Diet Tips:Label reading – how to spot the FODMAPs

By Caroline Tuck (PhD Candidate & Accredited Practising Dietitian)

Reading food labels can assist you to recognize suitable foods on a low FODMAP diet. The table below describes common, FODMAP containing ingredients and products where these ingredients may be found.

Remember that ingredients on food labels are listed in order of weight. So the first ingredient listed is in the highest quantity and the last ingredient listed is in the lowest quantity. When you are starting to re-introduce higher FODMAP foods, you may choose to try products which have high FODMAP ingredients such as garlic powder listed as minor ingredients. You just then need to monitor your tolerance.

NOTE: Whilst label reading is helpful, high FODMAP ingredients cannot always be identified. Some foods which may appear to be low FODMAP according to ingredients, may in fact be high FODMAP. So even if you find a product that looks like it would be safe, use trial and error to confirm that you are able to tolerate it. 

Common ingredients to avoid	Potential sources
Fructose	Soft drinks Some sweet foods e.g. cakes, confectionary Sports drinks and sports gels
High fructose corn syrup	Soft drinks Muesli bars Breads Jams
Honey	Sweetened products Muesli bars Breakfast cereals Breads
Lactose	Dairy products
Sorbitol	Chewing gums and mints Artificial sweetened products Cough medicines / lozenges
Mannitol	Chewing gums and mints Artificial sweetened products Cough medicines / lozenges
Xylitol	Chewing gums and mints
Isomalt	Chewing gums and mints
Garlic. Or garlic products e.g. garlic salt, garlic powder	Flavoured products e.g. pasta sauces, tomato pastes, stocks, flavoured biscuits/chips Dips
Onion. Or onion products e.g. onion salt, onion powder	Flavoured products e.g. pasta sauces, tomato pastes, stocks, flavoured biscuits/chips Dips
Wheat when it is a main ingredient (i.e. listed first to third on the ingredient list)	Breads Breakfast cereals Biscuits Pasta
Rye when it is a main ingredient (i.e. listed first to third on the ingredient list)	Breads Breakfast cereals Biscuits
Inulin	Yoghurts Biscuits
Fructan	High fibre foods
Fructooligosaccharides (FOS)	Protein powders Sports products
Chicory	Coffee substitutes
Fruit juices e.g pear juice, apple juice	Muesli bars Breakfast cereals Yoghurts Ciders
Fruit pieces which make up a significant portion of the food	Fruit yoghurts Muesli bars Breakfast cereals

Please note that this table is not exhaustive and not all products listed will necessarily contain these ingredients. Always check the food label to see what ingredients the product contains. 

           

Diet Tips:Quinoa Breakfast Pudding

By Lucy Taylor (Accredited Practising Dietitian)

Quinoa is a good choice on a low FODMAPs diet as it’s a good source of fibre and is higher in protein than other grains such as rice or corn (though it’s technically a pseudo-grain).

Quinoa flakes are made in a similar way to rolled oats – the grain is steamed and then rolled to create thin flakes. They can be used to make a hot porridge, but they have quite a strong flavour when heated that some people don’t like. When served cold and soaked in milk and a little sweetener, the quinoa has a subtle flavour that pairs well with fresh fruit.

This pudding is a quick, easy and nutritious breakfast for people who don’t have much time for meal preparation in the morning – simply place it in the fridge the night before and it’s ready to serve for breakfast. It’s also a good option for people who prefer to eat their breakfast on their commute or once they arrive at work – just mix everything together in a reusable container instead of a bowl.

LSA is a mix of ground linseed (also known as flaxseed), sunflower seeds and almonds which thickens the pudding, so don’t leave it out! LSA also provides additional dietary fibre, unsaturated fats and vitamin E.

Quinoa Breakfast Pudding .............................................................................................. AUTHOR: Lucy Taylor SERVES: 2 FODMAP LEVEL: 1 serve per sitting is considered low FODMAP .............................................................................................. INGREDIENTS ·         ½ cup rolled quinoa flakes ·         ¾ cup lactose-free milk or soy milk (made with ‘soy protein’ not ‘whole soy bean’) ·         1 tbsp LSA ·         2 tsp maple syrup or sugar ·         Low FODMAP Fruit to serve, e.g. pulp of 1 passion fruit, up to 10 medium strawberries, up to 10 raspberries, up to 20 blueberries, 1-2 chopped small kiwi fruit  *Don't forget to check the Monash University Low FODMAP diet app for details of  serving sizes and suggestions for low FODMAP vegetables! .............................................................................................. METHOD 1.     Place the quinoa, milk, LSA and maple syrup or sugar in a bowl and stir until well combined 2.     Cover using a plate or cling film and place in the fridge overnight 3.   Serve in the morning for breakfast topped with a serve of low FODMAPs fruit .............................................................................................. NUTRITIONAL INFORMATION NUTRITION INFORMATION (1 serve) Energy total Protein Fat total Carbohydrate 1160kJ 14g 7g 3g

           

Diet Tips:Research article: Not all FODMAPs are equal

By Caroline Tuck (APD, PhD Candidate)

An interesting study was published in 2013 about the effects of different FODMAPs.

FODMAP is an acronym for a group of carbohydrates that have been shown to cause symptoms in people with irritable bowel syndrome (IBS). The acronym stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols and includes the following carbohydrates:

·         fructose

·         lactose

·         sugar polyols (including sorbitol and mannitol)

·         fructans

·         galactooligosaccharides

Although these 5 sugar subgroups have been grouped together, they appear to have a different effects on the gut. This study compared the effects of fructose and fructans.

Sixteen healthy volunteers participated in the study. Subjects were given 4 different solutions: glucose (a well-digested/absorbed sugar) which acted as a control (or placebo); fructan; fructose or fructose with added glucose. After consuming each solution, subjects underwent MRI scans to assess the water content of the small intestine and the gas content of the large intestine.

The study showed that fructose caused an increase in the water content of the small intestine (probably due to osmosis), while fructans increased the gas content of the large intestine. The study highlights that different FODMAPs behave differently, even within the same gut. It also helps us to understand why different FODMAP may contribute to different IBS symptoms. The study suggests that dietitians should tailor a person’s low FODMAP diet to mitigate specific IBS symptoms.  

If you would like to read the full research article, the reference is here: Murray, K., V. Wilkinson-Smith, C. Hoad, C. Costigan, E. Cox, C. Lam, L. Marciani, P. Gowland and R. C. Spiller (2014). "Differential effects of FODMAPs (fermentable oligo-, di-, mono-saccharides and polyols) on small and large intestinal contents in healthy subjects shown by MRI." Am J Gastroenterol 109(1): 110-119.

           

Diet Tips:The super sensitive in IBS

By Caroline Tuck (APD, PhD Candidate)

Irritable Bowel Syndrome (IBS) can express itself in many different ways, resulting in different symptoms that may change over time. Therefore, IBS is not a straightforward condition to treat and the IBS management does not suit a ‘one-size-fits-all’ approach.

There are many IBS treatments available, including medications, dietary change, hypnotherapy and herbal remedies, with varying levels of evidence supporting their use. 

Therefore, two people (even with the same type of IBS – constipation predominant, diarrhoea predominant or mixed) may not respond to the same treatment.

At Monash University, we focus on diet therapies because this is our area of research expertise. We recommend people follow a low FODMAP diet for a short period of time followed by a period of rechallenges, during which higher FODMAP foods are reintroduced enabling people to assess their tolerance to the various FODMAP subgroups. Most people should not need to stay on a strict low FODMAP diet for life. The reason we suggest rechallenging with higher FODMAP foods is discussed in previous blog posts: 

http://fodmapmonash.blogspot.com.au/2015/06/just-2-6-weeks-it-is-not-diet-for-life_8.html and http://fodmapmonash.blogspot.com.au/2015/04/low-fodmap-diet-not-lifetime-diet.html

But for some people, reintroducing foods is not easy or straightforward. In fact, in more sensitive individuals, reintroducing higher FODMAP foods can be very hard. Some people find that symptoms return even if they reintroduce very small quantities of higher FODMAP foods. This may require the person to follow a strict low FODMAP diet for longer to maintain symptom control.

The complexities of treating IBS mean that consultation with a Dietitian is very important, especially in people very sensitive to dietary factors such as FODMAPs. 

How a Dietitian can help:

•          They can suggest other strategies (both dietary and non-dietary) to help improve food tolerance.
•          They can ensure your diet remains nutritionally adequate if you need to remain on a low FODMAP diet for longer periods.
•          They can recommend other dietary and non-dietary therapies that may improve symptoms further.
•          They can identify food triggers other than FODMAPs
•          They can work with your doctor/gastroenterologist to find the best treatment for you.

You may also find this blog post helpful: http://fodmapmonash.blogspot.com.au/2015/05/top-5-reasons-why-you-should-see_22.html

In the long term, we advise that a strict low FODMAP diet is not continued, even in super sensitive individuals. We also recommend you repeat unsuccessful food challenges because IBS symptoms and tolerance to different foods changes over time. Reintroducing foods very gradually can also improve your tolerance.

Diet Tips:The FODMAP Grand Tour Down Under: IBS relief

Animation artists are helping to visualise and communicate complex scientific findings. The Monash FODMAP Team has worked with the animation artist, Christopher Hammang (from the Garvan Institute in Sydney) to produce a short video that explains how FODMAPs trigger symptoms associated with IBS. 

We have found that when patients have a good understanding of the mechanisms by which FODMAPs trigger IBS symptoms, they find it easier to follow a low FODMAP diet.

The new animation video brings to life the physiological effects of FODMAPs; explains how FODMAPs trigger IBS symptoms, and shows the dramatic effects of a low FODMAP diet in this population. The animation visualises and communicates the findings of research, conducted over several decades, which has quantified the FODMAP composition of hundreds of different foods; described the mechanism by which the diet works, and shown that a low FODMAP diet improves symptom control in approximately three out of every four people with IBS.

The animation has so far received a very welcome response on social media and we hope it continues to be a valuable tool for clinicians and patients alike.

Here are some of the thoughts of our audience so far:

·        ‘Excellent video to explain the effect of FODMAPS on IBS sufferers.’

·        ‘This a great explanation thankyou!! I'm also so grateful for the low fodmap diet!!’

·        ‘This is exactly what I needed to explain to friends/family what the heck is going on in my gut! Thanks Monash team’

·         ‘Great work guys. This is going to be really useful to use in the clinic.’

·         ‘Such a great little piece of sci comms...well done!’

·         ‘This explains my tummy a bit better than I can’

We hope you like it too.

The Monash FODMAP Team

Diet Tips:Preventing festive flare-ups of IBS

By Peta Hill (Paedeatric dietitian)

This Christmas, many of us with IBS will suffer bloating, wind, abdominal discomfort and/or disturbances in bowel habits - even those us who normally have good symptom control. The combination of high stress levels with excessive consumption of rich foods and alcohol at this time of year can be a recipe for tummy trouble. Here are 5 tips for minimising festive flare-ups of IBS:

1.      Continue to eat balanced meals and snacks



Cocktail party food tends to be high in fat – a gut irritant – and contain hidden FODMAPs in marinades, dips, sauces and fillings. The more you consume, the more likely you are to experience symptoms of IBS. Therefore, continue to eat regular meals and snacks, including something before you go to the event - ideally a balanced low FODMAP light meal with protein, salad/vegetables and starch. This way you won’t arrive starving and be tempted to eat every canapé in sight!

2.      Fill up on low FODMAP wholefoods

Whether it’s drinks and nibbles or a sit-down meal, there will be foods you identify immediately as low or high FODMAP and others that you’re unsure of.  Try to fill-up on those you know you tolerate and simply sample those you’re unsure of. 

Party foods to enjoy - peanuts, hard yellow cheeses, olives, rice crackers, sushi, rice paper rolls, cold meats, smoked salmon, fresh seafood, plain barbequed or roast meats, roast vegetables and greens, onion free salads and fresh berries. 

3.      Enjoy alcohol at alternate events with low FODMAP foods

Alcohol is a gut irritant. Try to indulge in alcohol at alternate events, enjoying alcoholic beverages at one event and drinking sparkling water with lemon or lime at the next. If possible, enjoy alcohol at events where you know there will be low FODMAP food options available and choose sparkling at events with limited low FODMAP options.

4.      Plan recovery phases

Stress and anxiety can trigger IBS symptoms. Don’t over commit yourself this festive season and do schedule some early nights at home. On these nights, eat a well balanced low FODMAP meal, drink lots of water, have no alcohol and limit screen time to promote a good night’s sleep.

5.      When you can bring something, bring a low FODMAP option

When you need to bring a plate, bring something you enjoy and tolerate well. Here are some yummy low FODMAP variations to traditional festive favourites:

Appetiser

Smoked salmon makes a delicious appetiser but is often served on bagels or bread. For a low FODMAP twist on a smoked salmon appetiser try:

·         Smoked Salmon & Cucumber Appetizer and replace Greek yoghurt with lactose-free yoghurt or sour cream if lactose is an issue for you

·         Smoked Salmon Fingerling Potatoes and use lactose-free sour cream if lactose is an issue for you

·         Gluten-free blinis with smoked salmon and again, use lactose-free sour cream if lactose in an issue for you

Entrée

Platters make for fabulous entrees. Try:

·        Italian style antipasti plate but omit garlic and opt for spelt sourdough rather than regular bread

·         Fresh seafood platter

Main

Modify traditional stuffing recipes by:

·         Infusing oil or butter with chunks of garlic and onion, then removing chunks.

·         Using gluten free bread or bread-crumbs instead of regular. I recommend, using toasted cubes of gluten free bread.