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REDUCING FODMAPS

The FODMAP process is made up of 3 steps, with FODMAP elimination being the first step. This step is all about reducing FODMAPs in your diet to get relief from your gut symptoms as well as the flow on symptoms such as feeling awful and, fatigue and maybe reflux.

A common misconception is that we are getting FODMAPs out of the diet- but this is not strictly true. WE are just reducing the FODMAPs to a more manageable level to help reduce your gut symptoms.

The level the FODMAPs are reduced to is based on cut offs worked out by the Monash Low FODMAP diet. These cut off limits are set very, very conservative so that MOST people who are FODMAP sensitive will get a a good outcome and more manageable symptoms.

 

Having a realistic expectation is important here as our guts are designed to get a bit windy and overly full sometimes, depending on what we eat. WE are looking at managing the symptoms that get in the way of living your life, that stop you from doing normal activities. Not an absence of symptoms as that is not the way our guts work.

 

Having said that, going on the low FODMAP journey has helped hundreds of thousand of people (ok there are not definite estimates here , but a lot!!)  be able to reduce their symptoms, identify their triggers and reintroduce foods to a level that can be tolerated.

At the end of the day, you can still choose to eat and drink high FODMAP foods/fluids but you can bhave the knowledge and experience to make these decisions, and to know when you do get symptoms, what it was that likely set you off. 

And the best thing? If you are FODMAP sensitive, you can get results VERY QUICKLY! With a well constructed Low FODMAP diet- you can potentially see results within days or within a week. Without good advise, FODMAPs can creep in (naughty FODMAPs!) and make the process a bit longer.

The next steps are step2: testing/challenges to identify the foods causing your symptoms followed by step 3: reintroduction of foods. People tend to enjoy these stages as involves knowing what is going on and bringing foods back in.

Low FODMAP: step 1 

Low FODMAP elimination = the first step of your FODMAP journey. This is great as when you have the knowledge how to do this, along with all the hacks to make this easier, you have a good chance of seeing results quickly.

The diet can seem overwhelming at first- which is why getting some help is so useful to getting it done properly. Lest start with some simple steps.

Remember: FODMAPs are taken out as a collectiive the truth is that you may in fact be fine with some of the sub groups so will be able to bring these foods back in after elimination (step 1) and food trials (step 2).

As part of step 1 (elimination- reducing FODMAP dose)- we take them all out, unless it is clear that one of the sub groups are really fine, but this is only for a short time such as between 2-6 weeks.

Get the MONASH UNI Low FODMAP APP

First thing to do is get the Monash University Low FODMAP app. See upcoming blog of hacks to using this app.

 

The app is based on a traffic light system, so a green dot means that you can include this food in your Low FODMAP eating plan.

 

There are some foods that are moderate (orange dot) or high (red dot) in FODMAPs for a normal serve but in reduced amounts are Low FODMAP so can be included in your diet at these reduced levels.

 

There are some pointers around how to do this which will be explored in the upcoming blog.

SWAP OUT HIGH FODMAPS FOR LOW FODMAPS

Sounds easy but can easily be done but requires some pointers to help make this happen

Low FODMAP FRUIT:

 

Swap out high FODMAP fruits such as apples and stone fruit like plums and apricots for low FODMAPs: based on the Monash app you will see that there are some choices of Low FODMAP fruits: 

  • grapes

  • oranges and mandarins

  • kiwi fruit (great for constipation)

  • strawberries

  • just ripe bananas (avoid black spots, if a bit spotty- just have less than 1 banana)

Some high FODMAP fruits can still be consumed but in Low FODMAP amounts:

  • 1/4 cup blueberries

  • 1/2 punnet raspberries

  • 1/3 ripe or spotty banana

# Important to have only one serve of fruit (app gives an idea of serve sizes) at a sitting can can repeat 3-4 hours later.

# Watch out for smoothies: often have more than 1 serve of fruit

Low FODMAP VEG:

Swap out high FODMAP veg such as cauliflower for low FODMAPs: based on the Monash app you will see that there are some choices of Low FODMAP veg: 

  • potato

  • pumpkin eg Kent (not referring to butternut)

  • carrot

  • lettuce and greens such as spinach

  • parsnip

  • tomato 

  • broccoli

  • Sweet potato (watch this one as has an upper limit: stick to 1/2 cup at a meal or snack)

  • tinned beetroot

 

Some high FODMAP veggies can be eaten in smaller doses to be low FODMAP

  • Butternut pumpkin: no more than 1/3 cup

  • Peas: no more than 1 TBSP

  • Avocado: no more than 1/8th 

  • Brocollini: no more than 1/2 cup

Onion & Garlic

There are no safe amounts of onion or garlic determined by Monash University. The advice is always to avoid onion and garlic, even as small amounts added to sauces and as minor ingredients in food products such as stock. This is probably a more tricky part of the diet as onion and garlic is used as a minor ingredient in many food products from most flavoured crisps to many sauces and pre made foods.

There are a number of ways around this:

  • a number of products can be used instead of onion and garlic: garlic infused oil | Garlic and onion replacement powder | asafoetida powder (hing powder) available from Indian spice stores

  • spring onion: green tips and leek: green tips

  • choice of products known not to include onion or garlic - choose Low FODMAP certified and a specialised dietitian can provide brands to choose for some sauces such as sweet chilli sauce, curry powder, stock cubes, Simmer sauces, even some dips and soups

Breads and Cereals

The Low FODMAP diet does not mean a gluten free diet, as small amounts of wheat can be included in the diet as long as low FODMAPs. For people who feel they do not tolerate wheat, then specific gluten free ( products can be used.

NOTE: just because the food is gluten free does not mean it is Low FODMAP as can have high FODMAP ingredients such as dried fruit, inulin, soy flour, legume flours

  • if including wheat: choose spelt/wheat sourdough breads (not rye sourdough), Low FODMAP  certified breads such as Bakers Delight lofo bread, fructan reduced flours (Lofo pantry), small number of normal wheat dry or sweet biscuits, just make sure 3-4 hours between serves to keep the dose low.

  •  Choose gluten free pasta, corn based rather than soy flour based (can also have rice based and other GF flours such as buckwheat based)

  • Watch out for wraps: many a have high FODMAP ingredients such as soy flour/ legume flour as well as inulin, choose corn based eg corn tortillas

  • BF cereals: oats (regular rather than quick as has a higher limit), and many GF cereals or rice based cereals. Many are Low FODMAP certified.

Meats

REFERENCES

Yao, C. K., and Tuck, C. J. (2017) The clinical value of breath hydrogen testing. Journal of Gastroenterology and Hepatology, 32: 20–22. doi: 10.1111/jgh.13689.

Gibson, P. R. (2017) The evidence base for efficacy of the low FODMAP diet in irritable bowel syndrome: is it ready for prime time as a first-line therapy?. Journal of Gastroenterology and Hepatology, 32: 32–35. doi: 10.1111/jgh.13693.

Barrett, J. S. (2017) How to institute the low-FODMAP diet. Journal of Gastroenterology and Hepatology, 32: 8–10. doi: 

Tuck, C., and Barrett, J. (2017) Re-challenging FODMAPs: the low FODMAP diet phase two. Journal of Gastroenterology and Hepatology, 32: 11–15. doi: 10.1111/jgh.13687.

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