The low FODMAP diet is a diet which avoids small fermentable carbohydrates such as fructose, lactose, polyols and oligosaccharides to effectively manage 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, but it is tricky.
How do you make food choices to satisfy both the low FODMAP and the low chemical or failsafe diets?
JOIN THE COMMUNITY: BRAND NEW Dietitian led Facebook group: Amines, Salicylates and Glutamates: The Food Intolerance Dietitian for great information and community support.
1. Start with foods that are common to both elimination diets
Vegetables: peeled potato, green beans, swede, iceberg lettuce, mung bean sprouts, bean shoots and most cabbages (normal serve approximately 3/4 cup)
Meat: chicken, lamb, beef or white fish, most seafood: very fresh & plain
Eggs (long way from expiry date)
Dairy: lactose free milk, lactose free plain and unpreserved cream cheese, lactose free vanilla custard, pure butter, fresh plain or vanilla lactose free or traditional Greek yoghurt, lactose free cream
1/4 cup tinned lentils/ chickpeas - drained and rinsed well, sprouted mung beans
Firm tofu (if soy tolerated)
Oils: canola or sunflower or safflower or rice bran oil or pure butter (if dairy tolerated)
Sweeteners: pure maple syrup or rice malt syrup (useful alternative to honey) or regular 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 unpreserved wheat pretzels, plain rice crackers, plain rice cakes (no corn) and buckwheat pancakes.
The following GLUTEN FREE grains satisfy both diets:
Arrowroot flour
Buckwheat flour
Corn starch such as White Wings cornflour (avoid corn flour or maize flour)
Millet grains, puffs, flakes, flour
Teff
Oats (traditional- 1/2 cup for Low FODMAP, only 1/4 cups quick oats for low FODMAP)
Potato flour or potato starch
Psyllium hus /powder
Quinoa flour, puffed, flakes, grain
Rice, rice flour, rice bran, rice flakes, puffed rice
Sago
Sorghum flour (eg in GF Weet-Bix)
Tapioca flour & starch
GF flour and GF SR flour (check no maize flour or corn flour- maize starch or corn starch is acceptable)
2. Modify some foods so they are safe for both diets
Green tips spring onions
Use Low FODMAP sizes of Brussel sprouts (2) or celery (10g) or leek bulb (14g)
Low FODMAP serving sizes of drained and rinsed tinned chick peas (1/4 cup), tinned lentils (1/4 cup)
3-4 raw cashews or 1 tsp cashew paste (Low FODMAP serving size)
Small amounts carob 1 heaped tsp (useful in cooking)
Note for any high FODMAP foods that can be low FODMAP in small amounts: have low FODMAP amounts in a sitting and can repeat 3-4 hours later.
Careful not to stack: choose only one of these foods in a sitting unless you are sure they are different FODMAP sub groups. This is a complex concept and requires a discussion with a Food Intolerance Dietitian .
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 of pear may be trialled 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 & peeled cucumber .
4. Garlic: a Special Mention
Garlic may 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 your 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 the day you need. Note- freezes 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, although low in lactose (FODMAPs) are high or very high in amines.
All nuts except small amounts of raw cashews/ cashew paste
All seeds (except poppy seeds)
Raw sugar (all other regular sugars are fine)
Olive oil: swap for Canola, sunflower, safflower or rice bran oil
Chocolate: very high in amines
Fermented foods: very high in amines
Dried fruit: very high in salicylates and some will also be very high in amine
IMPORTANT POINTS
Combining both diets requires more time and planning but can be done.
Moderate salicylate foods need to be included especially fruit/ vegetables
Only restrict FODMAPs as required- if can tolerate lactose then don't need lactose free milk etc, or if can tolerate wheat fructans (ie bread) then can use unpreserved wheat bread as often as you like
As the combined diet is very limited, nutritional supplementation is often a good idea to cover any gaps in micronutrients
Guidance by a Food Intolerance 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 diet can be done, but to minimise elimination pain and enhance chances of success- enlist a Dietitian experienced and trained in food intolerances. Invest in your health.
Blog updated 08/04/2024
REFERENCES
RPAH elimination diet handbooks 1 and 2: with food and shopping guide. Anne Swain, Velencia Soutter, Robert Loblay, 2019 (revised edition).
Monash University low FODMAP app