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Step 1: FODMAP elimination

FODMAP elimination is the first step you will take in managing your gut symptoms. This step is all about reducing FODMAPs in your diet to get relief from your symptoms as well as the other gut related symptoms such as feeling awful and, fatigue and 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 of FODMAPs is reduced as per cut offs worked out by the Monash Low FODMAP diet. These cut off limits are set very conservatively so that MOST people who are FODMAP sensitive will get 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. We are not looking for an absence of symptoms as having a normal gut means it will vary and have symptoms from time to time.

 

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!!)  reduce and manage 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 have 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 advice, FODMAPs can creep in (naughty FODMAPs!) and make the process a longer than it should be.

Do it once- do it well (and make it easier).

The next steps are step 2: 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 of 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. 

Remember: FODMAPs are taken out as a collective- the truth is that you may in fact be fine with some of the sub groups but we won't know this until we can do the food trials (step 2). Everything until this point is a best guess- food trials give clarity and more certainty as to your triggers.

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 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 repeat 3-4 hours later.

# Watch out for smoothies: often there is more than 1 serve of fruit in a glass of smoothie

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 

  • Broccolini: 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)

  • 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

  • Pastry: needs to be made from GF flours or Low FODMAP flour (most commercial pastry are high in FODMAP even when gluten free)

 

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

# Just because it is GF does not mean it is low in FODMAPs- other high FODMAP ingredients can be added such as dried fruits, chickpea/besan flour,  other legume flours such as lentil flour, inulin, soy flour (high in FODMAPs > 4g), honey, fructose syrup, sorbitol/mannitol or other-ol additives, and high FODMAP fruits or fruit flavours such as mango

Meats, Seafood, Eggs, Oils

  • Meats/chicken when in their plain state (i.e. no sauces, not made into a patty or sausage) are naturally low FODMAP as they don't contain carbohydrates (to be a FODMAP- needs to be a carbohydrate)

  • The same can be said about fish, eggs and oils

  • BUT- when ingredients are added to them- they can be high FODMAP for example onion or garlic added to sausages or patties, or a garlic aioli/sauce added to fish seafood 

Legumes

Most legumes are high in FODMAPS (GOS) but there is some good news here:

  • Tinned lentils drained and rinsed are low in FODMAPs for a normal serve

  • Tinned chickpeas drained and rinsed are Low FODMAP for 1/4 cup which allows for some home made or specific brand store bought hummus to be consumed (note most hummus high in onion/garlic)

  • Small amounts of other legumes can be used carefully

 

Nuts and Seeds

  • There are loads of nuts and seeds that are Low FODMAP- suffice to say to stay away from cashews and pistachios (your favourite- I know!), and keep almonds and hazelnuts to "10 at a time and repeat 3 hours later limit". All the other nuts and nut pastes are fine, and I am talking pastes like peanut paste, even almond paste

  • All the seeds are great- chia | pepitas | all the seeds you can think of

 

# Make a trail mix- just take care as dried fruit usually an issue (mix with dried bananas instead or portion control an added dried fruit)

 

Dairy/lactose

  • Choose lactose-free milk

  • Cheese: don't worry about cheese as virtually no lactose- only limit amounts of unripened cheeses such as cream cheese (lactose free available), ricotta and cottage cheese

  • Cream/sour cream: if using less than 2 TBSP then normal is fine, but if having more per serve then lactose-free is a good idea

  • Yoghurt: lactose-free choices available

 

# Choose Greek traditional yoghurt (not Greek 'style') as the traditional process strains out some lactose. Start with 1/2 small tub = 100g and test tolerance, if ok trial full serve (180 or 200mg)

# Dairy free: soy milk made from soy protein (not soy beans), almond milk, 1/2 cup oat milk, and coconut milk is limited but the serve size usually comes under when used for example in curries

 

Processed Foods

Processed foods such as SAUCES can be a bit of an issue as tend to contain onion and garlic.

 

# Some brands can be identified as Low FODMAP - find out which brands of sauces are low in onion/garlic

There are so many ways to make this short term diet elimination easier to do, knowing you can eat some sourdough breads (unless you need to be gluten free), that you don't need to buy lactose-free cheese (unless is unripened i.e. cream cheese/ricotta/cottage cheese); there are certain brands of processed foods such as some sauces, some crisps/corn chips that are onion- and garlic-free; how to use legumes, which meats to be suspicious of eg sausages/patties/marinades and easy recipes that are Low FODMAP and up to date with the latest Monash Low FODMAP app information.

Get your gut calm- quickly

Bring it together in a personalised diet- tweaking your current diet to make it low FODMAP- and the implementation turns from hard to very doable.

Within 3-7 days- your gut could be so much improved. That quick. Do it once- do it right.

I look forward to working with you

Frances

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.