The Low-FODMAP Diet and Digestive Disorders " Anna a 32-year-old with a predominantly vegetarian diet "

Case study ( 2807 views as of September 24, 2018 )

Anna is a healthy 32-year-old female, with a predominantly vegetarian diet. She is known at work for being the "healthiest eater" and has little history of digestive upset. Her energy is great, and stress is not a major factor in her life. She is generally happy and well-adjusted to her job as an elementary school teacher.

Lately, Anna has noticed abdominal bloating on a regular basis, and has started to produce offensive flatulence. She hasn't changed her diet since these symptoms started, and tries her best to focus on eating nutrient-dense foods whenever possible.

Anna decides to book an appointment with her naturopathic doctor (ND) to discuss these concerns, and is relieved to hear that she likely suffers from a sensitivity to FODMAP's, or foods high in sugars that are easily fermented by certain gut bacteria. Anna starts a diet low in FODMAP sugars, and notices immediate improvement in her symptoms of gas and bloating.

FODMAP stands for "fermentable oligosaccharides, diassacharides, monosaccharides and polyols". Currently, evidence supports the use of a low FODMAP diet in managing symptoms of IBS. However, many patients with mild to moderate gas and bloating also respond well to this diet, especially if these symptoms are accompanied by a history of constipation, or sluggish bowels.

Considering some of the foods Anna is avoiding are staples in her diet, like apples, avocados and cauliflower, she is concerned about never reincorporating these foods into her regular diet. During her follow-up visit, Anna discusses her progress with her ND, who explains that composition of gut bacteria, bowel transit time, stress and hydration are additional factors that help predict FODMAP sensitivity, and that addressing these issues often results in decreased FODMAP sensitivity over time.

Ruling out life-threatening presentations is important. Had Anna been suffering from systemic nutrient deficiencies, severe constipation, abdominal pain, a fever, or bloody stool, she may have been referred to a gastroenterologist, or the ER for further examination. A low FODMAP diet is an excellent strategy in managing many cases of benign abdominal bloating. Your dietitian, nutritionist or naturopathic doctor can help you follow this diet, and provide additional support, if necessary.

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Conversation based on: The Low-FODMAP Diet and Digestive Disorders " Anna a 32-year-old with a predominantly vegetarian diet "

The Low-FODMAP Diet and Digestive Disorders " Anna a 32-year-old with a predominantly vegetarian diet "

  • I read the list that @Dr Kaleigh Anstett posted and it's very interesting. I would guess that vegetarians that are concerned about the amounts of FODMAP's in their diets could eat smaller portions more frequently. Smaller portions might help prevent discomfort
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  • Could you give some examples of things you can eat on a low FODMAP diet. Or, alternatively, list a few things that you should not be eating!
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    • Looks like most lean meats (chicken, fish, beef, pork), eggs, nuts and low-lactose dairy products like hard cheeses are low FODMAP choices. A vegetarian may have to get slightly creative since beans and lentils are considered high FODMAP choices. It looks like there are numerous options for vegetarians on the low FODMAP list posted by @Kaleigh to help manage digestive disorders.
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    • Please see the following for a list of foods that are low as well as foods that are high in FODMAPs: https://stanfordhealthcare.org/content/dam/SHC/for-patients-component/programs-services/clinical-nutrition-services/docs/pdf-lowfodmapdiet.pdf Keep in mind that reducing as opposed to eliminating FODMAPs is the goal, as many intermediate foods that aren't listed, have varying amounts of FODMAP sugars. It is also important to note that individuals have different tolerance levels; some may be able to consume small amounts of high FODMAP foods without discomfort, while others need to avoid high FODMAP foods very strictly. Trial and error is typically the most effective way to determine an individuals tolerance.
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    • What would Anna, as a vegetarian, eat as a protein source if legumes are not part of a low FODMAP diet ?
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    • What would Anna, as a vegetarian, eat as a protein source if legumes are not part of a low FODMAP diet ?
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    • As mentioned in the case study, high FODMAP foods are those that contain fermentable sugars. Some examples of high FODMAP foods (and therefore to be avoided in Anna's case) would be legumes, lactose-containing dairy, wheat-based bread/cereals, as well as some vegetables like asparagus and onions. Some things Anna could eat on a low FODMAP diet would be meats, fish, lactose-free dairy, bananas, oranges, cucumber, lettuce... among many other foods!
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  • Kaliegh, you made a comment about improving gut flora as a way to help the symptoms of bloating and having gas. Would you recommend a daily probiotic to perhaps help you get through this period of time while adjusting to a low FODMAP diet?
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    • @Kaleigh - thank you for commenting again. So interesting! I am considering trying out a probiotic, and the last time I went into a health food store I walked out of there with a $60 bottle of "super-probiotics". Is there a point when there can be too much of a good thing in a probiotic, and the added cost of the 'super' varieties won't give any added benefit when managing digestive disorders?
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    • A good quality probiotic can make a huge difference for those with gut dysbiosis, however those without digestion issues may not benefit to the same extent. The field of gut microbiology is diverse, and includes many different organisms and species with a wide range of clinical indications, extending well beyond the gut. A practitioner versed in this area is best consulted to determine an individuals specific needs. Typically, an individual's diet is a good indicator of their microbiome health, and will eventually shift bacteria into a healthier, balanced state allowing for efficient digestion and assimilation, that is of course, if the diet is rich in whole foods as a general rule.
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    • Great information @Kaleigh Anstett - there are so many products out there when looking for probiotics, and it is so helpful to have your insight into recommended probiotics to look for. Do you recommend probiotics for people with good health in general, or just for those with digestive disorder?
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    • Great question - Bifidobacterium infantis, a sub species of bifidobacterium longum, has the most evidence to support its use as a treatment component for those suffering from IBS. In my experience, this species is a great first start. Most patients do well will a broad spectrum probiotic containing lactobacilus and bifidobacterium species as a combination product as a second step, and for maintenance. Both Align, and Natren Life Start Pro powder, are excellent first steps, containing Bifidobacterium infantis.
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  • Would foods that contain wheat be considered high in FODMAP's? I've heard a lot about the wheat and bloating connection, but wonder if this is why?
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