Tag Archives: low FODMAP

What are the ‘milk’ choices that suit bowel function?

Many people are unsure whether or not they are better off using dairy milk or a dairy alternative. A number of options exist now with more appearing all the time. Dairy milk provides a range of nutrients that other non-dairy milks do not have. Many products add vitamins and minerals to improve the nutrient profile of their product and many don’t so don’t assume you are getting an alternative with a similar nutrient profile.

As a general rule if you are not opposed to drinking dairy milk there are significant nutritional benefits to doing so and lactose-free milk and yoghurt are readily available. There is negligible lactose in hard/yellow cheese such as chedder or parmesan so these can be eaten by those who consider themselves lactose-intolerant.

Lactose-free dairy milk is regular dairy milk with the lactose pre-split by added lactase enzyme so you don’t have to do this in your gut making for easy digestion of this milk. Lactose-free milk meets the digestibility requirement for the low FODMAP diet.

For those who prefer a non-dairy milk there are a range of options that will also meet these digestibility criteria at the serve size listed below though each differs in terms of nutrients like protein and calcium. Take a look at the nutrients per 100 gm on the nutrition information panel and compare the milks you are interested in so you can choose the one with the higher protein and calcium values.

Soy milk made from Soy protein, not whole soy bean  – 250 ml

Almond milk – 250 ml

Coconut milk(UHT) – 125 ml

Macadamia Milk – 250 ml

Oat milk – 30 ml

Quinoa milk – 250 ml

Rice milk-200 ml

Compare the nutrient information for each in the nutrients per 100 gm column on the label to determine how your choice stacks up compared with dairy milk. You may also be surprised at the long list of ingredients on the label of the dairy alternatives that are needed to make these products similar in texture and look to dairy milk.

Some people report that they find A2 milk more digestible than regular milk however it does not meet the digestibility levels required for inclusion on low FODMAP diet lists.

Fancy recipes for dietary tolerances

If you are struggling to make something delicious, different and a little bit fancy to share with friends and family or just enjoy yourself try the ‘intolerant cooks’ website(google intolerant cooks). Think Green Pork Curry, Crispy Pasta with Hot Smoked Trout and Peppered Strawberries and pan seared Chicken to name just a few of the special dishes.

This is the website of the television program ‘The Intolerant Cooks’ that focuses on dishes that are gluten free, lactose free and/or low FODMAP. The restaurateurs/foodies Karen Martini and Richard Barassi share the recipes form Series 1 and 2 online complete with pictures and series 3 is soon to start on television so check you TV quides. The episodes can be watched via the youtube links for each so you can see how to make the recipe so it comes together perfectly. The program is endorsed by the Coeliac Society and the FODMAP friendly program and provides a welcome set of instructions and recipes so those with dietary-requirement-fatigue can get some fresh ideas. Thanks Karen and Richard!

 

Some ‘bowel action’ chat

Lets have a chat about assessing the toilet contents from our bowel as most of us regularly look in there. From now on we will call this call this ‘poo’ for want of a better word as ‘feces’ or ‘stools’ are doctors terms and not what most of us use.

There is so much variation in what is normal that we need to focus on what is normal for us COMBINED with information about how easy our poo is to pass and whether we have regular diarhoea or constipation or odd coloured poo.

Poo will vary from one individual to another in terms of the shape, consistency and colour. Using the four steps below lets look at how we can use this information to assess our bowel habits when having concerns.

Step1.Consider: Form

This gives us an idea about whether or not we may be having constipation or too frequent stools. The Bristol Stool Chart was developed by Dr. K.W Heaton in the late 90’s to help us with this assessment, take a look and see how your bowel habits rate.

Reference: Heaton, K W & Lewis, S J 1997, ‘Stool form scale as a useful guide to intestinal transit time’. Scandinavian Journal of Gastroenterology, vol.32, no.9, pp.920 – 924.

The Bristol stool chart van be used for us to get an idea of how quickly our gut contents are moving through the bowel. Take a look and see where your poo, the end result of travels,  usually fits. Numbers 3-4 are the easiest poo types to pass and suggest an optimum processing/digestion time in our bowel. The lower numbers suggest constipation and the higher numbers suggest more rapid gut transit with less formed stools or diarrhoea.

Step 2. Consider Pain or Discomfort.

Think about whether you are having pain when you pass your poo, experiencing excess gas before you go or whether instead the whole event is unremarkable.

Step 3. Consider Colour.

Take a look at the colour of the poo. This is largely determined by the addition of  greenish bile salts from the liver, a digestive aid, which gradually change to brown as they do their job in the bowel while passing along. So brown is the ‘regular’ colour but lighter poo can occur and darker poo too as well as red poo.

Light poo suggests potentially insufficient bile salts being added to your gut contents.

Red tinged poo usually includes some blood from the large bowel and a visit to the dr is required to discuss/investigate where this blood is coming from. Black poo also can indicate blood but from a source higher up the bowel and needs investigation.

Dark poo will also be seen if you are taking an oral iron supplement, have eaten a lot of beetroot or blueberries due to the natural colours they contain. Artificially coloured foods such as licorice, bubble-gum icecream and the like may also do this.

Step 4. Consider frequency

Actually, how often you go is less important than what you are doing. For example one person may have four poos a day that are easy to pass and a number 3 on the Bristol Stool Chart, nothing worth noting there. Another person may have four poos a day that involve pain and discomfort and are number 1 on the chart, this is indicating constipation and small amounts of poo are being passed each time.  The constipated individual can get help to improve bowel function.

Step 5. Temporary or long-term changes?

Consider whether these changes such as light colour, dark colour, mucus, excess gas, constipation or diarrhea are just occurring briefly or if they are regular occurrences. Brief changes that pass can be quite normal but If you are having long-term problems with your bowel it is time to get some reassurance by investigating potential causes and solutions with your Doctor and an Accredited Practising Dietitian specialising in the gastrointestinal system http://www.digestiondietitian.com.au/. It could be that you need to adjust your dietary fibre intake http://www.digestiondietitian.com.au/2016/05/29/fibre-and-your-bowel/, trial a low-FODMAP diet http://www.digestiondietitian.com.au/2016/05/24/what-are-fodmaps/, take a few blood tests etc http://www.digestiondietitian.com.au/accurate-diagnosis/

 

 

Coeliac Disease and Non-Coeliac Gluten Sensitivity

Well this is an area of a lot of interest currently and it is important to separate the science from the speculation/internet sensation.

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Many people the world over find report that they have symptoms ranging from bloating, wind and abdominal distension/pain to diarrhoea and altered bowel habit when they consume a diet rich in wheat-based foods. Wheat (and grain relatives),Rye and Barley contain both gluten and fructans which are both hard to digest for some. It is commonly assumed by most folk that it is the gluten that is the problem because they are unaware of fructans and their potential role.  The assumption is made by these individuals that they have a gluten sensitivity.

The symptoms described above are seen in a range of gut disorders including Coeliac Disease, Diverticular disease or Chrohn’s disease as well as Irritable Bowel Syndrome for example. It is tempting for sufferers to start removing wheat from their diet however the exclusion of Coeliac disease is the important step they miss before doing this. The tests for Coeliac disease will only be accurate if wheat remains in the diet and the body reveals it’s reactions to the wheat in screening blood tests and if required,  biopsies. This will show up as abnormal blood antibody levels which will suggest a biopsy is needed and abnormal biopsy histology results can be discovered if they exist. Without the wheat going through the body the reactions won’t be there in either blood or biopsy and a diagnosis can be missed.

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Once these diseases have been excluded It may be that a trial of a low-wheat/rye/barley diet as part of a more more comprehensive low-FODMAP diet may be used to see if symptoms can be resolved.

It was once thought the exclusion of wheat in non-Coeliacs may aid symptom reduction due to the lower level of fructans. There is now suggestion in the science that it may be a reaction to gluten, different to that shown in Coeliac disease, that may worsen some gastointestinal symptoms in non-Coeliacs and this has been given the term non-Coeliac gluten sensitivity(NCGS).

Watch this space as the story unfolds. Well conducted research trials are few and far between but in the last few years a couple have appeared using subjects with self-reported NCGS that have been well designed to ensure all other causes have been accurately excluded.

The BOTTOM LINE- make sure Coeliac disease is accurately excluded before altering you diet.

If Coeliac disease is confirmed after abnormal blood test results and subsequent biopsy there is a very strict dietary protocol to follow to maintain a 100% gluten-free diet, 99 % is not enough removal for this healing of the gut with this condition.

If excluded the other dietary trials can be started in earnest.

What are FODMAPs ?

FODMAP stands for Fermentable Oligo-saccharides, Di-saccharides, Mono-saccharides and Polyols!!! These are a large groups of mostly naturally occurring carbohydrates which can be poorly absorbed in the small intestine and fermented in the large intestine by the bacteria there. You may know them by names such as fructose, lactose, Sorbitol, Mannitol or Isomaltose to name a few.

Research suggests limiting the diet in FODMAP-rich foods can reduce the symptoms that plague sufferers of Irritable Bowel Syndrome (IBS) including reducing the altered bowel habit(diarrhoea/constipation or both), bloating, excessive wind and abdominal discomfort/pain. With the help of an Accredited Practising Dietitian(APD) a low FODMAP diet trial can be arranged to suit your individual lifestyle so that you can comply with the recommendations and see if this approach offers you symptom relief.

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Your initial appointment

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A Digestion Assessment and Planning appointment with Clem will look in detail at your:

Your Perth digestion dietitian appointment includes:

Full medical and symptom history.

Quality of Life with this condition.

Diet history and Food frequency.

Test results and test planning.

Discussion of Dietary approaches for the short term while any underlying disorder is excluded and the long-term best approach once a diagnosis is made.

Meal and snack ideas to suit your dietary needs, intestinal needs and preferences.

How to practically manage your best diet in your day-to-day life, with your individual family and social commitments. This realistic and supportive approach is the key to being able to comply with the diet you need and feeling well.

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Allow some time as our initial appointment is one hour long. Contact your Perth digestion dietitian now.

 

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Veggies- the low FODMAP varieties

Veggies

Veggies

Veggies are good for us right? Yes, nutritionally they are one of the best group of foods we can eat in large volumes for good health and reducing our disease risk. This doesn’t mean that all veggies are easy to digest and individuals with symptoms of nausea, bloating, excess wind, abdominal pain, constipation or diarrhoea (big list!) may need to get eat only the most digestible vegetables that have lower levels of the FODMAP’s.

This list includes green beans, potato, carrot, capsicum, asian greens, jap pumpkin, tomatoes  and zucchini. Trialing the removal of other vegetables such as onion and garlic and limiting serve size of broccoli, sweet corn, snow peas and butternut pumpkin are some of the changes used in the test-phase of the low FODMAP diet.

Meals made with low FODMAP ingredients, as shown in the Lunch ideas post can help ease Irritable Bowel Syndrome symptoms and enhance your low FODMAP diet compliance. An Accredited Practising Dietitian with a Digestion specialty can help you put together a menu that will suit your preferences, home and work life so that you can trial this revolutionary diet approach.

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For an Appointment

Come and see Clemency, a Perth Accredited Practising Dietitian with a special interest in digestion. You can call or email, details below.

Please call reception:    Ph 08-92042588

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or send us an email:   admin@thenutritionspecialists.com.au

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