Category: Food Intolerance

How To Manage Diarrhoea

What is Diarrhoea?

Diarrhoea is a relatively common digestive issue that most people will experience at some stage throughout their lives. Diarrhoea is when we pass loose or watery stools more than 3 times a day, or more often than what is normal for you. It can range from being mild to severe and is some cases even life-threatening due to dehydration. Diarrhoea related illnesses are one on the highest causes of death worldwide. There are a few factors that can contribute to the occurrence of diarrhoea including changes to diet and lifestyle, medical conditions, stress and anxiety, infection and some medications.

Diarrhoea occurs when our intestines are unable to properly absorb the nutrients and fluid during digestion. The nutrients in the food that we eat are absorbed in our small intestine. The undigestible parts of our food then pass through to the large intestine, or colon, which absorbs most of the remaining fluid. The remaining waste is then formed into stools and collects in the end of the colon and rectum and passed out of the body during a bowel movement.

Diarrhoea can be described as being either acute or chronic. So, what’s the difference?

Acute diarrhoea: This occurs suddenly and is when we experience 3 or more loose watery stools a day which lasts for less than 2 weeks. Most of the time acute diarrhoea will resolve itself after 1-2 days. It is usually treated by replacing any fluid or electrolytes that have been lost.

Chronic diarrhoea: This is when we have had diarrhoea lasting more than 4 weeks. Chronic diarrhoea may be caused by an underlying condition such as inflammatory bowel disease (IBD), coeliac disease or irritable bowel syndrome (IBS).

What is Functional Diarrhoea?

What this means is that there is not a physical or physiological cause for your diarrhoea. A person may be otherwise healthy, however despite this, is still having trouble with experiencing a normal bowel movement. Although the prevalence of functional diarrhoea hasn’t been well studied, it is reported to occur in 1.5% to 17% of people. It is characterised by ongoing loose watery stools that do not meet the criteria for IBS, however you may experience abdominal pain or bloating.

Once other conditions have been ruled out a set of diagnostic criteria called the Rome IV Criteria for Diagnosing Functional Diarrhoea will be used to confirm if you have this. This includes whether you have had;

  • Loose or watery stools occurring in more than 25% of stools without predominate stomach pain or bloating.

You must also meet the following;

How Often Should I Have a Bowel Movement?

This is a question that I get asked quiet frequently by my clients. What is considered normal can be different from person to person as everyone’s gut and lifestyles are different, but it can range from multiple times per day to three times per week.

What’s important to remember is that occasional changes to your bowel habits are normal and having more frequent bowel movements does not mean that you have diarrhoea, as long as you are not experiencing any pain and are following your usual bowel habits. You only need to keep an on eye out for it if you start experiencing changes to your bowel habits. As I have mentioned, everyone is different, so if you have been having more than what’s “normal” for you, it may mean that you have diarrhoea.

How Do I Know if My Stools Are Normal?

The Bristol Stool Chart below is a great tool to use help you figure out if your stools are healthy or if there is anything to be concerned about. It shows the different types of stools that you can have.

  • Types 1 or 2 indicate that you have constipation.
  • Types 3 and 4 are healthy stools.
  • Type 5 means that your stools are progressing towards diarrhoea.
  • Type 6 or 7 indicate that you have diarrhoea.

Bristol Stool Chart

Symptoms of Diarrhoea

There are so many different symptoms that can be experienced with diarrhoea and it’s important to remember that these will vary from person to person.

Common symptoms can include;

  • Frequent loose, watery stools
  • Urgency to have a bowel movement
  • Bloating
  • Abdominal pain or cramps
  • Nausea
  • Vomiting

Serious symptoms can include;

  • Blood in your stools
  • Fever
  • Pus in your stools
  • Painful bowel movements
  • Ongoing vomiting
  • Unable to keep fluids down

Causes of Diarrhoea

Causes of Acute Diarrhoea

  • Stress and anxiety
  • Gastroenteritis
  • Food poisoning
  • Viruses such as calici virus, adenovirus and rotavirus
  • Travelling, this is sometimes referred to as “travellers’ diarrhoea”
  • Tropical diseases such as typhoid and cholera
  • Bacteria such salmonella, campylobacter and shigella
  • Parasites such as giardia lamblia, cryptosporidium and tapeworm
  • Alcohol
  • Caffeine
  • Medications such as antibiotics which have short-term use

Causes of Chronic Diarrhoea

  • Food Allergies
  • Food intolerances such as lactose intolerance
  • Irritable bowel syndrome, particularly IBS-D
  • Bile acid malabsorption
  • Coeliac disease
  • Inflammatory bowel disease (crohn’s disease or ulcerative colitis)
  • Chronic constipation
    • This can cause the bowel to become blocked with hard stools. This can lead to the bowel leaking watery stools around the blockage. This is called overflow diarrhoea.
  • Hormonal disorders such as hyperthyroidism & diabetes
  • Bowel Cancer
  • Medications including antibiotics, antacids that contain magnesium, laxatives and those to treat cancer

My Expert Tips to Help You Manage Diarrhoea

  1. Choose foods that are high in soluble fibre.
    • These include oats, high-fibre cereals, barley, white bread, white rice, pasta and bananas.
    • Peel the skin off fruit and vegetables.
    • Soluble fibre slows digestion which helps with absorbing excess fluid in your bowel and makes your stools firmer.
  2. Eat foods with protein every day.
    • Choose lean meats including chicken and beef, fish, eggs and tofu.
  3. Drink plenty of fluids to avoid dehydration.
    • This can include water, diluted juice or cordial and herbal teas.
    • Drink them at room temperature.
    • If you are experiencing severe diarrhoea, oral rehydration solutions such as Hydralyte may be helpful.
  4. Eat small, frequent meals throughout the day rather than large meals.
    • Try to eat every 2-3 hours.
    • Be sure to include a range of foods from all the 5 food groups including grains, proteins, dairy and alternatives, peeled fruit and vegetables.
  5. Take time to relax and decrease stress and anxiety.
    • This can include relaxation tapes, yoga, or massage as these may help improve gut symptoms.
    • Try gentle exercise such as walking.
  6. Avoid alcohol, juice, soft drinks and caffeinated drinks such as tea and coffee.
  7. Reduce your intake of insoluble fibre.
    • Avoid unpeeled fruits and vegetables, bran, wholemeal bread, wheat-based cereals, brown rice, dried beans, nuts and seeds.
    • You can replace wholegrain breads and cereals with white versions of these.
  8. Fibre supplements containing soluble fibre may also be helpful.
    • These include psyllium, oats and methylcellulose.
    • Make sure to increase your intake of these slowly.
  9. Limit your intake of high fat and spicy foods.
    • Avoid take-away and deep-fried foods, pastries, cream sauces, chips, butter and sausages.
    • Avoid foods with chilli in them.
  10. Avoid “sugar free” foods and those with artificial sweeteners such as chewing gum and lollies.
  11. Try a probiotic. Although everyone is different and what works for one person may not work for another, there is some evidence to suggest that probiotics containing Bifidobacterium infantis 1×108 may help improve diarrhoea.
  12. Manage any underlying conditions that may be contributing to your diarrhoea such as IBD or speak with your doctor about investigating and eliminating any potential medical conditions that may be causing your diarrhoea.
  13. If you have IBS go back to basics by following the low FODMAP diet until your diarrhoea has improved.
  14. Speak with an Accredited Practising Dietitian to get tailored advice and management strategies to improve your diarrhoea.
  15. If diarrhoea is severe you may need anti-diarrhoeal medication. Make sure to speak with your doctor to see which is most suitable for you.

If you’re struggling with diarrhoea and aren’t sure what to eat, I show my clients step by step how to follow the FODMAP diet to eliminate diarrhoea 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.

References

  1. Bijkerk CJ, Muris JWM, Knottnerus JA, et al (2004). Systematic review:the role of different types of fibre in the treatment of irritable bowel syndrome. Alimentary Pharmacology & Therapeutics. 19:245–51.
  2. Chey WD, Kurlander J & Eswaran S (2015). Irritable bowel syndrome: a clinical review. The Journal of the American Medical Association. 313:949-58.
  3. Drossman DA (2016). Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features, and Rome IV. Gastroenterology. 150:1262–1279.
  4. Gandy J & the British Dietetic Association. Manual of Dietetic Practice–Fifth Edition. 2014: 420-467.
  5. Gorbach SL (1997). Treating diarrhoea. BMJ. 314(7097):1776-7.
  6. Lacy BE, Mearin F, Chang L et al (2016). Bowel Disorders. Gastroenterology. 150:1393-1407.e5.
  7. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC (2006). Functional bowel disorders. Gastroenterology. 130: 1480–149.
  8. National Health and Medical Research Council. Eat for Health-Australian Dietary Guidelines. Canberra; 2013.
  9. 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.
  10. Schmulson MJ & Drossman DA (2017). What Is New in Rome IV. Journal of Neurogastroenterology and Motility. 23(2): 2093-0879.
  11. Thomas PD, Forbes A, Green J et al (2003). Guidelines for the investigation of chronic diarrhoea, Second edition. Gut. 52(Suppl V): v1–v15.
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Gluten Free, Low FODMAP Banana Muffins with Lemon Icing

Makes 12Muffins
Gluten Free
Dairy Free
Low FODMAP
Vegetarian
Low Natural Food Chemical Option Available

Ingredients:

Cake:
125g Nuttelex Lite (or other dairy free spread)
¾ cup raw sugar
2 eggs
2 cups mashed ripe bananas (around 4 bananas)
1 tsp baking soda
2 tbsp hot rice milk
2 cups gluten free plain flour
1 tsp baking powder

Icing:
2 cups icing sugar
¼ cup softened Nuttelex Lite (or other dairy free spread)
2 tbsp lemon juice
1 tsp grated lemon rind

Method:

  1. Preheat oven to 180ºc.
  2. Cream butter and sugar until light and fluffy.
  3. Add eggs one at a time, beating well after each addition.
  4. Add mashed banana and mix thoroughly.
  5. Stir baking soda into hot milk and add to creamed mixture.
  6. Sift flour and baking powder and fold into mixture.
  7. Lightly grease a 12-hole muffin tray and fill holes evenly with mixture, around 2/3 of the way.
  8. Place in the oven and cook for 15-20 minutes or until golden brown.
  9. Remove from oven, allow to cool in the tray for 5 minutes, then place on a cooling rack until completely cooled.
  10. Sift icing sugar into a bowl.
  11. Add Nuttelex.
  12. Add enough lemon juice so that it is a spreadable consistency when mixed.
  13. Add lemon rind and mix.
  14. Ice each muffin, use around a 1 tbsp quantity per muffin.
  15. Serve and Enjoy!

Tips:

  1. To make this recipe low in natural food chemicals;
    • Swap the banana for tinned pears in syrup or poach 4 pears until soft and mash.
    • Replace lemon juice and lemon rind in icing for 1 tsp of citric acid or serve without icing.
  2. Once cooled these store really well in the freezer in either a zip lock bag or airtight container, just leave the icing off.
  3. If you are wanting a simpler version of this, you can replace the baking soda, rice milk, baking powder and plain flour with gluten free self-raising flour.

Nutritional Information (Per Serve):

nutrition info

Food Group Servings (Per Serve):

food group info

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.

Cashew & Chive Hummus (Low FODMAP Option)

Serves 10Dip
Gluten Free
Dairy Free
Low Natural Food Chemical
Vegetarian & Vegan
Low FODMAP Option Available

Ingredients:
½ cup unsalted cashews
1 x 420g can chickpea, rinsed and drained
1 tbsp fresh chives
¼ cup rice bran oil
¼ cup water
Pinch of salt

Method:

  1. Place all ingredients into a food processor and process on high until blended together and smooth.
  2. Serve and Enjoy!

Tips:

  1. Serve this dip with some tasty wholegrain crackers and/or vegetables sticks.
    • Peeled carrot, cucumber and celery are great moderate natural food chemical choices.
    • If you are very sensitive, celery is a low food chemical option.
  2. This dip is also great to use in sandwiches in the place of butter or margarine.
  3. To make this recipe low FODMAP;
    • Either remove the cashews or replace them with unsalted peanuts.
    • Keep your serving size to ¼ cup or less.

Nutritional Information (Per Serve):

nutrition 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.

Chicken Carbonara (Low FODMAP Option)

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

3  4

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:

  1. Drizzle oil in large fry pan and place chicken and cook on medium heat until browned.
  2. While chicken is browning put water in a pot and bring to the boil. Once boiled add pasta and cook until al dente.
  3. Add vegetables to fry pan with chicken and cook until soft.
  4. 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.
  5. Drain pasta and add to fry pan.
  6. Stir pasta through chicken, vegetable and cream sauce until well combined.
  7. Serve and enjoy!

Tips:

  1. 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.
  2. To make this recipe low in natural food chemicals, simply remove the mushrooms as these are high in glutamate.
  3. 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.
  4. 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

  1. 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
  2. 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
  3. 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.
  4. 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.
  5. Royal Prince Alfred Hospital, Allergy Unit (2011). RPAH Elimination Diet Handbook with Food & Shopping Guide.
  6. Royal Prince Alfred Hospital, Allergy Unit (2016). Food Challenge Instructions Booklet.
  7. 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
  8. 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 4Roast Vegetables
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:

  1. 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.
  2. Place your favourite vegetables on a baking tray covered with baking paper and drizzle with olive oil and sprinkle with salt.
  3. Bake on high (around 220ºc) for 30-40 minutes or until golden brown.
  4. 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

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.

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:

  1. In a large saucepan place oil, parsley and spring onion. Cook until softened.
  2. Add beef mince and cook until browned. Use a wooden spoon to break it up into small pieces.
  3. Add cut carrot, potato and frozen peas. Stir well to combine.
  4. Add beef stock and cook until vegetables are tender. Add salt and pepper to taste.
  5. 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.
  6. Turn saucepan off and allow to cool slightly.
  7. Pre-heat oven to 220 degrees Celsius.
  8. Once cooled, place ¼ of the mixture onto one half of each puff pastry sheet, allow 1.5 cm around the outside edges.
  9. Wet your fingers and use them to wet the outside edges of your pastry.
  10. Fold puff pastry sheet in half and use a fork to press the edges together to encase your filling.
  11. Place on a tray lined with baking paper.
  12. 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.
  13. Place in oven and bake for 20-30 minutes or until golden brown.
  14. Serve & Enjoy!

Tips:

  1. Serve these delicious pasties with mashed potato and steamed vegetables of your choice.
  2. 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.
  3. 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

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.

Gut Lovin’ Pear Smoothie (Lactose Free Option)

Makes 2 Smoothies
Gluten Free
Low Natural Food Chemical
Lactose Free & Dairy Free Options Available

Ingredients:
250ml low fat milk
1 x 200g tub probiotic yoghurt such as Vaalia
2 x peeled pears

Method:

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

Tips:

  1. If you require a dairy free option, use dairy free alternatives for the milk and yoghurt, such as Rice or Soy Milk fortified with calcium and soy yoghurt.

To keep this low in natural food chemicals, avoid products made from coconut as this is high in natural food chemicals and unfortunately usually do not have added calcium.

2. If you require a lactose free option, use lactose free alternatives for the milk and yoghurt.

Nutritional Information (Per Serve):

Pear Smoothie Nutritional Information 2

Food Group Servings (Per Serve):

Food Group Table

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.

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:

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

Tips:

  1. To make this recipe low FODMAP, use lactose free alternatives for the milk and yoghurt and an unripe banana.
  2. To make this recipe dairy free, use soy alternatives for the milk and yoghurt.
  3. 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

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.

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.

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.

References

  1. 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
  2. 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
  3. 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
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  5. 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
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  10. 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.
  11. Morris DH & and Stare FJ (1993). Unproven diet therapies in the treatment of the chronic fatigue syndrome. Archives of Family Medicine. 2(2).
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  13. 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.
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  15. 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.
  16. 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.
  17. Wüthrich B (2005). Unproven techniques in allergy diagnosis. Journal of Investigational Allergology and Clinical Immunology. 15(2): 86-90.