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FODMAPs For Healthcare Professionals

Monash University: FODMAP Pioneers

FODMAP Pioneers

The team of gastroenterologists, registered dietitian nutritionists and researchers in the Department of Gastroenterology team at Monash University successfully developed a cutting edge dietary nutrition intervention shown to reduce the symptoms associated with Irritable Bowel Syndrome. Led by Peter Gibson, MD, Department Head, and Jane Muir, PHD, Head of Translational Nutrition Science, Monash University was the first to:

  • Classify those foods high in FODMAPs that can trigger IBS symptoms
  • Build a comprehensive database of amounts and types of FODMAPs in foods, including foods and beverages low in FODMAPs
  • Develop and trial the Low FODMAP Diet for efficacy in patients with IBS
  • Publish high-quality, peer-reviewed research demonstrating a Low FODMAP Diet is effective as first-line dietary treatment option for IBS
  • Watch this short video to learn more about how foods high in FODMAPs can trigger GI symptoms, and how the Low FODMAP diet works. ©2016 Monash University. Used with Permission. All rights reserved. Used under license by Nestlé.

 

FODMAPs At-A-Glance: The Smart Phone App

As the comprehensive Low FODMAP Diet database was available, the research team at Monash University developed a low FODMAP smart phone application to help users identify low FODMAP-safe foods – and even customize the “safety” levels to their individual food sensitivities -- right at their fingertips.

 

The Monash University Low FODMAP Food Certification Program

In 2015, the Monash University Low FODMAP Certification Program was launched in Australia. Certified products all undergo rigorous FODMAP testing in laboratories run by the Department of Gastroenterology at Monash. In addition to FODMAP testing and meeting the low FODMAP criteria, a dietitian reviews all products seeking certification to ensure they are a source of dietary fiber, and do not contain excessive amounts of fat, saturated fat, sugar or salt.

Science, Research Summaries and Links to Articles
FODMAP information FODMAP resources

The efficacy of a Low FODMAP Diet is supported by more than 30 clinical studies. A growing body of clinical research is bringing to the forefront new ideas about how to diagnose, understand, treat, and even alleviate the symptoms associated with Irritable Bowel Syndrome. In addition, translational research, such as that carried out by the Gastroenterology Research team at Monash University in Australia, is applying data from the lab to community interventions. Some of the most significant published works in this area, with emphasis on the Low FODMAP Diet, are summarized below. Links to journal abstracts follows.

 

  1. Food Choices can Impact Symptoms of Irritable Bowel Syndrome

Dr. Peter Gibson and Dr. Susan Shepherd prepared this review (2012) of the research on dietary interventions for the treatment of Irritable Bowel Syndrome. They summarized that indeed, limiting those foods in the diet responsible for the build of gas and bloat – namely those high in FODMAPs – do alleviate symptoms associated with the digestive discomfort of this disorder. Additionally, the article called for more research into FODMAPs and gluten sensitivity to help identify more accurate cause-and-effect relationships. In turn, this would help improve upon many overly restrictive diets being used to treat IBS at the time of publication.

 

More technical information….

Gibson and Shepherd expresse a common challenge with dietary intervention to treat IBS. While people may report food intolerances or “allergies” and their willingness to simply remove foods from their diet to avoid symptoms, he reports that this often leads to an overly restrictive diet that could leave a patient nutritionally compromised.

Science is only just beginning to delve into precise food-specific cause and effect, pointing to FODMAPs as one set of GI symptom triggers; food chemicals, which require more attention; and gluten, which has a long-known causality with celiac disease, and more recent connection with non-celiac gluten intolerance. It was also stated that psychosocial factors are intricately involved in visceral hypersensitivity – which can lead to both overly-reactive physical response in the gut and overly responsive pain thresholds as they correspond to food triggers. Gibson and Shepherd report that while dietary interventions may alleviate symptoms of IBS, they are not a cure, and future research into each of these areas can shed more light on this challenging area.

 

Reference: Gibson PR, Shepherd SJ. Food Choice as a Key Management Strategy for Functional Gastrointestinal Symptoms. Am J Gastroenterol. 2012;107:657-66.

 

  1. Low FODMAP Diet Reduces Gastrointestinal Symptoms in People with IBS.

FODMAPs include many short-chain sugars abundant in foods and beverages – and are said to be one cause of the belly pains that people with Irritable Bowel Syndrome (IBS) experience. A Low FODMAP Diet has been effectively used to help reduce these symptoms and this research puts even more science-based evidence behind the dietary intervention. In this randomized controlled, crossover study of people with IBS, the Low FODMAP Diet was an effective first-line treatment for 70 percent of people with a significant reduction in GI symptoms, including abdominal pain, bloating, gas and dissatisfaction with stool consistency – by half.

 

More technical information…

This research provides high-quality science in a randomized, controlled, cross-over study comparing the Low FODMAP Diet with a standard Australian diet and the patient’s usual intake patterns. IBS symptoms were more than halved with the low FODMAP eating pattern, and demonstrated efficacy for 70 percent - a vast majority - of patients with IBS.

 

 Participants were randomized to receive 21 days of a diet low in FODMAPs or 21 days of a diet containing FODMAP content of a typical Australian diet. Participants were blinded to the diets and almost all food was provided. After this 21-day diet, each participant entered a washout period of at least 21 days in which they resumed their usual diet and then crossed-over to the alternate diet. The second interventional diet was not commenced until the symptoms had returned to the same level as during the baseline period, as determined by direct questioning by a study investigator.

 

The results of the current study provide high-quality data to fill the science gaps. As symptoms were more than halved in IBS subjects and all measured symptoms were reduced to a level that arguably is considered good symptom control. The difference in symptoms between the 2 controlled diets was seen immediately and the greatest symptom control was achieved and maintained after 7 days of the Low FODMAP Diet. Interestingly, of the 70% of subjects who felt better on the Low FODMAP Diet, this encompassed subjects across all 4 subtypes of IBS

 

Reference: Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. A Diet Low in FODMAPs Reduces Symptoms of Irritable Bowel Syndrome. Gastroenterology. 2014;146:67-75.

 

  1. Nutrition Management Strategies for Irritable Bowel Syndrome: Review Paper

A wide variety of diets and food elimination practices have become common to provide some relief from the classic symptoms people experience with Irritable Bowel Syndrome. This review provides a thorough examination of the literature on each option, highlighting those with scientific merit, such as the low FODMAP eating plan.

 

More technical information….

Therapeutic elimination diets such as the FODMAP elimination plan, lifestyle changes, and select nutraceutical supplements such as peppermint oil and Iberogast should be considered for integration into the IBS management plan. Both herbals improve global symptoms and abdominal pain. The role of probiotics and prebiotics is less clear at this time.

 

Further advances in subtyping IBS will lead to more targeted nutrition modulation of the gut microbiome and improved outcomes. Future studies on the influence of food and food-based nutrients on IBS are warranted.

 

 Reference: Mullin GE, Shepherd SJ, Roland BC, Ireton-Jones C, Matarese LE. Irritable Bowel Syndrome: Contemporary Nutrition Management Strategies. JPEN. 2014;38:781-99.

 

  1. Irritable Bowel Syndrome: A Clinical Review

This summary organizes what is known to-date about Irritable Bowel Syndrome including:

  • History and prevalence of IBS
  • Medical characteristics and tests used to diagnose and differentiate it from other disease processes
  • Treatment options for the patient with this condition

 

It is hopeful that the future of science in this area will continue to improve the medical understanding of the cause of this challenging and debilitating medical condition. This will also help develop more advanced medical and non-medical treatment options. Meanwhile, this review concludes that strongest options include treating each patient according to their individual set of symptoms and needs, including interventions that may include diet, lifestyle, medical and behavioral options.  

 

More technical information….

Clinical review points:

  1. IBS remains an enigmatic cause of significant distress, morbidity, and disability. IBS is a common, symptom-based illness defined by the presence of abdominal pain or cramping in association with constipation, diarrhea, or both.
  2. The diagnosis of IBS can be confidently established with the use of symptom-based criteria, the exclusion of concerning features, and the judicious use of diagnostic testing.
  3. Concerning features that should prompt a more detailed evaluation include new onset of symptoms after age 50 years; unexplained weight loss; a family history of organic gastrointestinal diseases such as colon cancer, inflammatory bowel diseases, or celiac disease; gastrointestinal blood loss; and unexplained iron deficiency anemia.
  4. Successful management of patients with IBS begins with a trusting, positive, patient-physician relationship.
  5. A holistic approach that embraces lifestyle changes, dietary interventions, medications, or behavioral strategies offers the greatest likelihood of sustained treatment benefit.

 

Reference: Chey WD, Kurlander J, Eswaran S. Irritable Bowel Syndrome: A Clinical Review. JAMA. 2015;313:949-958.

 

  1. Low FODMAP Diet First Dietary Approach for Irritable Bowel Syndrome: A Review

This article provides a detailed review of 31 original research studies and 9 reviews, and summarizes the latest evidence to manage suspected food intolerance in IBS, including FODMAPs. To date, foods are not considered a cause, but rather symptom-triggering factors for IBS. Until a medical cure can be clarified, specific dietary elimination strategies, including the Low FODMAP Diet, can allow for some relief and improved quality of life for the person dealing with irritable bowel syndrome. The Low FODMAP Diet does improve symptoms in many (but not all) patients with IBS, and it is therefore recommended as a first-line dietary approach. It has been shown to be particularly effective with the support of FODMAP trained dietitians, who can ensure it is carried out properly.

 

More technical information….

Additional research on biomarkers that can help identify food intolerance and non-IgE mediated food allergy are needed. In addition to carbohydrates, which are being studied in detail through the FODMAP research, dietary fats and chemicals are called out as needing more attention in this area. It is also noted that the support of a nutrition professional can help ensure the Low FODMAP Diet is carried out properly, and monitored for nutritional adequacy over time.

 

Reference: Mansueto P, Seidita A, D’Alcamo A, Carroccio A. Role of FODMAPs in Patients with Irritable Bowel Syndrome: A Review. NCP. 2015;30(15):665-82.

Resources for My Practice

Educate yourself. Learn More. Become a leader in Low FODMAP Diet counseling.

Healthcare professionals who are interested in developing an expertise in FODMAPs for their practice can explore these opportunities for education and consider developing a professional toolkit of their own.

 

Educational Blog Resources

  • Monash University FODMAP blog available at www.fodmapmonash.blogspot.com
  • Kate Scarlata, RDN, LDN. The Well Balanced FODMAPer at: www.blog.katescarlata.com
  • Patsy Catsos, MS, RDN, LD. IBS Free At Last at : www.IBSFree.net
  • Order the new ProNourish™ low FODMAP drinks for your practice to help your patients stay compliant with a low FODMAP diet. ProNourish™ drinks contribute 3 g of low FODMAP fiber, 15 g of protein, are suitable for lactose intolerance (not for individuals with Galactosemia), gluten-free and do not contain sugar alcohols. Order samples, coupons and patient education materials at NestleNutritionSamples.com or learn more at Pronourish.com.
  • GastroDiet

 

Building a Professional Toolkit

 

Monash University Low FODMAP Diet Booklet

 

The Monash University Low FODMAP Diet Smart Phone App

Patient Education Handouts (for purchase)

Educational Programs

Information Coming Soon.

Relevant Organizations

Academy of Nutrition and Dietetics (AND)

  • Mission: To empower members to be the nation’s food and nutrition leaders.
  • Internet: www.eatright.org

 

American College of Gastroenterology (ACG)

  • Mission: To advance the medical treatment and scientific study of gastrointestinal disorders and strive to serve the evolving needs of physicians in the delivery of high quality scientific, humanistic, clinical, ethical, and cost-effective health care to gastroenterology patients.
  • Internet: www.gi.org

 

Association of Gastrointestinal Motility Disorders, Inc. (AGMD)

  • Mission: To serve as an integral educational resource concerning digestive motility diseases and disorders and function as an information base for members of the medical and scientific communities; to provide a forum for patients suffering from digestive motility diseases and disorders as well as their families and members of the medical, scientific, and nutritional communities.
  • Internet: www.agmd-gimotility.org

 

Crohn’s and Colitis Foundation (CCFA)

  • Mission: To cure Crohn's disease and ulcerative colitis, and to improve the quality of life of children and adults affected by these diseases
  • Internet: www.ccfa.org

 

Digestive Disease National Coalition (DDNC)

  • Mission: To work cooperatively to improve access to and the quality of digestive disease health care to promote the best possible medical outcome and quality of life for current and future patients with digestive diseases.
  • Internet: www.ddnc.org

 

Gastro-Intestinal Research Foundation (GIRF)

  • Mission: To raise funds for clinical and laboratory research in digestive diseases in the Gastroenterology Section at the University of Chicago Medical Center, and promote the education of the public regarding issues of digestive health.
  • Internet: www.girf.org

 

Gluten Intolerance Group

  • Mission: To provide support to people with gluten intolerances, including celiac disease, dermatitis herpetiformis, and other gluten sensitivities, so they can live healthy lives.
  • Internet: www.gluten.net

 

International Foundation for Functional Gastrointestinal Disorders (IFFGD)

  • Mission: To inform, assist, and support people affected by gastrointestinal disorders.
  • Internet: www.iffgd.org

 

National Digestive Diseases Information Clearinghouse (NDDIC)

  • Mission: The National Digestive Diseases Information Clearinghouse is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Established in 1980, the Clearinghouse provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public. The NDDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about digestive diseases.
  • Internet: www.digestive.niddk.nih.gov

 

North American Society for Pediatric Gastroenterology, Hepatology and Nutrition and NASPGHAN Foundation for Children’s Digestive Health & Nutrition (NASPGHAN)

  • Mission: To advance understanding of normal development, physiology, and pathophysiology of diseases of the gastrointestinal tract and liver in children; improve quality of care by fostering the dissemination of this knowledge through scientific meetings, professional and public education, and policy development; and serve as an effective voice for members and the profession.
  • Internet: www.naspghan.org

 

Society of Gastroenterology Nurses and Associates (SGNA)

  • Mission: SGNA is a professional organization of nurses and associates dedicated to the safe and effective practice of gastroenterology and endoscopy nursing. SGNA carries out its mission by advancing the science and practice of gastroenterology and endoscopy nursing through education, research, advocacy, and collaboration, and by promoting the professional development of its members in an atmosphere of mutual support.
  • Internet: www.sgna.org
Sources
  • Chey WD, et al. Irritable Bowel Syndrome: A Clinical Review. JAMA. 2015;313:949-58.
  • Gibson, PR, Shepherd SJ. Food Choice as a Key Management Strategy for Functional Gastrointestinal Symptoms. Am J Gastroenterol. 2012;107:657-66.
  • Halmos EP, et al. A Diet Low in FODMAPs Reduces Symptoms of Irritable Bowel Syndrome. Gastroenterol. 2014;146:67-75.
  • Kate Scarlata, RDN, LDN. FODMAP Resources. Available at katescarlata.com.
  • Mansueto P, et al. Role of FODMAPs in Patients with Irritable Bowel Syndrome: A Review. NCP. 2015;30(15):665-82.
  • Monash University Low FODMAP Diet for Irritable Bowel Syndrome. Available at http://www.med.monash.edu/cecs/gastro/fodmap/.
  • Monash University. 2016. The Monash University Low FODMAP Diet (Version 1.6) [Mobile Application Software]. Retrieved from https://itunes.apple.com/au/app/monash-university-low-fodmap/id586149216?mt.
  • Mullin GE, et al. Irritable Bowel Syndrome: Contemporary Nutrition Management Strategies. JPEN. 2014;38:781-99.