Popular Dietary Models - The Low FODMAP Diet

Question 1

FODMAPs

Answer 1

FODMAPs—An acronym for fermentable oligosaccharides, disaccharides, monosaccharides and polyols.
* FODMAPs are short-chain carbohydrates found in certain foods.
* They are poorly absorbed in the small intestine and ferment in the colon aggravating GI symptoms.
* The low FODMAP diet was developed at Monash University in Melbourne, Australia.
* It was designed to help combat IBS and is used as a therapy for other bowel disorders.
Polyols = low digestible carbohydrate compounds.
Short-chain carbs = have up to 10 sugars in their chain.

Question 2

FODMAPs with GI issues / SIBO

Answer 2

FODMAPs are found in many foods and are not an issue for most. In fact, colonic bacteria utilise them as a fuel source.
* In people with GI issues where gut motility is altered and / or the gut wall is highly sensitive, the increased water and gas generated as bacteria ferment FODMAPs which can cause GI symptoms including pain, bloating, diarrhoea or constipation.
* FODMAPs are also problematic in those with SIBO because they provide fuel for bacteria that are already causing issues by residing in the small intestine where they don’t belong.

Question 3

Foods to avoid:

Answer 3

High FODMAP foods to avoid and suitable alternatives include:

Vegetables
High FODMAP: Artichoke, asparagus, cauliflower, garlic, green peas, mushrooms, onion, sugar snap peas.
Low FODMAP alternatives: Aubergine / eggplant, beans (green), bok choy, bell pepper, carrot, cucumber, lettuce, potato, tomato, zucchini.

Fruits
High FODMAP: Apples, apple juice, cherries, dried fruit, mango, nectarines, pears, plums, watermelon.
Low FODMAP alternatives:Cantaloupe, grapes, kiwi fruit (green), mandarin, orange, pineapple, strawberries.

Protein sources
High FODMAP: Most legumes / pulses, some marinated meats / poultry / seafood, some processed meats.
Low FODMAP alternatives: Eggs, firm tofu, plain cooked meats / poultry / seafood, tempeh

Nuts and seeds
High FODMAP: Cashews, pistachios.
Low FODMAP alternatives: Macadamias, peanuts, pumpkin seeds / pepitas, walnuts.

Question 4

Stages

Answer 4

The FODMAP diet involves three stages:
1. Restriction
2. Reintroduction
3. Personalisation
* It is important to note that a strict FODMAP diet is not intended for long-term use.
* FODMAPs are important because of their role as prebiotics to support healthy gut flora.

Question 5

1st Stage: Restriction

Answer 5

1. Restriction:
   o strict avoidance of all high FODMAP foods
   o 2–6 weeks.

Question 6

2nd Stage: Reintroduction

Answer 6

2. Reintroduction
   o High FODMAP foods are progressively reintroduced to identify which types of FODMAPS and how much are tolerated
   o 8–12 weeks.

Question 7

3rd Stage: Personalisation

Answer 7

3. Personalisation:
   o Amount and type of FODMAPS are tailored to the individual.
   o Possibly longer term.

Question 8

FODMAP nutrient-dense food alternatives

Answer 8

If clients need to undertake the FODMAP diet, consider nutrient-dense food alternatives to some of the foods they will temporarily need to avoid.
* Garlic contains high amounts of fructans which are water-soluble and may leach into food. Opt instead for garlic infused oil.
* The bulbs of spring onions and leeks are also high in fructans whereas the green tops are not and still provide flavour.
* Don’t throw the bulbs away! Place them in a glass with water and the leaves will grow back (change the water every 2‒3 days).