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: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- 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