Written by Charlyn Ooi (Monash FODMAP Certified Dietitian) from Specialist Dietitian Consultancy

Have you been told by your doctor or health professional to go on the Low FODMAP diet but feeling unsure about where to start? Or have you been on a Low FODMAP diet for at least 2 weeks and you are still not getting full symptom relief?

The Low FODMAP diet can be complicated and it may get overwhelming to navigate through the plethora of information available out there. Get it right from the start and save time by avoiding these common pitfalls when following the Low FODMAP diet.

Mistake #1 – Being overly restrictive

It is inevitable to feel overwhelmed when you are trying to navigate the Low FODMAP diet on your own. I have seen clients who stick to the same diet day-in day-out once they have experienced symptom relief. They are too afraid to deviate from their ‘safe foods’ and end up missing out on social outings because they are worried about having another flare-up from eating out or attending parties. I am here to reassure you that following a Low FODMAP diet does not have to be boring.

Did you know that you can still have consume some types of high FODMAP foods but in small servings? If you have a sweet tooth and enjoy chocolates like me, you will be pleased to know that you do not have to cut out chocolates from your diet completely, even if you are sensitive to lactose. I highly recommend that you download The Monash University FODMAP Diet app – this is an extremely useful resource and provides credible, up-to-date information about the FODMAP content of different foods, including specifications on what a low FODMAP serve size is. According to the app, 1 fun-size milk chocolate bar (15g) or 2 squares milk chocolate (30g) is classified as low FODMAP. Dark chocolate (with more than 70% cocoa) is low FODMAP in a 30g serving (5 squares). When you are on the Elimination Phase, it is recommended that you only consume foods with the green light rating.

If you are looking for meal inspirations to expand your recipe library, check out these resources:

• Recipe websites: A Little Bit Yummy or Kate Scarlata
• Recipe books: Low FODMAP Recipes by Dr Sue Shepherd or FODMAP Friendly Kitchen by Emma Hatcher

Mistake #2 – Mistaking gluten-free products for also being low FODMAP

I often see clients confusing the Low FODMAP diet with the need to go gluten free. However, going gluten free is not recommended for individuals without Coeliac Disease and it can inadvertently increase the risk of nutrient deficiencies.

Gluten is a protein and it is found in many foods such as breads, pasta, oats, soy sauce and beer. Consuming trace amounts of gluten causes damage to the intestinal wall lining of the small bowel and it can be detrimental for coeliac sufferers. On the contrary, wheat is a carbohydrate sugar and it is often the culprit causing symptoms in individuals with IBS. It is easy to blame gluten for causing symptoms as gluten and wheat are commonly present in similar products such as breads and pastas. It is important to note that not all gluten free products are low FODMAP and vice versa. For instance, gluten free flours such as amaranth, besan flour, soy flour and lupin are all gluten free but high FODMAP. Therefore, it is important to read the ingredients list carefully. This leads us to the next point on label reading.

Mistake #3 – Not reading the label

It may seem like a hassle having to check the ingredients list initially but once you become more accustomed to the low FODMAP diet and get to know the products, it will become easier. Look out for the following ingredients that are high FODMAP:

• Inulin
• Fruit juice concentrate, agave, honey, molasses, high fructose corn syrup
• Sweeteners: Polyols (mannitol, xylitol, maltitol, isomalt)
• Onion or garlic powder
• Soy flour, besan flour, coconut flour, amaranth, lupin
• Soybean (e.g. Bonsoy soy milk)

To help provide consumers easily identify and choose low FODMAP products with confidence, Monash University and the FODMAP Friendly Program have tested and certified a range of low FODMAP products. Look out for products with these certification logos:

To make our lives even easier, FodShop has become the go-to platform for Fodmappers. It is the #1 online shop that offers FODMAP friendly products only, what a saving grace! They deliver within Australia and internationally – sign up to their newsletter and receive 20% discount on your first shop.

Mistake #4 – Not considering portion sizes & FODMAP Stacking

This is when the Monash FODMAP app comes in really handy. I will use green beans as an example - one serve of green beans (15 beans) is tested to be low FOMDAP (green light rating) and tolerated by most individuals with IBS. Having larger servings of more than 25 beans increases FODMAP intake and will most likely trigger symptoms in those who malabsorb sorbitol.

If you combine low FODMAP vegetables such as 15 green beans + ½ cup green capsicum + 1/3 cup zucchini to make a stir-fry, you may experience symptoms related to FODMAP stacking. Due to differences in individual FODMAP thresholds, it is difficult to predict when you will be affected by FODMAP stacking and you will only need to modify your recipe if the combination affects you. In the stir-fry combination above, it may help to replace zucchini with carrots which contains minimal FODMAP to avoid exceeding the threshold. You can read more about FODMAP stacking on the Monash University FODMAP page here.

Mistake #5 – Staying on the low FODMAP diet for too long

The Low FODMAP diet consists of 3 phases:

i) Elimination Phase

ii) Challenge Phase

iii) Maintenance Phase

Once you feel better on the Elimination Phase, it makes sense to keep going so you do not have to deal those nasty symptoms ever again. But do you know that restricting FODMAPs in the diet long-term can have negative impacts on your gut health? High FODMAP foods such as legumes contain prebiotics which promote the growth of good bacteria in the bowel and they are important for maintaining healthy gut microflora.

The Elimination Phase should only be undertaken for approximately 2 to 6 weeks. Research has shown that continuing on the Elimination Phase for more than 8 weeks can disrupt the diversity of the gut microbiome. Once you have completed the Elimination Phase and have at least 3 consecutive days of being symptom-free, you should consider reintroducing FODMAPs with the support of an experienced FODMAP Dietitian. The Challenge Phase is important for working out what your triggers are and identifying your individual tolerance threshold for each FODMAP sugar. The aim is to maintain a nutritionally balanced, varied and enjoyable diet without causing any flare-ups.

It is important that you speak to your Dietitian and GP/gastroenterologist if you do not experience any symptom improvement on the low FODMAP diet. There may be other underlying causes that are triggering your symptoms.

About Charlyn Ooi

Charlyn Ooi is the Founder and Principal Dietitian of Specialist Dietitian Consultancy. She has more than 10 years of clinical experience and specialises in the low FODMAP diet, paediatric nutrition and diabetes. She consults at 4 clinic locations across Perth and offers Skype/telephone consults for interstate and overseas clients. Follow Charlyn on @dietitian.charlynooi and contact her if you need more support on your FODMAP journey.