Dear Doctor: I was recently diagnosed with irritable bowel syndrome and was told to follow something called the low-FODMAP diet. Honestly, this is all so new that it’s stressful and confusing. Can you explain what’s going on?

Dear Reader: First, you’re not alone in feeling overwhelmed by a new and unexpected diagnosis. Not only are you getting a crash course on an unfamiliar medical state or condition, you’re also being asked to master the details of a new treatment regimen. This can easily add to your stress.

Your diagnosis means that your medical history, along with the symptoms you’ve described to your health care provider, match those of a chronic disorder known as IBS, or irritable bowel syndrome. Symptoms typically include recurrent abdominal pain, which is accompanied by bloating, cramping, gas, constipation or diarrhea. Many people living with IBS find that episodes of diarrhea will alternate with periods of constipation. IBS is a chronic condition, which means that it is managed rather than cured. The cause is unknown. However, recent research points to a gut-brain connection.

Diet is a first line of defense in managing IBS. The FODMAP diet your doctor recommended is an acronym for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. The “ODMAP” of the acronym are certain sugars, contained in some foods. (Not all carbohydrates are considered FODMAPs.)

For people with IBS, foods with these types of sugars are either not completely digested or are incompletely absorbed. The sugars also cause the foods that contain them to be osmotic, which means that they attract water. These factors can cause these foods to be fermented -- that’s the “F” in FODMAP -- by bacteria in the digestive tract, leading to the gastric symptoms of IBS.

Foods to avoid include those with fructose, which means fruit, honey and anything made with high-fructose corn syrup. Stone fruits like peaches, nectarines, plums, cherries and apricots also contain polyols, a carbohydrate known as a sugar alcohol, which is directly referenced in the FODMAP acronym. Also, avoid dairy products that contain lactose. Low-lactose milk products such as aged cheeses and lactose-free yogurt are usually OK. Other high-FODMAP foods include wheat products, onions, garlic, lentils, beans and legumes, including soy and soy products. Some artificial sweeteners also contain polyols, and should be avoided.

Because each person’s body responds differently to specific high-FODMAP foods, the diet is broken into two phases. The first phase asks patients to eliminate all high-FODMAP foods from their diet for a period of four to six weeks. In the second phase, the eliminated foods are gradually reintroduced. This allows problem foods to be identified.

Fine-tuning the FODMAP diet so that it is varied, interesting, nutritious and high in fiber is challenging. We suggest working with a registered dietitian nutritionist or certified nutritionist to craft a diet that is both effective and sustainable.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: A month ago, our 69-year-old mother became nauseated and had pain in her jaw. Then she got so weak that my brother made her go to the ER. It turned out she’d had a heart attack. She never had chest pain, so she had no idea anything bad was going on. Is that common?

Dear Reader: The scenario you’ve described could happen to at least half of the world’s population -- women. The symptoms of a heart attack in women can be very different from those in men, often with little or no overlap. A woman has a 50% higher chance of her heart attack being misdiagnosed than a man, according to the Centers for Disease Control and Prevention. Many women having a heart attack won’t get appropriate or timely treatment.

Heart attack is the term used to describe what happens when delivery of oxygen and nutrients to the heart is interrupted. This occurs when something stops or slows the flow of blood through a crucial network of vessels that surround the heart, known as coronary arteries. The blockage, which can be caused by a blood clot, plaque or a narrowing of the vessels, prevents blood that is rich in oxygen and nutrients from reaching the heart tissues. Without this blood flow, the heart muscles begin to die.

Recent research into heart disease in women has found that female patients’ major arteries are often clear of plaque, but that the smaller coronary blood vessels are adversely affected. This also results in a decrease or stoppage of blood flow -- and therefore oxygen and nutrients -- to the heart. Women with this type of coronary blockage will have seemingly normal angiograms, which adds to the diagnostic challenges.

With quick treatment after a heart attack, permanent damage can be limited. However, fewer women than men survive a first heart attack, due in part to their symptoms not being recognized. Unlike men, who often have the so-called “Hollywood heart attack,” with pain or numbness in the left arm followed by sudden and sometimes crushing chest pain, heart attack symptoms in women are subtler. They include the nausea, jaw pain and exhaustion that your mother experienced; pressure in the chest that doesn’t read as pain; indigestion or heartburn; pain in the throat, neck or back; vomiting; or shortness of breath. Women experiencing these symptoms should seek emergency medical care and state clearly that a heart attack is suspected.

Factors that increase heart attack risk for women -- and for men -- include smoking, high blood pressure, poor diet, being overweight, physical inactivity, diabetes and family history. To reduce risk, lifestyle changes are key. Eat more plant-based foods, limit animal fats, exercise, drink in moderation, maintain a healthy weight and don’t smoke. If possible, add some stress-reduction activities, such as meditation, yoga or hiking.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Hello again, dear readers, and welcome to the monthly letters column. Although it’s almost autumn, the heat waves keep on coming. Please take precautions. Stay hydrated, avoid peak heat hours and use your fans or air conditioning. If needed, seek out air-conditioned public places, such as shopping malls, libraries or local cooling centers. And now, your letters:

-- A reader whose mother has reached the age of 100 without eating vegetables wonders if this means she can skip that food group as well. “My mother, who speeds down the hall with her walker at an assisted living facility, has shunned vegetables her entire life,” she wrote. “She enjoys candy, cookies and bacon. I have inherited her distain for vegetables, but I force myself to eat them. Might I also forgo vegetables?”

While reaching 100 shows that her mother is doing something right, we just cannot ignore the abundance of literature supporting the health benefits of vegetables. Our advice -- we’re sorry! -- is to please keep eating them.

-- Many of you wrote regarding a column about gallstones. A reader from Hazelton, Pennsylvania, asked about a drug regimen to shrink gallstones.

“After numerous surgeries, my MRI shows I have gallstones,” he wrote. “I’m afraid to have another surgery and have asked to be put on ursodiol to shrink the gallstones, but my doctor ignores my request. Would ursodiol affect gallstones?”

Gallstones are crystalline masses that form within the gallbladder and interfere with function. Ursodiol, a bile acid taken as an oral medication, will reduce certain gallstones. It’s a conservative approach, and instead, most patients opt for cholecystectomy, a laparoscopic procedure to remove the gallbladder. Since you want try ursodiol first, make that very clear to your physician. Ask direct questions: Will ursodiol help my specific case? If the answer is no, ask why. If the answer is yes, request a prescription. If you don’t get clear answers, consider taking your test results to a different physician.

-- A reader with Grover’s disease, a challenging skin condition marked by raised red bumps on the body that are very itchy, offered a suggestion:

“I discovered that applying a thin coating of mentholated petroleum over the bump does two things for me,” he wrote. “First and fabulous, the itching pain ceases immediately. Second, over two to four days, the bumps dry up and don't spread, as they do if one scratches them.” This advice comes from an engineer who reports he has tried numerous approaches.

Thank you again for taking the time to send us your questions, comments and kind thoughts. We love hearing from you and will see you here for another letters column next month.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)