3 Tips to Satisfy that Sweet Tooth on a Low FODMAP Diet

I am a firm believer that when it comes to diet, moderation is key, and no food is per se a “bad” food. We all need a treat once in a while, and for many people, that means a “sweet treat”. I have to admit, this time of year especially, with the holidays humming and the weather turning chilly, I find myself wanting to bake some special treat, or warm up with an occasional cup of hot chocolate. Perhaps because it reminds me of when, as a teenager, I was skiing in the Alps during the Christmas break, and, after hours in the freezing temperatures, my friends and I would warm our hands (and our tummies) around a cup of hot chocolate (see my recipe for Italian Hot Chocolate below).

Although there are many low FODMAP dessert choices out there, the issue for people with IBS is eating too much at one sitting. This may make you consume too much fructose at once and lead to unpleasant symptoms. Before I give you my tips to enjoy sweets without incurring into tummy trouble, it is useful to understand how fructose is absorbed.

Fructose is a single-sugar unit (a monosaccharide, the “M” in the acronym FODMAP) which can be absorbed in two different ways: the first is by diffusion, which means the fructose molecule crosses the intestinal wall on its own; the second is by “piggybacking” with glucose on a transporter molecule. The first method is a slow and inefficient process, which may leave unabsorbed molecules in the small intestine. The second method is the most efficient but works well only when there are equal amounts of glucose and fructose to be transported, as the two molecules are paired up in the transport system. If there is more fructose than glucose, the excess fructose is not taken up and remains in the small intestine. As it is a small molecule, fructose has a high osmotic capacity, which means it draws water, leading to diarrhea. When it then travels the large intestine, it is fermented by the gut bacteria, resulting in gas production and bloating.

Most of the fructose in our diet is found in fruit and in sweeteners (together with glucose). As both absorption methods may lead to unabsorbed fructose molecules lingering in the small intestine, how well fructose is absorbed depends both on the dose consumed and the fructose to glucose ratio. There are two keys to ensuring you don’t get symptoms from fructose: one is to choose fruits and sweeteners with a balance of glucose and fructose and avoid or limit those that contain more fructose than glucose; the second is to avoid eating too much sugar at one sitting, as too large of a fructose load will overwhelm the system.

3 Tips to Satisfy your Sweet Tooth on a Low FODMAP Diet

 

1. Choose fruits and sugars with a good balance of fructose and glucose:

 

Suitable fruits*:

  • Banana

  • Blueberries

  • Cantaloupe

  • Kiwifruit

  • Oranges/mandarins/clementines/tangelo

  • Grapefruit

  • Grapes

  • Papaya

  • Pineapple

  • Raspberries

  • Strawberries

Suitable Sweeteners*

  • Sucrose (aka table sugar, also known as beet/brown/cane/castor/confectioner’s/granulated/icing/organic/refined sugar; raw sugar crystals, can juice crystals, cane syrup, evaporated milled cane juice, simple/sugar syrup)

  • Glucose

  • Dextrose

  • Palm Sugar

  • 100% Maple Syrup

  • Corn Syrup (is it mostly glucose)

  • Rice malt syrup

  • Stevia, powdered or liquid (not a sugar, but a non-nutritive natural sweetener)

    *These are “suitable” in appropriate portions – See the Monash University Low FODMAP Diet App. Fruit: It is recommended to consume no more than one portion of fruit per meal or snack. You can have more than one portion of fruit in one day, just be sure to separate them by at least 2-3 hours.

2. Avoid fruits and sugar with excess fructose (unless you have re-challenged them and found you can tolerate them)

Unsuitable fruits

  • Apple

  • Boysenberries

  • Cherries

  • Figs

  • Mango

  • Pear

  • Watermelon

Note: there are other “high FODMAP” fruits not listed here as they are high in sorbitol (not fructose).

Unsuitable sweeteners

  • Agave

  • Coconut sugar

  • Golden syrup*

  • Honey

  • Molasses

  • Sorghum syrup*

Note: Most high-fructose corns syrup (HFCS) has a similar fructose/glucose ratio to sucrose (about 55% fructose and 45% glucose). However, the fructose amount may vary from 42 to 90%. As it is not possible to know from the label which kind of HFCS it is, it is best to avoid it.

*These are high in Fructans (not fructose), a type of oligosaccharides (the “O” in FODMAP). Fructans are chains of fructose molecules that travel to the large intestine undigested and are fermented by our gut bacteria.

Artificial Sweeteners (aspartame, sucralose, and saccharine) are low in FODMAPs but, as some preliminary studies are showing that they may be harmful to our gut bacteria, many dietitians (myself included) are starting to recommend avoiding them altogether.

3. Avoid large loads of fructose in one sitting

This is where it is easy to get confused by the plethora of “low FODMAP desserts” appearing every day on blogging sites. Sure, these desserts may be made with gluten-free flours, low-lactose dairy products, and other low FODMAP ingredients, but a dessert is only low FODMAP at a portion size that limits the fructose content (most likely from the sugar) to a certain threshold.

Beware of desserts that end up having high amounts of sugar per serving (such as some cakes, brownies, or desserts with frosting or cream fillings).  A good rule of thumb is to limit the amount of sugar to about 1 tablespoon (15 grams) per sitting. This is not unreasonable given that, FODMAPs aside, the American Heart Association recommends limiting the daily intake of added sugars to no more than 6 teaspoons (25 grams) for women and 9 teaspoons (36 grams) for men.

Going back to my initial “everything in moderation” message, if you follow a healthy diet without excess added sugars, come the holidays, you may enjoy a dessert without guilt. Still, if you want to avoid symptoms, make sure the piece is small, or, if you really want to indulge for once, keep your overall FODMAP level low during the rest of the day. Your tummy will thank you, and you will be able to really enjoy the time you spend with your friends a family!

hot chocolate in an espresso cup.jpg

Italian Hot Chocolate


Ingredients

1 teaspoon cornstarch

1/3 cup water

2/3 cup lactose-free milk (whole or 2%) or almond milk

1 ½ oz (42 g) 72% dark chocolate, finely chopped

2 teaspoons sugar

Procedure

1.     In a small saucepan, dissolve the cornstarch in the water; add the milk and bring to a boil

2.     Lower the heat, and add the chocolate and sugar. Simmer for 1-2 minutes, stirring constantly, until the chocolate thickens.

3.     Pour into two 4-oz cups (preferably heated with hot water). Enjoy! 

Yield
2 servings (1 serving is equivalent to 10 grams of sugar, and under the low-FODMAP serving size for dark chocolate).

Note: this is so rich that you can make it into 4 servings and drink it, as it is popular now in Italian cafés, in espresso cups.

Got Beans? May Guide to Including Legumes on a Low FODMAP Diet

Legumes (also known as pulses) include beans, lentils and dried peas (chickpeas, split peas). Beyond the classic black, pinto, or garbanzo beans, you can now buy an incredible variety of lentils (red, yellow, green, black, split or not) and even heirloom beans, with different colors, flavors and shape.

If you thought legumes were boring, think again. Just a virtual visit to the cuisines or India (dals and channa masala), Morocco (Harira), the Mediterranean (Italian Ribollita), Latin America (black bean soup or pozole) and Japan (soy beans) will start making your head spinning with new ideas on how to vary your intake of legumes. And these are just a few examples. One could write and entire book on the different ways you could cook these nutritional powerhouses. Indeed, let’s then talk about why they are so good for us.

The Benefits of Legumes

First of all, they are the cheapest way (for your wallet and for the earth) to get protein in your diet. But if you think that they are “poor people’s” food, I am going to tell you that they are also “lucky people’s” food. Yes, because, in addition to the protein, they contain slow-digesting carbohydrates, tons of fiber, and come packaged with minerals (iron, magnesium, calcium, potassium), vitamins (folic acid and other B vitamins) and phytochemicals. Here is what they can do for us:

1)    Help with weight management and blood sugar regulation.Their high fiber content helps us feel full longer, and digest food slower. Even their carbohydrate portion is digested very slowly and helps improve blood glucose control and thus prevent (or control) diabetes.

2)     Help with constipation: they contain insoluble fiber, which creates bulk and moves stool through the GI tract faster.

3)     Help keep healthy cholesterol levels: they are one of the few foods high in soluble fiber, which binds cholesterol and helps excrete it (I wrote more on the subject in a previous article). They are also very low in saturated fat, and may help reduce the risk of cardiovascular disease when they replace high-saturated fat foods like burgers or cheese.

4)     Protect the body against disease as they contain antioxidants and other bioactive compounds. Although foods like blueberries and broccoli are more famous for their antioxidant content (you may have heard of anthocyanins and sulfuraphanes), legumes contain flavonoids, lignans, phytosterols, and other bioactive compounds that may protect us from chronic disease and inflammation.

5)     Help maintain a healthy gut due to their prebiotic fiber, which is the fast food for our good gut bacteria.

The American Diabetes Association, the American Heart Association and the American Cancer Society all recommend legumes as one of the most important food groups for disease prevention and optimal health.

Legumes on a low FODMAP diet

Legumes are rich in prebiotic fibers known as oligosaccharides (mostly GOS, or galacto-oligosaccharides, and also fructans). As humans don’t have the enzymes necessary to break these molecules down, they go through our GI tract unabsorbed, end up in the large intestine, where our gut bacteria digest them and use them for energy. Unfortunately, the result of this fermentation process is gas, and for people with IBS, it’s an exaggerated amount of gas, which can also induce bloating and pain.

For this reason, most beans, lentils, and dried peas are excluded during the elimination phase of the low FODMAP diet. Studies have shown that after only 3-4 weeks of a low FODMAP protocol, the gut bacteria diminish in variety and numbers due to a low prebiotic fiber intake. The good news is that they can repopulate after re-introducing foods high in prebiotics. Most people find that they tolerate some or most legumes, either in smaller or even larger portions.

Here is how to prepare them to minimize the gas production:

  • During the elimination diet, you can have small amounts (no more than ½ cup) of canned chickpeas and lentils as they as low enough in FODMAPs to be suitable for this phase.

  • Afterwards, if you pass the GOS challenge, you can start by reintroducing small amounts of other canned beans first, as the canning process drastically lowers the amounts of FODMAPs. You can read more about the effect of food processing on FODMAPs here. Be sure to drain them and rinse them well.

  • To increase the variety of beans in your diet, you may also want to try cooking them yourself. Soak them overnight, discard the soaking water, and cook them in fresh water until they are very soft. Start with channa dal, urad dal, and chickpeas (lowest in FODMAPs), then try butter beans, and red or green lentils. Last, try the higher-FODMAP varieties: soy, borlotti, lima, red kidney beans, and split peas (highest!).

  • Finally, the enzyme supplement alpha-galactosidase helps some people tolerate beans more easily.

Tips for cooking and eating legumes

  • Plan ahead: soak them the night before you intend to eat them. If you forget, stock your pantry with a few cans your favorite legumes to have some handy.

  • If you don’t have the time to cook them when you set out to make lunch or dinner, prepare them ahead of time (for example during the weekend), and store them in airtight containers or even freeze them in the portions you know you will need for your favorite recipes.

  • Add herbs and spices to vary the flavor: they are delicious! Cumin and coriander, when added to the cooking water, also help decrease the gas production.

  • You can add beans or chickpeas to any salad for a complete meal; prepare a quinoa-tabbouleh and add some chickpeas.

  • Have them as a snack: try my Spiced Roasted Chickpeas recipe.

  • Replace part of the ground beef in your Bolognese sauce with canned lentils.

  • Make your own hummus: You can use garlic-infused olive oil to replace the garlic, and canned chickpeas. Blend in a mixer with some lemon juice, a little water and salt to taste, then add cumin and paprika for additional flavor. Divide into the portion size that correspond to a maximum of ½ cup chickpeas.

  • Put them in soups or stews. Just start with the smallest amount you know you can tolerate, then slowly increase the portions and see how you tolerate them. Try my Mexican Lentil Chili below.

black lentils are low FODMAP.jpg

Mexican Lentil Chili

Ingredients

1 cup quinoa, rinsed and drained

1 Tablespoon olive oil

½ cup chopped green tops of scallions (1 oz.)

1 medium red or orange bell pepper (1/3 lb.), small dice

1 small green chili, de-seeded and minced

1-2 teaspoons chili powder (depending on desired level of heat)*

1 teaspoon ground cumin

½ teaspoon salt

1, 14-oz can diced tomatoes

1, 15-oz can black or brown lentils, drained and rinsed

½ oz dark (60 or 70%) chocolate, finely chopped

½ teaspoon lemon juice (optional)

3 Tablespoons chopped cilantro

*Make sure to check the ingredients’ list as some chili powder blends add garlic and/or onion. Spicy foods may be a trigger for some people. Adjust amount of chili powder according to tolerance.

Procedure

1.      Bring 1 and 1/2 cups water to a boil. Add a pinch of salt and quinoa. Bring back to a simmer, then lower the heat, cover and cook for 10-12 minutes. Stir, cover and let the quinoa rest for 5 minutes.

2.      While the quinoa is cooking, heat the oil in a Dutch oven or soup pot over medium heat. Add the scallion tops, bell pepper, and green chili. Cook for 6-7 minutes, until softened. Check and stir often, adding some water, if needed.

3.      Add chili powder, cumin and salt and stir for 1 minute.

4.      Add tomatoes and simmer, stirring occasionally, for 10-12 minutes, until thickened.

5.      Stir in lentils, quinoa, chocolate, and ½ cup water. Let simmer for an additional 5 minutes, until flavors have blended.

6.      Taste and add lemon juice, if desired, and adjust for salt, if needed.

7.      Garnish with cilantro. Serve with corn tortillas on the side.

Yield

4 servings

Storage

Store in the refrigerator for up to 4 days or in the freezer for up to 2 months.

 

 

5 Myths about the Low FODMAP Diet…Debunked!

1.     It’s a life-long diet

This is perhaps the most common misconception: that you should follow a low FODMAP diet for the rest of your life. This is just a temporary, learning diet and the “low FODMAP” part refers to the first phase of the diet, when you eliminate all high FODMAP foods. As soon as symptoms are reduced and you feel better, you need to re-challenge those foods gradually and systematically to find out your personal triggers. You can then craft your personalized FODMAP diet. Even then, you are not done. As symptoms wax and wane, you are encouraged to re-challenge more foods every 3-6 months.

2.     It’s the same for everyone

I often hear people tell me their doctor gave them a handout and told them to follow the low FODMAP diet. Period. It’s not that simple! This is not just a list of foods to avoid and foods to eat. Sure, a few foods have negligible amounts of FODMAPs and are “included” whereas other are high in FODMAPs and “excluded”, at least during the elimination phase. But so many foods are either low or high depending on their portion size. To complicate matters, there is the question of the FODMAP load in a single meal or snack. Most importantly, every person reacts to different foods and they will end up eating a modified FODMAP diet that is unique for them. This stresses the importance of securing the help of a registered dietitian who is knowledgeable in this topic to help navigate all its complexities.

3.     It’s a gluten-free diet

It is not, as gluten is not a FODMAP. FODMAPs are carbohydrates and gluten is a protein. However, gluten and a certain class of FODMAPs (fructans) coexist in wheat, barley, and rye. This is where the confusion comes. Wheat, barley, and rye and products made with these grains are excluded during the first phase of the diet to eliminate the fructans. In fact, some low FODMAP foods that contain gluten, such as soy sauce, are included. On the other hand, not all gluten-free products are low FODMAP. Many gluten-free breads and other baked products often contain high-FODMAP ingredients such as honey, agave, pear or apple juice, or inulin/chicory, which makes them not suited for a low FODMAP diet.

4.     It’s a lactose-free diet

Lactose is a FODMAP but the diet only needs to be low in lactose, not completely free of lactose. Lactose-free dairy products (milk, yogurt, cream cheese and ice cream) can be included. And so can those with minimal lactose content, for example hard cheeses like parmesan or cheddar, butter, and small amounts of cream and half-and-half.

5.     It’s a low-fiber diet

Finally, some people think they need to avoid all high-fiber foods. This is not true and can be counterproductive for those suffering of constipation. Depending on which kind of motility issue you may have (diarrhea or constipation), the fiber content will need to be adjusted and the type of fiber individualized (more soluble or insoluble fiber). Low FODMAP sources of fiber such as permitted amounts of chickpeas and lentils, low FODMAP vegetables and fruits, and low FODMAP whole grains (quinoa, brown rice, millet, oats, etc.) can and should be included. See my article 5 Tips to Eat More Fiber on a Low FODMAP Diet for more ideas.

3 Tips for Eating a Balanced Vegetarian or Vegan Low FODMAP Diet

FODMAPs are sugars and fibers that are either poorly absorbed or not absorbed at all. A low FODMAP therefore diet restricts the intake of carbohydrate-rich foods such as some grains, legumes, lactose-containing dairy, vegetables and fruits. When you add another restriction – that of a vegetarian or vegan diet, you might even wonder whether there is anything left to eat at all!

With some planning, and the help of a registered dietitian knowledgeable about FODMAPs, vegetarians and even vegans can follow a low FODMAP protocol and eat a balanced diet. As many foods are either eliminated or limited in portion sizes, vegetarians and vegans need to be especially careful in planning meals so to avoid deficiencies in protein, calcium, iron, vitamin B12 and, possibly, fiber.

Here are 3 tips to eat a balanced vegetarian or vegan low FODMAP diet.

1. Don’t skip the protein

Vegetarians are less at risk of eating too little protein as the low FODMAP diet includes eggs, lactose-free dairy products and a few types of cheeses. Vegans need to pay more attention. Each meal should include a low FODMAP source of protein such as legumes (canned lentils or chickpeas), tofu (firm, extra firm), edamame, or tempeh. I recently wrote My Guide to Eating Soy Foods on a low FODMAP Diet (including an Indonesian Tempeh recipe).

Among the low FODMAP grains, quinoa (and quinoa-based pasta), millet and oats are also high in protein - more than rice - and can contribute to the overall protein intake. According to vegetarian nutrition experts, vegetarians and vegans should aim to eat a little more protein than omnivores: about 1 g/kg body weight (instead of the general recommendation of 0.8 g/kg).

2. Include good sources of calcium

Calcium intake may be an issue for everyone on a low FODMAP diet due to the restriction of lactose. Vegetarians who like dairy products can eat lactose-free milk, yogurt, and a few kinds of hard cheeses. Vegans miss out on this food group entirely but can still meet their calcium needs by drinking calcium-fortified almond or hemp milk, and eating calcium-set tofu, and calcium-rich vegetables (bok choy and kale) and chia seeds. See more ideas in my article, 5 Tips to Eat Enough Calcium (including two tasty calcium-rich recipes).

3. Pump Up the Iron

A common pitfall for all vegetarians/vegans (whether on a low FODMAP diet or not) is eating too little iron. The best sources are, after all, red meat and organ meats. Breakfast cereals are fortified with iron but most of them are high in FODMAPs. Even so, careful meal planning can help you eat enough or close to enough. All the plant-based protein sources are high in iron (and zinc): legumes, soy products, nuts and seeds. The grains mentioned above are also rich in iron, as well as certain low FODMAP vegetables such as kale, chard, raw spinach, bok choy, and broccoli. 

You may have heard that the iron from plant foods is not as well as absorbed as the one from animal foods. However, adding a vitamin C-rich fruit or vegetable (for example, kiwi, strawberries, oranges, or red bell peppers and broccoli) at the same meal greatly increases the absorption of iron. Another useful tip is to avoid drinking coffee, tea, mint tea or cocoa with meals as the flavonoids or phenolic acid in these beverages bind the iron and reduce its absorption by as much as 50-90%. Finally, it would be best to eat calcium-rich and iron-rich foods in separate meals, as calcium and iron inhibit each other’s absorption. You need not worry about the foods that contain both (such as tofu or legumes). Mostly try not to drink lactose-free milk or almond milk with your lunch or dinner, and have those very high-calcium foods with breakfast and/or snacks.

Final Food for Thought…

A paper published by Monash University earlier this year found some popular vegan foods to have either a low or negligible FODMAP content: soy cheese, coconut yogurt, pea protein isolate, kelp noodles, vegan egg replacer, nutritional yeast, agar-agar, dulse, and spirulina. Check out the Monash University FODMAP Diet App for appropriate serving sizes.

Even when doing all things right, you may still be deficient in certain of these nutrients or may simply not be eating enough. It’s best to consult with a registered dietitian trained on the low FODMAP diet to see whether you may need to tweak your meals further or need a supplement (for example, B12 for vegans). Finally, don’t forget that the low FODMAP diet is a temporary diet and, once you have completed the re-challenge phase, you may be able to include many more foods, such as more varieties of beans and lentils, perhaps soy milk, and more choices or higher portions of vegetables.