As the year comes to a close, the holiday season is quickly upon us. It is a time to enjoy friendship and family, celebrate traditions, and most likely be invited to multiple holiday meals. This can be a tricky time for patients with functional GI disorders who need to be careful of what types of food they eat and to be wary of the quantity of food they eat. It can be easy to be lulled into the festivities and not pay attention to foods that contain GI trigger ingredients (high fat or rich foods and high FODMAP foods), or consume larger than intended portions. It’s important to note that every person tolerates foods differently and you know your body best. If you are concerned about what are the best types of food to eat for your GI condition, consult with your physician or a registered dietician / nutritionist who can best guide you to healthy eating habits that work best for you.

Fats: What type and how much?

The Centers for Disease Control (CDC) recommends that people should consume appropriate amounts of unsaturated fat, between 20%-35% of calories from fat, as part of a balanced diet. [2] Unsaturated fats include monounsaturated fats and Omega-6/Omega-3 polyunsaturated fats.

Types of Unsaturated Fat [2]
Monounsaturated Fats Omega-6 Polyunsaturated Fats Omega-3 Polyunsaturated Fats
Nuts, vegetable oils, olive oil, sunflower oil Soybean oil, corn oil, safflower oil Soybean oil, walnuts, flaxseed, fish (trout, herring, salmon)

Saturated fats are recommended to be consumed as less than 10% of daily fat calorie consumption. [2] Examples of saturated fat are animal fats (high fat dairy products and high fat animal meats) and palm and coconut oils.

Consuming healthy portions of fat is part of a balanced diet and should not have a significant impact on symptoms. However, eating a meal that has a significantly higher fat content can cause an increase in colonic contractions which can initiate symptoms of diarrhea, pain, rectal urgency and rectal distension. [3,4] Eating greater portions of high fat foods also delays gastric emptying while increasing bloating and abdominal pain. [4,5] Choosing foods that are lower in fat can reduce symptoms associated with functional GI disorders as well as forming part of eating a healthier diet.

What is FODMAP?

FODMAP is an acronym for “fermentable oligosaccharides, disaccharides, monosaccharides and polyols”. Kate Scarlata, a registered dietician and published author on FODMAP foods, defines FODMAPs as;

“…small commonly malabsorbed carbohydrates that can pull water into the intestine and are rapidly fermented by gut bacteria contributing to gas. When water and gas expand the intestine, this can contribute to pain. FODMAPs are found in everyday foods from apples, pears, garlic, onion, wheat, even in honey! The effects of FODMAPs are cumulative; you might be able to tolerate some but if you eat too many at the same time your belly may pay the price.”

Kate recommended on her blog several recipes for the holiday season, including low FODMAP entrees, side dishes, and desserts.[6] In addition to Kate Scarlata, Crystal Zaborowski Saltreli, CHC, who specializes in gastroparesis, also recommended recipes specifically for gastroparesis patients.[5]

It is important to focus on what you can eat (and enjoy eating) instead of worrying about what you have to exclude from your diet. The FODMAP diet is not meant to be an exclusionary diet for long periods of time but rather as a form of food trial and error.[3] After eating a low FODMAP diet for a trial period, try adding one food back one at a time to see if any GI symptoms return. The purpose of adding one food at a time is to see if any of the foods trigger symptoms. [1,5] As stated above, everyone tolerates foods differently and you should always consult a physician and/or a registered dietician to ensure you are consuming a balanced diet.

Where can I find a registered dietician / nutritionist?

Working with a nutritionist/registered dietician is important to learn how to best manage your diet, set realistic goals, and to guide you with pointers and continued support. Susannah Southern, RDN, LDN works in the UNC Outpatient Nutrition Clinic in Family Medicine and Gastroenterology. She emphasizes how important diet is in helping to control GI symptoms. Patients should create a list of meals for the week and create a shopping list prior to going to the grocery store. While at the grocery store, read the ingredients list on the nutrition label. You may find hidden high FODMAP foods where you didn’t expect them.

It is also important when seeking nutritional counseling that you contact your insurance carrier before scheduling the appointment. Insurance typically covers nutritional counseling for medically necessary diseases (cardiovascular disease, diabetes, hypertension, kidney disease, eating disorders, gastrointestinal disorders, and seizures.) but your insurer may not cover a specific functional GI disorder.

For information on how to set up an appointment with Susannah Southern, RDN, LDN, fax referrals to 919-966-6126, call for an appointment at 919-966-0210, or for further information, email at .

You can also use http://www.eatright.org/programs/rdnfinder/ to locate a registered dietician near you.

Here are a few general rules that may help to reduce GI symptoms.

1. Choose foods that are lower in fat and avoid foods you know will trigger symptoms. If you are at a party and do not have many options, limit your consumption of high fat and high FODMAP foods.

2. Do not over eat. Around the holidays, you may find yourself invited to multiple events. If you know that you’ll be attending multiple parties, limit the amount of food you consume at each party. A normal sized meal consumed multiple times in a short period of time can lead to an overload of the system.

3. It is O.K. to refuse the offer of food if you know it will make you symptomatic. Your health is more important!

FODMAP Food Examples from Stanford University Medical Center [1]
Food Type High FODMAP Low FODMAP Alternatives
Meat Protein Meats processed with high fructose corn syrup Beef, chicken, turkey fish, pork, eggs, shellfish
Dairy Products High lactose dairy, buttermilk, chocolate, creamy cheesy sauces, ice cream, cow, goat, and sheep’s milk, sour cream Lactose free dairy, cream cheese, hard cheese (cheddar, colby, parmesan), soft cheese (brie, feta, mozzarella), sherbet, Greek yogurt (small amounts)
Meat and Non-Dairy Alternatives Cashews, beans, black eyed peas, lentils, pistachios, soy beans Coconut and rice milk, nuts (walnut, macadamia, peanut, pecan, and pine), nut butters, tofu (firm)
Fruits Apples, applesauce, apricots, blackberries, boysenberries, canned fruit, dates, dried fruits, figs, guava, mango, nectarines, peaches, pears, plums, persimmon, prunes, watermelon Bananas, blueberries, cantaloupe, cranberries, grapes, honeydew, kiwi, lemon, lime, mandarin, orange, passion fruit, pineapple, raspberries, rhubarb, strawberries, tangerine, papaya
Grains Any food made with wheat/barley/rye when it is a major ingredient, gluten free/spelt grains made with foods to a limit (not over consuming), chicory root, inulin Gluten Free/Spelt grains** (corn, oats, potato, quinoa, rice, tapioca) included in: bagels, biscuits, breads, cereals, chips, crackers, noodles, pancakes, pastas, pretzels, tortillas, oatmeal, popcorn
Vegetables Artichokes, cauliflower, mushrooms, sugar snap peas, pumpkin, squash Alfalfa beans and sprouts, bamboo shoots, bell peppers, bok choy, carrots, common cabbage, cucumbers, eggplant, green beans, kale, lettuce, parsnips, potatoes, radishes, rutabaga, spinach, tomatoes, turnips, zucchini
Desserts Any food made with high fructose corn syrup and all foods to a limit (not over consuming) Any food made with low FODMAP foods
Beverages Any food made with high fructose corn syrup and all foods to a limit (not over consuming), fortified wines (sherry, port) Fruit and vegetable juices and smoothies made with low FODMAP foods
Seasonings, Condiments

Jam, jelly, pickles, relish, salsa, salad dressings made with high fructose corn syrup, Chutney, agave, garlic, garlic salt/powder, honey, hummus, molasses, onions (brown, leeks, shallots, Spanish, white, spring onion (white bulb), onion salt/powder, tomato paste, pesto with garlic, artificial sweeteners (isomalt, mannitol, sorbitol, xylitol) Jam, jelly, pickles, relish, salsa, salad dressings made with low FODMAP ingredients, butter, chives, cooking oils, garlic/onion infused oils, maple syrup without high fructose corn syrup, mustard, margarine, mayonnaise, spring onion (green stalks), olives, pepper, salt, seeds (chia, flax, pumpkin, sesame, sunflower), sugar, soy sauce, vinegar

**Spelt grain is an ancient sub-species of wheat from Europe that has a higher protein content, is easily digestible, but it also has gluten levels that affect celiac patients and those allergic to gluten and wheat products. [7]

Recipes

Slow Cooker Turkey Breast [5]

Ingredients

• 1 bone in turkey breast (6-7 lbs) with the skin removed.
• 1 Tbsp olive oil
• 1 tsp salt
• ½ tsp paprika
• ½ tsp thyme
• ½ tsp oregano

Directions:

1. Brush turkey with olive oil.
2. Combine the remaining ingredients in a small bowl and rub over turkey.
3. Transfer turkey to a 6-quart slow cooker.
4. Cover and cook on low for 6 hours or until internal temperature reaches 165 degrees Fahrenheit.

Maple Peanut Sesame Chicken [6]

Ingredients

• 1 lb chicken tenders (boneless, skinless)
• 2 Tablespoons all natural peanut butter
• 1 Tablespoon sesame oil
• 3 Tablespoons reduced sodium tamari (soy sauce)
• 1 Tablespoon sesame seeds
• 1 teaspoon ground ginger
• 1-1/2 Tablespoons pure maple syrup

Directions:

1. Wash and pat dry chicken.
2. In medium casserole dish, add peanut butter, sesame oil, soy sauce, sesame seeds, ginger and maple syrup whisking to blend.
3. Add chicken and toss to coat with mixture.
4. Cover and refrigerate for 30 minutes-several hours.
5. Keep chicken in ‘marinade’ and place casserole uncovered in oven.
6. Bake at 350 degrees Fahrenheit for 30 minutes or until chicken is cooked through. Serve over rice vermicelli noodles or baby salad greens.

Chocolate Peanut Butter Bits [6]

Ingredients

• 1/4 cup semisweet chocolate chips
• 1/4 cup oat bran
• 1/3 cup natural peanut butter
• 1/2 cup rolled oats
• 1 teaspoon vanilla paste or extract
• 1/4 cup walnuts
• 1/4 cup unsweetened shredded coconut
• 1 tablespoon maple syrup

Directions:

1. Toss all of the ingredients in a food processor with a steel blade.
2. Pulse mixture until blended (1-2 minutes)
3. Drizzle additional maple syrup if it is still too dry and roll into a ball.
4. Makes about 12-14 balls. Eat immediately or freeze and eat them cold.

Slow Cooker Rice Pudding [5]

Ingredients:

• 3/4 cup short grain rice
• 1-1/2 cups coconut milk
• 2 cups water
• 3/4 cup maple syrup
• 1-1/2 tsp vanilla
• 1 tsp ground cinnamon

Directions:

1. Combine all ingredients in a slow cooker and stir well.
2. Cover and cook on “Low” for 4 – 5 hours or on “High” for 2 to 2-1/2 hours.
3. Stir 2 – 3 times during cooking process.
4. Serve warm.

1. http://stanfordhealthcare.org/content/dam/SHC/for-patients-component/programs-services/clinical-nutrition-services/docs/pdf-lowfodmapdiet.pdf Accessed
October 22, 2014.
2. http://www.cdc.gov/nutrition/everyone/basics/fat/unsaturatedfat.html. Accessed 20 October 2014.
3. Cuomo R, Andreozzi P, Zito FP, Passanti V, Carlo GD, Sarnelli G. Irritable Bowel Syndrome and Food Interaction. World Journal of Gastroenterology. 2014; 20(27):
8837-8845
4. Haves PA, Fraher MH, Quigley EM. Irritable bowel syndrome: the role of food in pathogenesis and management. Gastroenterol Hepatol. 2014; 10(3): 164-74
5. Saltrelli CZ. Eating for Gastroparesis: Guidelines, Tips & Recipes. 2014.
6. http://blog.katescarlata.com/low-fodmap-recipes/. Accessed November 3, 2014.
7. Ranhotra GS, Gelroth JA, Glaser BK, Lorenz JK. Baking and nutritional qualities of a spelt wheat sample. LWT – Food Science and Technology. 1995; 28(1): 118-22.

Article written by Stefanie Twist, BA

Special thanks to Kate Scarlata and Crystal Zaborowski Saltreli, and Susannah Southern for their input and expertise.