Dietitian Goes Vegan Low FODMAP!
One week’s experience on the Low FODMAP diet
I am a Registered Dietitian. As my professional interest is in the dietary treatment of Irritable Bowel Syndrome (IBS) using the Low FODMAP diet I decided to practice what I preach and try to follow this diet myself for one week and also follow a vegan diet to see how difficult (or not) this was.
IBS affects one in five of us. The symptoms such as pain, bloating, wind, diarrhoea and/or constipation have a serious impact on quality of life. These symptoms can also cause anxiety and reduced energy levels.
This dietary treatment for irritable bowel syndrome (IBS) is relatively new to the UK and was initially developed by Dr Sue Shepherd in Australia 1999. In the UK it has been available as a treatment for around 10 years. Ongoing research in the UK is being carried out by Kings College London. Their results mirror those found in Australia in that this diet successfully manages the symptoms for around 75% of people with IBS who are supported by a Dietitian. Kings College recommends that this dietary change is supported by a Dietitian who has received additional training in this dietary intervention (which I have completed)
I feel that many vegans are already a highly motivated and knowledgeable group when it comes to food choice and are well practiced in having to plan ahead and ask questions when food is provided by others (be it restaurants, friends or family). All necessary skills in the successful implementation of a Low FODMAP diet.
FODMAP’s are fermentable carbohydrates FODMAP stands for;
O oligo-saccharides (fructans & Galactans)
D di-saccharides (lactose)
M monosaccharides (fructose)
P polyols (sugar alcohols)
Fermentable just means that these foods are poorly absorbed so stay in the digestive system for longer and are ‘fermented’ by bacteria producing gas, bloating and distention.
Oligo-saccharides are found in wheat, rye and barley. Various fruits and vegetables as well as pulses, legumes and beans
Di-saccharides are found in lactose which is a milk sugar so not part of the vegan diet.
Mono-saccharides such as fructose the sugar in fruit, honey and agave nectar
Polyols can be found in sugar free chewing gum & mints as well as various fruit and vegetables
FODMAP’s are found as an ingredient in many foods as well as the more obvious sources. It is recommended that they are completely removed from the diet for a period of 4 weeks followed by a reintroduction phase to test tolerance and avoid long term unnecessary dietary restriction.
These carbohydrates are poorly absorbed by most of us but only trigger symptoms in susceptible individuals. FODMAP’s cause fluid to be pulled into the intestine and, as they are not fully absorbed, they then pass into the large bowel where they are fermented by bacteria. It is these effects which lead to the symptoms of pain, bloating, wind and diarrhoea and/or constipation. Additional symptoms include low energy levels, noisy abdomen, frequent need to urinate, heartburn and nausea. A person may have some or all of these symptoms and they vary in severity from person to person
This is NOT an allergy but a functional gut disorder. Remember that these foods are poorly absorbed by many but only in susceptible individuals is the gut reaction severe enough to lead to notable symptoms.
The Low FODMAP diet is a 2 phase plan:
1. Removal of FODMAPs from the diet for 4 weeks. This is the most restrictive part of the diet but it is not long term
2. Following the first phase of removal from the diet (for 4 weeks) tolerance level needs to be tested for each FODMAP to avoid unnecessary long-term food restriction. The second phase of the diet, to assess tolerance, has been carefully designed and tested to tease out these effects in an individual so that the least restrictive dietary intake can be followed in the long term.
Many people feel they have an intolerance to gluten (protein) in wheat and gluten sensitivity in the population is on the rise. But it could be the fructans (fermentable carbohydrate) in wheat that are triggering their symptoms rather than the gluten. By removing the gluten containing foods many of the fructans will also be removed and a reduction of symptoms may occur. However, further improvement may be possible by exploring the Low FODMAP dietary approach.
If you have been diagnosed with Coeliac Disease gluten needs to be 100% removed from the diet for life. Coeliac disease affects 1 in 100 people in the UK, IBS affects 1 in 5 people in the UK, levels of gluten sensitivity are unknown.
One of the groups of foods which need to be restricted are pulses (peas, beans and lentils) this proved to be the most challenging aspect for me. I rely on hummus as a quick sandwich filling but I did find a wonderful tomato pate recipe using tofu and sundried tomatoes.
There are long lists of fruits and vegetables which need to be avoided but equally long lists of fruits and vegetables which are fine. So this was just a case of using fruits and vegetables from the acceptable group. Onions and garlic also need to be removed from the diet but garlic infused olive oil, chives and the green part of spring onions are fine. I found these to be an acceptable replacement for onions and garlic in recipes. Like many vegans I do not have many processed foods in my diet and so didn’t have the problem of trailing through the long list of ingredients these products often contain. Also many processed foods contain “hidden” ingredients under very generalised wording. Particularly onion and garlic which may be hidden under “flavourings” or “seasoning”.
I found that most recipes could easily be altered to be Low FODMAP.
Wheat products need to be removed from the diet. Gluten free products can be used, not because gluten is a FODMAP (gluten is the protein in wheat) but the fructans (the fermentable carbohydrate in wheat) may be. The process of removing the gluten also reduces the fructans. Sour dough spelt bread is acceptable on the diet but this can be difficult to find. It has to be sour dough other breads made with spelt flour are not suitable. I chose to make some of this bread using wholemeal spelt flour. Sough dough bread requires that you have a “starter” which needs approx. 1 week in the fridge to develop as this bread does not use yeast. There are many YouTube videos describing the process, whilst they do not mention spelt flour in particular, you just use the spelt flour in the same amounts. The bread itself is quite dense (think German Rye bread) and very filling. It also lasts well without going stale and freezes well if you make up a batch.
The low FODMAP diet can be lower in fibre. Using wholemeal spelt flour was one way I kept up a good intake of fibre as was brown rice. I also used linseeds and oats, particularly rough oat cakes to increase my fibre intake.
The first week of the diet is probably the hardest and I feel the diet would have become easier as suitable replacements were found for my usual dietary choices. This is also the feedback I have had from many of my clients.
I did plan out all the weeks meals and snacks prior to starting the diet something I encourage and help my clients to do.
My conclusion was that although it requires a little more planning following the diet as a vegan is perfectly possible. The level of dietary planning to ensure a long term nutritionally balanced intake would depend on how many of the FODMAPs needed to be avoided or restricted as identified in the reintroduction phase of the diet.
It is worth remembering FODMAPs do confer some important dietary benefits too. In particular to the balance of gut flora (bacteria) which is linked to being in general good health and a robust immune system. FODMAPs effectively feed the gut flora. Many of the excluded foods, particularly pulses, have positive effects on blood sugar, appetite control and as a source of iron, fibre and protein as well as ensuring a varied dietary intake is achieved.
It is for these reasons that only an individual who will experience significant IBS symptom reduction should follow this diet and also why the re-introduction phase to test tolerance is so important. For many with IBS these foods, with so many other health benefits, can be part of the diet even if in only limited amounts without inducing symptoms.
firstname.lastname@example.org Tel: 01702 343995 / 075 300 21102
If you have IBS and are interested in trying the Low FODMAP diet I offer a free initial telephone consultation. The diet requires 2 subsequent consultations either in person or via SKYPE please contact me for further information.
Diana Anderson Bsc. (Hons) RD