FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols, which are short-chain carbohydrates (sugars) that the small intestine absorbs poorly. Instead of being absorbed into your bloodstream, they reach the far end of your intestine where most of your gut bacteria reside.They ferment in the large intestine (bowel) during digestion, drawing in water and producing carbon dioxide, hydrogen, and methane gas that causes the intestine to expand. This causes GI symptoms such as bloating and pain that are common in disorders like IBS.
SYMPTOMS
Cramping
Diarrhea
Constipation
Stomach bloating
Gas and flatulence
DIETARY SOURCES
The main dietary sources of the four groups of FODMAPs include:
Oligosaccharides: Wheat, rye, legumes and various fruits and vegetables, such as garlic and onions.
Disaccharides: Milk, yogurt and soft cheese. Lactose is the main carb.
Monosaccharides: Various fruit including figs and mangoes, and sweeteners such as honey and agave nectar. Fructose is the main carb.
Polyols: Certain fruits and vegetables including blackberries and lychee, as well as some low-calorie sweeteners like those in sugar-free gum.
Put more simply, FODMAPs are certain types of carbohydrates — the sugars, starches, and fiber in foods.
What Is a Low-FODMAP Diet?
A low FODMAP diet cuts out many common products that contain certain foods. The principle behind the diet is to give the gut a chance to heal, especially if you have GI problems like IBS.
Who should try it?
The low FODMAP diet is part of the therapy for those with IBS and SIBO.
Benefits of a Low-FODMAP Diet
Have fewer digestive symptoms, like gas, bloating, diarrhea, stomach pain and constipation
Manage your IBS symptoms without taking medicine
Improve your quality of life
How to Follow a Low-FODMAP Diet?
A low-FODMAP diet is more complex than you may think and involves three stages.
Stage 1: Restriction – This stage involves strict avoidance of all high-FODMAP foods.
Stage 3: Personalization – This stage is to figure out what foods trigger your digestive problems and create a diet that gives you all the nutrients you need but includes only the FODMAPs you can handle.
Sample Low-FODMAP Shopping List
Protein: Beef, chicken, eggs, fish, lamb, pork, prawns and tofu
Whole grains: Brown rice, buckwheat, maize, millet, oats and quinoa
Dairy products: Milk (from cows, goats and sheep), ice cream, most yogurts, sour cream, soft and fresh cheeses (cottage, ricotta, etc) and whey protein supplements
Beverages: Beer, fortified wines, soft drinks with high-fructose corn syrup, milk, soy milk, fruit juices
RECIPES
VEGAN LOW FODMAP FRUIT CRUMBLE BARS
Ingredients
1 1/2 cups (149 g) gluten-free rolled oats
1 1/2 cups (180 g) brown rice flour
1/3 cup (45 g) tapioca starch
1 1/4 cups (267 g) firmly packed light brown sugar
½ teaspoon kosher salt
½ teaspoon baking soda
½ cup (57 g) chopped walnuts
½ teaspoon ground cinnamon
¾ cup (180 ml) melted coconut oil; I suggest refined
¾ cup (216 g) strawberry preserves
1 cup (125 g) fresh or frozen blueberries
1 cup (166 g) fresh or frozen sliced strawberries
Preparation
Preheat the oven to 375°F (190°C). Line a 9 x 9-inch (23 cm by 23 cm) pan with foil. Spray the foil with baking spray and line the foil with parchment, cut to fit the size of the pan with a 1-inch (2.5 cm) overhang on all sides. The layer of foil will allow you to lift the bars out of the pan cleanly and the parchment will keep the bars from sticking to the foil.
Put rolled oats, brown rice flour, tapioca starch, brown sugar, salt, baking soda, walnuts, and cinnamon in a large bowl. Toss with your hands or a wooden spoon to combine. Add coconut oil and mix, using your hands or a wooden spoon, until the crumble mixture holds together in large clumps.
Spread two thirds of the crumble mixture in the bottom of the pan and press down firmly to create an even layer, making sure the mixture reaches into the corners as well. Spread the fruit preserves over the crust, leaving half (12 mm) of space around the edges. Scatter the berries over the jam. Sprinkle with the remaining crumble, leaving space so that the berries show through.
Bake for 40–45 minutes, rotating between upper and lower oven racks halfway through baking, until the bars are golden brown, and the berries are bubbling. Allow to cool completely in the pan before transferring to the refrigerator to chill for at least 2 hours before cutting into 12 bars.
SALMON CHOWDER
Ingredients
2 tablespoons Low FODMAP Onion-Infused Oil or extra-virgin olive oil
1 cup (64 g) chopped scallions, green parts only
½ cup (36 g) finely chopped leeks, green parts only
4 cups (960 ml) Ultra High Temperature (UHT) unsweetened coconut milk
2 cups (480 ml) low FODMAP stock – fish (clam) or chicken
1- pound (455 g) celeriac, peeled and cut into large dice
1- pound (455 g) Yukon gold potatoes, peeled and cut into large dice
3 medium carrots, trimmed, peeled and cut crosswise into half inch rounds
1 bay leaf
½ teaspoon dried thyme
1- pound (455 g) skinned salmon, preferably Atlantic, cut into large chunks
Kosher salt
Freshly ground black pepper
Preparation
Heat oil in a large soup pot or Dutch oven over low-medium heat until shimmering. Add scallion and leek greens and sauté until softened but not browned, just a few minutes, then add coconut milk, stock, celeriac and potato dice, carrots, bay leaf and thyme and stir everything together well. Bring to a simmer and cook until celeriac and potatoes are tender, about 10 minutes.
Add the fish and continue to simmer until fish is opaque and cooked through; this will be about 5 minutes. Taste and season with salt and pepper; serve immediately.
What is FODMAP?
FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols, which are short-chain carbohydrates (sugars) that the small intestine absorbs poorly. Instead of being absorbed into your bloodstream, they reach the far end of your intestine where most of your gut bacteria reside.They ferment in the large intestine (bowel) during digestion, drawing in water and producing carbon dioxide, hydrogen, and methane gas that causes the intestine to expand. This causes GI symptoms such as bloating and pain that are common in disorders like IBS.
SYMPTOMS
Cramping
Diarrhea
Constipation
Stomach bloating
Gas and flatulence
DIETARY SOURCES
The main dietary sources of the four groups of FODMAPs include:
Oligosaccharides: Wheat, rye, legumes and various fruits and vegetables, such as garlic and onions.
Disaccharides: Milk, yogurt and soft cheese. Lactose is the main carb.
Monosaccharides: Various fruit including figs and mangoes, and sweeteners such as honey and agave nectar. Fructose is the main carb.
Polyols: Certain fruits and vegetables including blackberries and lychee, as well as some low-calorie sweeteners like those in sugar-free gum.
Put more simply, FODMAPs are certain types of carbohydrates — the sugars, starches, and fiber in foods.
What Is a Low-FODMAP Diet?
A low FODMAP diet cuts out many common products that contain certain foods. The principle behind the diet is to give the gut a chance to heal, especially if you have GI problems like IBS.
Who should try it?
The low FODMAP diet is part of the therapy for those with IBS and SIBO.
Benefits of a Low-FODMAP Diet
Have fewer digestive symptoms, like gas, bloating, diarrhea, stomach pain and constipation
Manage your IBS symptoms without taking medicine
Improve your quality of life
How to Follow a Low-FODMAP Diet?
A low-FODMAP diet is more complex than you may think and involves three stages.
Stage 1: Restriction – This stage involves strict avoidance of all high-FODMAP foods.
Stage 3: Personalization – This stage is to figure out what foods trigger your digestive problems and create a diet that gives you all the nutrients you need but includes only the FODMAPs you can handle.
Sample Low-FODMAP Shopping List
Protein: Beef, chicken, eggs, fish, lamb, pork, prawns and tofu
Whole grains: Brown rice, buckwheat, maize, millet, oats and quinoa
Dairy products: Milk (from cows, goats and sheep), ice cream, most yogurts, sour cream, soft and fresh cheeses (cottage, ricotta, etc) and whey protein supplements
Beverages: Beer, fortified wines, soft drinks with high-fructose corn syrup, milk, soy milk, fruit juices
RECIPES
VEGAN LOW FODMAP FRUIT CRUMBLE BARS
Ingredients
1 1/2 cups (149 g) gluten-free rolled oats
1 1/2 cups (180 g) brown rice flour
1/3 cup (45 g) tapioca starch
1 1/4 cups (267 g) firmly packed light brown sugar
½ teaspoon kosher salt
½ teaspoon baking soda
½ cup (57 g) chopped walnuts
½ teaspoon ground cinnamon
¾ cup (180 ml) melted coconut oil; I suggest refined
¾ cup (216 g) strawberry preserves
1 cup (125 g) fresh or frozen blueberries
1 cup (166 g) fresh or frozen sliced strawberries
Preparation
Preheat the oven to 375°F (190°C). Line a 9 x 9-inch (23 cm by 23 cm) pan with foil. Spray the foil with baking spray and line the foil with parchment, cut to fit the size of the pan with a 1-inch (2.5 cm) overhang on all sides. The layer of foil will allow you to lift the bars out of the pan cleanly and the parchment will keep the bars from sticking to the foil.
Put rolled oats, brown rice flour, tapioca starch, brown sugar, salt, baking soda, walnuts, and cinnamon in a large bowl. Toss with your hands or a wooden spoon to combine. Add coconut oil and mix, using your hands or a wooden spoon, until the crumble mixture holds together in large clumps.
Spread two thirds of the crumble mixture in the bottom of the pan and press down firmly to create an even layer, making sure the mixture reaches into the corners as well. Spread the fruit preserves over the crust, leaving half (12 mm) of space around the edges. Scatter the berries over the jam. Sprinkle with the remaining crumble, leaving space so that the berries show through.
Bake for 40–45 minutes, rotating between upper and lower oven racks halfway through baking, until the bars are golden brown, and the berries are bubbling. Allow to cool completely in the pan before transferring to the refrigerator to chill for at least 2 hours before cutting into 12 bars.
SALMON CHOWDER
Ingredients
2 tablespoons Low FODMAP Onion-Infused Oil or extra-virgin olive oil
1 cup (64 g) chopped scallions, green parts only
½ cup (36 g) finely chopped leeks, green parts only
4 cups (960 ml) Ultra High Temperature (UHT) unsweetened coconut milk
2 cups (480 ml) low FODMAP stock – fish (clam) or chicken
1- pound (455 g) celeriac, peeled and cut into large dice
1- pound (455 g) Yukon gold potatoes, peeled and cut into large dice
3 medium carrots, trimmed, peeled and cut crosswise into half inch rounds
1 bay leaf
½ teaspoon dried thyme
1- pound (455 g) skinned salmon, preferably Atlantic, cut into large chunks
Kosher salt
Freshly ground black pepper
Preparation
Heat oil in a large soup pot or Dutch oven over low-medium heat until shimmering. Add scallion and leek greens and sauté until softened but not browned, just a few minutes, then add coconut milk, stock, celeriac and potato dice, carrots, bay leaf and thyme and stir everything together well. Bring to a simmer and cook until celeriac and potatoes are tender, about 10 minutes.
Add the fish and continue to simmer until fish is opaque and cooked through; this will be about 5 minutes. Taste and season with salt and pepper; serve immediately.
Dr. Ravi Kumar completed his Bachelor of Health Sciences at McMaster University. He then pursued his Medical Doctorate and Urology residency at The University of Ottawa. He subsequently completed a fellowship in Urologic Oncology and Robotic Surgery at the Princess Margaret Cancer Centre at the University of Toronto. During his fellowship, he obtained a Master of Engineering from the Institute of Biomedical Engineering at the University of Toronto. He is the co-lead author of the Canadian Urological Association/American Urological Association guideline on the diagnosis and management of adrenal masses.
Dr. Kumar treats a wide variety of urologic conditions including BPH and kidney stones, with a special focus on delivering cutting-edge care for prostate cancer, kidney cancer and bladder cancer.
Dr. Ashwin Maharaj obtained his undergraduate degree in Biology/Physiology from the University of Western Ontario (BSc). e became certified through is a Diplomate of the American Board of Surgery and was certified as fellow of the American College of Surgeons (FACS) and recently recertified. He is a member of the Canadian Association of General Surgeons. His current clinical interests are devoted to outpatient acute and chronic gastrointestinal medicine/surgery as well as abdominal wall hernia surgery and practices in certified facilities in Toronto. He has research experience in gastrointestinal disease as well as surgical education teaching resident surgeons and medical students.
Dr. Diana Magee completed her undergraduate education at Cornell University followed by a Master of Public Health degree at Boston University. She received her medical degree from Queen’s University and completed her urology residency at the University of Toronto. While in residency she enrolled in the Surgeon Scientist program and completed her Master of Science in Health Services Research. She completed her fellowship in urologic oncology at Fox Chase Cancer Center in Philadelphia. Dr. Magee’s area of expertise is in the management of urologic cancers as well as performing minimally invasive surgery.
Dr. Pianezza completed his medical degree (MD) at the University of Ottawa in 2002. He became a member of the Royal College of Physicians of Canada (FRCSC). He then completed a one-year fellowship in minimally invasive surgery and endourology at the University of Alberta in Edmonton in 2008.
Dr. M. Pianezza has been a staff urologist in Sudbury at the Health Sciences North since January 2010. He was Head of Urology from February 2013 to September 2016. He is an Assistant Professor of Surgery at the Northern Ontario School of Medicine.
Dr. Heimrath completed his medical school at the University of Ottawa, his surgical residency at McGill University, and his Endourology, Minimally Invasive, and Robotics Fellowship at the University of Toronto. Dr. Heimrath’s areas of expertise include the management of complex kidney stones and urologic cancers as well as performing minimally invasive surgery. Since 2016, Dr. Heimrath has worked overseas in Malawi and Rwanda to explore opportunities to build urologic and surgical capacity in the developing world. He is a partner in the Urology Global Surgery initiative at the University of Toronto and holds a lecturer appointment with the University of Toronto.
Small intestinal bacterial overgrowth (SIBO) is a clinical condition characterized by a malabsorption syndrome due to an increase in microorganisms within the small intestine.
The Clinic at Beverly Hills offers patients the option between two industry leading gastric balloon procedures. The traditional endoscopy guided Orbera Gastric Balloon and the revolutionary swallowable Allurion Gastric Balloon.
Hemorrhoids are a natural part of the human body and, when healthy, assist with the closure of the anus.
Hemorrhoids are vascular cushions that move blood to and from the anus and help support the function of the sphincter. Most people think of hemorrhoids as the disorder known as hemorrhoids or piles.
Stress Urinary incontinence (SUI) means the uncontrollable loss of urine – an involuntary loss or leakage of urine during precipitating activities like coughing, laughing, sneezing, straining, exercising etc. Early signs of SUI are complaints relating to dysuria, frequency, and urgency. At TCBH Surgical Centre, we offer two treatment options for Stress Urinary Incontinence.
Benign prostatic hyperplasia (BPH) is a condition in which your prostate grows in size. Your prostate is a gland that rests below your bladder and in front of your rectum. It’s about the size of a walnut, and it surrounds part of your urethra. Your urethra is a tube that carries urine and sperm (ejaculate) out of your body. If your prostate grows in size, it can prevent urine and ejaculation from passing through your urethra. BPH is not cancerous. However, symptoms of BPH may indicate more serious conditions, including prostate cancer. TCBH Surgical Centre provides two treatment options.
RezumTM Water Vapor Therapy is a novel technology that helps people who are suffering from BPH symptoms.
In each application, sterile water vapor is released to the targeted prostate tissue. When the steam turns back into the water, all the stored energy is released, causing the cells to die.
Over time, your body’s natural healing response removes the dead cells, shrinking the prostate. With the extra tissue removed, the urethra opens, reducing BPH symptoms.
The maximum benefit may occur within three months. Patients’ responses to treatment can and do vary.
NanoKnife or Irreversible Electroporation (IRE) consists of placing a number of electrodes into the prostate to surround the area of significant cancer.
Short pulses of electricity using very high voltage are passed between the electrodes. This causes micropores to occur in all cells, including the cancer cells, which lead to their death.
Dr. Luke Fazio is the current Chief of Urology at Humber River Hospital. Dr. Fazio received his medical degree from McGill University in 1999. Following this, he finished his Endourology and Minimally Invasive fellowship at the University of Toronto. As the Urology Medical Director, he has brought many minimally invasive programs to TCBH and is working on future projects. He currently sits on numerous committees and is an advocate for innovation in healthcare. He is the physician lead for the Da Vinci Robotic Surgery Program. He also is the Chair of the Innovation Committee.
Dr. Bhargava has a primary focus of providing care for her patients in the form of minimally invasive procedures and cutting edge technology. She is the Medical Director of TCBH Surgical Centre (The Clinic at Beverly Hills Healthcare) and has been instrumental in bringing Laser Hemorrhoid Treatment to her Centre.
Achievements: Dr. Bhargava completed both her medical school and surgical residency at the University of Western Ontario. In addition to her Bariatric fellowship, she has also completed Minimally Invasive fellowship at the University of Cincinnati in Ohio. Dr. Bhargava has published multiple research papers and lead articles.
Memberships: Canadian Medical Association, Canadian Association of General Surgeons, Society of American Gastrointestinal and Endoscopic Surgeons, Royal College of Physicians and Surgeons of Canada, College of Physicians and Surgeons of Ontario, and American Society of Bariatric Surgery