Friday, 21 October 2016

NEW US RESEARCH: The Low FODMAP diet superior for the relief of abdominal pain and bloating

The Low FODMAP Diet & mNICE Diet Compared

By Dr Jane Varney

An interesting study was published by our colleagues at the University of Michigan this week (1). The US study compared the effect of two dietary interventions on IBS symptoms in people with diarrhoea predominant IBS (IBS-D). The interventions in question were the low FODMAP diet and a more traditional dietary approach, known as mNICE (modified guidance from the National Institute for Health and Care Excellence).

Ninety-two eligible subjects were recruited into the study, all of whom had IBS-D and most of whom were female (71%). Participants were randomised to either a low FODMAP diet or the mNICE diet for 4 weeks. Because this was also not a feeding study, a dietitian taught participants how to follow their respective diets, but participants were required to put this advice into practice and prepare their own meals. Resources developed at Monash and Michigan Universities were used to teach participants how to follow the low FODMAP diet. Guidance given to the mNICE group included to eat small frequent meals, to avoid trigger foods and to avoid excess alcohol and caffeine. This guidance was considered ‘modified’, because high FODMAP foods were not specifically excluded as would typically be the case on this diet.


The study revealed a number of interesting findings:

·         The diets were equally effective at providing ‘adequate relief’ of overall IBS symptoms, with improvements experienced in 41% of participants in the mNICE group and 52% of participants in the low FODMAP group.

·         More participants in the low FODMAP group experienced an improvement in abdominal pain, 51% versus 23%, p=0.008.

·         The greatest benefit of the low FODMAP diet was for relief of abdominal pain and bloating, with improvements in stool consistency, stool frequency and urgency also observed in this group.

Take home messages:

·         The low FODMAP and mNICE diets improve symptom control in roughly half of all people with IBS-D.

·         The low FODMAP diet may be a superior choice for the relief of some symptoms, namely abdominal pain and bloating
  1. Eswaran SL, Chey WD, Han-Markey T, Ball S, Jackson K. A Randomized Controlled Trial Comparing the Low FODMAP Diet vs. Modified NICE Guidelines in US Adults with IBS-D. Am J Gastroenterol. 2016.

Tuesday, 18 October 2016

Including Legumes on a Low FODMAP Diet

By Lyndal McNamara (Dietitian)
Legumes (otherwise known as pulses) include all types of beans, peas and lupins. The health benefits of regular consumption of legumes are well known (see table 1), predominately because they are low in saturated fat, have a low GI, are an excellent source of dietary fibre and contain a variety of phytochemicals (natural plant chemicals with health promoting effects).

Table 1: Health Benefits of Legumes

Nutritional characteristic

Associated health benefits

High in dietary fibre

-          Can assist with weight management by promoting a feeling of fullness after eating

-          Contain insoluble fibre, which adds bulk to stools and assists with preventing constipation

-          Contain soluble fibre, which assists in maintaining healthy blood glucose and cholesterol levels

-          Contain prebiotic fibre, which is fermented by colonic bacteria to short chain fatty acids and promotes overall digestive health

High in phytochemicals

-          Contain antioxidants and other bioactive compounds, which help to protect the body against disease

Low glycaemic index (GI)

-          Contain slowly digested carbohydrates, that improve blood glucose control and insulin response in those with diabetes and reduce risk of diabetes in healthy people

High in protein

-          Legumes are a great non-animal source of protein for vegetarians and vegans

Low in saturated fat

-          Assist with maintaining healthy cholesterol levels and reducing risk of cardiovascular disease

References: please see an extensive list of references on the Grains & Legumes Nutrition Council (GLNC) website

Legumes on a Low FODMAP diet

For those following a low FODMAP diet, legumes can be a troublesome food because they are naturally high in oligos; including galacto-oligosaccharides (GOS) and fructans.

The good news is that legumes do not need to be strictly avoided by people following a low FODMAP diet, with suitable ‘green’ serve information available for many legumes on the Monash app.

Because oligos dissolve in water, cooking and processing methods can affect the FODMAP content of legumes. For example, canned legumes or those that have been boiled and drained tend to be lower in FODMAPs as some oligos ‘leach’ out into the canning/cooking water and are removed when they are drained and rinsed. Read more here 

Dietary Recommendations for Legumes

The GLNC recommends enjoying legumes 2-3 times per week for maximum health benefits. Here are some suggestions for how to easily incorporate more legumes into a low FODMAP diet:

- Add a small can (125g) of chickpeas to stir-fries or curries – try this ‘low FODMAP Vegan Coconut & Pumpkin Curry’

- Substitute half of the meat in bolognaise sauce/casseroles for canned lentils- try this ‘low FODMAP slow cooked Lamb Casserole’:

- Sprinkle ¼ cup (53g) of cooked mung beans (boiled & drained) over salads  

- Add canned butter beans to homemade soups or stews

- Mix ¼ cup (42g) canned chickpeas with a small tin of tuna for a protein and fibre rich snack

- Add legumes to homemade dips- try this ‘Roasted Red Pepper & Pumpkin Hummus’

- Top an egg on toast for breakfast with homemade baked beans (using ¼ cup (35g) canned butter beans per person)

- Substitute meat in Asian style dishes for firm tofu or tempeh- try this low FODMAP ‘Marinated Tofu with Asian Greens and Rice’ or ‘Hot & Sour Asian Soup’:


Friday, 14 October 2016

Quinoa Porridge with Banana & Yoghurt

By Shirley Webber (Research Dietitian)
Looking for a gluten free low FODMAP breakfast. Here is a nutritious option to help boost your morning energy.

  • 125 ml water
  • 250ml lactose free milk (low fat alternative if tolerating lactose)
  • 50g quinoa flakes (raw) or 160g cooked
  • 1 banana
  • 50g lactose free yoghurt or if tolerating dairy opt for a plain low fat Greek yoghurt
  • 1 tsp maple syrup
  • Sprinkle of cinnamon (optional)


Energy total




Fat total

-          Saturated














1.       In a small saucepan, bring the water and half of the milk to the boil on the stove, then add your quinoa flakes, Turn the heat down to low and allow to simmer for approximately 5 minutes.

2.       Meanwhile slice 1 medium banana and set aside.

3.       When the quinoa reaches a thickened consistency pour into a bowl and top off with the remaining milk. Add the yoghurt and banana with a drizzle of maple syrup. Sprinkle some cinnamon over the quinoa porridge for extra flavour.


Tuesday, 11 October 2016

FODMAP Stacking – can I overeat “green” foods??

By Dr Jaci Barrett (Dietitian)

With the increasing amount of detail we share with you via our Monash University low FODMAP diet app, we are getting more and more questions about FODMAP stacking. Green foods on the app are low FODMAP and are therefore suitable on a low FODMAP diet, but more detail is provided in the app for some low FODMAP foods, where we reveal an upper limit serving size when the food then becomes red and therefore high FODMAP.
Broccoli and zucchini are good examples of this:
A standard serve of broccoli is ½ cup, which is low FODMAP and suitable for a low FODMAP diet. But you can see further details are given, revealing that large servings, >1 cup, contain high levels of the oligosaccharides and sorbitol.
For zucchini, a standard serve is ½ cup, also low in FODMAPs, with large servings >100g, high in fructans.
The important thing to know is that not all green foods have upper limit serving sizes. Most green foods are low FODMAP, even in very large serves. If there is no upper limit noted in the app, then you can safely eat a large amount. This is the case for vegetables such as carrot. Eggplant is green, but when you click on it you will see that very large quantities are amber due to a moderate amount of sorbitol.
The questions that come with this information are around FODMAP stacking. Can I eat ½ cup broccoli, ½ cup zucchini and 1 cup of eggplant all of which are green in these quantities? Are they still green if consumed together in the one sitting? Is there an additive effect?
For the vast majority of IBS patients following a low FODMAP diet, this sort of example will be tolerated. Even if the total FODMAP content goes above the green limit, most people manage to eat amber and even the lower limit of red serves of foods. Should you FODMAP stack during the initial 4 week strict low FODMAP dietary trial? You should feel comfortable eating reasonable portions of green foods in one sitting, but don’t be disheartened if you eat a larger amount. It will not undo all your good work. Most people won’t get symptoms from these type of foods. It’s the really high FODMAP foods that create the most havoc, such as onions, dried legumes and pears.
For foods with upper limit serving sizes, you can modify your meals to ensure your serving size is controlled. Broccoli soup is unlikely to be well tolerated if it is made purely out of broccoli and you eat 2 cups of it. But a modification of the recipe to bulk the broccoli out with parsnip, potato and carrot (all of which are green regardless of how much you eat), the end result will be a low FODMAP broccoli soup. Similarly, if you consider using zucchini strips as a pasta replacement, you just might want to watch how much you use. Keep it to a small zucchini (<100g), add your low FODMAP pasta sauce and serve it with a low FODMAP red cabbage (amber but OK if you don’t eat too much) and parmesan salad – YUM! Recipe coming in the following weeks!
In the end, we want you to remember that a low FODMAP diet should include green and amber foods (and for some people even some red foods). So, you can consume larger servings of foods that may bring them into moderate or high FODMAP levels as long as you don’t experience any nasty symptoms. The diet should be relaxed over time and we hope that the detailed information we share with you through the app will help you to achieve this.
We are more than happy to provide some guidance with further FODMAP stacking questions. What sort of food combinations have you been concerned about? Post them on facebook and we will provide some guidance on whether they are OK, and how you could modify your meal to lower the FODMAP content.

Friday, 7 October 2016

Not just another stir fry!

By Marina Iacovou (PhD Candidate and Accredited Practising Dietitian)
Following on from our recent blogpost of a low FODMAP stir-fry recipe, keep in mind that a stir-fry is one of those dishes that can be made in many different ways – to suit all tastes and tolerance levels. A stir-fry may be made low FODMAP to start with, but when symptoms are well-controlled and you are ready to re-introduce foods into your diet, add in a moderate-FODMAP ingredient and continue to monitor your symptoms. If well tolerated, next time include another ingredient from the moderate-high FODMAP group. When you get started with re-introducing foods into your diet, you may like to try an ingredient you have missed eating for some time, or work with your dietitian to create a list of ingredients to be re-introduced first.
Stir-fries can be made to suit vegans, vegetarians, pescatarians and meat-eaters – the options are many.  Some other dishes that can be adapted in the same way include, pizza, wraps consisting of a variety of meats, tofu and vegetables, and baked potatoes. See link for a previous blogpost on baked potatoes
Below is a list of the many ingredients you may include from the green serves (low FODMAP), the amber serves (moderate FODMAP) and the red serves (high FODMAP) for a stir-fry that suits your tastes and tolerance-level. All of these and more can be found in our Monash University low FODMAP diet app.

Low FODMAP (green)
Moderate FODAMP (amber)
Snow peas (7 pods)
Green beans
Button mushroom (1/2 tablespoon)
Firm Tofu
Savoy cabbage (3/4 cup)
Hazelnuts (20 nuts/30g)
Peas (18)
Spring onion (green part)
High FODMAP (high)
Lemon / lime juice
Spring onion / shallots
Oyster sauce
Bean sprouts
Bok choy
Snow peas (10 pods)
Choy sum
Red cabbage
Silken tofu
Snow peas (5 pods)
Almond / cashews
Mung beans

You may also like to include white, basmati or brown rice as the base to your stir-fry dish. Alternatively, try rice based noodles such as rice vermicelli.
Flavour with chilli, a variety of herbs and spices and garlic infused oil - for example, some ginger or galangal and lemongrass with coriander. You may also like to add, soy sauce, oyster sauce or a sweet and sour sauce. There are many ways to flavour a stir-fry and other dishes – it all depends on your preference.
Here are some images of a stir-fry I created at home which included a number of low FODMAP and moderate FODMAP ingredients, flavoured with ginger, coriander, an Asian stir-fry sauce and lime, served with basmati rice.


Please feel free to share your ingredient ideas for a stir-fry with us and others – not all stir-fries need to be the same.