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: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