! Better yet, don't buy foods with labels.
Need more resources?
If you want more information, please check out Dr. Sue Shephard's site; she developed the diet through her research at Monash University in Australia. I recommend checking out Kate Scarlata's website as well.