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:Summer smoothies!

By Marina Iacovou (Accredited Practising Dietitian, PhD Candidate)

Making smoothies are a great way to involve the kids and something everyone can enjoy. They are also quick and easy to make, with minimal mess.

The ingredient options for your smoothies are endless. You can mix ingredients together to suit your preference and even on a low FODMAP diet there’s still plenty of variety. This is also a good way to introduce small amounts of moderate or high FODMAP containing foods back into your diet. Read here and here on why re-introduction is important.

Here are some smoothie ideas to get you started – they are fruity and contain dairy:

 

·         Banana and strawberries or banana and blueberries

OR

·         Simply strawberry

OR

·         Cantaloupe and passionfruit

OR

·         Kiwi fruit

With

·         Soy milk, yoghurt and lots of ice

A favourite in our home is:

Banana and Blueberry Smoothie (Serves 4)

•          2-3 large sized bananas
•          Large handful of blueberries – at least 20-30
•          300 ml Soy milk
•          250g Vanilla yoghurt
•          Lots of ice

Tips and hints

•         Use lactose-free plain yoghurt and add 2 drops of vanilla essence, for vanilla flavoured yoghurt
•         Use any low FODMAP milk - each variety will give you a different flavour. See an here for alternative milk options 
•         Add 1 teaspoon of flaxseed oil for essential fatty acids, omega 3 and omega 6.
•         Add 1 teaspoon of oat bran for extra fibre.
•        Add 1-2 teaspoons of maple or rice-malt syrup (or honey when reintroducing foods) for extra sweetness.
•       If you are reintroducing foods into your diet, try adding a higher FODMAP containing fruit into the mix – you only need to add in a small amount to start with.  For example try 30g of mango or 30g of watermelon and add it with banana or strawberries or both.

 

•           If you are reintroducing lactose-containing dairy into your diet, try any yoghurt you have been missing. It may be fruit-based, plain or vanilla.
•            Including dairy adds calcium to the diet for growing bones and the need for maintaining good bone health as we get older. 

•            Dairy is also a great source of protein for the recovery and repair of tired muscles and an energy booster after an endurance event, or a day of hard labouring work. 
•            The addition of fruit helps add fibre to your diet, essential for good bowel health, and contain vitamins and antioxidants which is always a plus.

Enjoy! 

Diet Tips:Dietary Fibre Series- Soluble Fibre

By Shirley Webber (Research Dietitian)

Eating enough fibre on a low FODMAP diet can be challenging, but did you know that getting the right mix of fibres is also important? Food is made up of different types of fibres, namely insoluble fibre, soluble fibre, and prebiotic fibres (including resistant starch). 

These fibres serve different functions in the bowel and eating them in combination may promote different health benefits. Over the next few weeks we will discuss the different fibres types, including their function in the bowel and low FODMAP food sources. Let’s begin with soluble fibre.

Soluble fibre dissolves in water and forms a thick gel in our digestive tract. This slows gut transit time and helps us to feel fuller for longer. The gelatinous substance formed by soluble fibre also acts like a sponge during digestion, attracting fluid and softening stools to make it easier for waste to move through the bowel.

There are many health benefits associated with including soluble diet in your diet. Soluble fibre helps to stabilise blood glucose levels in people with diabetes. Soluble fibre may also lower levels of low density lipoprotein cholesterol (LDL-C), also known as bad cholesterol level. This may reduce risk of heart disease and bowel cancer. For those with constipation predominant IBS, including a variety of fibres in your daily diet can assist with maintaining regular bowel habits.

What foods contain soluble fibre?

Soluble fibre is found in some vegetables and fruit, oats, lentils, legumes, nuts and seeds. Including small quantities of these foods may improve stool consistency, but avoid large quantities which may exacerbate symptoms. 

Fibre supplements such as psyllium husks are also rich sources of soluble fibre. However, being fermentable, psyllium husks are tolerated by some people with IBS, but not all, so include in small doses initially and/or under the guidance of your dietitian.

Here are a few examples of foods you can trial in your diet to increase your soluble fibre intake:

• Breakfast: Add 30g of rolled or quick oats to your yoghurt or breakfast smoothie in the morning
• Snack: Have a fruit such as orange, passionfruit or banana.
• Lunch: Include wholegrain bread, brown rice or beans as an element of your meal
• Snack: Try a handful of low FODMAP nuts and seed
• Dinner: Include a variety of vegetables into your meal. High soluble fibre options include: brussels sprouts, sweet potato, turnip, collard greens, eggplant, carrots, potato, okra and green beans. Refer to the Monash app for serving size suggestions.
• Dessert: Try making a chia seed pudding: http://fodmapmonash.blogspot.com.au/2015/11/strawberry-chia-pudding-recipe.html

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

Diet Tips:Zucchini Pasta with Cabbage and Parmesan salad

By Dr Jaci Barrett

A few weeks ago we shared with you some information about FODMAP stacking, explaining that green foods are safe, some foods have an upper limit, and how this impacts when you combine foods. See here to read this blog again.

We wanted to show you how to “FODMAP stack” in a recipe and tempted you by mentioning a zucchini pasta and cabbage and parmesan salad…. Here it is.

This recipe contains a greenserve of zucchini and a green serve of common cabbage. Both of these foods become amberor red if eaten in larger quantities. If you eat more than 1 cup of common cabbage it will take you to a red serve. Try this as a challenge if you are at the stage of testing your tolerance to FODMAPs. We want you to try to step up your FODMAP intake and relax the diet over time. If you are not ready for that, you can swap common cabbage for red cabbage which is greenuntil even larger servings of 1 ²/₃ cups.

Ingredients:

Zucchini pasta – serves 1

• 1 small zucchini, cut into strips like spaghetti (<100g)
• 2 teaspoons olive oil
• ½ clove garlic, sliced
• 2 anchovies, sliced
• Chilli flakes, ~¹/₄ teaspoon or as desired
• 1 tablespoon grated Parmesan

Cabbage and Parmesan salad – serves 1

• 1 cup thinly sliced cabbage (common or red cabbage – see note above)
• ¹/₃ cup grated carrot
• 10g Parmesan, shaved with vegetable peeler
• 2 teaspoons olive oil
• 1 teaspoon apple cider vinegar
• Salt and pepper to taste

Method:

Zucchini pasta

1. Heat oil in small fry pan
2. Add sliced garlic and heat for 1 minute to add flavour into the oil
3. Remove garlic slices from pan and discard
4. Add anchovies and chilli and heat for 2 minutes, stir
5. Add zucchini and heat for 2 minutes, stir
6. Transfer to a plate and stir through parmesan

Cabbage and parmesan salad

1. Add cabbage, carrot and parmesan to a bowl and combine
2. Add olive oil, vinegar and salt and pepper

Nutrition Information/serve:

Energy	1509kJ
Protein	16g
Carbohydrates	8g
Fat	28g
Saturated fat	8g
Fibre	7g
Sodium	870mg
Calcium	379mg