vegetables

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.

bok choy is high in calcium.jpg

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 (5 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

 

5 Tips to Eat More Fiber on a Low FODMAP Diet

We all know fiber is a good thing. We keep reading articles about it in magazines and see packaged foods boasting "high fiber" claims in bold letters. Indeed, fiber has several health benefits: it helps our intestines function regularly and may help lowering cholesterol and blood sugar levels. 

People with IBS need to be careful about the amounts and types of fiber they eat so not to experience unwanted symptoms. Certain fibers are rapidly fermented in the large intestine and may lead to bloating, abdominal pain and excess gas. A few examples of foods that contain these types of fiber are onions, artichokes, wheat, and beans. These are the fibers a low FODMAP diet is designed to minimize.

Other types of fiber are slowly fermented and better tolerated, for example, the fiber in brown rice, kiwis, raspberries, carrots, and chia seeds.

How much fiber do we need? According to the Dietary Guidelines for Americans, and adequate fiber intake is 25 g per day for women and 38 g per day for men up to the age of 50 (a little less for older people). This is, however, for the general (healthy) population (sadly, most Americans consume too little fiber, an average of 15 g per day). Monash University recommends people with IBS eat between 25 and 30 g of fiber per day.

Here are 5 tips to eat more fiber:

1.     Don't be afraid to consume some fiber. Remember, this is a low FODMAP diet, now a zero FODMAP diet. On the other hand, don’t overdo it. Depending on your IBS subtype and symptoms (diarrhea or constipation), you might need to be on the low or high end of those recommendations. As you increase your fiber intake, make sure to also drink enough water during the day.

2.     Be sure to choose low FODMAP whole grains (brown rice, millet, quinoa) and don't limit yourself to the "white" stuff. There is a tendency for people to gravitate towards either avoiding grains altogether or mostly eat white rice, white-rice flour based products (crackers, gluten-free bread). By including more whole grains, in addition to the fiber (2-4 grams per cup of cooked brown rice, quinoa, quinoa-corn pasta or millet), you will get other important nutrients as well.

3.     Choose a variety of low FODMAP fruits and vegetables (keep the skin on) in small portions (1/2 cup is a good benchmark and will provide 2-4 grams of fiber) and spread them out throughout the day. Try some of these:

  • Fruit: raspberries, blueberries, strawberries, kiwifruit, oranges

  • Vegetables: carrots, radishes, kale, Swiss chard, eggplant

4.     Some canned legumes are ok even during the elimination phase (rinse and drain first). Try up to ½ cup per meal or snack (5-8 grams of fiber):

  • Lentils (great in soup, salads or chili)

  • Chickpeas (they are delicious roasted as a snack or sprinkled on salads)

  • Fresh or frozen edamame (boiled and rinsed)

5.     Don’t forget the nuts and seeds. In small amounts, these can contribute good amounts of fiber without triggering symptoms. Try up to 2 tablespoons per meal or snack (1-2 grams of fiber in most nuts/seeds; 10 grams in chia seeds):

  • Nuts: almonds or walnuts – great sprinkled on hot rice/quinoa cereal for breakfast

  • Seeds: pumpkin seeds (good by themselves or as topping for tacos) and chia seeds (in a smoothie or as chia pudding – see my recipe for Cocoa Chia Pudding below - who thought that eating more fiber could look like this?)

Finally, if you feel you need a fiber supplement, consult a dietitian before trying one on your own. If you choose the wrong fiber, you may make your symptoms worse. An expert dietitian can recommend one most suitable to your IBS subtype.

AdobeStock_Chocolate chia pudding.jpeg

Cocoa Chia Pudding

Ingredients

1 ½ cups unsweetened almond milk

¼ cup chia seeds

1 tablespoon unsweetened cocoa or raw cacao powder

1 packet powdered stevia (1 g)

1 teaspoon vanilla extract

A few chocolate shavings or 2-3 raspberries per serving to top (optional)

Procedure

1.     Combine the almond milk, chia seeds, cocoa, stevia, and vanilla extract in a bowl. Whisk until well combined and the mixture begins to thicken. Cover the bowl with plastic wrap and let sit in the refrigerator overnight or for 6-8 hours.

2.     When the pudding has set, give it one more stir, then portion into single-serve bowls. Alternatively, heat up in the microwave for a warm pudding.

3.     You can top with a small amount of shaved chocolate or 2-3 raspberries per serving, if desired.

Yield: 2 servings

Storage: Store in the refrigerator in an airtight container for up to 4 days.

Author: Antonella Dewell, Registered Dietitian Nutritionist & Natural Chef

10 Ideas for Healthy Low FODMAP Snacks

For people with IBS, the ideal meal pattern is to consume 3 moderately-sized meals and 1-2 small snacks, preferably spaced 3-4 hours apart. One reason is that large meals may end up accumulating a large load of FODMAPs and trigger symptoms. This may happen even if you are careful and choose only low FODMAP foods, as people with IBS are very sensitive to the distention of the stomach wall and, when it enlarges due to a large amount of food, the nerves that surround it send signals of pain/cramping to the brain (this is called visceral hypersensitivity).

It’s best to avoid “grazing” or eating semi-continuously as this is similar to stacking too many FODMAPs in the same meal. The intestinal tract needs to be empty at intervals during the day so that it can benefit from what are called “migrating motor complexes”, healthy cleansing waves that occur in the small intestine when it is empty.

All this makes snacking play an important role in the Low FODMAP diet. Here are 10 ideas for healthy and nutritious low FODMAP snacks (most of them are portable and can be used when traveling):

1.   Vegetables: choose red/yellow/orange bell peppers, baby carrots, cucumbers and cherry tomatoes, either alone or with a dip or spread (see ideas below)

2.   Dips/spreads: home-made Baba Ganoush (no garlic) or lactose-free cream cheese

3.   A handful (about 2 tablespoons) of low FODMAP nuts (no pistachios or cashews) or an ounce of peanuts; they can be raw, roasted, salty, spicy or even chocolate-covered

4.   Two rice cakes or half of a firm banana with 1-2 tablespoons peanut butter or 1 tablespoon almond butter

5.   Fruit: 1 cup grapes or pineapple chunks, 2 small kiwis, 1 medium orange or 2 small mandarins

6.   Lactose-free plain yogurt, alone or with 1 ounce of blueberries or raspberries

7.   Hardboiled eggs sprinkled with salt & pepper or cayenne/paprika

8.   A pouch of water-packed tuna, alone, with raw vegetables (see above) or a handful of low FODMAP rice crackers

9.   Popcorn without added high FODMAP ingredients like garlic/onion powder or honey

10. Home-made roasted chickpeas (up to half a cup). See my recipe below: 

Healthy Low FODMAP Snacks.jpg

Spiced Roasted Chickpeas

Ingredients

1, 15-oz can chickpeas, drained and rinsed

½ teaspoons freshly ground cumin*

½ teaspoon freshly ground coriander*

1 teaspoons paprika

¼ teaspoon salt

1 tablespoons avocado oil

Procedure

1.     Preheat the oven to 425ºF. Line a baking sheet with parchment paper.

2.     Dry the chickpeas by spreading them on towels on your kitchen counter.

3.     In a large bowl, mix the cumin, coriander, paprika and salt with the oil, then toss the beans into the bowl and mix until they are well coated with the spices.

4.     Spread the chickpeas onto the baking sheet in one single layer and roast for 10 minutes. Shake the sheet and then bake for another 15-18 minutes, or until crispy.

5.     Use as a snack or a protein and fiber-rich topping for a salad.

*Note: for best flavor, roast the coriander and cumin seeds in a skillet until aromatic, stirring often and being careful they don’t burn. Transfer them to a coffee or nut grinder and grind them to a powder.

Yield: 4 servings

Storage: Store in an airtight container in the refrigerator for up to 4 days.

Author: Antonella Dewell, Registered Dietitian Nutritionist & Natural Chef