Is a Low FODMAP Diet a Lactose-Free Diet? 5 Tips to Get Enough Calcium

It is a common misconception that a low FODMAP diet is a lactose or dairy free diet. It can be (if you have established that you are lactose intolerant or have a milk protein allergy) but it doesn’t have to.

A low FODMAP diet needs to be low in lactose as this is one of the short-chain carbohydrates that may trigger symptoms in people with Irritable Bowel Syndrome (IBS). If your body does not produce enough lactase – the enzyme that can split the lactose molecule into its singles sugars (glucose and galactose) – the unabsorbed lactose attracts water and travels to the large intestine undigested. There, our friendly bacteria ferment it, leading to unpleasant symptoms such as bloating, gas, stomach cramps, and diarrhea.

Calcium (together with vitamin D) is an important nutrient that helps build and maintain strong bones and teeth and has a role in keeping our muscles working (including our heart) and in helping nerves carry messages from the brain to other parts of our body. If you don’t get enough, we may become at risk for osteoporosis and fractures later in life. So, how can you make sure to get enough calcium on a low FODMAP diet? Here are a few tips.

1. Include some dairy products if you can

Small portions of certain dairy products, such as hard cheeses and cream cheese, contain minimal amounts of lactose and can be tolerated even by people with lactose intolerance. If you include lactose-free milk, yogurt, or kefir in your diet, you are less likely to be deficient in calcium. If you don’t, no worries: it is feasible to get enough calcium in your diet even without eating dairy. There are many other foods that are high in calcium.

2. Eat low FODMAP legumes

Beans and lentils contain good amounts of calcium. While on the elimination diet, you can only safely eat small portions of canned chickpeas and lentils. Soy beans and soymilk are high in FODMAP but edamame and firm tofu (drained) are excellent low FODMAP sources of calcium. If you have completed the re-challenge phase and know you tolerate them, you can experiment with other beans such as black, kidney and others and different kinds of lentils.

5. Go fishing

Well, you don’t really need to go fishing yourself. But if you are a pescatarian, you can enjoy canned fish with bones, especially salmon and sardines. The bones are small and soft and are edible, so throw them on a salad for an easy lunch.

3. Don’t forget the nuts and seeds…

Almonds and brazil nuts are high in calcium even at the low FODMAP serving of about 10 nuts. Nuts and seeds are also used to make non-dairy milk. In addition to almond milk, other low FODMAP varieties are hemp and macadamia. Although most kinds of non-dairy milk are fortified with calcium (and vitamin D), check the labels as some are not. I talked previously about chia seeds as a fiber superstar but this tiny seed is also high in calcium. If you haven’t yet, check out my recipe for Cocoa Chia Pudding (it has almond milk too!).

4. …and the vegetables!

Kale does not need a PR campaign as a superfood (one of its many benefits is that it is high in calcium) but the less-known Bok Choy certainly does. The baby variety is very easy to handle and prep fast. See this delicious, easy recipe for my Colorful Asian Stir-fry (guess what? It also has tofu!).

If you are not sure you are meeting your calcium needs, ask for the help of a dietitian who is versed in the low FODMAP diet. He/she can help you maximize your intake without risking unpleasant symptoms.

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Colorful Asian Stir-Fry

Ingredients

1 tablespoon high sunflower or avocado oil

8 oz. firm or extra firm tofu, cut into cubes

1-inch piece ginger, minced (about 2 teaspoons)

2 cups chopped (6 oz.) baby Bok Choy, stems and leaves separated, chopped

1 medium red or orange bell pepper (6 oz.), thinly sliced

1 medium carrot (2 oz.), thinly slices on the diagonal

1 tablespoon oyster sauce*

½ teaspoon toasted sesame oil

½ teaspoon sesame seeds (optional)

*gluten-free, if following a gluten-free diet

Procedure

1.     Heat a large heavy-bottomed skillet or wok on medium-high heat, add 1 teaspoon of the oil and the tofu. Let it cook for about 3 minutes or until browned, then turn the tofu pieces with a spatula and let them brown (2-3 minutes). Set aside.

2.     Add the remaining oil to the skillet or wok and, when hot, add the ginger. After 30-60 seconds, add the Bok choy stalks, bell pepper, and carrot (make sure the skillet is wide enough so not to overcrowd it or the vegetables will steam instead of stir-fry). Cook for 1- 2 minutes, stirring often until vegetables are crisp-tender.

3.     Add the baby Bok choy leaves and stir-fry for another 30-60 seconds, or until just wilted.

4.     Add oyster sauce and tofu and stir until the vegetables and tofu are coated. Turn the heat off and add the toasted sesame oil.

5.     Serve on top of brown rice and sprinkle with the sesame seeds, if desired.

Yield: 2 servings

Storage: Store in an air-tight container in the refrigerator for up to 3 days.

Author: Antonella Dewell, Registered Dietitian Nutritionist & Natural Chef

 

Probiotics for IBS: To Use or Not to Use? That is The Question

Probiotics are a hot topic these days. Articles in magazines highlight them, supplements are growing in greater numbers, and certain foods are supplemented with them.

Why do probiotics get so much attention? Probiotics are microorganisms that can live in our gut and might improve gut health. The scientific definition is: “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host”. Some of these potential gut benefits include fighting off bad bacteria, protecting the lining of our intestinal tract and minimizing intestinal permeability (also known as “leaky gut”). Studies in people with IBS are suggesting that they may also improve some symptoms.

It would seem natural for someone with IBS to think about trying one, but should you? It’s a big question without an easy or straightforward answer. Here are a few key points from the emerging literature:

1.   After only 3-4 weeks of a low FODMAP elimination diet, gut bacteria decrease in numbers and variety and probiotics may be useful in restoring them.

2.   A lot of research has been done to study the effects of probiotic supplementation in people with IBS but we don’t yet have all the answers and there isn’t enough consensus to give firm recommendations.

3.   Nonetheless, probiotics seem generally safe to use and if you’d like to try one, the researchers at Monash University recommends that you:

  • Don’t’ expect miracles, the improvement in symptoms may be mild at best
  • Take them consistently for 4 weeks as it may take that long to see any benefits
  • Make sure there aren’t any prebiotic fibers mixed with the probiotic supplement (such as inulin or fructo-oligosaccharides) as these may be poorly tolerated in people with IBS.
  • Those who are most likely to benefit from are IBS patients with mild symptoms and those with compromised microbiome, such as in post-infectious IBS.
  • Test only one management strategy at a time: try the low FODMAP diet first, then consider probiotics
  • Ask your doctor or gastroenterologist to recommend a product that has been researched for IBS and is most suitable for your symptom profile
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Last but not least, probiotics may be naturally present in some foods. You may want to consider including some low-FODMAP prebiotic foods in your diet:

  • Lactose-free yogurt and kefir
  • Some types of low-FODMAP cheese (mozzarella, cheddar, cottage cheese)
  • Miso
  • Tempeh
  • Sourdough spelt bread (unless you have celiac disease are gluten intolerant)

After you have completed the re-challenge phase of the low FODMAP diet, you may expand the range of probiotic-rich foods. If you tolerate the mannitol (a sugar alcohol), you may be able to eat small portions of sauerkraut or kimchi (beware that some may also contain garlic). If you tolerate oligosaccharides, you may be able to drink some kombucha. If you’d like to learn more about probiotics for IBS, read this great article from Monash University.

6 Tips for Eating Out on a Low FODMAP Diet

Preparing all your meals at home would be ideal while following a low FODMAP diet, as you have more control on what and how much you are eating. Still, it’s hard to avoid eating out completely. Whether you have a dinner date at a restaurant, are invited to a wedding, or need to travel, here are a few tips on how to navigate restaurants without getting GI symptoms.

1. Choose your restaurant wisely

This is key when you eat out. You will find blogs on how to choose meals at various ethnic restaurants (Chinese, Indian, Italian) but it will make your life simpler at this point to avoid certain restaurants altogether. For example, Indian dishes almost always include garlic and/or onions and mostly feature high-FODMAP vegetables and legumes. Chinese and Thai restaurant may be better as most of their dishes are rice-based but they rely a lot on garlic and onions when cooking vegetables or meat/poultry. Even if you find a gluten-free pizza place, the tomato sauce is almost always made with garlic and/or onions, and there is usually is way too much cheese. You will be able to eat in a variety of restaurants after you have learned what your trigger foods are but for now, keep it simple.

2. Keep it simple

Restaurants that will more likely have low FODMAP choices are those where you can order a chicken/meat/fish entree with a choice of side dishes. You can look up the menu for options such as rice and potatoes and a low FODMAP vegetable (kale, carrots, bell peppers, etc.). Look up the list of vegetables in the Monash App for more choices and appropriate serving sizes. If you are a vegetarian you can ask for firm tofu as a substitute for animal protein. Or have a protein-rich snack before your leave the house, and eat the starch and vegetables at the restaurant.

3. Beware of hidden FODMAPs

Stay away from menu items that may have hidden FODMAP ingredients: soups, stews and risotto (garlic and onion in the broth); marinated meats/fish or hamburgers (may have garlic or onion powder); sauces and salad dressings; creamed-based soups or pasta sauces.

4. Keep the portions small

Keep in mind that most restaurants serve portions that are larger than those most of us prepare at home, and any large meal may trigger symptoms in people with IBS. Have a low-FODMAP snack before going out so you don't get too hungry and take some of the restaurant food home to keep your meal size moderate. 

5. Don’t be afraid to ask

Do your homework before you head out or choose the restaurant and peruse the menu to see whether you have a few low FODMAP choices. Call ahead and ask the staff whether they allow substitutions (they may have ingredients they don’t feature on the menu that you can have in place of high-FODMAP items). Explain you can’t have even a trace of garlic and/or onions. Whereas pretty much everyone today is familiar with the term gluten-free, waiting staff or even chefs may not know what a FODMAP is and you will need to ask precise questions.

6. Avoid potential FODMAP overloading

If you plan to eat out ahead of time, make sure you are as strict as you can with your other meals and snacks. If you eat as low FODMAP as possible during the rest of the day, you will avoid the build-up effect of adding too many FODMAPs in the same day. And, if you end up eating a high-FODMAP ingredient accidentally, the effect will hopefully not be as bad, as your overall FODMAP load will be lower.

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