Why are low-FODMAP sourdough breads listed in your meal plans – these are often made from wheat, so aren’t they high in FODMAPs?
Typically, wheat, rye, barley and spelt flours are all high in FODMAPs. However, if a bread is made using a sourdough process, then the baker can treat the dough to make a final bread that can actually be low in FODMAPs. Many gluten-free breads are also low in FODMAPs. Regular bread making won’t usually break down FODMAPs, so it is recommended that breads should be sourdough and labeled as being low-FODMAP or “FODMAP Friendly,” just to be sure they are suitable.
I’ve completed Step One of the low-FODMAP diet and I feel great. Why should I do Step Two?
The goal of the second step is to work through a reintroduction process so that you can enjoy a liberalized diet and increase the variety of foods you eat while still maintaining your symptom control. It’s an important step so that your diet isn’t unnecessarily restricted. There’s no point cutting out more than you need to feel well. Also, we know that FODMAPs are beneficial for the health of the bowel (they act as prebiotics, which can assist in the production of products such as short-chain fatty acids, which enhance the health of the lining of the bowel wall).
Should I be using probiotics?
Probiotics are live bacteria that can help improve the numbers and balance of good bacteria in the large bowel. Bacteria naturally live in the bowel and are necessary to assist in bowel function and health. An enormous range of strains (types) of bacteria act as probiotics, and they work on the bowel in a variety of ways. A probiotic with bifidobacteria may be helpful if you have completed the Step Two reintroduction process and could not tolerate any high-FODMAP foods well. Speak with your doctor and/or specialist dietitian about probiotics, to make sure you’re taking the best probiotic for your needs.
What’s a normal amount of wind to have? How do I know if mine is a problem?
Here are some fast facts about wind/gas/farts/flatus:
Must I choose gluten-free foods?
No. Gluten is the protein component of wheat, rye and barley (and, in some countries, is considered to be present in oats). This is a very different molecule from FODMAPs, which are carbohydrates. As the FODMAP fructans are found in wheat, rye and barley, many gluten-free foods can be suitable since they’re not made from wheat, rye or barley. However, be aware! Not all gluten-free foods are suitable for a low-FODMAP diet – a gluten-free apple pie, for example, is not low-FODMAP. Also, people on a low-FODMAP diet can eat small amounts of wheat, rye and barley, while people on a gluten-free diet can’t have these at all.
I know soy is a legume high in FODMAPs, but what about soy milk? Is there any I can have?
Yes, some soy milks are low in FODMAPs, but it depends on the process involved in making them. A whole soybean contains FODMAPs, so when the whole bean is processed into soy milk, that soy milk will also be high in FODMAPs. Some soy milk manufacturers use a soybean extract that’s the protein part of the soybean and therefore leaves behind the part of the legume that contains the FODMAPs. Soy milks made from soy milk protein or soy milk extract are therefore low in FODMAPs and suitable for the diet. Read the ingredients list to determine the soy base the soy milk is made from.
Do I have to be careful of medicines that may contain FODMAPs?
The “sugar pill” in the contraceptive pill is made from lactose. People with lactose intolerance can handle up to 4 grams of lactose at a time, so given that the contraceptive pill doesn’t weigh 4 grams, it’s fine to continue to take.
FODMAPs are present in foods in much greater amounts than could be in a medication, so even if a medication contains FODMAPs, they’re likely to be well tolerated. Some medications are only taken for a short period of time, and aren’t likely to be a bother. If you’re taking a medication that does contain FODMAPs for an extended period of time and you feel it is contributing to your symptoms, don’t stop taking it, but speak to your doctor about a possible low-FODMAP alternative. If there isn’t an alternative, consider further restricting some dietary sources of FODMAPs to assist in minimizing your total FODMAP load.
Some cough medicines that are “sugar-free” may be sweetened with sorbitol and/or mannitol, sometimes in very high amounts. If these cause you symptoms, you might like to speak to your pharmacist about a brand that doesn’t contain polyols.
Can I eat sugar on the low-FODMAP diet?
Yes. Sugar is a disaccharide (double sugar) made up of one part fructose, one part glucose. It is in balance, so it is low-FODMAP. Eating sugar in moderation should not trigger symptoms of IBS. Moderate amounts include the amount of sugar you might have in a cake or cookie in this cookbook (or other low-FODMAP commercially available baked goods), the amount in a serving of chocolate, or the sugar added to tea or coffee. However, just as you have to be cautious about having too much orange juice due to a high fructose load, even though an orange is a balanced fruit, a similar caution is needed for sugar. If you are someone who could devour a bag of candy and cans of soft drink, i.e., lots of sugar at once, you are likely to have symptoms triggered because of too much fructose. Only eat a small handful of candy at a time and cap the soft drinks to no more than two small glasses at a time).
What’s the best piece of advice you can you give people about managing a food intolerance and continuing life as normal?
You may feel that your life is anything but normal when you embark on the low-FODMAP diet. You may think things that you haven’t had to think before. For example, “Where am I going to be today? Will I need to take food with me? Should I eat before I go? Will there be something that I can have?” Whether you want to consider it or not, you have to think about the food you will be eating. Some people cope with this easily, but for others it really is a big deal.
Will going on the low-FODMAP diet affect my weight?
There has been no hard evidence to show that the low-FODMAP diet has a direct effect on weight, leading to weight loss. However, anecdotal observations have found that following the two steps of the low-FODMAP diet generally reduces the number of processed foods eaten, and encourages a shift to healthier food choices. Healthier food choices may also come more easily as you will have a greater understanding of what foods work for you (and what foods don’t). It is possible that you will find that you are no longer choosing any food that is convenient – you’ll be thinking before you pop it in your mouth! Following the low-FODMAP diet also enables you to have more structure to your dietary planning. It could be that people may lose weight as a consequence of the change in the style of eating, rather than due to the influence of restricting FODMAPs per se. Don’t be fooled, though – there are plenty of low-FODMAP foods that are not so healthy, and overindulging in these won’t aid any weight loss goals you may have.
“ I just cannot accept that there is nothing people can do, unless it has to do with medication. That is why I was happy to see Sue Shepherd’s work. I have passed on her research to people who are suffering from IBS and had no clue they could eat all those things on the low-FODMAP diet. You know, Sue ought to be very proud of herself. She will always know that she made a difference in people’s lives – what an achievement. ”
Supermarkets manage their fruit and vegetables so that many are available all year round, including times when they are out of season. However, growing your own or heading to the local farmers’ market can be a way to enjoy fruit and vegetables at their flavorful, seasonal best!
|
SEASON |
FRUIT |
VEGETABLES |
|
SUMMER |
Bananas Berries: blueberries, raspberries, strawberries Cantaloupe Honeydew melons Kiwi Passion fruit Valencia oranges |
Bell peppers Carrots Cucumbers Eggplant Green beans Sprouts Tomatoes Zucchini/summer squash |
|
AUTUMN |
Bananas Berries: raspberries Grapes Limes Mandarins Olives Pineapples |
Asian greens: bok choy, choy sum Bell peppers Broccoli Cabbage Carrots Celeriac Fennel bulb Ginger Kale Lettuces and other salad greens Parsnips Potatoes Radishes Rutabagas Spinach Squash (except butternut) Turnips Zucchini |
|
Bananas Blood oranges Kumquats Lemons Limes Mandarins Olives Oranges Passion fruit Pineapples |
Asian greens: bok choy, choy sum Broccoli Cabbage Carrots Celeriac Fennel bulb Kale Kohlrabi Parsnips Potatoes Rutabagas Spinach Squash (except butternut) Turnips |
|
|
SPRING |
Bananas Berries: blueberries, strawberries Blood oranges Mandarins Pineapples Rhubarb |
Asian greens: bok choy, choy sum Broccoli Cabbage Carrots Chard Cucumbers Green beans Kohlrabi Lettuces and other salad greens Radishes Spinach Turnips Watercress |
|
FOODS |
SERVING SIZE |
DIETARY FIBER (GRAMS) |
|
Breads and cereals |
||
|
Bread, gluten-free |
1 slice |
1–2 |
|
Bread, gluten-free, multigrain |
1 slice |
3 |
|
Buckwheat groats (kasha), boiled |
1 cup |
5 |
|
Polenta |
½ cup |
2.1 |
|
Quinoa, boiled |
½ cup |
2.5 |
|
Rice, brown, boiled |
½ cup |
1.8 |
|
Rice bran |
2 tablespoons |
3 |
|
Rice cakes |
2 |
0.8 |
|
Rice flour, brown |
¼ cup |
1.8 |
|
Nuts and seeds |
||
|
Peanuts, raw |
½ cup |
6.5 |
|
Peanut butter |
1 tablespoon |
1 |
|
Popcorn, air-popped, plain |
2 cups |
2.4 |
|
Pumpkin seeds (pepitas) |
1 tablespoon |
0.5 |
|
Sesame seeds |
1 tablespoon |
1 |
|
Sunflower seeds |
1 tablespoon |
2 |
|
Banana |
1 medium |
3.1 |
|
Blueberries |
½ cup |
1.8 |
|
Cantaloupe |
1 slice |
1 |
|
Honeydew melon |
1 slice |
1 |
|
Kiwi, small, peeled |
1 |
2.1 |
|
Mandarin |
1 medium |
1.4 |
|
Orange |
1 medium |
3.1 |
|
Passion fruit |
1 (with seeds) |
6 |
|
Strawberries |
½ cup |
1.5 |
|
Vegetables |
||
|
Bell pepper |
½ bell pepper |
1.8 |
|
Broccoli, boiled |
½ cup |
2.6 |
|
Carrots, boiled |
½ cup |
2.4 |
|
Green beans, boiled |
100 grams |
3.2 |
|
Mixed vegetables, frozen, boiled |
1 cup |
4.5 |
|
Parsnips, peeled, boiled |
½ cup |
2.8 |
|
Potatoes, unpeeled |
1 large |
4 |
|
Side salad |
1 cup |
1.2 |
|
Tomato, raw |
1 medium |
1.8 |
|
Winter squash (except butternut), boiled |
½ cup |
1.9 |
|
Zucchini |
½ cup |
0.7 |
Sources: Figures adapted from NUTTAB Australia 2006 manufacturers’ analyses
This is Dr. Sue Shepherd’s dietetic consulting practice. Although it’s based in Melbourne, Australia, Skype consultations are available for people living interstate or overseas. Commencing consultations in 1997, Shepherd Works is Australia’s largest gastrointestinal nutrition dietitian practice, and has seen more than 10,000 patients with food intolerances. There are thirteen expert dietitians and two psychologists. Various low-FODMAP and gluten-free cookbooks are available via the website, along with other relevant resources and a repository of research studies.
This logo appears on food products that have been tested to be low-FODMAP per serving and has been registered around the world. You can eat with confidence the foods that display the logo on their packaging. Visit the website for an up-to-date list of the foods bearing the logo.
To find a registered dietitian near you who specializes in gastroenterology and/or food allergies, visit the website.
This is the professional association of American gastroenterologists. It has many helpful educational guides for consumers on the website, including information on the low-FODMAP diet.
I am thrilled to produce this comprehensive book that can help people navigate their own path to wellness and management of their IBS symptoms. As a dietitian, I see patients with so many dietary needs; it is a great pleasure to produce this book to help you if you need a low-FODMAP diet (and you can enjoy the recipes if you are also on a gluten-free diet).
Thanks to my dear family and my gorgeous fiancé, Adam. I am blessed to have the most wonderful family and partner – you mean the world to me. Thank you also to my most amazing team of dietitians at Shepherd Works. Your work has helped spread the FODMAP message, and I am so appreciative of all that you do to make Shepherd Works the home of understanding, professionalism and solutions for patients.
I have enormous gratitude for Ingrid Ohlsson at Pan Macmillan for inviting me to join her on this next FODMAP adventure. You have been inspirational to work with (again!); thank you. Thank you to the other wonderful folk at Pan Macmillan who have helped make this book come to life: Editors Foong Ling Kong, Danielle Walker, Nicola Young; Photographers Jeremy Simons (food shots) and Steven Brown (author shots); Makeup and Hair Stylist Paul Bedggood; Food Stylist Michelle Noerianto; Home Economist John Henseler. Thanks also to Kirby Armstrong for her gorgeous design.
And last, but certainly not least, thank you, the reader, for purchasing this book. I trust you will thoroughly enjoy it from cover to cover.
Best wishes for good health,
Dr. Sue Shepherd
