After consulting with a health care professional, such as their family doctor, naturopathic doctor, nutritionist or dietitian, many individuals with symptoms of irritable bowel syndrome (IBS) turn to a low-FODMAP diet. 

This is a specific type of elimination diet, which aims to remove certain small-chain carbohydrates from your diet to reduce IBS symptoms including abdominal pain, bloating, constipation, and diarrhea – with a success rate of up to 86% (1).

A low-FODMAP diet restricts consumption of most grains and dairy, many fruits, and all legumes… so, choosing a healthy snack may seem difficult. But, this hazelnut cocoa bites recipe provides a tasty snack while containing all low-FODMAP ingredients! Plus, the recipe is also paleo and vegan friendly, too!

Hazelnuts are filled with nutrients and antioxidants that support and protect many of our body’s systems. Specifically, hazelnuts are considered to be heart healthy. Studies of individuals with consistent hazelnut consumption show a reduction in their bad cholesterol (LDL) while their good cholesterol (HDL) levels remained the same (2).

Cocoa powder is produced by crushing cocoa beans and removing the fat content. While cocoa powder is most famously associated with the production of chocolate goods, research shows that cocoa powder alone can have a positive impact on blood pressure. Molecules within the cocoa powder react with molecules in the blood to expand blood vessels, ultimately lowering blood pressure (3). These have mainly been studied in healthy adults, and more studies on long-term effects are still needed.

Moderation is key while on a low-FODMAP diet because while many foods, including hazelnuts and maple syrup, are low-FODMAP in small quantities, the amount of FODMAPs gets higher and higher the larger a portion size that’s consumed. So, if you’re on a low-FODMAP diet, be sure to watch the serving size while enjoying this delicious snack!

References

1. Nanayakkara, W., Skidmore, P., O’Brien, L., Wilkinson, T., & Gearry, R. (2016). Efficacy of the low FODMAP diet for treating irritable bowel syndrome: the evidence to date. Clinical and Experimental Gastroenterology, 9, 131-142. doi: 10.2147/CEG.S86798
2. Orem, A., Yucesan, F., Orem, C., Akcan, B., Kural, B., Alasalvar, C., & Shahidi, F. (2013). Hazelnut-enriched diet improves cardiovascular risk biomarkers beyond a lipid-lowering effect in hypercholesterolemic subjects. Journal of Clinic Lipidology. 7(2), 123-131. doi: 10.1016/j.jacl.2012.10.005
3. Ried, K., Fakler, P., & Stocks, N. (2017). Effect of cocoa on blood pressure. Cochrane Database System Review. 4(4). doi: 10.1002/14651858.CD008893

Digestive health challenges are extremely common in Canada, and Irritable Bowel Syndrome (IBS) is the most common diagnosis given for those digestive challenges. IBS affects the intestine both by causing issues with motility (the way foods moves through your intestines) and sensitivity (the way the signals from the intestines are interpreted by the brain). IBS symptoms can range from irritating and annoying to disruptive, embarrassing, or even debilitating – leading to lost time at work or at school for nearly half of reported sufferers. (1)

Could You Have Undiagnosed IBS?

If you have:

• abdominal pain at least once a week in the last several months
• change in number of times per day or week you have a bowel movement
• constipation, diarrhea, or a combination of both (2)

a consultation may be helpful!

IBS symptoms can occur outside the digestive tract as well and may include insomnia, fibromyalgia, interstitial cystitis, chronic pelvic pain, temporomandibular joint (TMJ) disorder, back pain, migraine headaches, or mood disorders. (2)

How Common Is Digestive Upset & IBS?

More than half of the Canadian population report uncomfortable or inconvenient digestive symptoms on a weekly basis. (1) 18 – 20% of Canadians are dealing with some form of IBS, with twice as many women as men affected. These statistics of IBS sufferers put us well above the global average of 10-11%, and among the highest rates in the world. Sadly, only 40% of those with IBS symptoms seek help with their condition. (3)

For those who do seek support, the current first-line treatment suggestion is often to try a low-FODMAP diet. This approach is well-backed by studies that show 75%-86% of people who follow this type of diet plan report improved symptoms. (4, 5)

What Is The Low-FODMAP Diet?

A low-FODMAP diet is meant to minimize (not eliminate) specific fermentable forms of carbohydrates for a short time, typically 3-8 weeks, then systematically reintroduce them in larger quantities while monitoring for symptoms. Not everyone reacts to all possible trigger foods.

What Are FODMAPs?

FODMAP stands for “Fermentable Oligo-, Di-, Mono-Saccarides and Polyols”. These are specific short-chain forms of carbohydrates and sugar alcohols that are not digestible. (2)

Why Can FODMAPs Cause Digestive Upset?

Because FODMAPs are not digestible, they end up being fermented and digested by your gut bacteria. The end product of that is hydrogen gas, which can cause digestive symptoms such as bloating, flatulence and abdominal pain.

FODMAPs also tend to pull more water into the intestines contributing to diarrhea and urgency.

Monash University Low-FODMAP Explanation

Monash University originally developed the Low-FODMAP diet, and have done extensive research improving this dietary strategy. We love this simple, 3-minute video they produced explaining the Low-FODMAP diet and how it relates to IBS symptoms.

Common FODMAPs Include:

• Fructose: sugar found in fruits, refined corn sweeteners such as high fructose corn syrup
• Lactose: natural sugar found in dairy products
• Fructans: wheat products, onions and garlic, cruciferous vegetables such as broccoli and cabbage (1)
• Galactans: soy-based products, beans/legumes, and lentils
• Polyols: stone fruits such as peaches and plums, additive in sugar-free products such as gum and soda

High-FODMAP Foods, To Be Avoided On A Low-FODMAP Diet:

Vegetables: onions, garlic, artichoke, cabbage, broccoli, cauliflower, Brussels sprouts, asparagus, celery, beetroot, mushrooms

Fruit: apples, avocado, banana (ripe), peach, apricot, plum, nectarine, mango, pear, watermelon, cherries, blackberries

Grains: wheat foods (cereal, bread and baked goods, bran, couscous), rye, barley

Protein sources: processed meats, most legumes/lentils, cashews, pistachios

Dairy: Milk (cow, goat, sheep, soy), yogurt, cheese (ricotta, cream cheese)

Sweeteners: High Fructose Corn Syrup (HFCS), agave, honey, inulin, maltitol, xylitol, erythritol

Low FODMAP Foods, Generally Well Tolerated In Appropriate Servings Sizes Include:

Vegetables: Green beans, bell peppers, bok choy, carrot, cucumber, lettuce, tomato, zucchini, potato

Fruits: Cantaloupe, grapes, kiwi, banana (green tipped), blueberries, papaya, rhubarb, strawberries, pineapple

Grains (whole, gluten free): buckwheat, millet, oats, quinoa, brown rice, corn/maize

Protein Sources: meat (beef, pork, lamb), poultry (chicken, turkey), fish (tuna, salmon, prawns), eggs, macadamia nuts, pumpkin seeds, walnuts

Dairy and dairy alternatives: almond milk, brie, camembert, feta cheese, hard cheese, lactose-free milk

Sweeteners: maple syrup, molasses, rice malt syrup (4)

Pros & Cons Of The Low-FODMAP Diet

Pros

• 70-86% of those following a low FODMAP diet for IBS report improvement of their symptoms and overall wellbeing.
• Fewer sick days
• It’s a short-term commitment – while one may have to remain FODMAP aware for some time, the initial elimination phase is short, with the goal being reintroduction of as wide a diet as tolerated.

Cons

• Lots of Low-FODMAP lists that don’t agree, mixed messages.
• 14-30% of people following a low-FODMAP diet see little or no improvements.
• May initially eliminate or limit foods you are not reacting to, making the diet unnecessarily restrictive.

If you are concerned you may be reacting to gluten-containing grains, you may wish to have a blood test to rule out celiac BEFORE eliminating wheat and glutinous grains from your diet.

In Summary

Like most things, IBS and digestive challenges are best managed with a whole life approach including managing stress; physical activity levels; a healthy, whole-foods diet; and having a strong support system. All these factors contribute to overall health and well-being, and are important in resolving IBS symptoms. Taking that into consideration, a Low-FODMAP diet is still the current gold-standard to begin investigating the root cause of IBS symptoms due to the extremely high success rate.

If you’re considering taking steps to address digestive health concerns, Koru Nutrition would be happy to support you in reaching your health goals. Our skilled team of naturopathic doctors, nutritionists, and dietitians are here to help! You can book an appointment online now if you’re ready to take that step toward healing.

Alternatively, we’ve created a 7-Day Nutritionist-Designed, Digestion-Supportive, Low-FODMAP Meal-Plan that can help guide you in implementing a low-FODMAP diet. With 30+ simple but delicious Low-FODMAP recipes, getting started on a Low-FODMAP diet has never been easier! Check it out the downloadable PDF today, you deserve to feel better! 

References:

https://www.ibsdiets.org/fodmap-diet/fodmap-diet-chart/
https://pubmed.ncbi.nlm.nih.gov/22426087/
https://onlinelibrary.wiley.com/doi/full/10.1111/j.1440-1746.2009.06149.x
https://badgut.org/wp-content/uploads/IBS-Survey-Results-2016.pdf
https://www.monashfodmap.com/ibs-central/
https://pubmed.ncbi.nlm.nih.gov/15932367/
https://badgut.org/wp-content/uploads/IBS-Survey-Results-2016.pdf
https://www.monashfodmap.com/ibs-central/
https://pubmed.ncbi.nlm.nih.gov/22426087/
https://onlinelibrary.wiley.com/doi/full/10.1111/j.1440-1746.2009.06149.x
https://pubmed.ncbi.nlm.nih.gov/15932367/
https://www.ibsdiets.org/fodmap-diet/fodmap-diet-chart/

Symptoms including bloating, abdominal pain, constipation and diarrhea are all too familiar to an individual with irritable bowel syndrome (IBS).

For the management of IBS, a type of elimination diet, called the low-FODMAP diet, has shown success in improving these symptoms.

FODMAP is an acronym for short-chain carbohydrates that the human body has difficulty digesting, and therefore can lead to IBS symptoms. Recent studies suggest that up to 86% of patients find relief from these symptoms on a low-FODMAP diet (1). We’ve written more about the low-FODMAP diet here. Remember, it is important to talk to a health care professional, such as your family doctor or naturopathic doctor to rule out any more serious conditions within your digestive system. 

In the standard American diet (SAD), wheat is the biggest contributor to FODMAPs in the diet (2). It is typical for a SAD breakfast to contain wheat-based items such as cereal, bread, bagels, or baked goods. When these items are eliminated during a low-FODMAP diet, making breakfast can seem challenging. This recipe provides a flavourful, quick, and filling alternative to start your day! Plus, these breakfast sausages can be made in batches and frozen, to be heated in a toaster oven or pan for those on-the-go mornings.

Many fruits are considered high-FODMAP foods because they are high in fructose, a natural sugar. However, blueberries are low in fructose and are therefore safe to eat in moderate quantities on a low-FODMAP diet. Blueberries were also recently listed as one of our Top 10 Brain-Boosting Superfoods!

This recipe includes extra-lean ground turkey which, in addition to being a low-FODMAP food, is considered a heart healthy choice compared to other ground meats. It contains lower levels of saturated fats, which is a known risk factor for cardiac disease (3). Turkey also contains the amino acid tryptophan which is the building block of neurotransmitters that help us feel happy, sleep well, and reduce cravings. 

With garlic and onion both being high-FODMAP foods, it can be difficult to replace the flavour infusion these ingredients provide. Ginger is a wonderful low-FODMAP flavour alternative incorporated into this recipe. Ginger also has the added benefit of having anti-inflammatory and antioxidant properties (4), and an affinity for soothing the digestive system.

1. Nanayakkara, W., Skidmore, P., O’Brien, L., Wilkinson, T., & Gearry, R. (2016). Efficacy of the low FODMAP diet for treating irritable bowel syndrome: the evidence to date. Clinical and Experimental Gastroenterology, 9, 131-142. doi: 10.2147/CEG.S86798

2. Dunn, S., Datta, A., Kallis, S., Law, E., Myers, C., & Whelan, K. (2010) Validation of a food frequency questionnaire to measure intakes of inulin and oligofructose. European Journal of Clinical Nutrition, 65(3), 402-408. doi: 10.1038/ejcn.2010.272

3. O’Keefe, J., & DiNicolantonio, J. (2018). Effects of dietary fats on blood lipids: a review of direct comparison trials. Open Heart. 5(2). doi: 10.1136/openhrt-2018-000871

4. Mashhadi, N., Ghiasvand, R., Askari, G., Hariri, M., Darvishi, L., & Mofid, M. (2013). Anti-Oxidative and Anti-Inflammatory Effects of Ginger in Health and Physical Activity: Review of Current Evidence. International Journal of Preventative Medicine. 4(1), 36-42.