IBS Awareness Month Blog 2
What is the Low FODMAP Diet? A focus on the Elimination Phase of the diet
Last week we discussed what Irritable Bowel Syndrome (IBS) is and how it is diagnosed. This week we are discussing the Low FODMAP Diet, in particular the elimination phase of the diet.
If you have IBS, you may have heard of the low FODMAP diet. The low FODMAP diet is a therapeutic diet used for symptom management for people with IBS. There has been substantial research published supporting the efficacy of the low FODMAP diet for symptom relief in people suffering with IBS.
The low FODMAP diet has shown to improve IBS symptoms of up to 70% of IBS sufferers who have tried the low FODMAP diet.
What are FODMAPs?
FODMAPs are short-chain carbohydrates, which are poorly absorbed in the small bowel. They are then fermented in the large bowel, creating increased gas production and luminal water. This physiological effect is present in all people. However, in people with IBS, the gut is hypersensitive and can cause symptoms like painful cramps, excessive flatulence, bloating, diarrhoea and constipation.
What does FODMAP stand for?
The Low FODMAP Diet Consists Of Three Phases. The Three Phases Are:
Phase 1: Elimination
Phase 2: Challenge & Reintroduction
Phase 3: Maintenance
This Week, We Will Shed Some Light On Phase 1
The Elimination Phase
The elimination phase is the first phase of the low FODMAP diet. It involves completely eliminating high FODMAP foods for 2-6 weeks until IBS symptoms settle. It is highly recommended to commence the elimination phase under the guidance of an Accredited Practising Dietitian (APD) to ensure you are eating the right foods, whilst maintaining nutritional adequacy.
If the low FODMAP diet does not relieve any symptoms, it is recommended to see your APD to ensure that what you are eating is in fact low FODMAP, as there are many foods that may have unsuspecting high FODMAP ingredients. Whilst the low FODMAP diet does have a high rate of efficacy, it does not work for everyone, which is why it is important to consult your APD to manage your IBS in a way that is most effective for you.
What Nutrients Do I Need To Look Out For During The Elimination Phase?
The elimination phase is not designed to be a life-long diet as it can be restrictive and create nutritional inadequacies if not undertaken with the guidance of an APD. Some nutrients that may be at risk when on the low FODMAP diet for an extended period of time (longer than 2-6 weeks without re-introduction) include:
Calcium is an important nutrient for bone health as well as heart, muscle and nerve functioning. Dairy is one of the main food sources in which we can meet our calcium intake. However, most dairy foods also contain lactose and therefore are high in FODMAPs. This puts people on the low FODMAP diet at risk of calcium deficiencies and need to be weary of how to increase their dietary intake of calcium through low FODMAP sources of foods.
Some low FODMAP, high calcium foods include:
- Lactose-free milk
- Low lactose-cheeses e.g. swiss, cheddar, feta and mozzarella
- Calcium enriched rice milk
- Canned salmon and sardines
Iron is responsible for ensuring healthy red blood cells are present in the body to circulate oxygen to your organs and muscles. Iron is readily available in meat products like beef, lamb and chicken liver. It is also present in plant-based products like nuts and seeds, legumes, silken tofu, some cereals and wholegrains. Iron can be a nutrient at risk when on a low FODMAP diet, particularly if you are a vegetarian or vegan as a lot of high FODMAP foods are also main iron sources.
Some low FODMAP, high iron food sources include:
- Pumpkin seeds
- Iron fortified cereals such as cornflakes, rice bubbles
- Firm tofu (note: silken tofu is high FODMAP)
For more information about how you can meet your iron requirements whilst following the Low FODMAP Diet you can head to one of our previous blogs ‘Meeting iron needs when on a Low FODMAP Diet’.
Prebiotics are a type of fibre which promotes the growth of good bacteria in your gut. Some high FODMAP foods like garlic, onion and wheat bran contain prebiotic fibres, meaning that there is reduced prebiotic intake during the elimination phase. The low FODMAP diet is designed to have 3 phases including a reintroduction phase, which is important for establishing your tolerance levels to each FODMAP group. Once your individual tolerance levels have been established, tolerated high FODMAP foods can be re-introduced into your diet to assist with the growth of healthy gut bacteria to balance the microflora in your colon.
What are some High FODMAP Foods to avoid during the Elimination Phase and some Low FODMAP foods you can include?
*Please note: This is not an extensive list
-Gluten free products can be high FODMAP if they contain high FODMAP flours such as: soy and chickpea flour.
-Bananas can be high FODMAP if they are ripe (this increases the fructan content)
-Firm tofu is Low FODMAP, however silken tofu is high FODMAP
– Serving sizes of foods are crucial when following the Low FODMAP Diet. Appropriate serving sizes can be found on the App’s below.
If you want to know more about the low FODMAP diet, here are some helpful apps you can download:
FODMAP Friendly App: http://fodmapfriendly.com/app/
Monash University low FODMAP diet app: https://www.monash.edu/industry/success-stories/fodmap
The Low FODMAP Diet Doesn’t Have To Be Boring!
This is what a day of low FODMAP diet eating can look like.
Oats made with strawberries and lactose-free milk or lactose-free yoghurt.
Two rice cakes with peanut butter and half a firm banana (ripe banana’s are high in fructans).
Low FODMAP sandwich made with low FODMAP bread (i.e. Bakers Delight LoFo Loaf), ham, cheddar cheese, spinach, lettuce and tomato.
Handful of walnuts.
Grilled salmon with cucumber, spinach and mashed potato.
Next week we will be talking all about the re-introduction phase of the Low FODMAP Diet so stay tuned!
Until next time,
Written by: Charmaine Duong (APD, AN)
Edited by: Atlanta Miall-Shorten (APD, AN, AccSD)
- Biesiekierski JR, Masuy I. The FODMAP Approach: Recent Evidence and Remaining Questions. J Dig Dis Hepatol. 2017 Apr. 2017(06).
- Gatroenterological Society of Australia (GESA). Information about Low FODMAP Diet To Improve Irritable Bowel Syndrome (IBS) Symptoms Control. 2013. http://cart.gesa.org.au/membes/files/Consumer%20Information/Low%20FODMAP%20Diet.pdf
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