Diet Tips:Prebiotics and probiotics: what are they and should I be including them on a low FODMAP diet?

By Dr Jane Varney

Let’s start with prebiotics. A prebiotic is a type of fibre that passes through the gastrointestinal tract undigested and stimulates the growth and/or activity of certain ‘good’ bacteria in the large intestine. While all prebiotics are considered ‘fibre’, not all fibre has prebiotic effects. Because certain FODMAPs have prebiotic effects, namely fructans and galacto-oligosachairdes (GOS), a low FODMAP diet restricts intake of prebiotic fibres. 

This is one of the reasons why a low FODMAP diet is not considered a lifetime diet and why the rechallenge phase is so important. Indeed, a prebiotic rich diet is considered a healthy diet for the general population (without IBS). Diets rich in prebiotic fibres may encourage a healthy balance of gut bacteria, potentially benefiting digestion, the absorption of minerals and immune system function.

Probiotics on the other hand, are live microbial food supplements that feed on prebiotics. Common varieties include lactobacilli or bifidobacteria. Probiotics are available in a number of forms: they are found naturally in some yoghurts and fermented milk, they are sometimes added to infant formula and they are available as dietary supplements. 

Probiotics may play a role in gut health, by inhibiting the growth of pathogenic (disease causing) bacteria, assisting in the digestion and absorption of nutrients, contributing to short chain fatty acid production and maintaining a healthy immune system.

There is some evidence that probiotics can help with IBS symptoms, but this may vary depending on which probiotic preparation is used. Our advice is to try one management strategy at a time. Commence a low FODMAP diet first and if you have not achieved good symptom control after 2-6 weeks on the diet, then discuss other management strategies with your dietitian, including the possibility of introducing probiotics.

 

Diet Tips:NEW PUBLICATION ALERT: Consistent prebiotic effect on gut microbiota with altered FODMAP intake in patients with Crohn’s disease: a randomised, controlled cross-over trial of well-defined diets

By CK Yao (Accredited Practising Dietitian, PhD candidate)

Research by our team has recently identified that a reduction in FODMAP intake in individuals with Crohn’s disease who were in remission produced significant changes in the gut bacteria, particularly selected species with beneficial roles in gut health.

The effectiveness of a low FODMAP diet therapy in inflammatory bowel disease (IBD) had only been explored in a group of patients with IBS-like symptoms and inactive IBD. Considerable improvement in symptoms occurred in > 50% patients after 6 weeks of the diet. However, it is not known whether a low FODMAP diet there may be potential negative changes as seen in a recent study in IBS. An ‘imbalance’ in gut bacteria may already be occurring in some individuals with inflammatory bowel disease.

We recently studied the habitual FODMAP intake and gut bacteria of 8 participants with stable Crohn’s disease and the effects of altering their diets. They were fed diets containing either low FODMAP or a ‘typical Australian’ diet (see sample meal plan) for 3 weeks, followed by a 3-week break before crossing over to the other diet. Daily gut symptoms were measured as well as changes in stool bacteria during both dietary periods.

Sample meal plan	Typical Australian diet	Low FODMAP
Breakfast	Honey quick oats or wheat flakes with dried fruit cereal with ½ cup lactose-free milk Packaged peaches	Brown sugar and cinnamon quick oats or rice bubbles with ½ cup lactose-free milk 2 kiwi fruit
Morning tea	Lactose-free yoghurt 2 rye vita crackers with cheese	Lactose-free yoghurt 2 rice cakes with cheese
Lunch	Wheat sandwich Vegetable fritata Apple juice	Spelt sandwich Low FODMAP vegetable frittata Cordial
Afternoon tea	Pear 2 chocolate biscuits	Banana 2 gluten-free chocolate biscuits
Dinner	Braised lamb shanks with vegetables Salmon and vegetable couscous	Braised lamb shanks with low FODMAP vegetables Salmon with low FODMAP vegetables and quinoa
Supper	Apple sorbet	Raspberry sorbet

Study findings:

•       When on a typical Australian diet, there was a significant increase in beneficial bacteria associated with favourable health outcomes compared to a low FODMAP diet, consistent with a ‘prebiotic’ effect.
•       However, overall symptoms, abdominal pain, bloating and excess flatulence were almost doubled than symptoms on a low FODMAP diet.
• Interestingly, the habitual FODMAP intake in participants with Crohn’s disease was low, similar to levels on a low FODMAP diet. Not surprisingly, the low FODMAP diet did not improve the severity of gut symptoms compared to symptoms on their habitual diet.  

Take home messages:  A high FODMAP diet may produce beneficial prebiotic effects for gut health in Crohn’s disease. It suggests that trialling this diet during periods of active inflammation may not necessarily be ideal for the large bowel.  On the contrary, a low FODMAP diet may be beneficial in reducing residual IBS-like symptoms in individuals with inactive Crohn’s disease.  A specialist gastrointestinal dietitian will be able to advise on finding a balance between consuming adequate prebiotic FODMAPs and maintaining good symptom control.

Read the full article here.

 

Diet Tips:Including Legumes on a Low FODMAP Diet

By Lyndal McNamara (Dietitian)
 

 

Legumes (otherwise known as pulses) include all types of beans, peas and lupins. The health benefits of regular consumption of legumes are well known (see table 1), predominately because they are low in saturated fat, have a low GI, are an excellent source of dietary fibre and contain a variety of phytochemicals (natural plant chemicals with health promoting effects).

Table 1: Health Benefits of Legumes

Nutritional characteristic	Associated health benefits
High in dietary fibre	-          Can assist with weight management by promoting a feeling of fullness after eating -          Contain insoluble fibre, which adds bulk to stools and assists with preventing constipation -          Contain soluble fibre, which assists in maintaining healthy blood glucose and cholesterol levels -          Contain prebiotic fibre, which is fermented by colonic bacteria to short chain fatty acids and promotes overall digestive health
High in phytochemicals	-          Contain antioxidants and other bioactive compounds, which help to protect the body against disease
Low glycaemic index (GI)	-          Contain slowly digested carbohydrates, that improve blood glucose control and insulin response in those with diabetes and reduce risk of diabetes in healthy people
High in protein	-          Legumes are a great non-animal source of protein for vegetarians and vegans
Low in saturated fat	-          Assist with maintaining healthy cholesterol levels and reducing risk of cardiovascular disease

References: please see an extensive list of references on the Grains & Legumes Nutrition Council (GLNC) website http://www.glnc.org.au/legumes/legume-references/

Legumes on a Low FODMAP diet

For those following a low FODMAP diet, legumes can be a troublesome food because they are naturally high in oligos; including galacto-oligosaccharides (GOS) and fructans.

The good news is that legumes do not need to be strictly avoided by people following a low FODMAP diet, with suitable ‘green’ serve information available for many legumes on the Monash app.

Because oligos dissolve in water, cooking and processing methods can affect the FODMAP content of legumes. For example, canned legumes or those that have been boiled and drained tend to be lower in FODMAPs as some oligos ‘leach’ out into the canning/cooking water and are removed when they are drained and rinsed. Read more here 

Dietary Recommendations for Legumes

The GLNC recommends enjoying legumes 2-3 times per week for maximum health benefits. Here are some suggestions for how to easily incorporate more legumes into a low FODMAP diet:

- Add a small can (125g) of chickpeas to stir-fries or curries – try this ‘low FODMAP Vegan Coconut & Pumpkin Curry’

- Substitute half of the meat in bolognaise sauce/casseroles for canned lentils- try this ‘low FODMAP slow cooked Lamb Casserole’:

- Sprinkle ¼ cup (53g) of cooked mung beans (boiled & drained) over salads  

- Add canned butter beans to homemade soups or stews

- Mix ¼ cup (42g) canned chickpeas with a small tin of tuna for a protein and fibre rich snack

- Add legumes to homemade dips- try this ‘Roasted Red Pepper & Pumpkin Hummus’

- Top an egg on toast for breakfast with homemade baked beans (using ¼ cup (35g) canned butter beans per person)

- Substitute meat in Asian style dishes for firm tofu or tempeh- try this low FODMAP ‘Marinated Tofu with Asian Greens and Rice’ or ‘Hot & Sour Asian Soup’:
 

Enjoy!

Diet Tips:Dietary Fibre Series - Prebiotic Fibre

Erin Dwyer (Research Dietitian)

 

We know eating enough fibre on a low FODMAP diet can be challenging and that getting the right mix of fibres is very important, so let’s discuss prebiotic fibre.

There has been a lot of talk recently about prebiotics and probiotics and how they can affect the gut, but what really are they?

Prebiotics (including resistant starch) are non-digestible fibres found in certain foods that can stimulate the growth of some bacteria. This means that instead of being broken down within the gut the prebiotic fibre travels through the gut, stimulating growth and/or activity of probiotics i.e. the good bacteria!

Here's a list of foods that are high in prebiotics that have a 'green serve’ size – take a look at the Monash low FODMAP App to find out more!

Fruits and Vegetables	Grains and Cereals	Legumes, lentils, nuts and seeds
Artichokes	Oats	Mung beans
Beetroot	Buckwheat kernels	Lima beans
Butternut Pumpkin	Wheat free Gnocchi	Nuts – Almonds and hazelnuts
Pomegranate seeds	Wheat bran	Canned chickpeas
Dried paw paw	Pasta (wheat/spelt), cooked and cooled	Canned lentils

If you are following or have followed a low FODMAP diet you may notice many of the foods listed above are high in FODMAPs. This is because fructans and galacto-oligosaccharides (GOS) are prebiotic fibres.

So if prebiotics are often high in FODMAPS, but considered part of a healthy diet, how can they be included on a low FODMAP diet?

Here are a few ideas to get you started

·         Firstly, remember that a low FODMAP diet is only meant to be LOW in FODMAPs, not completely depleted of FODMAPs

·         Also, after the initial strict phase of the diet, you may find through the rechallenge phase that you actually tolerate moderate serves of fructan and GOS rich foods quite well

·         Certain canned legumes that have been rinsed and drained are lower in FODMAPs - you can find a safe ‘green serve’ of legumes and lentils in the Monash FODMAP App. Try this recipe http://fodmapmonash.blogspot.com.au/2016/01/low-fodmap-vegan-coconut-pumpkin-curry.html

·         You can purchase wheat free Gnocchi for a low FODMAP option, serve it with a low FODMAP pasta sauce and salad – You can try this recipe http://fodmapmonash.blogspot.com.au/2016/09/low-fodmap-chicken-and-gnocchi-pasta.html

·         Add ¼ cup (green serve) of pomegranate seeds to your salad for great texture and a little sweetness

·         Snack on some almonds or hazelnuts (10 for a green serve)

It is also important to remember to continually test your tolerance to FODMAP containing foods, you may find you can tolerate different prebiotics in varying amounts. For some guidance in reintroduction you can look back on this past blog post:

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