Marnie Nitschke, APD
Marnie is an experienced FODMAP-trained dietitian consulting at Everyday Nutrition
If you’re reading this, you’ve no doubt heard of the Low FODMAP diet. More and more people are doing it, and plenty of doctors and dietitians are recommending it. These days it’s the first line of dietary therapy recommended for those with IBS. We now have apps, websites, books and online courses dedicated to the Low FODMAP Diet. But you may be surprised that back in 2001 when I graduated as a dietitian, our Masters of Dietetics class hadn’t even heard the word FODMAP. The diet was yet to be perceived!
When confronted with an IBS patient, doctors and dietitians alike inwardly cringed. What advice could we give them? Eat more fibre? Eat less fibre? A vague recommendation to avoid ‘windy foods’. And why did so many people find bread and pasta problematic? The IBS client was the one that made our heart sink, because we just didn’t know what to tell them. But behind the scenes, exciting things were happening in the realm of nutrition research.
During this time, Melbourne dietitian Sue Shepherd was seeing great results in with IBS patients in her private practice, using what was called at the time the ‘fructose malabsorption’ diet. Fructose (the monosaccharide or single sugar) and fructans (oligosaccharides, or chain-length form of fructose) were the main culprits targeted, and in simple terms, it looked something like this:
Back then, information about the fermentable sugar content of foods was hard to come by. Lists were devised using the scarce data available, but also anecdotal evidence (ie. commonly reported trigger foods). Mesculine lettuce mixes, green beans and cabbage were out. Mushrooms and rye bread were in. Hydrogen breath testing was frequently recommended, and depending on results, avoidance of lactose was another strategy applied.
By this time, research was underway and being published by Sue Shepherd and the Monash University team. Foods began being tested using new techniques and equipment, and our knowledge of fermentable sugars was growing. As the researched progressed, we learned that polyols and galactooligosaccharides were also part of the puzzle. And this was built into the dietary advice given to patients.
By this time, the team of researchers at Monash had developed a well-structured and defined diet specifically for patients with IBS. Sue released the first of her many cookbooks dedicated to the diet, titled Irresistibles for the Irritable, and word was spreading. The low FODMAP diet soon had a name, and by 2006, research was being published that proved it’s efficacy as a dietary treatment for IBS.
Being fortunate enough to work alongside Dr Shepherd and the team at Shepherd Works for nearly 10 years, I’ve seen the low FODMAP diet develop and change over time. Since the launch of the Monash University smartphone app in 2012, the information available to consumers and practitioners has expanded exponentially. These days, instead of just high or low, we now have ‘moderate’ categories, and detailed information about the serving sizes and various FODMAPs present. Instead of yes or no, we need to distinguish between different varieties of berries, pumpkin and mushrooms before deciding on their suitability.
Following clients through their FODMAP and food intolerance journey, I’ve seen that the low FODMAP diet works for a great many. Which is fantastic! But what strikes me and other dietitians in this specialized field is that there is still so much left to learn. And given it’s a constant learning process for trained dietitians, it’s easy to see just how overwhelming today’s low FODMAP diet can be to the newcomer.
Do you know the most common advice I hear myself telling clients in private practice of late? Let’s just relax a bit and stop sweating the small stuff. And that they don’t need to get the diet 100% right to see results. Big picture changes will often get great results – as did the clunky old ‘fructose malabsorption diet’ we were working with 15 years ago!
There is no doubt in my mind that becoming too focused on lists and minute details can stress people out and backfire monumentally. If you are feeling bamboozled about your intolerance symptoms, and starting to feel like food is your worst enemy, I’d strongly encourage you to consult an experienced dietitian for help. Our training and experience means we can guide you through the minefield of dietary information out there. We’re not the food police – we actually love food!
Marnie & Joanna are gut health expert dietitians with the knowledge and skills to support you with personalised advice and gut health solutions. We consult privately in Melbourne’s inner South East and via Skype. To make an appointment or seek advice, you can call any of the consulting rooms directly or email us at firstname.lastname@example.org