Vegan Dietitian Goes Low FODMAP!

I am a Registered Dietitian who also happens to be a vegan.  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.

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 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 6 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 75% of people with IBS who are supported by a Dietitian. Kings College recommends that this dietary change is supported by a registered Dietitian who has received additional training in this dietary intervention.

In Dr Shepherd’s book “The Complete Low FODMAP diet” vegans are not discouraged from attempting the diet. In practice I feel that many would be discouraged by health care professionals who do not understand veganism and feel it is already too restrictive. I feel that we are already a highly motivated and knowledgeable group when it comes to food 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;

F fermentable                                                   

O oligo-saccharides (fructans & Galactans)                      

D di-saccharides (lactose)

M monosaccharides (fructose)

A and

P polyols (sugar alcohols)

Fermentable just means that these foods are poorly absorbed so stay in the digestive system 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 unneccessary 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 all but only in susceptible individuals is the gut reaction severe enough to lead to notable symptoms. 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.  In addition these carbohydrates have a combined effect meaning that an individual FODMAP may be tolerated but all the FODMAP’s together in the diet combine to overload the system.  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 tailored dietary plan can be produced.

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 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 (although it is thought only 24% of those affected are diagnosed) IBS affects 1 in 5 people in the UK, levels of gluten sensitivity are unknown.

For more information on the Low FODMAP diet visit my website www.dans.org.uk

My Experience

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 which I will continue to use (contact me if would like the recipe diana@dans.org.uk)

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.  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 generalized wording.  Particularly onion and garlic which may be hidden under “flavorings” 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 causing any problems (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 a good week (or more) without going stale and freezes well if you make up a batch.

The low FODMAP diet can be low in fibre.  Using wholemeal spelt flour was one way to keep 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 become easier as suitable replacements were found for usual dietary choices.  I do not have IBS but I did notice that my digestion generally felt more settled remember these foods are poorly absorbed by most of us.  However, they do confer some important benefits too.  In particular to the balance of gut flora (bacteria) which is linked to being in general good health with a robust immune system.  They also act as natural laxatives and constipation can be a side effect of following the diet.  Many of the excluded foods, particularly pulses, have positive effects of managing blood sugar, appetite control and as a source of iron.  And are, in part, why a well-balanced vegan diet usually rich in pulses is such a healthy diet.

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 most many of these foods with so many other health benefits can be part of the diet even if in only limited amounts without inducing symptoms. 

If you have IBS and are interested in trying the Low FODMAP diet I offer a free initial telephone consultation.  More information is available at www.dans.org.uk

I can offer a 10% discount if you quote the code: VeganFODMAP2015 when you contact me.

diana@dans.org.uk  Tel: 01702 343995 / 075 300 21102