Tuesday, 27 September 2016

Have you seen what’s new in the Monash Low FODMAP Diet App?

Food Guide

You may have noticed that we have re-ordered categories in the Food Guide section and added two new categories: Nutritional Drinks and Snacks, Bars and Cookies. Foods listed in the new, Snacks, Bars and Cookies category were previously listed in the Breads and Cereals category, but we separated these to make it easier to find specific foods.
 
 
New Flags

We are now testing food products sourced from all over the world. Have a look in this section to see if foods from your country have been tested or alternatively, consult this section when you travel to find country specific information about the FODMAP content of local food. Providing users with country specific information about FODMAP food composition is important because of international differences in food supply and in food processing techniques that may affect FODMAP content. Filters in the food guide enable app users to only display foods relevant in their country. 
 
 
More Detail about Serving Sizes
We are now giving app users more information about the serving size at which green serves of fruit and vegetables become amber serves. This allows users to determine the upper limit serving size that would still be considered low in FODMAPs. Examples of fruit and vegetables with more serving size information include aubergine, red cabbage, cherry tomatoes, pineapple, cumquats and green kiwi fruit.
 

Nutritional Guidelines:
Consistent with our goal to encourage app users to follow a healthy, well balanced diet that is consistent with the Australian Guide to Healthy Eating, we have updated the guide section with reminders to eat 2 serves of fruit and 5 serves of vegetables each day. When you click into a food in the fruit and vegetable categories you will see a reminder that you can eat multiple serves of ‘green’ foods in one sitting and that you should eat at least 2 serves of fruit and 5 serves of vegetables each day.
 


A dietitian can provide advice on how to incorporate these recommendations into your low FODMAP diet. Our blog also includes many healthy, low FODMAP recipe ideas and the following pages may give you ideas on how to incorporate more fruit and vegetables in your diet: https://www.eatforhealth.gov.au/ and http://gofor2and5.com.au/.

The Monash FODMAP Team welcomes feedback on your experiences using the app and where possible, we take this into consideration when planning app updates.

 
           

Friday, 23 September 2016

Low FODMAP Chicken and Gnocchi Pasta Bake

Recipe by Lyndal McNamara (Dietitian)
Serves 5-6
 
 
Ingredients:
  • 1 large zucchini, diced
  • 1 large red capsicum, diced
  • 200g Jap pumpkin, diced
  • 2 tsp. garlic infused olive oil
  • 1x 500g packet gluten-free gnocchi*
  • 1x 500g jar tomato passata (tomato puree)
  • 100g baby spinach leaves
  • 1 large handful fresh basil leaves
  • 400g cooked chicken breast, shredded
  • 2 tsp. cracked black pepper
  • ½ cup grated parmesan cheese
 
Method:
  1. Preheat oven to 220°C. Spray a large baking dish with olive oil spray.
  2. Add chopped zucchini, capsicum and pumpkin to baking dish and toss with garlic-infused olive oil to coat. 
  3. Roast vegetables in oven for 20-25 minutes or until beginning to soften.
  4. Meanwhile, cook gnocchi according to packet instructions; drain and set aside. 
  5. Heat tomato passata in a large pot and stir through baby spinach leaves and basil leaves until wilted slightly. Add cooked chicken, black pepper, gnocchi and roasted vegetables and stir to coat in sauce.
  6. Pour gnocchi and sauce mixture back into the baking dish and top with grated Parmesan. Bake for a further 10-15 minutes or until golden.
Tips:
  • *Gluten-free gnocchi is typically made from Low FODMAP ingredients including potato, potato flour/rice flour/corn flour and egg. Be sure to check the packet first for any added high FODMAP ingredients.
  • Consider including one or more serves of 'moderate' FODMAP vegetables during the rechallenge phase or as tolerated for a prebiotic boost (e.g. substitute Jap pumpkin for butternut pumpkin or sweet potato, add a small amount of green peas etc.) - use the app to guide you.

Nutrition Information/serve:
 
Energy
1721kJ
Protein
31.8g
Fat
9.2g
Saturated fat
3.6g
Carbohydrates
50.6g
Fibre
8g
Sodium
802mg



Tuesday, 20 September 2016

#FODMAPchat Twitter Forum- Summary of Responses

Thank you to all who participated in our September 2016 Twitter chat. For all those that wanted to participate but couldn’t make it for the chat, here is a summary of the conversation:

Q1. Is there a standard re-challenge protocol to use with all patients on a low FODMAP diet?
We wish it was that simple, but unfortunately there is no standard protocol for re-challenging FODMAPs. It is so important to seek the assistance of an experienced dietitian to individualise the FODMAP challenge process to the needs and symptoms of each patient. The length of the re-challenge, foods chosen and the portion sizes used may also vary between each individual. Dietitians may find it useful to ask their patient which foods they miss the most from their regular diet and consider introducing those foods first when getting them started on re-challenging.
The re-challenge phase is an important part of the low FODMAP diet, but research studies on this specific area are lacking. Unfortunately, a rechallenge research trial is very difficult to design and conduct.



Q2. Should all FODMAP subtypes be challenged in every patient?
It is important that all FODMAP subtypes that have been restricted are re-challenged. For some patients lactose may remain in the diet, even during the initial elimination phase, if lactose intolerance is not evident. We always recommend re-challenging fructose due to unreliability with the fructose breath testing.  
A key point to note is that often just because an individual didn’t tolerate one particular food within a subtype of FODMAPs doesn’t mean that this person won’t tolerate any other foods within that subtype. The portion sizes of these foods may need to be adjusted. Seeking the assistance of a dietitian to tailor the diet to an individual is essential.
As each person’s FODMAP tolerance and their FODMAP threshold varies, a dietitian may need to be more cautious with one person who is extremely sensitive compared to another person who may have reasonable FODMAP tolerance. No two patients are alike and personalising the diet will assist patients with expanding the diet long term, which is very important.
Starting with a subtype of FODMAPs that the patient may tolerate better can ease the patient into the rechallenge process.


 

Q3. How long should each FODMAP challenge go for?
The answer varies depending on the patient and their symptoms and their level of anxiety about doing the re-challenge. For those who need a cautious approach, slowing down the challenge to testing a food every second day over the course of a week may be appropriate. For others, a typical challenge of a new food is to introduce a small portion and increase the amount every day for 3-4 days.

Q4. What sort of doses of foods should be used for FODMAP challenges?
There are no set portion sizes that suits each person. How much should be used depends on the individual, their symptom severity and tolerance level. As a general rule, half of a normal serving of a particular FODMAP containing food would be consumed on day 1, then increase the serving size on the second and third day.



Q5. What do you do with a patient who has severe reactions to all challenges?
For highly sensitive patients it may be necessary to slow down the re-challenges to small serves of a particular food consumed every second day. Alternatively try using different foods to the previous challenges in small amounts. If the patient continues to react to even small amounts, alternative therapies may need to be considered or they should be referred back to their GP for further investigations.
Small intestinal bacterial overgrowth (SIBO) may be a contributing factor in those with ongoing symptoms, however SIBO is very difficult to diagnose. A glucose breath test can be undertaken, but this is not a perfect science and will not diagnose SIBO in all cases.
Assess the patient’s stress levels as stress is one factor that can further exacerbate symptoms with challenges increasing stress and anxiety.  Continue to provide support and encouragement during the re-challenge phase.



Q6. What are some helpful tips to increase fibre intake on low FODMAP diet?
Some handy hints for increasing fiber while on a low FODMAP diet:

·         Try and include a vegetable with breakfast, such as tomato or spinach,

·         Add small amounts of low FODMAP legumes or pulses to soups, stews and salads - You may want to start by adding canned legumes and pulses as they tend to be lower in FODMAPs than fresh options

·         Aim to include fiber at each meal and snack, this may include oats, baked potatoes with the skin, oranges, quinoa and chia seeds

·         Also making food swaps such as using brown rice rather than white rice will help increase fiber
 
Q7. What are some of the key hidden FODMAPs that can be found in US commercial products?
Hidden ingredients aren’t always so hidden so do encourage your patients to check the ingredient label for foods and supplements high in FODMAPs particularly looking at sweeteners and added fibres such as inulin, fructose, high fructose corn syrup, crystalline fructose, lactose, and apple/pear juice concentrate. Also check liquid medications, chewable vitamins, powdered protein supplements or shakes for sweeteners that are often high in polyols or fructose.

Please remember to check the Monash University low FODMAP app for more information on US products that we have tested for FODMAP levels that includes sauces, gluten free breads and jams containing fructans and HFCS.

 Q8. Are fermented foods suitable on a low FODMAP diet?
There is a huge interest in this area and yes there are some fermentable foods that are low in FODMAPs, however not all low FODMAP foods remain low in FODMAPs when fermented.  Tempeh is low in FODMAPs and a good vegan option for a low FODMAP fermented option. We have also found spelt sourdough bread to be low in FODMAPs.

Sauerkraut has recently been tested and found an interesting result. 1 Tablespoon of Sauerkraut is low in FODMAPs however becomes moderate to high in the Polyol (mannitol) in a larger serve despite common cabbage being low in FODMAPs. We also tested fermented red cabbage and found that when red cabbage was fermented it was low in FODMAPs when consuming only ½ a cup but contained moderate Oligosaccharides (Fructans) at 1 cup, whereas fresh is still low in FODMAPs at these portion sizes.

Kefir is only high in lactose so another suitable option for those who are not lactose intolerant.

We can’t always predict what is going to happen to low FODMAP foods once they have been processed in some way or another and therefore these foods need to be tested. We will share this knowledge via our Monash University low FODMAP app as the foods are tested.



Q9. What next if the low FODMAP diet does not improve symptoms?
When the low FODMAP diet is unsuccessful for a particular patient then look further into their diet history to see if excess fats, sugar and caffeine, or an inadequate intake of fibre are contributing to their symptoms. Further investigate if other dietary factors may be relevant for each individual patient such as histamine, Type IV hypersensitivity or IgE- mediated food allergy.

The low FODMAP diet doesn’t always work for everyone. If it does not work it is very important that FODMAPs are reintroduced into the diet. A dietitian can continue to provide support and assistance to a patient in achieving a healthy balanced diet, consider other dietary factors that may be playing a role, as well as working with other health professionals to investigate other factors contributing to symptoms.



Q10. What are some handy hints for travelling on a low FODMAP diet?
Travelling while trying to follow a low FODMAP diet can be difficult. Monash University are testing more international foods and will continue to add these to the Monash University low FODMAP diet app under specific country flags.

Plan ahead. Pack low FODMAP snacks to avoid getting hungry and therefore grabbing something that may flare up symptoms. If lactose is an issue then carrying Lactaid / Lacteeze and/or Beano + Dairy defence could assist with managing symptoms if you are limited with food choice. For the very organised traveler, take a soft side lunch bag or cooler in your luggage to carry low FODMAP snacks purchased at your destination. Request a hotel room with a mini fridge to store low FODMAP options.

For domestic trips you may want to take your own fruit, cheese, nuts, snack bars or nutritional drinks.

Note that patients may actually tolerate foods better whilst travelling due to having less stress and anxiety to contribute to symptoms and being in a relaxing state may help relieve some symptoms.


Thank you to all who participated in the fodmapchat and for those who missed this twitter chat feel free to check out the hashtag #fodmapchat for the discussion and follow us on Facebook and twitter to stay in the loop for when the next one will be happening.

Remember to encourage patients to download the Monash University low FODMAP diet app to further fund research and food testing as well as to get all the latest food testing information.
           

Friday, 16 September 2016

Modifying Recipes - High FODMAP to Low FODMAP

By Lyndal McNamara (Dietitian)


Starting a Low FODMAP diet can be challenging, particularly when you are cooking for a family who may not share your dietary requirements. Learning to modify your family's favourite recipes to make them Low FODMAP (and/or add high FODMAP ingredients later) is a simple way to avoid cooking multiple different meals each night. Below is an example of one of my favourite stir-fry recipes, which has been modified to make it Low FODMAP without loss of flavour or familiarity. 

High FODMAP Beef Stir-fry (serves 4)
Ingredients:

  • 400g lean beef stir-fry strips
  • 1 tbs. olive oil
  • 1 tablespoon garlic, minced*
  • 2 tablespoons honey*
  • 1 tablespoon reduced-salt soy sauce
  • 1 tablespoon finely grated fresh ginger
  • 440g packet Udon noodles*
  • 200g snow peas*
  • 150g cauliflower florets*
  • 150g carrot, cut into sticks
  • 2 tablespoons oyster sauce
  • 3 shallots, thinly sliced*
  • 1 tablespoon toasted sesame seeds, to serve 

* Denotes high FODMAP ingredients 


Low- FODMAP Beef Stir-fry (serves 4)
Ingredients:
  • 400g lean beef stir-fry strips
  • 1 tbs. garlic infused olive oil
  • 2 tablespoons maple syrup
  • 1 tablespoon reduced-salt soy sauce
  • 1 tablespoon finely grated fresh ginger
  • 200g packet dry rice noodles
  • 200g carrot, cut into sticks
  • 150g red capsicum, cut into strips
  • 150g green beans, cut in half
  • 2 tablespoons oyster sauce
  • ½ bunch spring onion, green tops only, thinly sliced
  • 1 tablespoon toasted sesame seeds or crushed peanuts, to serve
Method:

  1. Combine beef slices, maple syrup, soy sauce and ginger in a medium bowl and set aside.
  2. Meanwhile, cook rice noodles according to packet instructions.
  3. Add garlic infused olive oil to a wok or large, deep frying pan and set over high heat.
  4.  Add beef to wok and stir-fry until browned all over; set aside.
  5. Add vegetables to wok; stir-fry for 5 minutes, or until tender. Add reserved beef, cooked noodles, oyster sauce and sliced spring onion green tops to wok and toss to combine.
  6. Divide stir-fry among serving plates and sprinkle with sesame seeds or peanuts to serve.


Recipe Ingredients

The Finished Product


Nutrition Information/serve:

Energy
1506kJ
Protein
26.2g
CHO
37.5g
Fat
10.5g
Saturated fat
2.5g
Sodium
725mg
Iron
3.9mg

Other tips for modifying recipes (but keeping the whole family happy) 
  • Use the Monash Low FODMAP app to identify high FODMAP ingredients in your recipes and substitute them for a similar, low FODMAP alternative.  
  • Cook high FODMAP ingredients separately and stir through at the end of cooking after removing your low FODMAP serve. 
  • See the 'about' section in the Monash Low FODMAP app for more tips on adding flavour without symptoms! 


           

Tuesday, 13 September 2016

New App Food Category - Nutritional Drinks

We get many enquiries from dietitians about the FODMAP content of nutritional drinks, so are excited to announce the latest product to join our Monash University Low FODMAP Certification program, ProNourish™ by Nestle Health Science. 

ProNourish™ is a nutritious, low FODMAP drink that can be included as a mini-meal or snack by people with digestive sensitivities such as IBS. The drink provides a range of vitamins and minerals, is high in protein, a source of fibre, and importantly, low in FODMAPs, as confirmed by analyses performed at Monash University laboratories. 

This final point differentiates the Nestle product from other similar products in the market place, many of which contain high FODMAP ingredients such as inulin and fructo-oligosaccharides (FOS). ProNourish™ is available in two delicious flavours, French Vanilla and Strawberry Banana. 

The product is listed in the Monash University Low FODMAP diet smartphone app under the new, ‘Nutritional Drinks’ category and is available for purchase by US consumers both in-store and online.