Easy Roast Vegetables (Low FODMAP Option)

Serves 4
Gluten Free
Vegetarian & Vegan
Low FODMAP & Low Natural Food Chemical Options Available

Ingredients:
4 x Medium Potatoes
4 x Carrot, cut into halves
500g Brussels Sprouts, ends trimmed
Olive Oil or Rice Bran Oil
Salt to Taste

Method:

Wash and pat dry all your vegetables. Do not peel them and leave the skins for added fibre.
Simply place your favourite vegetables on a baking tray covered with baking paper and drizzle with olive oil and sprinkle with salt.
Bake on high (around 220ºc) for 30-40 minutes or until golden brown.
Serve with your preferred protein & Enjoy!

Tips:

If you have natural food chemical intolerance, I would recommend using rice bran oil as a substitute to olive oil.
This recipe is moderate in natural food chemicals due to the carrot and skins of the potato. However, you can substitute the carrot with swede or celery and peel the potatoes if you would like to make this low in natural food chemicals.
This recipe is also low in FODMAPs if you keep your intake of brussels sprouts to 2 or less. However, you can also substitute these with eggplant (1 cup is low FODMAP) or red capsicum.

Nutritional Information (Per Serve):

Nutrient Info

Food Group Servings (Per Serve):

Food Group Servings

If you’re looking for support on how to follow the FODMAP diet so that you can eliminate your bloating and live your best life, apply for coaching.

Chicken Carbonara (Low FODMAP Option)

Serves 4
Lactose Free & Gluten Free
Low Natural Food Chemical & Low FODMAP Options Available

Ingredients:
Drizzle of Rice Bran or Canola Oil
1 x Chicken Fillet (cut into small 2-3cm pieces)
250g (small tub) Pre-cut Mushrooms
½ Red Cabbage
300ml Light Lactose Free Cream (I used 1 x tub of Zymil Light Thickened Cream)
3 cups or 250g Uncooked Gluten Free Spiral Pasta

Method:

Drizzle oil in large fry pan and place chicken and cook on medium heat until browned.
While chicken is browning put water in a pot and bring to the boil. Once boiled add pasta and cook until al dente.
Add vegetables to fry pan with chicken and cook until soft.
Add cream to chicken and vegetables and cook on a low heat. Make sure your stir frequently as you do not want to overcook the cream. Cook until cream is a thick consistency, this usually takes around 7-10 minutes.
Drain pasta and add to fry pan.
Stir pasta through chicken, vegetable and cream sauce until well combined.
Serve and enjoy!

Tips:

To make this recipe low FODMAP, simply remove the mushrooms. Although red cabbage is medium in FODMAPs at 1.5 cups, each serve of this meal has less than ¾ cup of red cabbage, which is low FODMAP serve.
To make this recipe low in natural food chemicals, simply remove the mushrooms as these are high in glutamate.
If you are removing the mushrooms you can simply increase the amount of red cabbage in this recipe by 1 cup to substitute. This will still be low FODMAP and low in natural food chemicals.
If you are not sensitive to natural food chemicals, you can also use Olive Oil if you prefer. I used rice bran oil and I am sensitive to natural food chemicals. As I included mushrooms in this recipe, I didn’t want to risk exceeding my tolerance threshold by also including olive oil.

Nutritional Information (Per Serve):

nutrient info

Food Group Servings (Per Serve):

Food Group Info

If you’re struggling with bloating and aren’t sure what to eat, I show my clients step by step how to follow the FODMAP diet to eliminate bloating and live their best life. Being diagnosed with IBS doesn’t have to be a punishment when you know what to do, how to eat and how to live your best life and I’ll show you that when we work together, apply for coaching.

What To Do When Your FODMAP Diet Hasn’t Eliminated Bloating in IBS

Before we get into natural food chemical intolerance, I think it is important to understand the difference between a food allergy and a food intolerance, as these are not the same.

A food allergy is due to our immune system reacting to a food protein that the body wrongly thinks is harmful, which causes a person to have a reaction and get symptoms. Whereas a food intolerance does not involve the immune system and reactions are rarely life-threatening. A food intolerance is when a person cannot properly digest or fully break down and absorb certain foods. If you would like to learn more about food allergies and food intolerance’s, you can read my “How to Eat More Foods With IBS (Food Allergy vs Intolerance)” blog here.

What are Natural Food Chemicals?

Food chemicals are found naturally in many everyday foods and there is a significant amount of variation in the make-up of natural chemicals in food. For most people these do not cause any issues or symptoms. However, in people who are more sensitive, such as those with irritable bowel syndrome (IBS), they can cause just as many symptoms as artificial food additives.

The most common natural chemicals found in foods are salicylates, amines, and glutamate. These are most likely to cause symptoms is sensitive people as they are found in a large number of many different common foods and are therefore eaten the most in people’s diets.

Salicylates

These are natural chemicals found in plants and are present in many fruits, vegetables, nuts, tea and coffee, honey, herbs and spices, flavourings, and most alcohols. The level of salicylates in food decreases as the food ripens and levels are highest in the skin. Salicylates are also found in some medications, such as aspirin and herbal remedies.

They are also found in many natural flavourings used in food, drinks and medications, such as mint and fruit flavours and are used to scent perfumes, washing powders, cleaning products, toiletries and botanical oils, particularly lavender, eucalyptus and tea tree.

Amines

These are a product of either protein breakdown or fermentation. They are found in meats, cheese, fish products, fruits, vegetables, and many alcoholic beverages. The level of amines found in fruit increases with ripening, such as in banana, tomatoes and avocado. Foods particularly high in amines include chocolate, jams and flavoured spreads, fruit juices, sauces and fermented products such as beer, wines and yeast extracts.

Glutamate

Glutamate is an amino acid present in most foods as it is a building block for proteins. Glutamate in used in the preparation of many meals as it enhances the flavours of foods. Foods containing natural glutamate include cheese, tomato, mushrooms, meat and yeast extracts, soy sauce and stock cubes. Monosodium glutamate (MSG) is also often used as an additive in soups, sauces and snack foods to increase the flavour and is commonly used in Asian cooking.

FUN FACT: Did you know that “organic” foods may actually not be better for those with a food intolerance?

Why you might ask…growing foods without pesticides and herbicides actually results in them significantly increasing the amount of salicylates and other chemicals that they naturally produce.

However, you can minimise and avoid the amount of pesticide residues and natural chemicals by peeling the skin off your fruit & vegetables and removing the outside leaves of lettuce & cabbage.

Natural Food Chemical Intolerance

Natural food chemical sensitivity or intolerance occurs when these natural chemicals (salicylates, amines, and glutamate) result in someone experiencing symptoms. When ingested these chemicals cause reactions by irritating nerve endings in different parts of the body which leads to symptoms. These symptoms can be different in each person and can include;

Bloating
Nausea
Stomach discomfort or pain
Diarrhoea
Headaches and migraines
Recurrent hives and swelling
Sinus trouble
Fatigue or feeling run down
Flu-like aches and pains

In children symptoms can include;

Irritability and restlessness
Exacerbation of behavioural problems such as ADHD.

In baby’s symptoms can include;

Colic
Irritability
Eczema
Loose stools
Nappy rash

The presence of symptoms after ingesting a food that you are intolerant to is dose dependent. A small amount of a food high in natural food chemicals may not be enough to cause a reaction straight away. However, eating a large amount that goes over your individual threshold can cause a reaction. Since these chemicals are found in many different foods they can accumulate in the body over time. Therefore, eating small amounts regularly can lead to symptoms occurring after a few days. The image below from the Royal Prince Alfred Hospital (RPAH) Allergy Unit is a great visual representation showing how these chemicals can gradually build-up until they exceed our threshold.

Dose Dependency Image

Management of Natural Food Chemical Intolerance

Management is dependent on your individual threshold to these natural food chemicals. Those with a low threshold are recommended to avoid large doses of these and are often required to follow a low chemical diet. However, those with a higher threshold may only need to avoid meals containing high levels of these chemicals but can still eat small amounts.

How an Elimination Diet Can Help

An elimination diet is important in the diagnosis of food intolerances as, unlike allergies, there are no skin tests or blood tests that can be used. Trying to eliminate foods or natural food chemicals one at a time can often lead to unclear results as to which foods or chemicals are actually triggering your symptoms.

Determining the dietary triggers to your food intolerance’s is incredibly important. This will allow you to know which foods you can and cannot eat safely and which foods are likely to trigger your symptoms. It will also allow you to avoid unnecessarily restricting foods from your diet.

The only reliable and effective way of determining which natural food chemicals are triggering your symptoms is to eliminate all of these at one time and wait for your symptoms to settle. This can be a big adjustment to your current diet and eating habits and may seem difficult and overwhelming at first. You may feel that meals times become more complicated or that eating out is no longer fun. However, you can take a deep breath and relax! There are so many easy strategies that an Accredited Practising Dietitian (APD) who specialises in food intolerances, such as myself, will be able to provide you with so that you can still enjoy your activities and have pleasure from eating.

It is very important to remember that an elimination diet should only be completed under the supervision on an APD and only for a short amount of time. This is due to the fact that people following a restrictive diet, such as an elimination diet, are more at risk of nutrient deficiencies. An APD will provide you with appropriate substitutes to your favourite foods while ensuring you are getting all the nutrition you need with a healthy, balanced diet and a wide variety of foods.

When Should You Consider an Elimination Diet?

Food chemicals are believed to exacerbate and cause gut symptoms in some people with IBS due to their guts being more sensitive.

A low chemical elimination diet is usually recommended to be trialled in those that have tried the low FODMAP diet and found that it did not give them a significant improvement in their symptoms. It also recommended for those who experience additional symptoms other than just in their gut.

The FODMAP diet is a therapeutic diet and is often used and recommended in the medical management of those with IBS. This diet helps to determine if these carbohydrates are responsible for triggering symptoms in those with IBS. To learn more about IBS & the FODMAP diet you can read my “Identify Your IBS Type To Manage Bloating & IBS)” & “The Journey Towards Managing Your Bloating & IBS (FODMAP Phase 1-3)” blogs.

Whereas an elimination diet aims to identify if a person’s symptoms are triggered by chemicals found in foods, rather than carbohydrates. So, they focus on quite different food components. Some foods low in natural food chemicals are also high in FODMAPs, so although FODMAPs and food chemicals can cause similar symptoms, it can sometimes be difficult to determine which elimination diet is the most suitable.

The low FODMAP diet is recommended to be trialled first as it is less restrictive and are more likely to trigger IBS symptoms. Studies have shown that a low FODMAP diet can improve gut symptoms in up to 75% of people with IBS. However, as mentioned above, if symptoms are still being experienced, then the low chemical elimination diet is recommended for IBS.

The RPAH Elimination Diet

The RPAH Allergy Unity have developed an elimination diet specifically used for the investigation and management of suspected food intolerances. There are 4 stages of the RPAH elimination diet protocol.

Stage 1: Elimination Diet

The elimination diet is followed for at least 2 weeks. However, symptoms may take up to 6-8 weeks to settle. This phase of the diet requires people to avoid any foods high in natural food chemicals and substitute these with low natural food chemical alternatives.

There are 3 possible approaches to this stage of the diet. These include a strict, moderate or simple approach and your dietitian will discuss which approach is most suitable for you.

Restricting high food chemical foods enables us to determine if someone is responding to the low food chemical diet and whether it is resulting in a decrease in their symptoms. Once someone has had at least 5 days in a row free of symptoms they can begin the food challenge stage of the diet.

Stage 2: Challenges

This stage involves the challenging or reintroduction of each of the food chemicals in a systematic way that is well planned to ensure that the results you get are clear and accurate. During this stage people continue to follow the low food chemical diet as their base diet, with each food chemical group being challenged one at a time. A dietitian will give advice and guidance on which food to use for challenging, the order to reintroduce them and also the amount. This stage helps to determine which food chemicals may be triggering a person’s symptoms.

Stage 3: Liberalisation

STEP 1 – Personalised Diet

This stage usually lasts at least 3-4 weeks and is where the food chemicals that a person did not react to are added back into their diet based on the results from their challenges. During this stage people continue to avoid food chemicals that they reacted to.

STEP 2 – Identifying Tolerance Thresholds

A person moves onto this step when they feel comfortable with their personalised diet. This step involves testing a person’s threshold for each of the food chemicals that they reacted to, to determine the amount of a food chemical that they can tolerate before getting symptoms.

This is a particularly important part of the diet as it will identify whether a person may be able to tolerate a low, moderate or high amount of a food chemical before getting symptoms.

Stage 4: Long-Term Management

This is where different food chemicals are added back into the diet based on person’s individual tolerance. This stage is a particularly important phase of the diet as it enables us to develop a long-term balanced diet to ensure people are able to maintain and improve their overall health and quality of life.

If you’re looking for support on how to follow the FODMAP diet or RPAH elimination diet so that you can eliminate your bloating and live your best life, apply for coaching.

References

Australasian Society of Clinical Immunology and Allergy (ASCIA). Food Allergy [Internet]. Cited 2019 May 28. Available from: https://www.allergy.org.au/patients/food-allergy/food-allergy
Australasian Society of Clinical Immunology and Allergy (ASCIA). Food Intolerance [Internet]. Cited 2019 May 28. Available from: https://www.allergy.org.au/patients/food-other-adverse-reactions/food-intolerance
Barrett JS & Gibson PR (2012). Fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) and nonallergic food intolerance: FODMAPs or food chemicals? Therapeutic Advances in Gastroenterology. 5(4):261-8.
Perry CA, Dwyer J, Gelfand JA, Couris RR, McCloskey WW (1996). Health effects of salicylates in foods and drugs. Nutrition Review. 54(8):225-40.
Royal Prince Alfred Hospital, Allergy Unit (2011). RPAH Elimination Diet Handbook with Food & Shopping Guide.
Royal Prince Alfred Hospital, Allergy Unit (2016). Food Challenge Instructions Booklet.
Royal Prince Alfred Hospital, Allergy Unit. The Role of Natural Salicylates in Food Intolerance [Internet]. Cited 2019 October 12. Available from: https://www.slhd.nsw.gov.au/rpa/allergy/resources/foodintol/development.html
Skypala IJ, Williams M, Reeves L, Meyer R & Venter C (2015). Sensitivity to food additives, vaso-active amines and salicylates: a review of the evidence. Clinical and Translational Allergy. 5:34.

Low FODMAP Roast Vegetables

Serves 4
Gluten Free
Low FODMAP
Vegetarian & Vegan

Ingredients:
4 x Medium Potatoes
4 x Medium Carrots, cut into halves
400g Kent Pumpkin, cut into wedges roughly the same size as the potatoes
2 x Large Zucchini, cut each into 4 pieces
Olive Oil
Salt to Taste

Method:

Wash and pat dry all your vegetables. Do not peel them and leave the skins for added fibre. If you prefer you can remove the pumpkin skin as I have.
Place your favourite vegetables on a baking tray covered with baking paper and drizzle with olive oil and sprinkle with salt.
Bake on high (around 220ºc) for 30-40 minutes or until golden brown.
Serve with your preferred protein & Enjoy!

Tips:
This recipe is low in FODMAPs if you use kent pumpkin (like I did) & keep your intake of zucchini to 1/3 cup or less.

However, you can also substitute these with eggplant (1 cup is low FODMAP) or red capsicum.

Nutritional Information (Per Serve):

Nutrition Info LoFo Roast Veges

Food Group Servings (Per Serve):

LoFo Veges Serves

Delicious Homemade Pasties (Low FODMAP Option)

Makes 5 Pasties
Gluten Free
Low FODMAP Option Available

Pastie 2 Pastie 1

Ingredients:
5 Sheets Pre-Prepared Gluten Free Puff Pastry Sheets, thawed
500g lean beef mince
1 Large Carrot, peeled & cut into small ½ cm cubes
1 Large Potato, peeled & cut into small ½ cm cubes
1 cup Frozen Peas
¼ cup Continental Parsley, rinsed and chopped
1-2 Spring Onion Stalks, rinsed and thinly sliced
Extra Virgin Olive Oil
2 cups Gluten Free Beef Stock
2-3 tbsp Gluten Free Corn Flour
1 egg
Salt and Pepper to Taste

Method:

In a large saucepan place oil, parsley and spring onion. Cook until softened.
Add beef mince and cook until browned. Use a wooden spoon to break it up into small pieces.
Add cut carrot, potato and frozen peas. Stir well to combine.
Add beef stock and cook until vegetables are tender. Add salt and pepper to taste.
In a small bowl add corn flour and mix with water to form a paste. Add to mince and vegetable mixture and stir well until combined and until it forms a thick gravy like consistency. If it is still a bit watery simply add some extra corn flour.
Turn saucepan off and allow to cool slightly.
Pre-heat oven to 220 degrees Celsius.
Once cooled, place ¼ of the mixture onto one half of each puff pastry sheet, allow 1.5 cm around the outside edges.
Wet your fingers and use them to wet the outside edges of your pastry.
Fold puff pastry sheet in half and use a fork to press the edges together to encase your filling.
Place on a tray lined with baking paper.
In a bowl beat egg well and use a pastry brush or your fingers to brush or coat the top of your pasties with the egg as a glaze.
Place in oven and bake for 20-30 minutes or until golden brown.
Serve & Enjoy!

Tips:

Serve these delicious pasties with mashed potato and steamed vegetables of your choice.
To make your pasties low FODMAP, use the green parts only of the spring onion, a low FODMAP beef stock and replace the peas with green beans cut into 1cm pieces.
This dish is also moderate in natural food chemicals for those that are sensitive to these.

Nutritional Information (Per Serve):

Nutritional Info

Food Group Servings (Per Serve):

Food Group Serves

Low FODMAP Banana & Strawberry Smoothie

Makes 2 Smoothies
Gluten Free
Low FODMAP & Dairy Free Options Available

Ingredients:
250ml low fat milk
1 x 200g tub probiotic yoghurt such as Vaalia
1 x medium banana
4 x medium strawberries.

*OPTIONAL: For extra fibre, you can also add 1 tbsp chia seeds.

Method:

Place all ingredients in a blender and blend for 2-3 minutes or until well combined.
Serve & Enjoy!

Tips:

To make this recipe low FODMAP, use lactose free alternatives for the milk and yoghurt and an unripe banana.
To make this recipe dairy free, use soy alternatives for the milk and yoghurt.
This recipe is moderate in natural food chemicals. To make this recipe low in natural food chemicals replace the banana and strawberries with 2 peeled pears or click here for a low natural food chemical version of this recipe.

nutrient table

Food Group Servings (Per Serve):

Food Group Table

How The Gut Works With The Brain To Manage IBS

What is the Gut-Brain Axis?

Have you ever felt butterflies in your stomach when you’re nervous? Or ever felt the need to run to the bathroom right before you leave to go for a job interview? Thankfully there is an explanation for this! The link or communication pathway between your gut and your brain, also known as the gut-brain axis is what causes this to occur. This communication pathway is bidirectional, so it works in two directions. This means that your brain and how you are feeling can influence your gut activities (hence the nervous poos), and what is happening inside your gut can have an effect on your brain, generating particular feelings, emotions, thoughts and even behaviours.

How Does This Gut-Brain Axis Work?

Neurons or chemical transmitters are the main communicators and their role is to send information up and down the vagus nerve, which connects the gut to the brains limbic system (home of the emotions and stress in the brain). So, these neurons are regularly going back and forth sending these messages between the two systems, keeping them in contact.

The gut and brain are constantly in communication with one another and this line of communication is a rather convenient way for your gut to keep the brain up to date with your overall health. Research also suggests that your gut microbiome also plays an important role in the gut-brain axis.

The Gut Microbiome & the Gut-Brain Axis

Trillions of microbes or bacteria live throughout the body, all having various roles, with around 90% of these living all throughout the gut! Primarily, the gut microbiome plays important roles in digestion, production of hormones (to transmit messages!) and protection against pathogens, which are bacteria, viruses, or other microorganisms that can cause disease.

Each of our individual gut microbiome’s vary, with a large range of influencing factors, all starting from the moment we are born! For example, a vaginal birth means that you were exposed to the bacteria in your mother’s birth canal, immediately gaining exposure to a range of different species. Whereas a caesarean birth means you were exposed to bacteria located on the skin and less exposure to these varied species. Therefore, the diversity of gut bacteria is lower in infants born via caesarean section and the composition of their gut microbiome is different to those born vaginally. Fortunately, how you are born is not the only factor influencing the make up of your gut microbiome! There are so many more factors influencing the variety you have, including where you live, your work/home environments, who you are in contact with each day and most importantly, what you eat!

A wide variety of gut bacteria means a wide range of hormones being produced by the microbiome including serotonin (happy hormone) and dopamine (the hormone stimulating learning and memory). Once the microbiome releases these hormones, they are transported through the vagus nerve, stimulating the brain, which improves mood and memory. This helps to explain the link found between the diversity of the gut microbiome and its influence on anxiety and depression. Research suggests that a disturbance and reduced diversity of gut bacteria can have a link to increased feelings of anxiety and depression, with less of the serotonin and dopamine being produced.

Impact on Our Health & the Important Role of Nutrition

There are so many factors influencing the diversity, or the variety of different types of gut bacteria, in our gut microbiome. However, it is important to acknowledge that out of all these things, diet is the one factor that we can easily manipulate to help improve the diversity of our bacteria. Since a large portion of the microbiome is found in our gut, the types of foods we eat can influence their diversity.

The types of food that we eat and the nutrients that they contain can have a large influence on not only our gut bacteria, but the gut-brain axis overall, with studies linking our diet to our mental awareness, cognition, moral principles and our emotions. Variation is key! Research is still in its infancy, however studies involving dietary changes to positively influence the gut microbiome have shown many positive changes to mental health. So, in other words, the more variety in your gut microbiome, the happier you are!

The Gut-Brain Axis & Irritable Bowel Syndrome

As we now know, our gut and brain are constantly in communication with one another and when something goes wrong with one, the other reacts. Unfortunately, this is the case with people with irritable bowel syndrome (IBS) and is a perfect example of how the two systems communicate and influence each other. Research in this area is much more associated with animal studies rather than humans however, a significant link has been found between the gut microbiome, the gut-brain axis and in turn IBS symptoms, with significant links between stress and the gut microbiome response. Reality is, there is a link between IBS and stress/anxiety with stress reducing the diversity of the gut microbiome overall, increasing inflammation within the gut (with less production of those happy hormones).

How Can Food Help the Gut-Brain Axis?

Studies suggest that including probiotics and prebiotics in the diet can help in improving the diversity of gut bacteria with abnormal gut function improving when these foods are included in the diet.

Prebiotics are a form of fibre that passes through the digestive tract and into the large intestine where the good bacteria feed off the prebiotic, producing by-products that positively stimulate the gut-brain axis. Therefore, prebiotics have a large role in improving the diversity and the actions of the bacteria in the gut and in turn, the brain.

Probiotics, however, are the good gut bacteria already present in our body which have also been added into foods such as yogurt, kefir and even supplements. Currently the research available does suggest that there is a potential for health benefits with enough present in the gut, however we are currently unsure if probiotics consumed in the form of foods and supplements can survive the journey through the digestive system, suggesting they may not have extensive health benefits.

So overall, it is recommended a diet with a wide variety of high fibre foods (prebiotics), vegetables, fruit and grains with the inclusion of dairy products like yogurt and milk, can help to increase the diversity of the gut microbiome to stimulate positive activity in the gut and therefore the brain.

Why Should You Know About the Gut-Brain Axis?

The phrase “gut feeling” gets thrown around quite a bit, however, is an important concept. What you’re eating and how you’re feeling can often be interrelated, which most people are not aware of. If you do not have an overall varied and healthy diet, this may have an influence on the way you think or feel and can result in feeling fatigued, “cloudy” or emotional. This might be your gut-brain axis feeding back to you! If you think this might be the case, book in to see a dietitian, who can help you improve your overall diet and gut health.

Start Improving Your Gut Microbiome Now with These Simple Steps!

Choose a wide range of different fruits and vegetables daily! Remember to try to incorporate 2.5 cups of vegetables and 2 pieces of fruit daily.
Increase your intake of fibre by including more prebiotic foods into your diet! (See below for some suggestions).
Include a wide range of wholegrain foods into your diet! Remember, the more seeds and grains, the better.
Introduce omega 3 fats! Think about incorporating more oily fish into your diet and try to do so at least 2 times per week.
Don’t be afraid to try new foods! Perhaps a food you’re considering trying may have a positive effect on your gut microbiome or introduce a new strain!

Examples of Prebiotic Foods to Help Improve Your Gut Microbiome!

Garlic
Onion
Bananas
Soybeans
Red kidney beans and other legumes
Grapefruit
Rye
Bran Cereals
Oats
Cashews

Written by Stephanie Monacella

Steph is a final year student dietitian completing her last two weeks of the Masters of Dietetics course at Deakin University. “I am very passionate about using my knowledge and skills that I have learnt to provide the public with nutrition related content from the most up to date scientific evidence-based research.”

References

Carabotti M, Scirocco A, Maselli MA & Severi C (2015). The gut-brain axis: interactions between enteric microbiota, central and enteric nervous systems. Annals of Gastroenterology. 28(2):203–209.
Clapp M, Aurora N, Herrera L, Bhatia M, Wilen E & Wakefield S (2017). Gut microbiota’s effect on mental health: the gut-brain axis. Clinics and Practice. 7(4).
Kennedy P (2014). Irritable bowel syndrome: A microbiome-gut-brain axis disorder? World Journal of Gastroenterology. 20(39):14105.
Martin C, Osadchiy V, Kalani A & Mayer E (2018). The Brain-Gut-Microbiome Axis. Cellular and Molecular Gastroenterology and Hepatology. 6(2):133-148.
Mohajeri M, La Fata G, Steinert R & Weber P (2018). Relationship between the gut microbiome and brain function. Nutrition Reviews. 76(7):481-496.
Monash University Department of Gastroenterology. Prebiotic Diet – FAQs [Internet]. Cited 2019 June 6. Available from: https://www.monash.edu/medicine/ccs/gastroenterology/prebiotic/faq#3
Oriach C, Robertson R, Stanton C, Cryan J & Dinan T (2016). Food for thought: The role of nutrition in the microbiota-gut–brain axis. Clinical Nutrition Experimental. 6:25-38.
Thursby E & Juge N (2017). Introduction to the human gut microbiota. Biochemical Journal. 474(11):1823-1836.
Umu Ö, Rudi K & Diep D (2017). Modulation of the gut microbiota by prebiotic fibres and bacteriocins. Microbial Ecology in Health and Disease. 28(1):1348886.

Why Your Bloating & IBS Isn’t Managed (Food Allergy & Intolerance Testing)

Having food allergies and intolerance’s myself, this topic is one that is particularly close to my heart and one that I am quite passionate about.

There is currently so much information available, particularly online, about how to test for food allergies and intolerance’s. Unfortunately, a lot of this information and the sites it is available on are unreputable sources and, more often than not, offer inaccurate advice and misinformation.

With those of us with food allergies and intolerance’s, or that have a family member or friend with these, it can become incredibly confusing and overwhelming trying to make our way through all the information, which, as mentioned above, unfortunately isn’t always accurate.

These sites take advantage of a particularly vulnerable group of people who are often desperate for an answer and resolution to their symptoms. They have usually been experiencing symptoms for a long period of time and, I know from my personal experience, are willing to try anything to get some kind of relief from their symptoms and a reason as to what is causing their symptoms.

Why Having the Right Test is Important

It is incredibly important to have a food allergy or intolerance properly diagnosed as some food allergies can be life-threatening. Determining the dietary triggers to your food allergies or intolerance’s will allow you to know which foods you can and cannot eat safely and which foods are likely to trigger your symptoms.

It is also important to know whether your symptoms are due to a food allergy or a food intolerance as these are not the same. A food allergy is due to our immune system reacting to a food protein that the body wrongly thinks is harmful, which causes a person to have a reaction and get symptoms. Whereas a food intolerance does not involve the immune system and reactions are rarely life-threatening. A food intolerance is when a person cannot properly digest or fully break down and absorb certain foods. If you would like to learn more about food allergies and food intolerance’s, you can read my “How to Eat More Foods With IBS (Food Allergy vs Intolerance)” blog here.

It will also allow you to avoid unnecessarily removing or restricting foods from your diet. Following a restrictive diet when it is not medically required can place us more at risk of nutrient deficiencies. These can have long-term negative effects on our health including digestive problems, skin conditions, fatigue, decreased cognitive function and can even lead to malnutrition.

Recommended, Proven & Validated Tests

In Australia, Medicare rebates are available for scientifically validated tests. What this means is that the test is proven to work in identifying whether you may have a food allergy and that you can be confident in the results that you receive from these tests.

However, it is really important that these tests are not used on their own and are used and interpreted alongside your detailed medical, diet and lifestyle history by your medical practitioner and dietitian.

Coeliac Screening Blood Tests

These tests should be conducted to eliminate whether the cause of a person’s symptoms is due to coeliac disease. Coeliac disease is an autoimmune condition which can significantly impact on a person’s health. These tests can include;

Anti-tissue transglutaminase antibodies (tTG-IgA)
Deamidated gliadin peptide (DGP) IgA and IgG.
Anti-endomysial antibodies (EMA).

If coeliac disease is left undiagnosed or untreated the surface area of our bowel can decrease which affects how we absorb nutrients, which can result in nutrient deficiencies. It can also affect other areas of the body including our bones and joints, organs and skin. So, it is very important to exclude this as a potential cause of symptoms.

Skin Prick Tests

Skin prick testing is currently the easiest way to test for allergies. A big benefit of these tests is that you can talk to your doctor about the results to your tests at the time they are done, rather than having to wait for results, as results are available within 20 minutes. Clinical studies have shown that skin prick tests improve how accurately allergies are diagnosed.

These tests are usually done on a person’s forearm. A drop of an extract of the allergen(s) your doctor is testing for is put on the location and a small prick is made into the skin. If you are allergic to the allergen a small itchy lump with a red circle , also known as a wheal and flare, will develop.

You may experience a small amount of discomfort, mainly from being itchy, but they are not usually painful and swelling usually subsides within a couple of hours. These are also usually tolerated well by children.

It is really important that these tests are only be performed by a trained health professional, such as a clinical immunologist, who will be able to accurately understand the results and safely conduct the test.

IgE Blood Tests

These tests were previously known as RAST (RadioAllergoSorbent Test) tests. IgE stands for Immunoglobulin E antibodies. These antibodies are a protein in the blood that is made, or produced, in response to a specific allergen, which the body sees as being harmful and combines with this. IgE blood tests measure the amount of these antibodies in the blood against a specific allergen.

These tests are usually recommended or performed when skin prick testing may not be able to be done. This can include those that take medications such as antihistamines or have severe skin conditions such as eczema.

Patch Tests

Past testing is useful in testing for allergic contact dermatitis. This could be triggered by things such as preservatives in cosmetics, plants and metal. These tests are conducted by applying an allergen paste to a rash-free area of the skin using hypoallergenic tape. This is usually on a person’s back. The area has to be kept dry and the tape is left in place for 48 hours.

Over the 48 hours, observations of the site are conducted at different times. If a rash that looks similar to eczema appears, it can indicate a sensitivity to the allergen being tested.

Oral Allergen Challenge Tests

If the cause of a severe allergic reaction is unable to be established, an oral allergen challenge test may be needed to confirm a diagnosis. This is usually conducted by a clinical immunologist/allergy specialist who uses foods or medication to test for an allergic response. This is also completed in a safe clinical environment with resuscitation equipment available in case a severe allergic reaction occurs.

Elimination Diets

These are the gold standard for testing for food intolerance’s. They involve elimination of a particular food or foods for a short period of time, usually 2-6 weeks. This is then followed by a controlled reintroduction or food challenges to identify any dietary triggers to a person’s symptoms. These are completed under the supervision of an Accredited Practising Dietitian and a medical practitioner.

Other Tests

Hydrogen Breath Tests

This is a test I get asked about quiet often by my clients and is actually not a test that I would recommend.

Hydrogen breath tests are known to be used to investigate carbohydrate or sugar malabsorption, particularly in those with Irritable Bowel Syndrome (IBS). Carbohydrates which are commonly tested are called FODMAPs which include fructose, lactose and sorbitol. If you would like to learn more about FODMAPs you can read my “The Journey Towards Managing Your Bloating & IBS (FODMAP Phase 1-3)” blog here.

Hydrogen breath tests are based on the idea that when the bacteria in our gut ferments, or breaks down, these carbohydrates which are unable to absorbed, gas is produced. This gas then diffuses or spreads into the blood stream and is then expelled in the breath.

However, these tests have limited usefulness in identifying carbohydrate malabsorption for a numerous reasons. These include;

Studies have shown that the occurrence of FODMAP malabsorption in those with IBS is actually similar to the general population when diagnosed via these tests, so no real difference is seen in those with IBS and those without IBS.
These tests are also rarely used for FODMAPs as these are poorly absorbed and broken down by everyone, not just those with IBS, an intolerance or malabsorption.
The amount of carbohydrates consumed, or the sugar load, in these tests is also very high. Consuming these amounts of carbohydrates speed up the transit time in all our guts which will increase malabsorption and the likelihood of everyone having these tests getting symptoms. Therefore, results found become clinically inappropriate as they are unable to determine a person’s true tolerance level.
The results of these tests are unable to be reproduced. For example, you may have a breath test one day and get a positive result and repeat the same test at another time and get a negative result.
These tests can give both false positives and false negative results. I know from my own person experience, I had a hydrogen breath test for lactose which came back negative, but I am most certainly lactose intolerant.

Total IgE Tests

Although total IgE antibodies may be higher in those with allergies, elevated total IgE antibody levels are also found in people who have eczema, parasite infections and some rare medical condition. Total IgE levels do not prove that the symptoms a person may be experiencing are due to an allergy. On the other end of the scale, normal IgE levels do not mean that an allergy can be excluded. Therefore, this test is not often recommended when testing for food allergies.

Eosinophil Counts

Eosinophils can cause inflammation in our tissues in allergies. These are a type of white blood cell that specialise in killing worms and parasites. High levels can sometimes be found in those with hay fever, eczema and asthma. However, as with total IgE tests, high eosinophil levels do not mean that sometimes symptoms are caused by an allergy and normal levels do not eliminate an allergy. Therefore, this test is not often recommended when testing for allergies.

Unproven and Unvalidated Tests

Unfortunately, these types of tests are often recommended by those practising complementary or alternative therapies. Not only are these not evidenced-based but can also be very pricey. I know of some of my clients that have paid close to $1000 to have some of these tests done.

Currently in Australia, unproven allergy tests and treatments are not regulated. This means they can still be listed by the Therapeutic Goods Administration (TGA) without even having to prove that they work. The only time that unproven tests claiming to treat, or cure allergies and other immune conditions are regulated, is if the person giving the advice or recommending the test is a registered medical practitioner.

These unorthodox tests can be misleading, and treatment based on the inaccurate results of these tests can lead to using treatment strategies that do not work and in some cases can even be harmful. But most importantly it can delay proper diagnosis of a food allergy or intolerance and the implementation of effective management and treatment interventions.

In Australia, there are no Medicare rebates available for these tests and their use is not recommended.

IgG Blood Tests

This is another test that I get frequently asked about by my clients. Unfortunately, this is one that some of my clients have had done prior to seeing me that has led them to unnecessarily eliminate and restrict many foods from their diet.

IgG stands for Immunoglobulin G antibodies. This test claims that higher IgG levels to a food(s) indicate that a person has a food intolerance. There is currently no credible scientific evidence to support the use of this test in diagnosing food allergies or intolerance’s or that these antibodies can cause a person symptoms.

IgG antibodies simply shows that we have been exposed to a food, not that we have a disease or condition as a result of being exposed to a food. I like to describe these almost like the “bouncers” of our immune system that keep track of any of the foods that we have eaten or been exposed to before. Almost like ticking off guests on a guest list at an event…Oh yes, seen you before, tick!

Even with scientific studies showing the ineffectiveness of this test, it continues to be promoted in the public and I very often see misleading advertisements promoting these. They are not recommended to be used as a tool for diagnosing food allergies or intolerance’s.

Cytotoxic Food Testing

These include Bryan’s test and the Alcat test. These are blood tests which mix white blood cells with a food and claims that if they increase in size this shows that a person has an allergy to that food.

In Bryan’s test the white blood cells are assessed under a microscope. Whereas, the Alcat test analyses the blood samples on a laboratory machine. The results found during these tests are not the same as those obtained using clinically proven methods for allergy testing.

There is no scientific basis or rationale for these tests. The results to these tests have been scientifically shown to be unable to be reproduced. When the same blood sample is tested multiple times, different results are found.

Kinesiology

This test works on the idea that foods can cause an imbalance of energy in the body and claims to be able to diagnose a food intolerance by testing how our muscles react to particular foods. During this test a person holds a glass vial which has the particular food in it and the person conducting the test then tests how the muscle responds.

This test is not recommended as scientific research shows that the results obtained from these tests are no better that those by chance. This unfortunately can lead to the unnecessarily elimination of food from the diet which, as mentioned above, can have many negative health consequences.

Vega Testing

This test claims to be able to identify a disease by measuring electrical currents in the body. A person holds a positive electrode in one hand and a negative electrode in the other and a sealed container with an “allergen” in it is put into the electrical circuit. A change in electrical current is said to identify that a person is allergic to that food.

Scientific research studies show that the results from these tests are no better than those obtained by chance. When this technique has been formally examined, results show that practitioners are unable to tell the difference between healthy people and people with allergies and also between an allergen or placebo control solution. As with cytotoxic tests, the results found during these tests are not the same as those obtained using clinically proven methods for allergy testing.

These unproven allergy tests often unnecessarily recommend a long list of food that need to be removed and excluded from the diet. As I mentioned above, eliminating foods from the diet when it is not required and in the absence of sound nutrition advice can lead to nutrient deficiencies and malnutrition.

Iridology

This test claims to be able to diagnosis various conditions by examining patterns in the iris of the eye. This test is based on completely theoretical ideas which have not been proven to work. The concern with this test is that our irises are as individual to each person as a fingerprint and do not change and as such can be used as “biometric identification markers” to differentiate us from each other.

Scientific studies show that the practitioners using this technique are unable to identify a healthy person from a sick person. When given pictures of irises of the same person that were taken only moments apart, practitioners gave the same person different diagnoses.

Hair Analysis

This test is used in testing for drug use, such a, marijuana, and for lead and mercury poisoning. However, it’s use in testing for allergies has no scientific basis and is unproven. This test is conducted by sending off a small strand of hair to a laboratory where energy fields in the hair and measured. This is then compared to a set of pre-determined data and claims to be able to identify a food intolerance or sensitivity.

VoiceBio Test

This test claims to measure the frequency of different body organs using an analysis of a person’s voice by a computer. It is said to work on the idea that our internal organs talk to each other by sound waves and that each of our organs vibrate at specific frequencies, which can detect if an organ is not functioning normally. This technique is not based on any scientific principles and there is no evidence that these results are useful in diagnosing allergies or any other type of condition.

Pulse Testing

In these tests a pulse is measured before and then again 15 minutes after eating a particular food. An increase of 10 beats per minute is said to indicate a food intolerance. This test is not recommended as scientific research shows that there is no relationship between an elevated pulse rate and a food intolerance.

Other Unproven Tests

Other tests with no scientific basis include reflexology, stool and oral neutralisation tests. These are not proven to work and therefore have no clinical role in diagnosing or managing any kind of medical condition.

References

Australasian Society of Clinical Immunology and Allergy (ASCIA). Allergy Testing [Internet]. Cited 2019 June 18. Available from: https://www.allergy.org.au/patients/allergy-testing/allergy-testing
Australasian Society of Clinical Immunology and Allergy (ASCIA). Unorthodox Allergy Tests and Treatments [Internet]. Cited 2019 June 18. Available from: https://www.allergy.org.au/patients/allergy-testing/unorthodox-testing-and-treatment
Australasian Society of Clinical Immunology and Allergy (ASCIA). Unorthodox testing and treatment for allergic disorders [Internet]. Cited 2019 June 18. Available from: https://allergy.org.au/hp/papers/urticaria/?task=view&id=262
Braden B (2009). Methods and functions: breath tests. Best Practice & Research: Clinical Gastroenterology. 23(3):337-52.
British Dietetic Association (BDA). Food Allergy and Intolerance Testing [Internet]. Cited 2019 June 18. Available from: https://www.bda.uk.com/foodfacts/food_allergy_intolerance_testing
Buchanana AD, Green TD, Jones SM, Scurlock AM, Christie L, Althage KA et al (2007). Egg oral immunotherapy in nananaphylactic children with egg allergy. Journal of Investigational Allergology and Clinical Immunology. 119(1):199-205.
Drisko J, Bischoff B, Hall M & McCallum R (2006). Treating irritable bowel syndrome with a food elimination diet followed by food challenge and probiotics. Journal of the American College of Nutrition. 25(6):514-22.
Enrique E, Pineda F, Malek T, Bartra J, Basagana M, Tella R et al (2005). Sublingual immunotherapy for hazelnut food allergy: a randomized, double-blind, placebo-controlled study with a standardized hazelnut extract. Journal of Investigational Allergology and Clinical Immunology. 116:107-9.
Gasbarrini A, Corazza GR, Gasbarrini G, Montalto M, Di Stefano M, Basilisco G, et al (2009). Methodology and indications of H2-breath testing in gastrointestinal diseases: the Rome Consensus Conference. Alimentary Pharmacology & Therapeutics. 29(Suppl. 1):1-49.
Katelaris CH, Weiner JM, Heddle RJ, Stuckey MS & Yan KW (1991). Vega testing in the diagnosis of allergic conditions. The Australian College of Allergy. Medical Journal of Australia. 155(2):113-4.
Morris DH & and Stare FJ (1993). Unproven diet therapies in the treatment of the chronic fatigue syndrome. Archives of Family Medicine. 2(2).
Noh G, Ahn HS, Cho NY, Lee S & Oh JW (2007). The clinical significance of food specific IgE/IgG4 in food specific atopic dermatitis. Pediatric Allergy and Immunology. 18(1):63-70.
Shah ED, Basseri RJ, Chong K, Pimentel M (2010). Abnormal breath testing in IBS: a meta-analysis. Digestive Diseases and Sciences. 55(9):2441-9.
Taylor JP, Krondl MM, Spidel M & Csima AC (2002). Dietary adequacy of the rotary diversified diet as a treatment for “environmental illness”. Canadian Journal of Dietetic Practice and Research. 63:198-201.
Teuber SS & Porch-Curren C (2003). Unproved diagnostic and therapeutic approaches to food allergy and intolerance. Current Opinion in Allergy and Clinical Immunology. 3(3):217-21.
Teuber S & Beyer K (2007). IgG to foods: a test not ready for prime time. Current Opinion in Allergy and Clinical Immunology. 7(3):257-8.
Wüthrich B (2005). Unproven techniques in allergy diagnosis. Journal of Investigational Allergology and Clinical Immunology. 15(2): 86-90.

The Journey Towards Managing Your Bloating & IBS (FODMAP Diet Phase 1-3)

What is the FODMAP Diet?

The FODMAP diet is a therapeutic diet and is often recommended to those who have Irritable Bowel Syndrome (IBS). IBS is a common gastrointestinal disorder that affects 1 in 7 adults and is characterised by symptoms that are not explained by other disorders such as coeliac disease and inflammatory bowel disease. The most common symptoms of IBS include; stomach pain, bloating, wind, diarrhoea, constipation and nausea.

These symptoms can lead to stress and anxiety and affect our quality of life. The exact cause of IBS is not completely understood, however there are a number of things that may trigger symptoms (to learn more about IBS read my “Identify Your IBS Type To Manage Bloating & IBS)” blog).

The dietary cause of the symptoms associated with IBS is largely due to a group of carbohydrates called FODMAPs. This is an acronym which stands for;

Fermentable
Oligosaccharides
Disaccharides
Monosaccharides
And Polyols

Examples of FODMAPs include fructose, lactose, fructans and sorbitol. These carbohydrates, or sugars, can be poorly absorbed in the small intestine and fermented or broken down in the large intestine. This produces gas which leads to the symptoms associated with IBS. FODMAPs are also small and increase the amount of water delivered throughout the gut. This is called an osmotic effect. The gas produced by the large intestine in combination with this osmotic effect can cause changes to our gut motility or it’s movement. This can result in the symptoms of constipation and/or diarrhoea.

FODMAPs are found in many common foods including fruit, vegetables, grains and dairy. Although these carbohydrates are poorly absorbed in everyone, they are believed to affect and cause symptoms in people with conditions such as IBS as their guts are more sensitive. It’s important to remember that FODMAPs are not the cause of IBS, however limiting these in the diet can help control IBS symptoms.

Did you know that a low FODMAP diet can help improve gut symptoms in up to 75% of people with IBS?

In order to follow a low FODMAP diet it is vital that you plan ahead as the diet can be quite restrictive and involves a number of changes to your diet. This means that you are more at risk of nutrient deficiencies. Therefore, it is recommended that the FODMAP diet be completed under the supervision on an Accredited Practising Dietitian (APD) as they are able to provide you with appropriate low FODMAP substitutes to your favourite foods while ensuring you are getting all the nutrition you need with a healthy, balanced diet and a wide variety of foods. Studies also show that those with IBS who follow the low FODMAP diet with the assistance of an APD can get better relief from their symptoms.

The 3 Phases of the FODMAP Diet

There are 3 phases to the FODMAP diet.

Phase 1 – Low FODMAP or Elimination Phase.

This usually occurs over 2-6 weeks. This phase of the diet requires people to avoid any high FODMAP foods and substitute these with low FODMAP alternatives. Restricting high FODMAP foods enables us to determine if someone is responding to the low FODMAP diet and whether it is resulting in a decrease in their IBS symptoms.

The low FODMAP diet can be restrictive and people often struggle with the amount of variety in their diet and also flavour. FODMAPs also contain fibre and are natural prebiotics, so those on a low FODMAP diet can struggle with meeting their fibre requirements which can lead to constipation. So, a big consideration is the long-term consequences of a low FODMAP diet. And this is one of the reasons why it is only recommended for a short period of time of 2-6 weeks.

Phase 2 – Reintroduction or Challenge Phase

This usually takes around 6-8 weeks to complete. This phase involves the challenging or reintroduction of each of the FODMAP groups in a systematic way that is well planned to ensure that the results you get are clear and accurate. During this phase people continue to follow the low FODMAP diet as their base diet, with each FODMAP group being challenged one at a time. A dietitian will give advice and guidance on which food to use for challenging, the order to reintroduce them and also the amount.

This phase helps to determine if FODMAPs may be triggering a person’s symptoms. It not only helps to identify which FODMAPs may be triggering a person’s symptoms, but also how much. This is a particularly important part of the diet as it will identify whether a person may be able to have a particular FODMAP or tolerate a small, medium or large amount of a FODMAP before getting symptoms.

Phase 3 – FODMAP Personalisation

This is where different FODMAP groups are added back into the diet based on the results from a person’s challenges. This phase is a particularly important phase of the FODMAP diet as it enables us to develop a long-term balanced diet to ensure people are able to maintain a healthy gut to improve their overall health and quality of life.

Expert Tips for Phase 1

My expert tips to follow during the elimination phase of the FODMAP diet are;

Find a low FODMAP substitute for any high FODMAP foods in the diet so that those following the diet can still enjoy all the meals they love.
Include foods from all 5 food groups to make sure that all nutritional requirements are met and to decrease the risk of developing a nutrient deficiency.

Strategies to add flavour without adding high FODMAP foods are also important. My expert tips are:

Use spices or herbs like basil, chili, cumin, ginger, pepper, rosemary or thyme on meat, fish, chicken, or vegetables.
Use maple syrup instead of honey to sweeten baked goods or cereal.
Avoid flavouring foods with onion or garlic powder.
Drink water, regular or decaffeinated coffee or black tea instead of herbal teas and fruit drinks or juices.

Expert Tips for Phase 2

The main thing that I hear clients struggle with and are concerned about during this phase of the FODMAP diet is managing a potential flare up of their symptoms during
the challenges. My expert tips to help with this are:

Take time to relax. This can include relaxation tapes, yoga, or massage as these may help improve gut symptoms.
Participate is regular exercise such as walking, cycling, swimming.
Take time when eating meals and make sure food is chewed well. Eating fast can result in us swallowing more air which can lead to symptoms such as bloating.
Keep a food and symptom diary during each of the FODMAP challenges to help identify which FODMAPs caused symptoms.
Using hot packs is also a great option to help improve gut symptoms.

Expert Tips for Phase 3

As the name suggests, this personalisation phase is individual for everyone. My expert tips to follow during the personalisation phase of the FODMAP diet are;

Let the results of the challenge phase guide the order in which each FODMAP is reintroduced back into the diet.
Reintroduce foods that were well tolerated first.
Try not to become disheartened if symptoms are experienced. Some gut symptoms from time to time are quite normal. We only need to become concerned if our symptoms are staring to impact on our ability to do our usual activities and quality of life.
Keep track of any symptoms that may be experienced. It can be helpful to rate symptoms on a scale of 1-10, with 1 being no symptoms and 10 being severe symptoms.

If you’re newly diagnosed with IBS and bloating and told by your doctor to follow the FODMAP diet, but now you have no idea where to start, you’re not alone because 1 in 5 Australians have IBS. But you don’t have to be that person that lives with it for the rest of your life uncontrolled. You can manage it by following the FODMAP diet so that you can eliminate bloating and live your best life, apply for coaching.

References

Gandy J & the British Dietetic Association. Manual of Dietetic Practice–Fifth Edition. 2014: 460-466.
Gibson PR, Shepherd SJ (2010). Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. Journal of Gastroenterology and Hepatology. 25: 252–258.
Monash University. The 3 steps of the FODMAP diet [Internet]. Cited 2019 April 22. Available from: https://www.monashfodmap.com/blog/3-phases-low-fodmap-diet/
Monash University. Monash University Low FODMAP DietTM Application for Android. Cited 2019 April 22.
National Institute for Health and Care Excellence (NICE) (2008). Irritable bowel syndrome in adults: Diagnosis and management of irritable bowel syndrome in primary care. CG61.
Tuck C & Barrett, J (2017). Re-challenging FODMAPs: the low FODMAP diet phase two. Journal of Gastroenterology and Hepatology. 32 (Suppl 1): 11–15.

5 Steps To Manage Bloating On a Low FODMAP Diet

Did you know that our gut bacteria and gut microbiome can influence our overall health? This includes Irritable Bowel Syndrome (IBS), heart disease, our immune system, mental health, body weight and sleep patterns.

What is the Gut Microbiome?

The gut microbiome is very complex and can vary from person to person. It is a term used to describe the large and diverse group of microorganisms, also sometimes referred to as stomach bacteria or gut bugs, that live in our gastrointestinal tract. The diversity and amount of these bacteria increase throughout the gut from the stomach, to the small intestine and then large intestine or colon. Did you know that your colon has the most amount of gut bacteria?

Diet and the Gut Microbiome

Our diet significantly affects the makeup and diversity of our gut microbiome. The composition of our gut microbiome can begin to change in as little as one day after changing our diet. This can influence our overall health by the products that are made when the bacteria in our colon breaks down or ferments the nutrients that we have eaten in our diet.

These are mainly certain types of carbohydrates called fructans (including inulin and oligofructose) and fibre (including resistant starch, wheat bran, beta-glucan and psyllium). These are also known as prebiotics and produce short-chain fatty acids (SCFA). These help to protect our gastrointestinal tract, speed up repair of any damage in our gastrointestinal tract and reduce inflammation.

It is also important to remember that although diet has a major impact on the gut microbiome, some medications and conditions can also alter its composition. These include constipation, IBS, inflammatory bowel disease and some nutritional supplements.

The Importance of Fibre

Fibre is an important nutrient in improving our overall health. Adequate fibre intakes have been shown to decrease a person’s risk of developing chronic diseases such as bowel cancer, cardiovascular disease and diabetes. Fibre can also help with making us for fuller for longer after meals and plays a vital role in making sure our gut is working normally and keeping our gastrointestinal system healthy.

Eating enough fibre has been shown to;

Decrease cholesterol levels.
Control our blood glucose levels.
Improve constipation.
Decrease loose stools, manage diarrhoea and the symptoms associated with diarrhoea such as stomach pain, cramps and wind.
Increase the number of good bacteria in our gut.

Fibre is the edible parts of plants that are unable to be digested, or broken down, and absorbed in our small intestine. These are then either partly or fully broken down by the bacteria in our large intestine.

In Australia, it is currently recommended that women consume 25g of fibre per day and men consume 30g of fibre per day. However, most Australians currently do not consume enough fibre.

For those with IBS, it can be difficult to eat enough fibre when following a low FODMAP diet because they are eating less of these carbohydrates that contain fibre and are also natural prebiotics. Prebiotics are known for promoting “good bacteria” in our gut which assists with improving our overall gut health. Prebiotics have been scientifically shown to impact the gut microbiome in healthy people.

Follow My 5 Easy Steps to Keep Your Gut Healthy Like a Pro!

STEP 1: Increase Your Intake of Fruit

Try and eat at least 2 pieces of low FODMAP fruit each day such as strawberries, unripe bananas, grapes, rockmelon, pineapple, oranges and kiwifruit. Choose a variety of different types and colours of fresh fruit that are in season and try using fruit for snacks and desserts. They are a good source of vitamins, including vitamin C, and folate and provide potassium, dietary fibre and carbohydrates in the form of natural sugars. Edible skins are particularly high in fibre, but fibre is also in the fruit flesh.

STEP 2: Increase your intake of Vegetables

Try and eat at least 2.5 cups of low FODMAP vegetables each day such as whole broccoli, spinach, potatoes, carrots, tomatoes, red capsicum, eggplant and bok choy. Include a variety of different types and colours including low FODMAP beans and legumes. Try new ways of cooking with vegetables like roasting, baking, barbequing and stir-frying. Including these in your diet can provide a range of nutrients as they are a good source of vitamins, minerals and dietary fibre.

STEP 3: Include a wide variety of wholegrain breads, cereals and pastas in your diet

These provide more dietary fibre, vitamins and minerals than refined or white versions of grain (cereal) foods. Eating wholegrain and/or high fibre cereal foods will not only keep your gut bacteria happy but can help reduce the risk of heart disease, type 2 diabetes, excessive weight gain, and some cancers. Low FODMAP options include spelt and gluten, wheat and rye free products.

STEP 4: Limit your Intake of Red Meat

Great substitutes are poultry, fish, eggs, tofu, nuts and seeds, and legumes/beans. It is currently recommended that no more that 455g of cooked lean red meat is eaten per week as eating larger amounts can be linked with a higher risk of developing bowel cancer. Eating large amounts of protein from animal sources has also been shown to alter our gut microbiome. This can decrease the amount and diversity of the gut bacteria found in our gastrointestinal tract.

STEP 5: Make Sure you Drink Plenty of Water

Drinking enough water helps make sure that we do not get dehydrated and can also assist with decreasing our risk of constipation. You may have heard a lot about how much water we should drink, such as 8 cups or 2 litres per day, however as we are all different, there is no one amount that is recommended for everyone. The best way to judge if you are drinking enough water is by looking at the colour of your urine. Dark urine likely means that you may be dehydrated and have not had enough fluid, while clear urine means you may be drinking too much. Aim for a pale-yellow colour as this is likely to indicate you are well hydrated.

References

Collins SM (2014). A role for the gut microbiota in IBS. Nature Reviews Gastroenterology & Hepatology. 11: 497-505.
Fraher MH, O’Toole PW, Quigley EMM (2012). Techniques used to characterize the gut microbiota: a guide for the clinician. Nature Reviews Gastroenterology & Hepatology. 9: 312-22.
Gibson PR, Shepherd SJ (2010). Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. Journal of Gastroenterology and Hepatology. 25: 252–258.
Hong SN, Rhee PL (2014). Unraveling the ties between irritable bowel syndrome and intestinal microbiota. World Journal of Gastroenterology. 20: 2470-81.
National Health and Medical Research Council. Eat for Health-Educator Guide. Canberra; 2013:11-23.
National Health and Medical Research Council. Nutrient Reference Values for Australia and New Zealand-Executive Summary. Canberra; 2006.
Sekirov I, Russell SL, Antunes LCM, Finlay BB (2010). Gut microbiota in health and disease. Physiological Reviews. 90: 859-904.