Diet Tips:Low FODMAP diet provides both short- and long-term relief of gut symptoms

By Dr Jane Varney

Good news for people following a low FODMAP diet! A recent study conducted by researchers at Kings College London measured the long-term effectiveness of a low FODMAP diet. The study followed 100 participants with IBS from baseline (pre-FODMAP restriction), through the elimination and rechallenge phases and for 1 year thereafter. Participants reported their gastrointestinal symptoms at baseline (before FODMAP restriction), at 4-8 weeks (after FODMAP restriction) and at 1 year (following a rechallenge phase). Dietitians taught participants how to implement the elimination and rechallenge phases, but participants made their own food selections (meals were not provided in this study).

Sixty-two percent of participants reported satisfactory relief of symptoms after the initial elimination phase and the majority of these participants (71%) continued to experience satisfactory symptom relief at 1 year. Almost all of the participants who responded to the diet at 1 year continued to avoid high FODMAP foods at least half of the time.

So what are the take home messages from this study? Reassuringly, the study shows that a low FODMAP diet improves IBS symptoms in both the short, and long-term. The study also suggests that some degree of FODMAP restriction may be necessary to maintain adequate symptom control in the long-term. It is here that we issue a note of caution. Given the adverse changes in gut microbial populations associated with long-term adherence to a low FODMAP diet, we always encourage people to enter a re-challenge phase and under the guidance of a dietitian, find an acceptable balance between the occasional inclusion of moderate and high FODMAP foods (naturally rich in healthy prebiotics) and adequate symptom control.  In the long-term, we advocate people follow the least restrictive diet necessary. Further research into the rechallenge and long-term maintenance phases of the diet is warranted.

Reference:

Martin, L., van Vuuren, C., Seamark, L. (2015) Long term effectiveness of short chain Fermentable carbohydrate (FODMAP) restriction in patients with irritable bowel syndrome. Gut, 64: A51-A52.

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Diet Tips:Milk alternatives on a low FODMAP diet

By CK Yao (Accredited Practising Dietitian, PhD candidate)

The food industry has responded to consumer demand and now produces a large range of milks from plant sources, coconut, and almond.

In our latest Monash University Low FODMAP app update, we included plant-based milks that were tested in collaboration with the dietitians at King's College, London, UK.

Our tests revealed that the majority of European soy milk products were made from soy beans, whereas Australian soy milks were made either from soy beans or soy protein extract. Soy milk made from soy beans tends to be high in the FODMAP, galacto-oligosaccharide (GOS). By contrast, soy milk made from soy protein extract tends to be low in FODMAPs as the carbohydrate component (GOS) is removed in processing.

If you can't find soy milk products made from soy protein extract, low FODMAP milk alternatives include:

·         Almond milk

·         Coconut UHT milk

·         Soy milk made from ‘hulled’ soy beans

·         Hemp Milk  (not available in Australia or NZ, but widely available in Europe and USA)

·         Coconut UHT milk  (small serves)

·         Soy milk made from hulled soy beans (small serves)

      →See the Monash App for serving sizes.

Nutrition tip: Whilst plant-based milks are good low FODMAP alternatives, they do not contain the natural benefits of lactose-free dairy products, including calcium, vitamin B12 and phosphorus. These nutrients are important for cognitive function and building strong, healthy bones and teeth.

If you have a dietary requirement for plant-based milks, ensure that the product you choose is calcium fortified (≥120mg/100ml). This will ensure that 1 x 250 ml glass of plant-based milk provides one serve of calcium (based on the Australian Healthy Eating guidelines).

Remember, a low FODMAP diet does not need to be a dairy free diet.