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: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:Dietary Fibre Series - Resistant Starch

By Dr Jaci Barrett 

This is part 4 of our series on dietary fibre. This week we’re talking about resistant starch! 

What is resistant starch?

As suggested by the name, resistant starch is starch that escapes digestion by the small intestine. There are four types of resistant starch:

• RS1 is not accessible by digestive enzymes – sources include partially milled grains and legumes
• RS2 escapes digestion because of the nature of the food – sources include underripe bananas and high-amylose starches
• RS3 is produced when foods are cooked and then cooled – sources include bread, tortillas, cooked then cooled potatoes, rice and pasta
• RS4 is a chemically modified starch

What does resistant starch do in the gut?

Resistant starch and other types of fibre move through the gut to the large intestine where they act as food for the gut bacteria. Resistant starch acts as a prebiotic – see previous blog post in this series ---link. Fermentation of resistant starch releases beneficial short chain fatty acids which promote a healthy colon.

Resistant starch is slowly fermented in the large intestine. It differs from FODMAPs due to this slow fermentation rate. FODMAPs are rapidly fermented and result in rapid increases in intestinal gas which, in IBS, can induce symptoms of pain, bloating and discomfort. 

Resistant starch is slowly fermented over time. The gradual release of gas does not result in the same degree of gaseous distension and discomfort as with FODMAPs.

What are some good food sources?

Food sources of the different subtypes of resistant starch are listed above, but the following table outlines the amount of resistant starch per serve in foods with a green low FODMAP serve, so that you can seek out high resistant starch foods to include in your diet to improve bowel health.

Food	Resistant Starch (g)
Underripe banana, 1 medium	4.7
Rolled oats, 1/4 cup, uncooked	4.4
Oats, 1 cup, cooked	0.5
Lentils, 1/2 cup, cooked	3.4
Hi-maize resistant starch, 1 tablespoon	4.5

Reference: Murphy MM, Douglass JS, Birkett A. Resistant starch intakes in the United States. J Am Diet Assoc. 2008;108(1):67-78.