Saturday, 25 June 2016

A low FODMAP Mediterranean-style diet

By Dr Jane Varney 

Have you heard about the health benefits of a Mediterranean style diet? This dietary pattern has its origins in Crete, Greece and is credited with reducing morbidity and mortality from a range of chronic diseases. The diet encourages consumption of plant based foods, including fruits, vegetables, olive oil, legumes, nuts, seeds, and wholegrains. Fish intake is encouraged, while smaller quantities of lean meat are advised. Wine can be consumed in moderation (with meals), while high sugar foods should be limited to special occasions only. Sounds pretty good, right? 

So how can you adapt a Mediterranean style diet to your low FODMAP dietary needs? Here are some tips to get you started:

1. Use olive oil as your main fat (60 ml/day)
2. Include low FODMAP vegetables with every meal (400g/day)
3. Eat 2 legume meals per week, using canned chickpeas (1/4 cup is a green serve) and canned lentils (1/2 cup is a green serve)
4. Include at least 2 serves of fish per week (include oily fish such as salmon, tuna and sardines)
5. Eat small portions of red meat (2 or fewer serves per week)
6. Eat fresh, low FODMAP fruit daily. Eat low FODMAP dried fruit (cranberries) and nuts (pecans, peanuts, pinenuts) as snacks or desserts
7. Eat 200g yoghurt per day and cheese in moderation (choose low lactose varieties if lactose intolerant)
8. Include low FODMAP, wholegrain breads and cereals with meals, for example, brown rice, buckwheat kernals, oats, oat bran, porridge, quinoa flakes, rice bran, spelt sourdough bread, wheat and fruit free muesli, spelt flakes and oat bran
9. Include small quantities of wine with meals, but limit intake to less than 100ml per day
10. Include high sugar foods on special occasions only

Friday, 24 June 2016

The Classic Burger

By Marina Iacovou (Accredited Practising Dietitian and PhD Candidate)

This is a classic beef burger recipe with a twist. Burgers are quick and easy to make, and can include a variety of vegetables. They can also be low FODMAP, or a good way to re-introduce some moderate-high FODMAP-containing foods back into your diet.

Recipe - makes 6-8 burgers:
(Preparation time 15 minutes, cooking time ~5-10 minutes)

·         Beef burgers
o   500g lean beef mince
o   1 egg
o   1 tablespoon of olive oil
o   ½ cup spring onion (green part) – finely chopped
o   ¼ cup of fresh continental (flat) parsley – finely chopped
o   ¼ cup of fresh coriander – finely chopped
o   Handful of chives
o   1 medium sized carrot – grated
o   2 medium sized button mushrooms* – finely chopped
o   Cracked pepper
·         Accompaniments and condiments
o   Bread / roll / bun of your choice
o   Fresh tomato / lettuce / cucumber
o   Hard cheese – cheddar / tasty / haloumi
o   Tomato sauce / BBQ sauce / lemon juice
*N.B Mushrooms are high in FODMAPs, but have been included in this recipe to give an example of how to introduce small amounts of high FODMAP foods during the rechallenge phase of the low FODMAP diet.

  • Combine beef, egg, olive oil, selected vegetables, herbs and spices into a large bowl and mix together. Divide mixture into 6-8 portions and roll into balls.  
  • Spray or drizzle olive oil into a pan or on a BBQ plate. Heat oiled pan/BBQ plate first before placing burgers.
  • Cook burgers on a medium heat for ~3 minutes each side or until cooked through.
  • Add fresh salad vegetables, cheese and condiments of your choice, as toppings to the cooked burger and bun.

Tips and hints:
·         Adding a little bit of chopped vegetables like mushroom, carrots and/or zucchini adds moisture, colour and helps to increase vegetable intake for kids and adults alike
·         For a crispy bun, cut in half and chargrill the top side, or both sides
·         For melted cheese, top the inside of the bun with your choice of cheese and place under the grill. Haloumi can be cooked on its own in the pan or BBQ plate
·         Use your choice of herbs and spices e.g. cumin, mint
·         Use other vegetables in the burger mixture e.g. finely chopped zucchini
·         Add a small amount of the white spring onion or more mushroom, if re-introducing high FODMAP foods back into your diet
·         Whether you are serving burgers for the family, in a social setting, or at a BBQ, place all salad vegetables, cheese and condiments in the middle of the table, and everyone can add what they like to their burger
·         Include a variety of gluten-free, wholemeal, sourdough spelt breads/rolls in the middle of the table
·         For a vegetarian / vegan burger recipe please see an earlier blog post



Monday, 20 June 2016

Timing of symptoms

By Dr Jaci Barrett (APD)

IBS is very common, but the symptoms are varied – constipation, diarrhoea, alternating bowel habit, bloating, abdominal distension, abdominal pain, excessive gas and borborygmi (intestinal noises). Some people experience all of these symptoms at some time or another, while others have more specific symptoms, for example where bloating is the major symptom. When symptoms are experienced, people often consider what they most recently ate to determine the trigger food. Were there FODMAPs in that meal? What other foods could have contributed? Many times we hear patients state that within minutes of food hitting their stomach, they are on the toilet with urgency, diarrhoea and abdominal cramps. Is this possible?

Let’s consider the anatomy of the human gastrointestinal system:

Bowel transit studies indicate that in healthy individuals, the time taken for a substance to move from the mouth to the anus is somewhere between 12 and 48 hours.

The small intestine is particularly long – 6 metres in fact. The large intestine is ~1.5 metres long. So given the time it takes for food to move through the gut, symptoms experienced immediately after swallowing a suspect food cannot be attributed to the fermentation of FODMAPs ….

So how does this immediate symptom induction occur in some people?
The most likely explanation is the impact of hormones and nerve regulators that are triggered when we eat. For instance, when food enters the stomach, hormones such as cholecystokinin and secretin are released. These hormones stimulate the production of enzymes that aide digestion. In addition, when the stomach is stretched by the entry of food, nerves in the digestive system are stimulated. These nerves stimulate the movement of intestinal muscles which push food and digestive juices through the gut.

Because digestion takes many hours to days, the intestinal tract is always full of digestive contents from previous meals, and as a meal is consumed, these existing intestinal contents are moved through the intestines. So if the existing intestinal contents contain FODMAPs or other problem food components, symptoms may be experienced upon eating that have nothing to do with the current meal and everything to do with the previous meal/s. These delayed symptoms can be confusing and may have you pinpointing the wrong trigger food.

So what is the take home message? Consider previous meals you have eaten and whether they could have played a role, or whether there are other complicating factors such as stress that has had an impact on bowel function. If you are still confused and unable to work out what is causing your symptoms, keep a list of foods you have eaten over the 48 hours prior to experiencing symptoms and show this to your dietitian to utilise his/her food detective expertise!

Friday, 17 June 2016

Low FODMAP Hot & Sour Asian Soup (Vegan)

By Alana Scott, low FODMAP cook from A Little Bit Yummy
Image by Alana Scott- A Little Bit Yummy
Looking for a tasty low FODMAP Asian soup? Try this vegan hot and sour soup, which is packed full of flavour. You may notice a few ingredients you haven't seen in our app before! This recipe contains several newly tested foods to look out for in the new update. It even contains mushrooms! I know what you’re thinking… mushrooms are not low FODMAP! However, canned mushrooms have recently been tested by Monash University and results show that they get the green light. This may be due to the processing methods in canning the mushrooms. We recommend giving the mushrooms a rinse before adding to your recipe. 

Tuesday, 14 June 2016

Food Allergy or Food Intolerance?

By Lyndal McNamara (APD)

The terms food allergy and food intolerance are often confused as they can have similar symptoms, but they actually refer to two very different conditions. Whilst both ‘food allergy’ and ‘food intolerance’ broadly describe an adverse reaction that occurs in response to exposure to a particular food, there are a number of important differences between the two conditions.

Thursday, 2 June 2016

A1 vs A2 milk – What’s the big deal?

By Shirley Webber

With the milk industry in the limelight at the moment many people are asking questions about what we are actually consuming. One questions that we often get is “what is the difference between A1 and A2 milk?”

The Monash University team are conducting a study at the moment looking into the effects of these two different milks and what effects A1 vs A2 milks may have on gut transit time, behavioural/psychological health and gastrointestinal symptoms.

So what’s the difference?

A1 and A2 are two proteins that are part of the casein proteins found in dairy products and we refer to these as beta-casein A1 and beta-casein A2.

The image below shows the composition of 1 cup of milk:

As you can see from the image above one cup of milk contains water, lactose, fat, minerals and protein. Within the protein we find casein and whey. There are various types of casein with beta-casein making up 2-3 grams of milk solids.
These beta-caseins are produced by different types of cows.

Interesting fact: beta-casein A2 is the original beta-casein produced in cow’s milk. A natural mutation over a number of centuries occurred where cattle began to also produce A1 beta-casein, affecting mainly Holstein cows (cattle from European origin).
The image below show the types of cattle used in milking and the A1 vs A2 beta-caseins that they produce.

Holstein cow’s milk =  1:1 A1 & A2 milk beta-casein

Guernsey or Jersey cow’s milk = high % in beta-casein A2

Goats, water buffalo, sheep, cattle from Asian origin and human breast milk = proteins similar to A2

Let’s get into a little more science. A1 and A2 beta casein proteins are made up of 209 amino acid chains. There is only one amino acid difference between the A1 amino acid strand compared to the A2 amino acid strand. This very small structural difference results in a big difference in the way the protein breaks down and is digested in our gut.

When the A1 amino acid chain breaks down it produces a peptide called BCM-7. BCM-7 (beta-casein morphin) is an opioid-like compound. In the human body, BCM-7 has been shown to slow down gut transit time (slows transport of food / digestion throughout the body) therefore can cause a change in bowel function, influence gut bacteria and inflammation in the gut. It is thought these changes can mean some individuals poorly tolerate milk.

There have been many animal studies conducted in this area but more investigation needs to be conducted to investigate what effects these different milk proteins has in humans.
The major point to make is that BCM-7 production does not occur after we consume the A2 beta-casein. So choosing A2 beta casein rich milk products may help some individuals.

For our research investigating the different effects of A1 vs A2 beta-casein milk we are looking for healthy and IBS constipation predominant volunteers to help shine some light onto this topic.

Healthy volunteers:
     Age between 18 – 60 years
     Live in Melbourne
     Have no known gastrointestinal conditions
     Age between 18 – 60 years
     Living in Melbourne
     Have non-diarrhoea predominant Irritable Bowel Syndrome (IBS)
     Do not have any other gastrointestinal disease (eg. Coeliac disease, Crohns disease, Ulcerative Colitis)

What do you get?
We will be providing our participants with all milk that is to be consumed during two intervention periods of this study (A1/A1 and A2/A2 milks) as well as providing our participants with cheese. You get to have full access to a dietitian to assist you throughout the study and a free consultation at the conclusion of your participation.

What are we asking of participants?
To follow a dairy free diet with the exception of the milk and cheese that we will be providing. Be able to attend 9 consultations at the Alfred Hospital over 12 weeks of doing this study. Also be willing to give blood and small faecal samples.

Find out more about the study here

Dutch Specialities on a low FODMAP Diet

By Peta Hill (Paediatric Dietitian)

One of the best ways to experience a new country and culture is to taste the food. However, estimating the FODMAP content of a foreign cuisine’s dishes is very tricky when you don’t know the ingredients. Here are some insights into five Dutch delights. Unfortunately these products have not been tested for their levels of FODMAPs, so the best we can do is make a judgement of their FODMAP content based on ingredients.