Laura Manning is a Clinical Dietitian at The Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center at Mount Sinai. Today, she is discussing the Benefits of Staying Hydrated.

Getting Comfortable with the Elimination Phase

The Elimination Phase of the Low FODMAP Diet means that we remove all foods containing fermentable carbohydrates that may be causing IBS-type symptoms.  This is a highly effective method to help determine our trigger foods.  When consumed and combined with our gut bacteria, trigger foods can cause potential gas, bloating, constipation and diarrhea.  The feedback we receive from following the Low FODMAP diet can provide us with lifelong tools to optimize our digestion. Understanding which foods we may be intolerant to can help us modify what we eat when dining out, traveling or simply having a comfortable belly during the workday.  It has become a widely used therapy, backed by science, to help people with gastrointestinal issues learn how they can manage their symptoms with food choices. (do you need me to list the studies, there are many…)

The Elimination Phase involves limiting lactose, fructose, fructans, galacto oligosaccharides and poyols, including foods such as certain dairy products, honey, garlic, onions and mushrooms, to name a few.  The most common (almost panic) questions I receive when speaking to patients is “how am I going to avoid garlic and onions when it is in everything I eat at home and at restaurants?” and “I thought garlic and onions were good for me?” The truth is that garlic and all other FODMAPs are not bad for you at all, but certain patients need to take a break from them for a while, then add them back in at a later date to determine their tolerance threshold.

It is true that garlic, onion, shallots and leeks are the base of most cuisines worldwide and appear on every restaurant menu. They also serve as healthy additions to a diet and have been proven to have cardiovascular health benefits due to the sulfur compounds (allicin) they contain when they are crushed, chopped cooked with and chewed. These ingredients also impart such a fragrance that as soon as you begin to cook with them, they fill your home with an aroma that makes you feel as though you’re dining al fresco on the Mediterranean Sea. As a dietitian, knowing that a patient who is reporting so many of the classic IBS symptoms, and uses so much of these fructans everyday, makes me feel confident that the Low FODMAP diet will be successful in improving their symptoms.

So, how do you flavor your meals while doing a low FODMAP diet?

There are so many other ways to add flavor without adding garlic and onions – trying new options may even expand your palate! Other flavorful options include dried or fresh herbs, such as basil, thyme, parsley, oregano, cilantro, and spices, such as pepper, mustard, cinnamon, chili powder, paprika, saffron and turmeric. However, it is important to know that dried versions of garlic and onions in powder form are not used in the elimination phase. These items have just been simply dehydrated – all FODMAPs remain in a concentrated form. A solution for those missing onions is to use a pinch of an Indian spice called asafetida, available at specialty spice markets. Additionally, you can use the green parts of spring onions and chives to retain a bit of onion flavor.

A perfect solution for those who still don’t know what to do without garlic flavoring is to sauté whole garlic cloves in oil and remove the bulb before eating.  Another tip is to use infused oils, which is an excellent way to keep the flavor of the garlic without the FODMAPs (see recipe below). This is because FODMAPs are not soluble in oil, so the flavor can be extracted from the fructan without the fermentable carbohydrate remaining.  Since fructans are soluble in water, cooking with them in soups and stocks will contain the fructan and will not be allowed in the Elimination Phase. An important tip to remember when shopping for soups and stocks is to read the product ingredient labels to see if they contain a FODMAP. Whether the stock comes in liquid or powder form to be reconstituted, most do contain garlic and onions and should be avoided.  Simply make them with infused oils and other herbs and spices and you will be able to enjoy all of your favorite dishes. There are now soups, stocks and dressings on the market that are Low FODMAP certified! It is great to know that there are now many seasoning options on the market that do not contain FODMAPs and can be a very helpful way of adding combinations of flavor to meals.

How to Make Infused Oil

For the best infused flavors, start with the right oils.

It is best to use an olive oil that is light to mild to highlight the infused herbs instead of a stronger, grassy-type like extra virgin that may mask the infused flavors. It is also recommended to use canola, sunflower, or safflower oils because of their neutral flavors.

Cold infused

  • Best for using fresh herbs (parsley, basil, thyme, etc.)
  • Use 1 cup of loosely packed fresh herbs to 1 quart of oil
  • Use a food processor to chop up the herbs and then combine with oil
  • No need to let it sit for a long period of time.  Just strain it and be sure to store in a glass bottle in the fridge.  This type will last about 1 week.

Heat infused

  • This method is best for using woody herbs and dried spices (rosemary, chiles, peppercorns, garlic, etc.)
  • Heat the oil to 250°F and add ingredients after the oil has been removed from the stove and cools for 30 minutes. Let it sit until you reach your desired flavor. Strain it and store in a glass bottle.
  • This oil does not need to be refrigerated.

ENJOY!!!

—-

DISCLAIMER: Mount Sinai is an investor in Epicured. This material is for informational purposes only, and Mount Sinai makes no representation or guarantee as to any results or experience with Epicured. You should consult with your physician before using a dietary program such as Epicured. Mount Sinai employees do not receive material benefit from endorsing or recommending Epicured. 

Laura Manning is not employed by Epicured. Laura is a full-time employee of the Mount Sinai Health System and receives no compensation, monetary or otherwise, from Epicured. 

Laura Manning is a Clinical Dietitian at The Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center at Mount Sinai. Today, she is discussing the Benefits of Staying Hydrated.

Keys to Staying Hydrated All year 

Hydration has been on top-of-mind for a lot of us lately as temperatures soar during the summer months. The hot, humid weather should act as a reminder to drink plenty of fluids to prevent dehydration – a potentially dangerous condition that can occur when we neglect to drink adequate amounts of liquid before, during or after strenuous activity. Dehydration can lead to confusion, mood changes, constipation, kidney stones, changes in blood pressure and higher body temperatures,. Though the body has an amazing system for signaling to our brains when we’re thirsty, we cannot rely solely on feelings of thirst. Being proactive and consistent with our fluid intake is key to preventing dehydration and its negative side effects.

Water is critical to overall human well-being – we can survive much longer without food than we can without water. As an essential nutrient, water supports cell structure, helps regulate body temperature, lubricates joints and organs, and transports nutrients throughout the body. Daily fluid intake recommendations vary by age, gender, activity level and presence of a chronic or an acute health condition. Under regular circumstances, daily water intake should be about 2.7 liters (91 ounces) for women and 3.7 liters (125 ounces) for men.

How do you stay Hydrated with IBS?

Adequate hydration is increasingly important for individuals with chronic conditions such as Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD). IBS patients are advised to drink up to 1.5-3 L (~ 35 mL/kg) of fluid per day to replace fluid loss from diarrhea and/or to help manage constipation. Patients with IBD also have an increased need for liquids when experiencing flares, as the fluid loss can be high from increased diarrhea and ostomy output. Individuals with Crohn’s and Ulcerative Colitis may also benefit from fluids with added electrolytes such as sodium, potassium, and chloride, to replenish stores more effectively. However, beware of oral rehydration solutions or sports drinks on the market – these might not have the best ingredient profile to accomplish electrolyte replenishment and may be too high in sugar and too low in sodium. It is important to speak to your doctor and/or dietitian about safe fluid replacement during flares.

Water alone is not the sole source of hydration. Many beverages containing water, such as juice, tea, coffee and dairy/non-dairy substitute products also count towards your total fluid intake. Hydration can even be obtained via certain foods. For instance, cantaloupe, cucumbers, strawberries, and spinach have the highest water content, while items like bread and almonds have the lowest. Therefore, we do not need to rely solely on fluids to stay hydrated. Consuming more fruits and vegetables, which have added natural vitamins and fiber, is a great supplement to help us maintain adequate fluid levels.

Is Alcohol good for Hydration?

One type of fluid that may be counterproductive to hydration is alcohol. Alcohol can act as a diuretic on the body, causing increased fluid losses as it signals the kidneys to excrete increased fluids instead of retaining a normal healthy level. Alcohol is also a gastrointestinal irritant if consumed in large quantities, especially if you react to the FODMAP content found in drinks like rum and very sweet wines. According to the 2015-2020 Dietary Guidelines for Americans, safe alcohol limits are described as no more than 1 drink per day for women and no more than 2 drinks per day for men. A drink is defined as 12 oz of regular beer (5% alcohol), 5 oz of wine (12% alcohol), or 1.5 oz of 80-proof distilled spirits (40% alcohol). Drink in moderation and consider alternating with another beverage between cocktails at the next party or bar-b-que. Enjoy all of your summer activities, but be sure to make an effort to hydrate properly – there are so many beverage and food items to choose from!

Resources that can help you:

Mount Sinai Make an appointment at the Feinstein IBD Clinical Center here or contact the office at 212.241.8100.

Epicured For exceptional low FODMAP, IBD-friendly prepared meals delivered right to your door, visit our menu.

PURCHASE Our Cold Brew with Almond Milk!

________________

DISCLAIMER: Mount Sinai is an investor in Epicured. This material is for informational purposes only, and Mount Sinai makes no representation or guarantee as to any results or experience with Epicured. You should consult with your physician before using a dietary program such as Epicured. Mount Sinai employees do not receive material benefit from endorsing or recommending Epicured. 

Laura Manning is not employed by Epicured. Laura is a full-time employee of the Mount Sinai Health System and receives no compensation, monetary or otherwise, from Epicured. 

REFERENCES: 

[1] Manz F. Hydration and disease. J Am Coll Nutr. 2007;26(5 Suppl):535s-541s.

[1] Popkin B, D’Anci K, Rosenberg I. Water, hydration, and health. Nutr Rev. 2010;68(8):439-458.

[1] Water needs. http://www.nationalacademies.org/hmd/Reports/2004/Dietary-Reference-Intakes-Water-Potassium-Sodium-Chloride-and-Sulfate.aspx. Accessed from the internet, July 10, 2018.

[1] Addressing the Role of Food in Irritable Bowel Syndrome Symptom Management.

Capili B, Anastasi JK, Chang M

J Nurse Pract. 2016 May; 12(5):324-329.

[1] U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015-2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Cited 2017-01-05. Available from: http://health.gov/dietaryguidelines/2015/guidelines/

[1] Larsson S, Wolk A. Coffee Consumption and Risk of Liver Cancer: A Meta-Analysis.Gastroenterology. May 2007. 132(2):1740-1745.

[1] Sinha R. Caffeinated and decaffeinated coffee and tea intakes and risk of colorectal cancer in a large prospective study. Am J Clin Nutr.

2012 Aug;96(2):374-81.

[1] Corrao G, Zambon A, et al. Coffee, caffeine and the risk of liver cirrhosis. Ann Epidemiol. 2001 Oct;11(7):458-65.

[1] Ascherio A, et al. Prospective study of caffeine consumption and risk of Parkinson’s disease in men and women. July 2001 50(1) 56-63.

[1] Zhang Y, et al. Coffee consumption and the incidence of type 2 diabetes in men and women with normal glucose tolerance: The Strong Heart Study. Nutr Met and Card Dis. June 2011: 21(3)418-423.

[1] Jiang-nan Wuae, S, et l. Coffee consumption and the risk of coronary artery diseases: A meta-analysis of 21 prospective cohort studies. Intl J Card. 2009 Vol 137,3; 216-225.

[1] Coffee Consumption. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Available at https://health.gov/dietaryguidelines/2015/guidelines/. Accessed from the Internet July 11, 2018.

[1] McKenzie YA, Bowyer RK, Leach H, Gulia P, et al. British Dietetic Association systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults (2016 update).J Hum Nutr Diet. 2016 Oct; 29(5):549-75.

[1] Caffeine Chart. Center for Science in the Public Interest. . www.cspi.org. Accessed from the web July 11, 2018.

[1] Capili B, Anastasi JK, Chang M Addressing the Role of Food in Irritable Bowel Syndrome Symptom Management. J Nurse Pract. 2016 May; 12(5):324-329.

 

Laura Manning is a Clinical Dietitian at The Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center at Mount Sinai. Today, she is Discussing Coffee’s Health Benefits.   

Is Coffee bad for you?

Over the years we’ve been told countless myths about coffee – it’s dehydrating, it causes cancer – to name a few. However, we have good news for coffee lovers: these myths have recently been debunked! According to the World Health Organization (WHO), coffee has been officially removed from the list of potentially cancer-causing beverages. It is also not associated with dehydrating effects. In fact, coffee is packed with antioxidants – studies have shown that it may have a protective effect against cancers of the liver and colon, as well as protective benefits from cirrhosis, Parkinson ’s, type 2 diabetes and cardiovascular diseases. The 2015 Dietary Guidelines for Americans determines that moderate coffee consumption (3-5 cups a day) is not associated with the development of major chronic diseases. Just be careful to avoid beverages with high amounts of added sweeteners and creamers and choose items like Epicured’s Cold Brew with Almond Milk (only 130 calories).

Benefits of Caffeine in Coffee

For some people, the caffeine in coffee has a mild laxative effect on the bowels which helps us go to the bathroom. This can be positive if you have IBS with constipation. Caffeine can also stimulate the kidneys, causing you to think that you are urinating much more than you should. According to dietary guidelines for managing IBS, people should be assessed for their caffeine tolerance – it is suggested to limit intake to 400 mg per day in adults. As a note, the average amount of caffeine in one 8oz cup of coffee brewed at home is 95mg. However, coffee chains can have as high as 475mg in a serving (serving size may be as large as 20 oz). It is also worth noting that many foods and other beverages contain caffeine such as sports drinks, chocolate, ice cream, iced teas and even over the counter analgesics. For those that have identified caffeine as a trigger, but enjoy the flavor of coffee and tea, simply opt for the decaf versions or try a combination of water and decaf tea (peppermint, rooibos, white and a weak green or chai tea) infused with low FODMAP fruits.

Resources that can help you:

Mount Sinai Make an appointment at the Feinstein IBD Clinical Center here or contact the office at 212.241.8100.

Epicured For exceptional low FODMAP, IBD-friendly prepared meals delivered right to your door, visit our menu.

PURCHASE Our Cold Brew with Almond Milk!

________________

DISCLAIMER: Mount Sinai is an investor in Epicured. This material is for informational purposes only, and Mount Sinai makes no representation or guarantee as to any results or experience with Epicured. You should consult with your physician before using a dietary program such as Epicured. Mount Sinai employees do not receive material benefit from endorsing or recommending Epicured. 

Laura Manning is not employed by Epicured. Laura is a full-time employee of the Mount Sinai Health System and receives no compensation, monetary or otherwise, from Epicured. 

REFERENCES: 

[1] Manz F. Hydration and disease. J Am Coll Nutr. 2007;26(5 Suppl):535s-541s.

[1] Popkin B, D’Anci K, Rosenberg I. Water, hydration, and health. Nutr Rev. 2010;68(8):439-458.

[1] Water needs. http://www.nationalacademies.org/hmd/Reports/2004/Dietary-Reference-Intakes-Water-Potassium-Sodium-Chloride-and-Sulfate.aspx. Accessed from the internet, July 10, 2018.

[1] Addressing the Role of Food in Irritable Bowel Syndrome Symptom Management.

Capili B, Anastasi JK, Chang M

J Nurse Pract. 2016 May; 12(5):324-329.

[1] U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015-2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Cited 2017-01-05. Available from: http://health.gov/dietaryguidelines/2015/guidelines/

[1] Larsson S, Wolk A. Coffee Consumption and Risk of Liver Cancer: A Meta-Analysis.Gastroenterology. May 2007. 132(2):1740-1745.

[1] Sinha R. Caffeinated and decaffeinated coffee and tea intakes and risk of colorectal cancer in a large prospective study. Am J Clin Nutr.

2012 Aug;96(2):374-81.

[1] Corrao G, Zambon A, et al. Coffee, caffeine and the risk of liver cirrhosis. Ann Epidemiol. 2001 Oct;11(7):458-65.

[1] Ascherio A, et al. Prospective study of caffeine consumption and risk of Parkinson’s disease in men and women. July 2001 50(1) 56-63.

[1] Zhang Y, et al. Coffee consumption and the incidence of type 2 diabetes in men and women with normal glucose tolerance: The Strong Heart Study. Nutr Met and Card Dis. June 2011: 21(3)418-423.

[1] Jiang-nan Wuae, S, et l. Coffee consumption and the risk of coronary artery diseases: A meta-analysis of 21 prospective cohort studies. Intl J Card. 2009 Vol 137,3; 216-225.

[1] Coffee Consumption. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Available at https://health.gov/dietaryguidelines/2015/guidelines/. Accessed from the Internet July 11, 2018.

[1] McKenzie YA, Bowyer RK, Leach H, Gulia P, et al. British Dietetic Association systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults (2016 update).J Hum Nutr Diet. 2016 Oct; 29(5):549-75.

[1] Caffeine Chart. Center for Science in the Public Interest. . www.cspi.org. Accessed from the web July 11, 2018.

[1] Capili B, Anastasi JK, Chang M Addressing the Role of Food in Irritable Bowel Syndrome Symptom Management. J Nurse Pract. 2016 May; 12(5):324-329.

 

Laura Manning is a Clinical Dietitian at The Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center at Mount Sinai. Today, she is discussing the basics of lactose intolerance.   

THE BASICS

According to the 2020 Dietary Guidelines for Americans, it is recommended that adults consume 3 servings of low fat or fat free dairy products daily as part of a healthy diet.[i] Dairy products consist of milk, yogurt, cheese and kefir and supply the primary source of calcium for Americans. Calcium is associated with improved bone health and is especially important to consume during childhood and adolescence, as bone mass is being built at this time.[ii] In adults, dairy intake is associated with lower blood pressure[iii] and a reduced risk of cardiovascular disease[iv] and type 2 diabetes. [v],[vi]

One 8-ounce glass of milk from cows, sheep and goats consists of carbohydrates (12g of lactose) for energy, protein (6-8g of casein) for growth, fat for brain health, and the all-important calcium for bone development. The fat content can vary widely as there are a variety of milk choices on the market; from milk that contains zero fat (skim) to milk with a full fat content (whole). Additionally, dairy milk is comprised of phosphorous, potassium, magnesium, vitamins A, D, B12, niacin and riboflavin. It is a widely consumed beverage and supplies us with important nutrients across the lifespan.

Fact: Most people are born with the innate ability to digest dairy, as lactose is found in breast milk. However, the ability to digest dairy milk may become more and more difficult as we get older. It is estimated that about 30 million Americans are lactose intolerant by the age of 20.[vii]

WHAT CAUSES LACTOSE INTOLERANCE?

We typically digest milk with an enzyme (lactase) found in our small intestine. Lactase cleaves the sugar from milk into glucose and galactose to make it more digestible. This product is then absorbed into the bloodstream to be used for energy. However, some people may not produce adequate amounts of the lactase enzyme and, as a result, may experience symptoms such as gas, bloating and diarrhea soon after consuming milk products. Low enzyme levels cause the lactose to remain intact as it travels to the colon, where it attracts bacteria and begins to ferment. The uncomfortable symptoms associated with an intolerance are a result of this fermentation process.

TYPES OF LACTOSE INTOLERANCE

Primary lactose intolerance is the most common food intolerance in the world and is more prevalent among certain cultures. It is the most common form of the disorder and is often founds in people of African, Asian, Hispanic, Mediterranean and southern European descent. Secondary lactose intolerance may arise due to an injury, surgery or illness where inflammation or changes in the small intestinal structures occur. Crohn’s and Celiac disease are the two most common intestinal diseases associated with having lower levels of lactase production. This is a very frequent topic that I discuss with patients at the IBD Center at Mount Sinai. Lactose intolerance can also present during a Crohn’s or Ulcerative Colitis flare.

There is a small subset of people who may have intolerance to casein, the protein component in milk. Of the 6-8 grams of casein in milk, 2-3 grams are known as beta casein and come in two forms, known as A1 and A2. Most cows contain an even distribution of A1 and A2, but before milk became industrialized, most cows were producing A2. A2 milk may be an easier to tolerate form of milk and you will see it beginning to pop up in the dairy aisle.

YES, THERE ARE LACTOSE-FREE CHEESES!

If you have lactose intolerance, it does not mean that you should avoid all dairy products. This is a common misconception and can lead people to miss out on the important nutrients that dairy products provide. There are varying levels of lactose in dairy products, ranging from 12 grams in a glass of cow’s milk to 1 gram in a serving of aged cheddar cheese. Most people with lactose intolerance can tolerate up to 12g of lactose in one sitting, and approximately 18g of lactose if spread throughout the day.[i] However, some individuals may need the help of an added enzyme to assist with their digestion. Over-the-counter enzyme pills and chewables consumed at the time of meal will help break down the lactose, making it more enjoyable to eat without all of the gas and bloating that typically accompanies digestion. It may even be possible to train the body to tolerate lactose if given small amounts over a period of time.[ii] Additionally, having lactose-containing dairy as part of a meal, rather than on an empty stomach, will further help aid in the digestion process.[iii]

On a Low FODMAP diet, lactose is one of the fermentable sugars that should be lessened in the elimination phase of the diet. You are able to consume dairy products on the Low FODMAP diet, but the lactose content should be small. Take a look at the Nutrition Facts label. The lactose will be considered ‘low’ if there are 4 grams of carbohydrate or less per serving. Just be sure, keep it to the serving size indicated and have one single serving per meal. Low lactose cheeses permitted with this diet include aged cheeses such as cheddar, Swiss and Parmesan. Greek yogurt is low lactose as well, but try stick to the unflavored/original yogurts and add fruits for natural sweetness. You’ll be happy to know that butter is almost completely lactose free! You can also select dairy products that contain the lactase enzyme in them. Dairy can be challenging to tolerate for many people, but following a few guidelines on food choice and quantity allows you to keep it in your diet and reap all the nutritional benefits dairy has to offer.

Resources that can help you:

Mount Sinai Make an appointment at the Feinstein IBD Clinical Center here or contact the office at 212.241.8100.

Epicured For exceptional low FODMAP, IBD-friendly prepared meals delivered right to your door, visit our menu.

DOWNLOAD the Low FODMAP Cheeseboard infographic!

________________

DISCLAIMER: Mount Sinai is an investor in Epicured. This material is for informational purposes only, and Mount Sinai makes no representation or guarantee as to any results or experience with Epicured. You should consult with your physician before using a dietary program such as Epicured. Mount Sinai employees do not receive material benefit from endorsing or recommending Epicured. 

Laura Manning is not employed by Epicured. Laura is a full-time employee of the Mount Sinai Health System and receives no compensation, monetary or otherwise, from Epicured. 

REFERENCES: 

[1] Dietary Guidelines for Americans 2015-2020. Recommended amount of dairy to be consumed daily for Americans 9 years and older. www.choosemyplate.gov. accessed June 8, 2018.

[1] Weaver CM, et al. The National Osteoporosis Foundation’s position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations. Osteoporosis Int. Published online Feb 8, 2016.

[1] Machin DR, Park W, Alkatan M, Mouton M, Tanaka H. Effects of non-fat dairy products added to the routine diet on vascular function: a randomized controlled crossover trial. Nutr Metab Cardiovacs Dis. 2015;25(4):364-369.

[1] Dalmeijier, GW, et al. Dairy intake and coronary heart disease or stroke: A population-based cohort study. Int J Cardiol 2013;167:925-929.

[1] Margolis, KL, et al. A Diet High in Low Fat Dairy Products lowers diabetes risk in in post menopausal women. J Nutr 2011;141:1969-1974.

[1] Sluijs I, et al. The amount and type of dairy product intake and incident of type 2 diabetes: results from the EPIC-InterAct Study. Am J Clin Nutr 2012;96:382-390.

[1] Lactose intolerance. Statistics accessed from the web June 6th, 2018. U.S. National Library of Medicine. https://grh.nlm.nih.gov/condition/lactose-intolerance#statistics.

[1] Corgneau M, Scher J, et al. Recent advances on lactose intolerance: Tolerance thresholds and currently available answers. Crit Rev Food Sci Nutr. 2017;57(15):3344-3356.

[1] Pribila BA, Hertzler SR, Martin BR, Weaver CM, Savaiano DA. Improved lactose digestion and intolerance among African-American adolescent girls fed a dairy rich diet. J Am Diet Assoc. 2000; 100(5):524-8.

[1] Shaukat A, Levitt MD, et al. Systemic Review: Effective management strategies for lactose intolerance. Annals Int Med. 2010; 152(12):797-803.

 

 

 

 

 

 

 

 

Laura Manning is a Clinical Dietitian at The Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center at Mount Sinai.

Inflammatory Bowel Diseases (IBD) such as Crohn’s disease and ulcerative colitis are believed to be caused by a combination of genetic predisposition and alterations in the gut microbiota. These disorders are on the rise in industrialized areas like North America and Western Europe [1], forcing scientists to reconsider the role of modern diets in the development and management of these diseases. Indeed, our gut bacteria look quite a bit different from our ancestors’ as we eat more and more processed foods to help us keep up with our busy lives and to allow us to prepare foods quicker and easier.

Can Food Choices Descrease Your IBD Risk?

Studies show that certain dietary patterns may put people at greater risk for IBD [2]. For example, having a low-fiber, high-fat diet may increase inflammation and cause disease relapses. This is typical of a diet with a lot of processed foods. In contrast, a diet high in soluble fibers, fruits and vegetables and low in saturated fat may be beneficial to our microbiome and have anti-inflammatory properties. [3,4]

Our Low FODMAP Lemon Rosemary Chicken meets many of Laura’s “IBD-friendly” requirements. Photo credit: Ben Fink Productions for Epicured.

FOOD AS IBD TREATMENT

In addition to conventional medication focused on modifying the immune-inflammatory pathways in the gastrointestinal (GI) tract, diet can also play an essential role in the management of IBD, especially for patients with a lot of unpleasant GI symptoms such as diarrhea, urgency and abdominal cramps. Unfortunately, there is not enough scientific evidence to suggest that there is a “silver bullet” diet for IBD, or, for that matter a single diet approach that can take someone with IBD from a very severe flare-up all the way down to remission (i.e. no signs of inflammation at all).

The good news is that in academic medical centers across the world (including at Mount Sinai where I practice), there are studies underway to look at the link between IBD and a variety of diets, including, of course, low FODMAP.

Low FODMAP & IBD: What We Know Today

There is very strong evidence showing the benefits of the Low FODMAP diet for managing symptoms in patients with Irritable Bowel Syndrome (IBS), a much more common disorder of gut-brain dysregulation with many of the same symptoms as IBD [5].  We are now seeing that the diet can help manage symptoms in patients with IBD as well, especially when they’re in remission. Here’s why:

Often times, a person with IBD can be technically in remission (a healed intestinal tract) but continue to experience symptoms that mimic an IBD flare-up. This is known as IBD with IBS overlay and it is extremely common, affecting 40-60% of IBD patients. High FODMAP foods can trigger IBS symptoms in people with IBD and make them feel like they are experiencing a flare-up [6]. In fact, in a recent study, the Low FODMAP diet was shown to lower symptoms like gas, bloating, diarrhea, nausea and fatigue [7,8] in patients with IBD.

FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) are hard to digest sugars which pass through the small intestine without being properly broken down by enzymes. Once these sugars reach the colon, they cause an osmotic shift bringing more water into the lumen which causes all the potential unpleasant side effects of pain, bloating and diarrhea. Additionally, the bacteria ferment (think of brewing beer), and the residual FODMAPs give off gas, as if there wasn’t enough to manage!

“OK… SO WHAT CAN I EAT?”

The most common question patients with IBD ask me is “what can I eat?” My goal is to help patients find ways to eat that will allow them to manage symptoms and feel like they are in control. That’s where the low FODMAP diet becomes so useful. A FODMAP elimination and reintroduction process can be a life-changing tool for IBD patients to identify the triggers that add to their daily stress. We know food alone does not cause IBD but many patients will begin to notice “trigger foods” that increase their symptoms of gas, bloating, and diarrhea. The best way to identify your trigger foods is to simply keep a journal of what you eat. Note if there are changes that occur in our bowel function when certain foods are eaten more than others.

IT’S NOT: ‘ONE SIZE FITS ALL’

Don’t get frustrated. What works for one person with IBD may not work for another. This is one of the many challenges that I have as a dietitian working with patients at the Feinstein IBD Center at Mount Sinai. Having worked with patients with IBD for over 15 years, I have seen many different diet therapies work and not work, and I must tailor suggestions to each individual person.

Food is a very important topic because it evokes a lot of emotion in people. People with IBD must carefully think about what to eat and the timing of their meals and if I can offer suggestions that help ease this stress, then I can successfully increase their nutrition, allow people to eat comfortably at work and at gatherings and lessen anxiety that commonly accompanies mealtime. Food is a large part of our culture as well as a basic human need and patients with IBD welcome guidance to help manage their disease and lead the healthiest life they can.

Resources that can help you:

Mount Sinai Make an appointment at the Feinstein IBD Clinical Center here or contact the office at 212.241.8100.

Epicured For exceptional low FODMAP, IBD-friendly prepared meals delivered right to your door, visit our menu.

IBD 101 Here are the basics: IBD (including Crohn’s Disease and Ulcerative Colitis) is an autoimmune condition where the digestive tract becomes inflamed and forms ulcerations that can cause a wide range of symptoms including frequent bowel movements, weight loss, and vitamin deficiencies. The gastrointestinal (GI) tract contains harmless bacteria that aids in digestion and the metabolism of vitamins. In people with IBD, the body mistakes the bacteria as foreign invaders and cells travel from the blood system to the GI tract, creating an inflammatory response and causing a variety of GI symptoms [9]. IBD can also affect your eyes, skin and joints and can have a profound impact on daily life.

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DISCLAIMER: Mount Sinai is an investor in Epicured. This material is for informational purposes only, and Mount Sinai makes no representation or guarantee as to any results or experience with Epicured. You should consult with your physician before using a dietary program such as Epicured. Mount Sinai employees do not receive material benefit from endorsing or recommending Epicured. 

Laura Manning is not employed by Epicured. Laura is a full-time employee of the Mount Sinai Health System and receives no compensation, monetary or otherwise, from Epicured. 

REFERENCES: 

[1] Molodecky, N.A.; Soon, I.S.; Rabi, D.M.; Ghali, W.A.; Ferris, M.; Chernoff, G.; Benchimol, E.I.; Panaccione, R.; Ghosh, S.; Barkema, H.W.; et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology 2012, 142, 46–54.

[2] Hou JK, Abraham B, El-Serag H. Dietary intake and risk of developing inflammatory Bowel disease: a systematic review of the literature. Am J Gastroenterol 2011;106:563–73.

[3] Brown, K.; DeCoffe, D.; Molcan, E.; Gibson, D.L. Diet-induced dysbiosis of the intestinal microbiota and the effects on immunity and disease. Nutrients 2012, 4, 1095–1119.

[4] Ananthakrishnan AN, Khalili H, Konijeti GG, et al. A prospective study of long-term intake of dietary fiber and risk of Crohn’s disease and ulcerative colitis. Gastroenterology 2013; 145:970–977.

[5] Schumann D, Klose P, Lauche R, Dobos G, Langhorst J, Cramer H. Low fermentable, oligo-, di-, mono-saccharides and polyol diet in the treatment of irritable bowel syndrome: A systematic review and meta-analysis. Nutrition, Jan 2018;45:24-31.

[6] Selina R Cox Alexis C Prince Clio E Myers Peter M Irving James O Lindsay Miranda C Lomer Kevin Whelan Fermentable Carbohydrates [FODMAPs] Exacerbate Functional Gastrointestinal Symptoms in Patients With Inflammatory Bowel Disease: A Randomised, Double-blind, Placebo-controlled, Cross-over, Re-challenge Trial Journal of Crohn’s and Colitis. Dec 2017; 11

[7] Zhan, Y.L.; Zhan, Y.A.; Dai, S.X. Is a low FODMAP diet beneficial for patients with inflammatory bowel disease? A meta-analysis and systematic review. Clin. Nutr. 2017.

[8] Prince AC, Myers CE, Joyce T, et al. Fermentable carbohydrate restriction (low FODMAP diet) in clinical practice improves functional gastrointestinal symptoms in patients with inflammatory bowel disease. Inflamm Bowel Dis 2016;22:1129–1136.

[9] What are Crohn’s and Colitis. http://www.crohnscolitisfoundation.org/what-are-crohns-and-colitis/what-is-crohns-disease/. Accessed from the web May 12, 2018.