Tuesday, 11 October 2016

FODMAP Stacking – can I overeat “green” foods??

By Dr Jaci Barrett (Dietitian)

 
With the increasing amount of detail we share with you via our Monash University low FODMAP diet app, we are getting more and more questions about FODMAP stacking. Green foods on the app are low FODMAP and are therefore suitable on a low FODMAP diet, but more detail is provided in the app for some low FODMAP foods, where we reveal an upper limit serving size when the food then becomes red and therefore high FODMAP.
Broccoli and zucchini are good examples of this:
 
 
A standard serve of broccoli is ½ cup, which is low FODMAP and suitable for a low FODMAP diet. But you can see further details are given, revealing that large servings, >1 cup, contain high levels of the oligosaccharides and sorbitol.
For zucchini, a standard serve is ½ cup, also low in FODMAPs, with large servings >100g, high in fructans.
The important thing to know is that not all green foods have upper limit serving sizes. Most green foods are low FODMAP, even in very large serves. If there is no upper limit noted in the app, then you can safely eat a large amount. This is the case for vegetables such as carrot. Eggplant is green, but when you click on it you will see that very large quantities are amber due to a moderate amount of sorbitol.
 
The questions that come with this information are around FODMAP stacking. Can I eat ½ cup broccoli, ½ cup zucchini and 1 cup of eggplant all of which are green in these quantities? Are they still green if consumed together in the one sitting? Is there an additive effect?
For the vast majority of IBS patients following a low FODMAP diet, this sort of example will be tolerated. Even if the total FODMAP content goes above the green limit, most people manage to eat amber and even the lower limit of red serves of foods. Should you FODMAP stack during the initial 4 week strict low FODMAP dietary trial? You should feel comfortable eating reasonable portions of green foods in one sitting, but don’t be disheartened if you eat a larger amount. It will not undo all your good work. Most people won’t get symptoms from these type of foods. It’s the really high FODMAP foods that create the most havoc, such as onions, dried legumes and pears.
 
For foods with upper limit serving sizes, you can modify your meals to ensure your serving size is controlled. Broccoli soup is unlikely to be well tolerated if it is made purely out of broccoli and you eat 2 cups of it. But a modification of the recipe to bulk the broccoli out with parsnip, potato and carrot (all of which are green regardless of how much you eat), the end result will be a low FODMAP broccoli soup. Similarly, if you consider using zucchini strips as a pasta replacement, you just might want to watch how much you use. Keep it to a small zucchini (<100g), add your low FODMAP pasta sauce and serve it with a low FODMAP red cabbage (amber but OK if you don’t eat too much) and parmesan salad – YUM! Recipe coming in the following weeks!
In the end, we want you to remember that a low FODMAP diet should include green and amber foods (and for some people even some red foods). So, you can consume larger servings of foods that may bring them into moderate or high FODMAP levels as long as you don’t experience any nasty symptoms. The diet should be relaxed over time and we hope that the detailed information we share with you through the app will help you to achieve this.
We are more than happy to provide some guidance with further FODMAP stacking questions. What sort of food combinations have you been concerned about? Post them on facebook and we will provide some guidance on whether they are OK, and how you could modify your meal to lower the FODMAP content.

12 comments:

  1. Is it possible that some people may not be able to even tolerate the low fodmap serving for a particular food? For example 1/2 cup of broccoli. When I last ate vegetables, I had a small portion of (cooked from frozen) cauliflower, broccoli and carrots and on more than one occasion when I ate this, I had a painful flare up even tho I think from memory that the portions were within the recommended sizes (although I did not weigh them out)
    The other query is about vegetables with no upper limit. During a recent flare up of chronic diarrhoea lasting about a week but mushy stools for longer, my dietician told me to reduce the fibre in my diet, stop eating salads, seeds, peel all vegetables. My stool remained mushy and formless until I stopped eating carrots. Now I eat no vegetables at all and my dietician has recommended staying off them and taking vitamin supplements instead. So what should people do if they can't even tolerate the unlimited low fodmap green foods?

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    1. Hi there, it is certainly true that FODMAP tolerance varies between people, and some people may be more sensitive to FODMAPs than others. This is why seeing a dietitian for guidance through the elimination and rechallenge phases is important, because it enables you to establish your individual level of FODMAP tolerance. It is also true that your tolerance to FODMAPs can change over time. So rechallenging poorly tolerated FODMAP subgroups is important. Although reducing fibre intake during an acute bout of diarrhoea may be helpful, this is not a healthy long term solution. It is also probably unnecessary. If your dietitian is experienced in IBS and the low FODMAP diet she should be able to guide you through the elimination-rechallenge phases to determine more specifically what your triggers are. This means you can be on the least restrictive diet necessary long term.
      Kind regards, Jane

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  2. This article's topic is very helpful. I have been doing the diet for a year and it is the sole issue I still have problems with. It takes three days for most foods to react in my system, thus trying to not overstack green-lighted foods is very difficult. I have studied many sites for info on the importance of correct portions of FODMAP foods and mixing foods and there are a shocking lack of information in respect of how much info you can discover about FODMAPS now. Thank you for this article. More on quanity and mixing ingredients would be appreciated :-)

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  3. This is such a helpful article. Thank you so much . Even though I have had help from a FODMAP trained dietician, this still clears up questions that have been unanswered. I hope you will be able to put forward even more information on the cumulative impact of FODMAPS in the future. I think many people will benefit from a clearer understanding of these issues and of portion size. All the best, Joy

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  4. Hi Douneth, I agree that this is useful and was/is actually one of my greatest curiosities. My immediate thought was to look at the different saccharides that are high in the food as shown on the App. For example 1 sweet corn on cob is high in Polyols and moderate in Oligos but 1/2 is OK. Add that to 1/2 cup butternut pumpkin which is moderate in the same it could push over into the red. But say you put some haloumi cheese with the pumpkin (which is moderate in lactose at 4 slices but green at 2) you would be OK with 2. I agree, I would like more on this. Maybe if we spread the word and more people buy the App Monash will have more funds for research.

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  5. I strongly agree that what the community needs most is more clarity into the particulars of how much fodmaps are in these green/yellow foods gram for gram. I get the help on basic level for people first coming into the daunted and confusing world of fodmaps to have a green/red light system. However, if you guys on the cutting edge of the research could give us better ways to quantify how much fodmaps every food had say per 100g so we could better understand our fodmap tolerance thresholds and how much we were getting from various foods it would be enormously helpful.

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    Replies
    1. Yes, yes yes yes. Completely agree. I am a fairly big guy, so it is extremely frustrating when a) I need to eat a lot for starters in order to be satisfied and b) I don't know how much I can actually eat and when to stop.
      I agree, pretty much all we need is a fodmap counter, something that can tell us how much fodmaps are in a food gram for gram. I just hope they can fix this problem in the next 20 years because most of my older family members have IBS so it looks like my kids will be affected by it as well.

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  6. I strongly agree that what the community needs most is more clarity into the particulars of how much fodmaps are in these green/yellow foods gram for gram. I get the help on basic level for people first coming into the daunted and confusing world of fodmaps to have a green/red light system. However, if you guys on the cutting edge of the research could give us better ways to quantify how much fodmaps every food had say per 100g so we could better understand our fodmap tolerance thresholds and how much we were getting from various foods it would be enormously helpful.

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  7. I would gladly pay for an app food diary which would count total fodmap content instead of calories. Especially if it also had the ability to log symptoms and analyse longer term patterns, but as a start, a fodmap counter would be great.

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  8. Broccoli heads and stalks on the APP state they contain fructose not oligosaccharide. Whereas a whole piece of broccoli contains oligos (fructans). I presume the fructose is an error on the otherwise wonderful APP?

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  9. I strongly agree that serving suggestions in grams would be far preferable to servings like "10 green beans" for the purposes of clarity. If that could be incorporated into the Monash research, that would be a huge blessing! Even so, thank you for all you do. It is so helpful even without the gram information!

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  10. I am so embarassed. I just opened the Monash app and realized that gram-measures of foods are right there. I've just always missed them! Thank you for all of your hard work, and I'm sorry to have commented without double-checking the app!

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