IBS or Fructose Malabsorption or ?
#367474 - 05/17/12 04:46 PM
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Yumeji
Reged: 05/16/12
Posts: 6
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I am still new to Heather's EFI diet and am in the process of a diagnosis (most likely IBS-C); however, I have noticed that I tend to react negatively (gas, bloat, distention, pain/cramps, fatigue) to the following foods: prunes, apples, inulin (fibre supplement mixes, protein bars), sorbitol (Benefiber tablets), wheat (i.e. 32 mini pretzels, 1 bun), bran (Quaker Corn Bran Squares, Kellogg's All-Bran), nuts, seeds, and coffee. Fortunately, I'm safe with oatmeal.
Yesterday I tried eating a raw, peeled, apple cut into quarters and began to bloat after eating more than one quarter. Today, I tried consuming 2 tablespoons of no name® unpasteurized honey on an empty stomach with no problems. So 50 minutes later I consumed a small packet of Heinz applesauce and immediately began to bloat.
According to the EFI diet, I should be fine with white wheat and applesauce as both are listed as soluble fibres. However, I'm also aware both contain fructose (and fructans) which made me wonder if it was a matter of fructose malabsorption. Hence the experiment with honey (high fructose to glucose ratio and no insoluble fibre). Did I consume enough honey to (dis)prove fructose malabsorption? If so, why am I reacting to wheat and applesauce?
HEINZ APPLE PEAR CINNAMON:
Ingredients: Apple puree, Pears, Water, Cinnamon (High monounsaturated sunflower seed oil), Lemon juice concentrate, Ascorbic acid (to maintain colour).
Nutritional Information (Per 1 pouch/128 mL): Calories 100, Fat 0.4 g, Sodium 4 mg, Carbohydrate 23 g, Fibre 3 g, Sugars 19 g, Protein 0.5 g, Vitamin A 0%, Vitamin C 100%, Calcium 2%, and Iron 25%.
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Welcome to the board,
It sounds like you are generally familiar with FODMAPS of which fructose and fructans are two of the five groups of FODMAPs that can be problematic for individuals with functional bowel disorders like IBS. If you aren't fully aware of FODMAPs then the first two links in my signature will give you more information.
A tablespoon of honey contains about 7.5 grams glucose and 8.6 grams of fructose. Therefore 2 tablespoons of honey will contain about 2.2 grams of excess fructose that can contribute to fructose malabsorption. As you may be aware some people are sensitive to low amounts of excess fructose while others can tolerate higher amounts. In fact many normal individuals can handle up to 60 grams of excess fructose before they experience problems. For a fructose malabsorption breath test you drink a solution containing 25 grams of pure fructose. It is quite likely that you didn't eat enough honey to cause a malabsorption symptoms.
In comparison 100 grams of apple (a very small apple) contains about 4.3 grams glucose and 8 grams of fructose for about 3.7 grams of excess fructose. It is quite possible that you eat enough apple or applesauce with enough excess fructose to give you difficulties.
Fructans are long chains of fructose molecules. They can take much longer to cause a reaction than pure fructose. And you may need to eat more to cause symptoms. Also, it is possible to be sensitive to excess fructose but not fructans unless eaten in large amounts. I cannot tolerate small amounts of excess fructose but I can eat lots of fructans with no problem.
Ask lots of questions there are many knowledgeable individuals on the board 
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STABLE: ♂, IBS-D 50+ years - Science of IBS
The FODMAP Approach to Managing IBS Symptoms
Evidence-based Dietary Management of Functional GI Symptoms: The FODMAP Approach
FODMAP Chart & Cheatsheet
The Role of Food & Dietary Intervention in IBS
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Thank you for the informative response! Interestingly enough, according to Table 1 of the Gibson and Shepherd article, apples are high in both fructose and polyols. I wasn't aware of the latter, however looking back now it seems to all make sense. I've already been tested for lactose intolerance via hydrogen breath test which was negative and I suppose a fructose breath test would be no different. Perhaps it's the oligosaccharides and polyols that I have difficulties with (i.e. wheat, legumes, apples, unripe bananas, prunes, sorbitol).
When it comes to FODMAPs, do most stick with restricting globally or individually? In the article it explains that global restriction is recommended as FODMAPs are not the underlying cause but rather provide opportunities for IBS symptoms to arise. However, this combined with Heather's EFI recommendations would be quite difficult to follow long term.
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It is quite possible to have problems with fructose and not with lactose. It is worth having the test or restricting intake of foods with excess fructose especially with polyols until you are certain it isn't a problem.
My approach was to restrict FODMAPs globally and then eventually try introducing foods from different FODMAP groups one at at time and see what happens. As a result I found I have difficulty with lactose, glactans, fructose and polyols. I don't have problems with fructans.
It is quite easy to follow Heather's diet with FODMAP restrictions. I have been doing it for a few years with no problems. You will note that in the Gibson and Shepherd article they say "If adherence was strict, attention may
be needed to modify intake of resistant starch and insoluble and soluble fiber. Other dietary triggers such as food chemicals may need to be considered, as should potential factors such as caffeine, fat, meal size and regularity." This is where Heather's diet play a big role. I find it a pity that individuals who are writing popular books and articles fail to deal with this issue whereas Heather deals with it straight-on.
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STABLE: ♂, IBS-D 50+ years - Science of IBS
The FODMAP Approach to Managing IBS Symptoms
Evidence-based Dietary Management of Functional GI Symptoms: The FODMAP Approach
FODMAP Chart & Cheatsheet
The Role of Food & Dietary Intervention in IBS
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Wow, 4/5! That's quite the combination. Have you completely eliminated those groups from your diet, or are you still able to consume them less frequently in smaller amounts?
Going off on a tangent here, what is the consensus regarding FODMAPs and infused foods or beverages? For instance, in regards to fructans is it safe to consume tea with chicory or broth with onion and garlic?
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Yes - I have completely eliminated them from my diet. I don't eat anything even in small amounts.
Caution about infusion. Infused garlic-oil is in the low FODMAP table in Gibson and Shepherd. You can infuse garlic into oil but not into water. The oligosaccharide dissolve in water but not in oil. So you can flavor oil and remove the garlic before using. However it can cause problems if you infuse garlic flavor into water. And substitute the green part from spring onions and chives for regular onions as they are low in FODMAPs.
BTW chicory (inulin or FOS) is used a soluble fiber supplement. It is a rapidly fermenting oligosaccharide that can produce a lot of gas and discomfort for some individuals with IBS.
Here is another FODMAP table that you may find useful. It says garlic and onions can be oil-infused.
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STABLE: ♂, IBS-D 50+ years - Science of IBS
The FODMAP Approach to Managing IBS Symptoms
Evidence-based Dietary Management of Functional GI Symptoms: The FODMAP Approach
FODMAP Chart & Cheatsheet
The Role of Food & Dietary Intervention in IBS
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It's good to hear there are safe FODMAP alternatives for garlic and onion since they're used in many savory dishes. I did download the pdf chart you posted a while ago as it seemed to be the most updated reference online. In addition, I picked up a copy of Patsy Catsos' "IBS: Free at Last, 2nd ed." since the cost of ordering one of Sue Shepherd's books or from Monash University was well over $60 CAD.
Out of curiosity, are highly fermentable foods responsible for the distention while high fat foods are responsible for the cramping? I'm wondering if I eliminate the high FODMAP foods from my diet will I still be distended after every meal. It doesn't seem to be gas, but rather water (osmosis?) which makes me believe that it's related to excess fructose, fructans, GOS, and polyols and not necessarily fats. Unless I'm mistaken and even consumption of high fat foods (i.e., ground pork, peanuts) can cause distention.
Currently I'm taking 500 mg of Jamieson magnesium a day for IBS-C which has been working. I've read that excess magnesium that isn't absorbed works by drawing water into the colon to soften the stools. If not FODMAP foods, could this be causing the distended stomach after every meal?
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FODMAPs can be responsible for distention from gas and cramping from for example a change in osmolarity of the bowel drawing in water.
Recall that in the Gibson & Shepherd article they say "If adherence was strict, attention may be needed to modify intake of resistant starch and insoluble and soluble fiber. Other dietary triggers such as food chemicals may need to be considered, as should potential factors such as caffeine, fat, meal size and regularity." Things other than FODMAP including fat may effect bowel distention and motility.
There is an excellent write-up on magnesium NIH web site. In particular, you may find the section on "What is the health risk of too much magnesium?" of interest. It might be worth removing the magnesium for a week or two and see if things change.
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STABLE: ♂, IBS-D 50+ years - Science of IBS
The FODMAP Approach to Managing IBS Symptoms
Evidence-based Dietary Management of Functional GI Symptoms: The FODMAP Approach
FODMAP Chart & Cheatsheet
The Role of Food & Dietary Intervention in IBS
Edited by Syl (06/12/12 07:32 AM)
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my mum cooks soups with onions, one or two onions in a pot of soup for flavour. but the soup is of course water, not oil, ie through this method the fructans from the onion do go into the soup?!
if chives and regular onions also cause bloating, not to mention bok choy, bean sprouts - why??
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now: stable through EFI+FODMAP dieting (no lactose/no fructose/some fructans and some polyols)
before: IBS-D(pseudo-diarrhoea), bloating, often unbearable pain esp from too much fat: Apr 2007- Dec 2010
FODMAPs: http://www.todaysdietitian.com/newarchives/072710p30.shtml
[I've tried VSL#3 -> I could tolerate v good amounts of IF (even with less SF), it worked great (but overall I find it too expensive)]
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PS as for grapes, not sure whether these recommendations are meant for Americans/Australians/Britons, but here in Britain I'm pretty sure that our grapes have excess fructose. romaine lettuce is also meant to have a lot of excess fructose (1g per 100g (which is around 4 big outer leaves)). in other words I can only think/conclude that even safe FODMAP foods have to be experimented with individually.
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now: stable through EFI+FODMAP dieting (no lactose/no fructose/some fructans and some polyols)
before: IBS-D(pseudo-diarrhoea), bloating, often unbearable pain esp from too much fat: Apr 2007- Dec 2010
FODMAPs: http://www.todaysdietitian.com/newarchives/072710p30.shtml
[I've tried VSL#3 -> I could tolerate v good amounts of IF (even with less SF), it worked great (but overall I find it too expensive)]
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