FODMAP elimination
FODMAP elimination is the first step you will take in managing your gut symptoms. This step is all about reducing FODMAPs in your diet to get relief from your symptoms as well as the other gut related symptoms such as feeling awful and, fatigue and reflux.
​
A common misconception is that we are getting FODMAPs out of the diet- but this is not strictly true. We are just reducing the FODMAPs to a more manageable level to help reduce your gut symptoms.
​
The level of FODMAPs is reduced as per cut offs worked out by the Monash Low FODMAP diet. These cut off limits are set very conservatively so that MOST people who are FODMAP sensitive will get a good outcome and more manageable symptoms.
Having a realistic expectation is important here, as our guts are designed to get a bit windy and overly full sometimes, depending on what we eat. We are looking at managing the symptoms that get in the way of living your life, that stop you from doing normal activities. We are not looking for an absence of symptoms as having a normal gut means it will vary and have symptoms from time to time.
Having said that, going on the low FODMAP journey has helped hundreds of thousand of people (ok there are not definite estimates here, but a lot!!) reduce and manage their symptoms, identify their triggers and reintroduce foods to a level that can be tolerated.
​
At the end of the day, you can still choose to eat and drink high FODMAP foods/fluids but you can have the knowledge and experience to make these decisions, and to know when you do get symptoms, what it was that likely set you off.
​
And the best thing? If you are FODMAP sensitive, you can get results VERY QUICKLY! With a well constructed Low FODMAP diet- you can potentially see results within days or within a week. Without good advice, FODMAPs can creep in (naughty FODMAPs!) and make the process a longer than it should be.
Do it once- do it well (and make it easier).
​
The next steps are Challenges to identify the foods causing your symptoms followed by Reintroduction of foods. People tend to enjoy these stages as involves knowing what is going on and bringing foods back in.
​
Reducing FODMAPs in your diet
Low FODMAP elimination = the first step of your FODMAP journey. This is great as when you have the knowledge of how to do this, along with all the hacks to make this easier, you have a good chance of seeing results quickly.
​
The diet can seem overwhelming at first- which is why getting some help is so useful to getting it done properly.
​
Remember: FODMAPs are taken out as a collective- the truth is that you may in fact be fine with some of the sub groups but we won't know this until we can do the food challenges. Everything until this point is a best guess- food trials give clarity and more certainty as to your triggers.
Get the MONASH UNI Low FODMAP APP
First thing to do is get the Monash University Low FODMAP app.
The app is based on a traffic light system, so a green dot means that you can include this food in your Low FODMAP eating plan.
There are some foods that are moderate (orange dot) or high (red dot) in FODMAPs for a normal serve but in reduced amounts are Low FODMAP so can be included in your diet at these reduced levels.
There are some pointers around how to do this to make it so much easier which is why getting a Specialist Dietitian involved can be really worthwhile.
SWAP HIGH FODMAPS for LOW FODMAPS
Sounds easy but requires some pointers to help make this happen.
​
Low FODMAP FRUIT:
Swap out high FODMAP fruits such as apples and stone fruit like plums and apricots for low FODMAPs: based on the Monash app you will see that there are some choices of Low FODMAP fruits:
​​​
-
oranges and mandarins
-
blueberries
-
kiwi fruit (great for constipation)
-
just ripe bananas (avoid black spots, if a bit spotty- just have less one third of the too ripe banana)
​
Some high FODMAP fruits can still be consumed but in Low FODMAP - as the app is being constantly updated, I wont give examples here.​
​
Low FODMAP VEGETABLES:
​
Swap out high FODMAP veg such as cauliflower for low FODMAPs: based on the Monash app you will see that there are some choices of Low FODMAP vegetables.
-
Potato
-
Carrot
-
Lettuce and greens such as spinach
-
Parsnip
-
Broccoli heads
-
Tinned beetroot
​
Onion & Garlic
The advice is always to avoid onion and garlic, even as small amounts added to sauces and as minor ingredients in food products such as stock. This is probably a more tricky part of the diet as onion and garlic is used as a minor ingredient in many food products from most flavoured crisps to many sauces and pre made foods.​
​
Breads and Cereals
The Low FODMAP diet does not mean a gluten-free diet, as small amounts of wheat can be included in the diet as long as low FODMAPs. For people who feel they do not tolerate wheat, then specific gluten-free products can be used.
​
NOTE: just because the food is gluten free does not mean it is Low FODMAP as can have high FODMAP ingredients such as dried fruit, inulin, soy flour (think San Remo GF pasta), legume flours
​​
​Sour dough bread (not made from rye unless certified Low FODMAP is usually well tolerated if gluten is tolerated: just keep to 2 slices of bread in a sitting and wait 3-4 hours before having more or other Low FODMAP wheat foods.
# Watch out for wraps: many have high FODMAP ingredients such as soy flour/ legume flour as well as inulin, choose corn based eg corn tortillas​
​
Meats, Seafood, Eggs, Oils
-
Meats/chicken when in their plain state (i.e. no sauces, not made into a patty or sausage) are naturally low FODMAP as they don't contain carbohydrates (to be a FODMAP- needs to be a carbohydrate)
-
The same can be said about fish, eggs and oils
-
BUT- when ingredients are added to them- they can be high FODMAP for example onion or garlic added to sausages or patties, or a garlic aioli/sauce added to fish seafood
​
Legumes
Most legumes are high in FODMAPS (GOS) but there is some good news here, but some have reduced serves that suit a Low FODMAP diet.​
Nuts and Seeds
-
There are loads of nuts and seeds that are Low FODMAP- suffice to say to stay away from cashews and pistachios (your favourite- I know!), and keep almonds "10 at a time and repeat 3 hours later limit". All the other nuts and nut pastes are fine, and I am talking pastes like peanut paste and almond paste
-
All the seeds are great- chia | pepitas | all the seeds you can think of
​
Dairy/lactose
-
Choose lactose-free milk
-
Cheese: don't worry about cheese as virtually no lactose- only limit amounts of unripened cheeses such as cream cheese (lactose free available), ricotta and cottage cheese
-
Cream/sour cream: if using less than 2 TBSP then normal is fine, but if having more per serve then lactose-free is a good idea
-
Yoghurt: lactose-free choices available
​
# Dairy free: soy milk made from soy protein (not soy beans), almond milk, 1/2 cup oat milk, and coconut milk is limited but the serve size usually comes under when used for example in curries
Processed Foods: processed foods such as SAUCES can be a bit of an issue as tend to contain onion and garlic.
# Some brands can be identified as Low FODMAP - find out which brands of sauces are low in onion/garlic.
GET SPECIALISED HELP
​
There are so many ways to make this short term diet elimination easier to do, knowing you can eat some sourdough breads (unless you need to be gluten free), that you don't need to buy lactose-free cheese (unless is unripened i.e. cream cheese/ricotta/cottage cheese); there are certain brands of processed foods such as some sauces, some crisps/corn chips that are onion- and garlic-free; how to use legumes, which meats to be suspicious of eg sausages/patties/marinades and easy recipes that are Low FODMAP and up to date with the latest Monash Low FODMAP app information.
​
Get your gut calm- quickly: bring it together in a personalised diet- tweaking your current diet to make it low FODMAP- and the implementation turns from hard to very doable.
​
Within 3-7 days- your gut could be so much improved. That quick. Do it once- do it right.
​
I look forward to working with you
​
Frances Walker.
REFERENCES
​
Yao, C. K., and Tuck, C. J. (2017) The clinical value of breath hydrogen testing. Journal of Gastroenterology and Hepatology, 32: 20–22. doi: 10.1111/jgh.13689.
​
Gibson, P. R. (2017) The evidence base for efficacy of the low FODMAP diet in irritable bowel syndrome: is it ready for prime time as a first-line therapy?. Journal of Gastroenterology and Hepatology, 32: 32–35. doi: 10.1111/jgh.13693.
​
Barrett, J. S. (2017) How to institute the low-FODMAP diet. Journal of Gastroenterology and Hepatology, 32: 8–10. doi:
​
Tuck, C., and Barrett, J. (2017) Re-challenging FODMAPs: the low FODMAP diet phase two. Journal of Gastroenterology and Hepatology, 32: 11–15. doi: 10.1111/jgh.13687.