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:Research article: Group or One-on-one FODMAP education?

By Caroline Tuck (APD, PhD Candidate)

King’s College in London has recently published a research article comparing group vs. one-on-one low FODMAP diet education in patients with Irritable Bowel Syndrome. This has never been researched before.

The study compared 263 patients receiving Dietitian-led group education (no more than 12 people in each group) to 101 patients receiving the more traditional approach of one-on-one sessions with a Dietitian. Before being enrolled in the study, each patient was assessed to check suitability to either group or one-on-one education. They asked each patient to rate their symptoms before and after intervention.

Overall, the study found that more participants were satisfied with their symptom control after education than before, suggesting that the low FODMAP diet was working. However, participants were equally satisfied after group versus one-on-one education, showing that the different types of education were equally beneficial; 54% were satisfied with symptom control after group education and 60% were satisfied with symptom control after one-on-one education.

There are a few things to keep in mind here. In some cases, seeing a Dietitian on an individual basis is important. This is especially the case if you have any additional food intolerances / allergies / preferences. It is also important to keep in mind that the low FODMAP diet is not always a one-size-fits-all approach, therefore you may benefit from seeing a Dietitian who is able to adapt the diet to closely suit your needs and symptoms.

We always recommend you consult with your Doctor first, before attempting any dietary change.

Thanks King’s College for a very interesting research article investigating something that has never been looked at before!

Whigham, L., Joyce, T., Harper, G., Irving, P. M., Staudacher, H. M., Whelan, K., & Lomer, M. C. E. (2015). Clinical effectiveness and economic costs of group versus one‐to‐one education for short‐chain fermentable carbohydrate restriction (low FODMAP diet) in the management of irritable bowel syndrome. Journal of Human Nutrition and Dietetics.

Diet Tips:Talking tofu

By Dr Jane Varney

There’s been a lot of discussion regarding the FODMAP content of tofu recently, so we're going to clear up some of the confusion!

Also known as bean curd, tofu is a nutritious and versatile food that features heavily in vegetarian and Asian cuisines. Made by coagulating soy milk and pressing the curds into block moulds, it is low in fat, low in kilojoules and high in protein, making it a healthy addition to any diet. 

There are a wide range of tofu varieties on the market that vary in moisture content and texture. Typically, firmer varieties have had more water pressed out of them, while softer varieties are either unpressed or have had less water pressed out of them.

 

Silken tofu is unpressed and has the highest water content, making it a suitable addition to creamy foods such as smoothies, desserts, sauces, and dips. It is often used as a substitute for eggs in baked dishes. Firmer varieties of tofu have a lower water content and can be sliced, baked, fried, stir-fried or scrambled.

But what is the FODMAP content of tofu and how much can safely be included in a low FODMAP diet?

The answer to this question depends on the variety of tofu in question. Our analyses have revealed that silken tofu is high FODMAP in a 140g serve, due to the presence of oligos (GOS and fructans), whereas firm tofu is low in FODMAPs in a 170g serve.

Tofu, firm, drained	Serving size	Rating
1 serve	170g (⅔ cup, cubed)	Low
½ serve	85g (⅓ cup, cubed)	Low
Tofu, silken, drained
1 serve	140g (⅔ cup)	High
½ serve	70g (⅓ cup)	High

 Why the difference, we hear you ask? We think it is due to differences in food processing methods. As you might remember from previous blog posts, FODMAPs (particularly fructans and GOS) are water soluble, so drained, firm tofu (with a lower water content) is lower in FODMAPs than silken tofu that has a high water content.

The take home message: drained, firm tofu is a nutritious, low FODMAP source of protein that can be enjoyed in Asian and vegetarian dishes. 

Check out our tofu recipes included in the app and previous blog posts:

Marinated tofu recipe

Scrambled tofu recipe

Vegan, gluten free french toast

Diet Tips:The Classic Burger

By Marina Iacovou (Accredited Practising Dietitian and PhD Candidate)

This is a classic beef burger recipe with a twist. Burgers are quick and easy to make, and can include a variety of vegetables. They can also be low FODMAP, or a good way to re-introduce some moderate-high FODMAP-containing foods back into your diet.

Recipe - makes 6-8 burgers: (Preparation time 15 minutes, cooking time ~5-10 minutes)   Ingredients: ·         Beef burgers o   500g lean beef mince o   1 egg o   1 tablespoon of olive oil o   ½ cup spring onion (green part) – finely chopped o   ¼ cup of fresh continental (flat) parsley – finely chopped o   ¼ cup of fresh coriander – finely chopped o   Handful of chives o   1 medium sized carrot – grated o   2 medium sized button mushrooms* – finely chopped o   Cracked pepper ·         Accompaniments and condiments o   Bread / roll / bun of your choice o   Fresh tomato / lettuce / cucumber o   Hard cheese – cheddar / tasty / haloumi o   Tomato sauce / BBQ sauce / lemon juice *N.B Mushrooms are high in FODMAPs, but have been included in this recipe to give an example of how to introduce small amounts of high FODMAP foods during the rechallenge phase of the low FODMAP diet. Method: Combine beef, egg, olive oil, selected vegetables, herbs and spices into a large bowl and mix together. Divide mixture into 6-8 portions and roll into balls.   Spray or drizzle olive oil into a pan or on a BBQ plate. Heat oiled pan/BBQ plate first before placing burgers. Cook burgers on a medium heat for ~3 minutes each side or until cooked through. Add fresh salad vegetables, cheese and condiments of your choice, as toppings to the cooked burger and bun.                                                                     Tips and hints: ·         Adding a little bit of chopped vegetables like mushroom, carrots and/or zucchini adds moisture, colour and helps to increase vegetable intake for kids and adults alike ·         For a crispy bun, cut in half and chargrill the top side, or both sides ·         For melted cheese, top the inside of the bun with your choice of cheese and place under the grill. Haloumi can be cooked on its own in the pan or BBQ plate ·         Use your choice of herbs and spices e.g. cumin, mint ·         Use other vegetables in the burger mixture e.g. finely chopped zucchini ·         Add a small amount of the white spring onion or more mushroom, if re-introducing high FODMAP foods back into your diet ·         Whether you are serving burgers for the family, in a social setting, or at a BBQ, place all salad vegetables, cheese and condiments in the middle of the table, and everyone can add what they like to their burger ·         Include a variety of gluten-free, wholemeal, sourdough spelt breads/rolls in the middle of the table ·         For a vegetarian / vegan burger recipe please see an earlier blog post http://bit.ly/1DWLqOs Enjoy!

Diet Tips:Low FODMAP Thai Green Chicken Curry

By SOME foods

Thai Green Chicken Curry         ............................................................................................. Serves: 4 (one serves is low FODMAP)                ............................................................................................. INGREDIENTS 1 jar of SOME Foods Thai Green Curry 400g skinless chicken, diced 340g bok choy, chopped 300g red capsicum, sliced 200g carrot, finely sliced 200g bean sprouts 300g jasmine rice METHOD Heat a medium fry pan then add the chicken, cooking until evenly browned. Add the bok choy stalks, capsicum & carrot to the pan and pour over the jar of SOME Foods Thai Green Curry. Stir to combine and simmer until the chicken is cooked through, adding the bok choy leaves and bean shoots a few minutes before the end.  Serve with rice cooked according to the instructions on the packet.

Diet Tips:Going to the Movies? Can I Snack on Popcorn?

Newly Tested Food: Popcorn

By Lyndal McNamara (APD)

Exciting news from the Monash FODMAP team- Your favourite movie treat has now been tested and meets our low FODMAP criteria in a <100g serving! So what does a 100g serving of popcorn actually look like? To answer this question we ventured to our local cinema and investigated the typical popcorn buckets on offer, and here are the results:

 So the good news is that you can still enjoy a small box of cinema popcorn (or 1/3 of a medium box or ¼ of a large box if you are sharing) as part of your low FODMAP diet. It is important to note that many cinemas now offer flavoured popcorn or flavouring sachets that you can add yourself. If you are planning on choosing a flavoured option, just be sure to check the ingredients list first for any high FODMAP ingredients such as garlic powder, onion powder, honey or high fructose corn syrup.

Cinema popcorn is also usually popped in oil with butter and salt added, so can be quite high in calories, saturated fat and sodium. High fat foods can trigger IBS symptoms in some individuals, so consider this type of popcorn an occasional treat and be mindful of how much you eat in one sitting.  Despite this, a typical serve of plain, air-popped popcorn (60g) makes a nutritious and satisfying snack, providing around 9g of dietary fibre and 8g of protein. Why not try making your own air-popped popcorn at home with one of these low FODMAP flavour toppers- Enjoy! Lyndal McNamara (APD)

•   For a savoury option, lightly spray your hot popcorn with olive oil spray and sprinkle with smoked paprika, dried oregano and parmesan cheese (1 tbs. max)
•  For a sweet option, lightly spray your hot popcorn with coconut oil spray and sprinkle with cinnamon, icing sugar (1 tsp max.) and cocoa powder 

Diet Tips:Kumquat Jam

 By Shirley Webber

Kumquat Jam ............................................................................................. INGREDIENTS: 280g Kumquats 1 cup of Sugar 1/2 Lime Water METHOD: Preparing the Kumquats 1.       Give kumquats a clean removing any leaves or sticks still attached at the top of the kumquats. 2.       Prick a couple of holes in the sides of each kumquat using a toothpick. 3.       Place Kumquats in a small pot and cover with boiling water, enough to cover the kumquats. 4.       Bring the water to a boil over a medium heat and simmer for 10 minutes. 5.       Drain the water off the kumquats and repeat step 4 two more times. (Add boiling water and simmer for 10 minutes). 6.       Drain the kumquats. Syrup 1.       Place 1 cup of sugar in a pot and add ½ cup of boiling water. 2.       Heat the pot for 10 minutes stirring occasionally and be careful to not burn the sugar. Cook until the sugar mixture has thickened. 3.       Add the kumquats to the thickened mixture. 4.       Keep mixture on a low heat for another 15 minutes or until the kumquats are translucent. 5.       Squeeze the juice from half of fresh lime into the pot and stir until combined. 6.       Leave the mixture on low heat for another minutes or two. 7.       Turn the heat off and leave the mixture to cool. This jam is great for a morning toast or use this on the side of a cheese platter instead of a fig jam for something different to wow your friends with.

           

Diet Tips:Caccuiccio (Seafood Stew)

By SOME Foods - http://somefoods.com.au/

Caccuiccio (Seafood Stew)         ............................................................................................. Serves: 4 ............................................................................................. Ingredients 1 jar of SOME Foods Capsicum, Olive & Chilli Sauce 1 tablespoon (15mls) extra virgin olive oil 1 small fennel bulb (no more than 200g) 2 medium sized carrots (about 200g) 1 cup (250ml) white wine 1 teaspoon salt 400g white fish fillets (such as mullet, mulloway, snapper or flathead) 400g green (raw) prawn meat Optional for garnish Lemon (cut into wedges) Parsley Preparation Remove stalks, any rough outer leaves and the base from the fennel bulb, then dice into ½ cm cubes. Make sure the final prepared amount weighs no more than 200g (as single serving sizes of 100g contain high amounts of Oligos – fructans and Polyols – mannitol) Peel the carrots and remove both ends, then dice into ½ - 1 cm cubes. Cut the fish into roughly 3cm cubes. Devein the prawns (if needed) Method – the sauce Heat the olive oil in a medium, heavy based, pot or pan over high heat then add the diced fennel and carrot. Fry until the fennel starts to brown.  Add the white wine and deglaze the pan (i.e. scrape up all of the yummy brown flavoursome bits that have stuck to the pan). Turn the heat down to medium then add the jar of Capsicum, Olive & Chilli Sauce and salt. Mix through thoroughly and bring to a simmer. Put the lid on and turn the heat to low, stirring occasionally.  When the carrot is just becoming tender (about 5-7 minutes), add in the prawns and cubes of fish, stirring to incorporate. Put the lid back on and continue simmering until the seafood is cooked (roughly another 4-5 minutes). Serve with 1 cup of cooked rice (1/3 cup uncooked) or a slice or two of gluten free/sourdough spelt bread.