Combining low FODMAP & low chemical elimination: part 2
The low FODMAP diet is a diet which avoids small fermentable carbohydrates such as fructose, lactose, polyols and oligosaccharides to treat irritable bowel symptoms.
The low chemical diet (FAILSAFE | Royal Prince Alfred Hospital) reduces salicylates, amines, glutamates and troublesome food additives such as msg (621) to treat gut symptoms and many other symptoms such as migraines, chronic mouth ulcers, eczema or rashes and extreme fatigue.
It is not unusual to combine these diets.
How do you make food choices to satisfy both the low FODMAP and the low chemical or failsafe diets?
1. Start with foods that are common to both elimination diets
Vegetables: potato, green beans, swede, ice berg lettuce, mung bean sprouts, bean shoots and some cabbage
Meat/chicken: fresh & plain
Dairy: lactose free milk, lactose free plain and unpreserved cream cheese, lactose free vanilla custard, pure butter, fish plain. our vanilla lactose free or traditional Greek yoghurt (needs to be fresh, sometimes commercial are not fresh enough), lactose free cream
Tinned lentils - drained and rinsed well, sprouted mung beans
Tofu (if soy tolerated)
Oils: canola or sunflower or safflower or soy oil or butter (if dairy tolerated)
Sweeteners: pure maple syrup or rice malt syrup Useful alternative to honey) or normal white or brown sugars
Alcohol: the 3 alcohols low in food chemicals are also low in FODMAPs: gin, whisky and vodka. Phew! Note that alcohol can be a gut irritant, so be cautious
Snacks: plain potato chips eg Red Rock Deli, 1/2 cup wheat pretzels, plain rice crackers and plain rice cakes (no corn), buckwheat pancakes.
The following GLUTEN FREE grains satisfy both diets:
Corn starch such as White Wings cornflour (not corn flour or maize flour)
Millet, millet flour/meal (teff)
Potato flour or potato starch
Psyllium husks or powder
Quinoa, quinoa flour, puffed quinoa
Rice, rice flour, rice bran, rice flakes, puffed rice
Sorghum flour (eg in GF weet-bix)
Tapioca flour & starch (cassava).
GF flour and GF SR flour (not corn flour though) or LOFO flour
2. Modify some foods so they are safe for both diets
Green tips spring onions and leeks
Use Low FODMAP sizes of Brussel sprouts (2) or celery (10g)
Small amounts of tinned butter beans, tinned chick peas, tinned garbanzo beans, boiled green or red lentils, boiled lima beans and boiled mung beans for Low FODMAP
3-4 raw cashews (Low FODMAP serving size)
Small amounts carob (useful in cooking)
1 tsp golden syrup
3. Make some Compromises
To be nutritionally adequate, some low FODMAP foods moderate in food chemicals need to be included.
Some like to go strict for one week to lower content of food chemicals and FODMAPs then bring in some moderate salicylate or amine foods. How much to bring in depends on your individual sensitivity.
Some compromises will usually revolve around
Fruit: as the only fruit for the strict elimination level is pears which is super high in FODMAPS, compromise usually involves common bananas (just ripe of course), but not lady fingers
Additionally with fruit, small amounts may be trialled of pear as often used in recipes - noting that 1 tsp is low in FODMAPs
Vegetables: including either restricted or liberal amounts of vegetables that are moderate in food chemicals and also low in FODMAPs such as peeled carrot and peeled cucumber & sweet potato.
4. Garlic: a Special Mention
Garlic be included in very limited amounts for the low chemical diet but tend to be the most offending vegetable for people with FODMAP intolerance so usually needs to be completely avoided.
An option is making own garlic infused oil using tolerated oil such as rice bran oil however need to be careful about sterilising jars to reduce the risk of botulism. Make and keep in fridge for a couple of days before making a fresh batch. Does freeze well.
Due to the double restriction, appropriate vitamin and mineral supplementation is recommended, along with energy boosts if calorie needs are not being met.
5. Avoid the Following
Ripened cheeses: such as parmesan, Colby, tasty, brie, Coon, Swiss
All seeds (except poppy seeds)
Combining both diets requires more though and planning but can be done.
Moderate salicylate foods need to be included especially fruit/ veggietables
Only restrict FODMAPs as required- if can tolerate lactose then don't need lactose free milk etc, or if can tolerate wheat fructans then can use unpreserved wheat bread as often as you like
As the combined diet is very limited, nutritional supplementation is required
Guidance by a Dietitian well versed in both diets is required to ensure nutritional replacements for lost nutrients, provide options to increase protein and calorie intake to sustain weight and muscle
This is not the sort of diet to do on your own, you should be on it only for a limited time before food is reintroduced, and always under the guidance of a specialised dietitian in food intolerances.
Blog updated 20/8/19
RPAH elimination diet handbook: with food and shopping guide. Anne Swain, Velencia Soutter, Robert Loblay, 2011 (revised edition).
Monash University low FODMAP app. Version 2.0.12. Accessed 28/07/2018.
FODMAP FRIENDLY app, version 3.7. Accessed 28/07/18
Sprouting, does it reduce the FODMAP content of foods? Monash University FODMAP blog, 28/4/17. Accessed 03/6/2018. https://www.monashfodmap.com/blog/sprouting-does-it-reduce-fodmap-content/