How To Eat Healthy To Manage Bloating On a FODMAP Diet

In Australia, this week in Smart Eating Week which aims to help increase awareness of health and nutrition within the community. We often talk about healthy eating for the general population, but what about those with specific medical conditions needing to follow a specific diet?


In this blog I will focus on irritable bowel syndrome (IBS) and the FODMAP diet. The FODMAP diet can be challenging to follow. I often get new clients, who have tried it own their own, saying that they struggle with limiting the different foods and have been restricting their diet more than they need too. In this blog I will share with you some simple smart eating tips to help you eat healthy and meet all your nutritional needs while on the FODMAP diet.


What are FODMAPs & What is The FODMAP Diet?

IBS is a common functional gastrointestinal disorder that affects 1 in 7 adults or 15% of the population worldwide. It is described by symptoms that are not explained by other conditions such as coeliac disease and inflammatory bowel disease. Through changes to your diet and lifestyle, the nutritional management of IBS aims to improve your quality of life and decrease the frequency and severity of your symptoms.


The dietary cause of the symptoms associated with IBS is largely due to a group of carbohydrates called FODMAPs. This sounds like a really technical word, but it is just an acronym used to describe a group of carbohydrates, or sugars, which are found in a lot of everyday foods including fruit, vegetables, grains and dairy. It stands for;

  • Fermentable

  • Oligosaccharides

  • Disaccharides

  • Monosaccharides

  • And

  • Polyols

Examples of FODMAPs include fructose, lactose, fructans and sorbitol. 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.


The FODMAP diet is a therapeutic diet and is often recommended to those who have IBS. This means that it is actually used as part of the medical management or treatment for those with IBS. A low FODMAP diet can help improve gut symptoms in up to 75% of people with IBS.


Why is Healthy Eating on a FODMAP Diet Important?

When following a low FODMAP diet it is important to 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 of a specialised Accredited Practising Dietitian (APD), such as myself, as we 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 FODMAP diet with the assistance of an APD can get better relief from their symptoms.


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 natural prebiotics. Prebiotics are known for promoting diversity and increase the number of 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. 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.


Healthy eating is also the key to feeling your best, both now and in the long-term. Nutrition plays an important role in the everyday functions of our bodies. Maintaining a healthy diet gives your body the energy and nutrients it requires to function. It also has numerous health benefits including lowering your risk of developing diabetes, heart disease, excessive weight gain and some cancers. A healthy diet can also improve your mental health by improving your mood, increasing your concentration and decreasing feelings of fatigue, anxiety and depression. The best way to get in all the nutrients you need is to eat a variety of low FODMAP foods from the five different groups every day. I will discuss these is detail below.


Healthy Eating on a Low FODMAP Diet – The 5 Food Groups


Vegetables and Legumes

Including these in your diet can provide a range of nutrients as they are a good source of vitamins, minerals and dietary fibre. Vegetables can help decrease the risk of developing some chronic diseases including heart disease and some cancers. They are low in energy/calories, so incorporating a high variety of these into your diet can help to maintain a healthy weight. All vegetables also provide vitamin C. Low FODMAP vegetables including capsicum, broccoli, bok choy and tomatoes are particularly high in vitamin C. Legumes and beans, such as canned lentils, are also a good source of protein, iron, zinc and carbohydrate.


How Much Should You Aim For?

  • Women 19 years old & above = 5 serves per day.

  • Men aged 19-50 years = 6 serves per day.

  • Men aged 51-70 years = 5½ serves per day.

What is a low FODMAP Serve?

  • ½ cup cooked green or orange vegetables

  • Whole broccoli, spinach, carrots or kent pumpkin.

  • ½ cup canned lentils

  • 1 cup green leafy or raw salad vegetables

  • Most lettuce varieties and leafy greens are low FODMAP at this serving size.

  • ½ cup or ½ cob sweet corn

  • ½ medium potato or other starchy vegetables

  • Sweet potato, taro or cassava are low FODMAP at a serving size of ½ cup.

  • 1 medium common tomato

Fruit

Fruit are a good source of vitamins, including vitamin C, and folate and provide potassium, dietary fibre and carbohydrates in the form of natural sugars. As with vegetables, including fruit in your diet each day can help reduce the risk of some chronic diseases, including heart disease and some cancers. They are also low in energy, so including these in your diet can help maintain a healthy weight.


How Much Should You Aim For?

  • Men & Women 19 years old & over = 2 serves per day.

What is a low FODMAP Serve?

  • 1 medium unripe banana or orange

  • 2 small kiwi fruits or mandarins

  • 1 cup diced fruit

  • Cantaloupe, pineapple, strawberries, grapes

  • Or only occasionally: 125ml (½ cup) cranberry juice (with no added sugar)

Grains (Cereal)

Grain foods provide us with a range of different nutrients including carbohydrates, protein, dietary fibre and a wide range of vitamins and minerals including folate, thiamine, riboflavin, niacin, vitamin E and iron. Try and 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 these 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.


How Much Should You Aim For?

  • Men aged 19-70 years & Women aged 19-50 years = 6 serves per day.

  • Women aged 51-70 years = 4 serves per day.

What is a low FODMAP Serve?

  • 1 slice bread

  • Keep in mind that although most breads are low FODMAP at 1 slice, they can become high FODMAP at 2 slices.

  • Low FODMAP options at 2 slices include sourdough, spelt and gluten free white bread.

  • ½ medium roll or flat bread

  • As above regarding low FODMAP options.

  • ½ cup cooked rice, gluten free pasta, gluten free noodles, quinoa

  • ½ cup cooked porridge

  • 2/3 cup low FODMAP cereal flakes

  • ¼ cup fruit free muesli

  • 3 low FODMAP crispbreads or crackers

Lean Meats & Alternatives

These are a good source of protein, iron, zinc and other minerals and B group vitamins. Great substitutes for lean meats are poultry, fish, eggs, tofu, nuts and seeds, and legumes/beans. Just remember that vitamin B12 is only naturally found in animal-based foods, but can also be found in fortified plant-based products. The iron and zinc in animal-based foods is also more easily absorbed by the body than the iron and zinc from eggs and plant foods.


It is currently recommended that no more that 350g of cooked lean red meat is eaten per week as eating larger amounts can be linked with a higher risk of developing chronic diseases such as heart disease, diabetes and 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.


Fish and seafood are sources of long chain omega-3 polyunsaturated fatty acids. Eating fish regularly is linked with a lower risk of heart disease, stroke, dementia and age-related macular degeneration.


How Much Should You Aim For?

  • Women aged 19-50 years & Men aged 51 years & above = 2½ serves per day.

  • Men aged 19-50 years = 3 serves per day.

  • Women aged 51 years & above = 2 serves per day.

What is a low FODMAP Serve?

  • 65g cooked lean meats such as beef, lamb, veal, pork, goat or kangaroo

  • 80g cooked lean poultry such as chicken or turkey

  • 100g cooked fish fillet or one small can of fish

  • 2 large eggs

  • 1 cup or canned legumes/beans such as lentils

  • 170g firm tofu

  • 30g low FODMAP nuts, seeds, peanut butter

Dairy & Alternatives

These are an excellent source of calcium and very few other foods in the Australian diet are as high in calcium as dairy foods. They are also a good source of other nutrients including protein, potassium, magnesium, iodine, riboflavin, zinc and vitamin B12. Eating dairy foods and alternatives also help lower the risk of high blood pressure, heart disease, stroke, type 2 diabetes and some cancers. The best choices for those with high cholesterol are low or reduced fat varieties. Many dairy products also contain prebiotics which means they help to increase the diversity of your gut bacteria and keep your gut microbiome healthy.


How Much Should You Aim For?

  • Men aged 19-70 years & Women aged 19-50 years = 2½ serves per day.

  • Women aged 51 years & over = 4 serves per day.

What is a low FODMAP Serve?

  • 1 cup fresh lactose free milk

  • 2 slices of hard cheese

  • ¾ cup lactose free yoghurt

  • 1 cup soy (made from soy protein) or rice milk with added calcium

15 Smart Eating Tips on a FODMAP Diet

1. Plan ahead and stock up on easy nutritious foods like;

  • Low FODMAP wholegrain cereals and other grain foods.

  • Lactose free milk

  • Canned lentils

  • Eggs

  • Frozen or canned foods without added sugars or added salt

  • This way you can eat at home more often and cook meals yourself by adding fresh ingredients that you know will be low FODMAP.

2. Choose a variety of different types and colours of fresh vegetables and fruits that are in season.


3. Try new ways of cooking with low FODMAP vegetables like roasting, baking, barbequing and stir-frying.


4. Add extra low FODMAP vegetables and legumes to your recipes.


5. Include at least 1-1.5 cups of low FODMAP vegetables with your lunch.

  • Such as whole broccoli, spinach, potatoes, carrots, tomatoes, red capsicum, eggplant and bok choy.

6. Include at least 1.5-2 cups of low FODMAP vegetables with your dinner.


7. Try and eat at least 2 pieces of low FODMAP fruit each day.

  • Such as strawberries, unripe bananas, grapes, cantaloupe, pineapple, oranges and kiwifruit.

8. Add fruit to your breakfast cereal, smoothies or yoghurt.


9. Keep edible skins on your fruit and vegetables.


10. Try having a small handful of nuts or seeds as snacks.


11. Use fruit for snacks and desserts.


12. Include 2 serves of fish or seafood into your diet per week.


13. Include at least 1 or 2 meat-free and plant-based meals each week.

  • You can include eggs, legumes (like canned lentils) and firm tofu, nuts and seeds.

14. Include small amounts of foods rich in unsaturated fats such as;

  • Oils, spreads, nut butters/pastes and avocado.

15. Limit your intake of packaged and processed foods as these can often be high in saturated fat, sodium and added sugar and also hidden FODMAPs.

If you would like some support to take control of your IBS, click here to watch my program video to learn how I can help you eliminate your bloating WITHOUT feeling confused or overwhelmed.

References

  1. Brown K et al (2012). Diet-induced dysbiosis of the intestinal microbiota and the effects on immunity and disease. Nutrients. 4:1095– 119.

  2. Collins SM (2014). A role for the gut microbiota in IBS. Nature Reviews Gastroenterology & Hepatology. 11: 497-505.

  3. Gandy J & the British Dietetic Association. Manual of Dietetic Practice–Fifth Edition. 2014: 460-466.

  4. Gibson PR & Shepherd SJ (2010). Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. Journal of Gastroenterology and Hepatology. 25: 252–258.

  5. Heart Foundation. Dairy and Heart Healthy Eating: Position Statement. National Heart Foundation of Australia; 2019.

  6. Heart Foundation. Meat and Heart Healthy Eating: Position Statement. National Heart Foundation of Australia; 2019.

  7. Hills RD et al (2019). Gut Microbiome: Profound Implications for Diet and Disease. Nutrients. 11:1613.

  8. National Health and Medical Research Council. Eat for Health-Australian Dietary Guidelines. Canberra; 2013.

  9. National Health and Medical Research Council. Eat for Health-Educator Guide. Canberra; 2013.

  10. National Health and Medical Research Council. Nutrient Reference Values for Australia and New Zealand-Executive Summary. Canberra; 2006.

  11. 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.

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