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:A bit of bloating is beneficial

By Dr Jaci Barrett

Bloating is one of the most common gastrointestinal symptoms. It can occur as a sensation of gas stretching the gut, with or without actual distension, when the abdomen is visually swollen. Bloating often results in significant discomfort and/or pain and is a major complaint in many patients with irritable bowel syndrome.

One of the major aims of the low FODMAP diet is to reduce bloating by restricting short chain carbohydrates from the diet that are fermented by gut bacteria. The fermentation process is responsible for the gas release and distension of the gut that leads to bloating. 
As we have pointed out previously, the low FODMAP diet should only be followed strictly short term. 

The diet should be relaxed long term to ease the burden of following the diet, but more importantly to reintroduce some FODMAPs back into the diet for their potential benefits. This benefit arises from the fermentation of FODMAPs by gut bacteria – the reason we restrict FODMAPs in the first place – but small amounts of FODMAPs are fuel for good bacteria and is likely to be important in long term gut health.

Many people try the reintroduction or rechallenge phase and state they have failed - their symptoms returned on reintroduction of the foods and they went back to a strict low FODMAP diet. This will be necessary for symptom control only in the minority of extremely sensitive individuals. For everyone else, it may be that smaller amounts of FODMAPs need to be trialed, and in fact, the return of symptoms needs to be looked at in a different way.


When you experience symptoms, it is vital that you are tuned in to the severity. Pain and significant discomfort are not OK and you can discuss these outcomes with your treating dietitian who can advise further on future challenges and food trials you may better tolerate. But for many people, the reintroduction of FODMAPs, or FODMAP ingestion when eating, results in gas production and a little bloating. The initial thought is that there has been a reaction and the food should again be removed from the diet, but we ask you to think about it in a different light.

Fermentation and gas production after eating high FODMAP foods is beneficial to the gut. If you experience some gas related symptoms that are tolerable and perhaps just include some mild bloating and flatus, this could be a good sign that you are providing fuel that encourages good bacteria in your gut. Everyone experiences some bloating and flatus and it is important not to immediately consider these as ‘symptoms’ of IBS, rather they should be considered a normal part of healthy digestion (as long as there is no significant discomfort or pain!).

So remember, a little gas is a good thing.

           

Diet Tips:Adding glucose to high FODMAP foods – does it really help?

By Marina Iacovou (PhD Candidate and Accredited Practising Dietitian)

In an earlier blog post this year (http://bit.ly/1WvWU5Y) we speculated that although early studies suggested adding glucose to fructose may improve tolerance, the strategy was not looking promising – instead all it was doing was adding more sugar to the overall diet.  There was confusion around this strategy with individuals adding glucose to all FODMAPs, not just fructose, which is the only FODMAP that could benefit from glucose addition. Consuming glucose tablets became common practice for many people when eating onion and garlic, foods rich in fructans, not fructose, which scientifically will not improve symptoms.

We can now confidently tell you that adding glucose to foods to help with the absorption of FODMAPs, even fructose, does not work.

One of our PhD candidates, Caroline Tuck, has published work on this very topic. If you want to read the full publication, please click here.

A brief summary of the study and its findings:

• Patients with a positive fructose breath test (“fructose malabsorption”) and functional bowel disorders such as IBS, were recruited. Healthy participants were recruited as a reference/control group
• Participants were provided with 6 different sugar solutions (PART A) – some acted as control solutions (glucose only) and others were combinations of fructose and glucose, and fructans and glucose which were compared to fructose alone and fructan alone
• Additional studies (PART B) were undertaken. where glucose was added to whole foods high in excess fructose
• It was a series of two randomised controlled, double or single-blinded crossover trials – this means that the participants (and in part A the researchers) were not aware what solutions were being consumed and the solutions were given in a random order. As such the results are more reliable
• Overall, breath hydrogen scores and patient symptoms did not improve with the addition of glucose to fructose or fructan solutions, or to whole foods
• Breath hydrogen responses in healthy participants were similar to patients with functional bowel disorders – showing that “fructose malabsorption” is normal
• The results of the study, question the reliability of breath hydrogen tests in a clinical setting. 

So we can conclude that: 1) breath hydrogen tests, particularly to fructose, are unreliable – this is consistent with a previous study we posted about http://bit.ly/2fSaVcn and 2) Overall, the strategy of adding glucose to drinks or foods to lessen the effects of dietary FODMAPs on functional gastrointestinal symptoms, has no evidence.

Some of you may have been doing this already – taking glucose tablets with high fructose foods. If you really feel it helps, you can continue, but remember these points:

• Your total sugar intake will increase significantly
• Your tolerance to FODMAPs, including fructose, can fluctuate over time, so maybe this strategy is working because your tolerance to fructose has improved and you can drop the glucose without significant symptoms

Something to consider…

Tuck CJ, Ross LA, Gibson PR, Barrett JS, Muir JG. Adding glucose to food and solutions to enhance fructose absorption is not effective in preventing fructose-induced functional gastrointestinal symptoms: Randomised controlled trials in patients with fructose malabsorption. J Hum Nutr Diet. 2016.