For anyone over 50, nothing compares to the dread induced by a doctor who declares “It is time for a colonoscopy.” The procedure is bad enough, particularly for a modest person. Thank goodness it all happens when we are asleep! The real dread comes, however, the day before the “procedure” when purging the guts of all of its waste is our prime mission—certainly not my idea of a good time.
My colonoscopy was actually a year ahead of the normal schedule. I had observed some changes in my bowel movements. I will spare you the details of my symptoms. Suffice it to say that they were of sufficient concern to me to voluntarily go through the trauma early. This event was the fourth that I have completed in my lifetime, and I noted some differences from my earlier experiences. I was particularly amazed at all the disposable plastic tubing that I observed in the setup just after being wheeled into the operating theater and before I passed out. Also, I observed that there were many medical professionals involved in the process, all of whom seemed interested in giving me the proper care I desired.
It just so happened that as I was emerging from the cloud of anesthesia my wife had left the room for a restroom break. The gastroenterologist who had performed the procedure informed me that they had found and eliminated some polyps. He gave me some pretty pictures for my scrapbook and told me that he wanted me to try a new diet. He also indicated that I will have the opportunity to be screened again in five years. That will probably be my last one as they rarely scope out people older than 75. By the time my wife returned, the nurse had pulled out a sheet of paper she had scanned from the internet on the low FODMAP diet. The nurse asked if I ate many dairy products. I said that I did, and she said that the dairy foods might be my problem. Then we left the hospital and went across the street to break my fast with a big meal of eggs and hashbrowns but no dairy. It was only later that I read the doctor’s orders suggesting that I not eat big meals for several hours after my procedure.
What is FODMAP?
- F is for Fermentable
- O is for Oligosaccharides (in wheat and in spices)
- D is for Disaccharides (lactose)
- M is for Monosaccharides (fructose)
- A is for and, and
- P is for Polyols (sorbitol and mannitol)
Put it all together and it spells out an extremely restrictive diet designed to eliminate all the FODMAPs in the diet. The general theory behind the diet is that certain chemicals from our foods reside in our gut and can be fermented by the microbes that inhabit it resulting in objectionable actions collectively known as IBS—Irritable Bowel Syndrome. There appears to be a wide variation in manifestations of the disorder and individual susceptibility. Symptoms can include abdominal pain, bloating, constipation followed by diarrhea, obnoxious gas emanations, and an urgent need to defecate. Most of the FODMAPs are components of whole foods. The additives in processed foods in this class are high fructose corn syrup and the polyols. Fructose is also a primary component of honey, grapes and other fruits. Polyols are also natural components of many whole fruits such as apples and blueberries as well as whole vegetables such as avocado and sweet potato.
To eliminate all foods containing FODMAPs would leave the dieter with very little to eat. Thus, the recommended diet suggests small quantities of certain foods like ½ cup of berries or most other fruits, ½ cup of many vegetables including onions and green beans, and 2 tablespoons of peanuts or almonds. Foods with little or no FODMAPs include eggs, meats, hard cheeses, potatoes, and carrots. Yes, I know that cheese is a dairy product, but hard cheeses are the curds in the cheese-making process. The whey is skimmed off these curds, and it is the whey that carries the lactose.
Starting out. As a food scientist I had the advantage of a good knowledge of food composition. From my years as an instructor of Food Chemistry I was familiar with all the FODMAP terms. I actually had read about the diet previously, but knew little about it and had no clue that I would eventually be on one. I went on the internet, but recommendations were confusing and contradictory. I went to amazon.com and found two books on the topic by RDs—The Low-FODMAP 6-Week Plan & Cookbook and The IBS Elimination Diet and Cookbook. I developed a diet plan from the second book as it seemed more relevant to my needs than the first one.
Patsy Castos, MS, RDN, LN provided a very nice set of dietary plans with a few useable recipes, including Traffic Light Chili, the one that made a hit with my wife. The author also provided an aggressive plan, a more modest option and a shortcut. I opted for the aggressive plan. My concerns going into the diet were that it
- would be difficult for me to maintain my weight
- called for many foods that contained saturated fats such as eggs, meat and cheese, and
- cut out fiber with only small amounts of fruit, not many vegetables and no whole grain cereal containing wheat.
Methods. I went through a seven-week trial. The first two weeks I eliminated high-FODMAP foods with allowances for small amounts of certain foods that contain FODMAPs. Without them, the diet would be sparse indeed. Challenges began on Tuesday of the third week on which I had a ¼ cup of onions as a representative food from Oligosaccharides not associated with gluten. The next day I had a cup of oatmeal, ¼ cup of raisins, ½ cup of cashews, 2 teaspoons of garlic and ½ cup of black beans. Then I waited not-so-patiently and observed any evidence from my bowel movements over the next five days.
On the following Tuesday, I started all over again challenging my digestive tract with the Disaccharide lactose. I repeated the process on subsequent Tuesdays for the Polyol sorbitol, the Polyol mannitol, and the Oligosaccharides associated with gluten. I did not challenge with the Monosaccharide fructose as I have been very careful for the last 30 years not to overconsume sugars such as fructose and sucrose to prevent the progression of a diagnosis of prediabetes to full-blown diabetes.
Results. It became apparent early in the process that a low-FODMAP diet is not a great one to be on. Some of the food is enjoyable, but much of the good stuff is limited to small amounts. I noticed a loss of weight over the weeks, which was a good thing for the first five pounds which I wanted to lose earlier. Unfortunately, I kept losing weight, bottoming out at eight pounds.
The biggest frustration in my low-FODMAP diet experience was that none of the challenges proved conclusive. I did observe some moderate symptoms with wheat-associated Oligosaccharides and with the Disaccharide lactose. All other FODMAPs led to either only mild or no symptoms. Elimination of lactose from my diet was still not sufficient. Even just one bagel, four slices of pizza or a single hamburger over a week elicited an undesirable response. Currently, I am avoiding lactose and gluten to see if I can stabilize my gut. On the positive side, despite greater consumption of fats, particularly saturated fats and less dietary fiber, my blood lipids and other blood values are within the standard range.
Discussion. I confess to being disappointed that the program did not provide definitive answers. It is now fifteen weeks since my colonoscopy, and I would like to move on with my diet and my life. With the miracle of processed, lactose-free dairy products, I can have my milk and associated products without consequences. I note that nondairy offshoots of these products are not nearly as good as the real thing and tend to mold soon after they are opened.
Giving up bagels, sandwiches, pizza and whole-wheat breakfast cereal is much harder. Gluten-free bread makes good, dense toast but is not great for sandwiches. Gluten-free bagels are too dense for my purposes. I haven’t tried gluten-free hamburgers or pizza yet, but my expectations are not great. I have yet to find a whole grain cereal with at least 10 grams of fiber that is not wheat based. Fortunately, I can still enjoy beer. Gluten-free breads have long shelf lives when frozen, but they mold in less than a week at room temperature. I have much more empathy for my niece and anyone else who is also gluten-free.
I must admit I am enjoying eating more beef, cheese, eggs and fries than I did before I started worrying about FODMAPs. I am eating out less, eating about the same amount of processed foods and trying to reincorporate more fruits and vegetables back into my diet. I have gained back the three pounds I didn’t want to lose and am happy with my current BMI of 22.7. Watch this space for updates on my diet.
Next week: Celebrating 70 years of eating