The Low FODMAP Diet – The what, the why and the how

The term FODMAP is an acronym that stands for

Fermentable Oligo-, Di- and Mono-saccharides, And Polyols

These types of carbohydrates got their own team name based on the length of their carbohydrate chains and have been known to worsen the symptoms of some digestive disorders, such as irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). These short-chain carbohydrates are poorly absorbed in the small intestine, attract excess water to the intestine and as they sit around waiting to be processed, they rapidly ferment in the gut, which can lead to increased gas, distention, bloating, cramping, and diarrhoea.

 

Oligosaccharides are unable to be digested as humans lack the digestive enzymes required to break them down. Foods that fit this category are artichokes, asparagus, beets, brussels sprouts, broccoli, cabbage, fennel, garlic, leeks, okra, onions, peas, shallots, wheat, rye, barley, legumes, lentils, chickpeas, apples, peaches, persimmon, watermelon, and pistachios

A disaccharide, Lactose is a made up of two sugar units. Lactose is only a FODMAP when there is an insufficient level of lactase, the enzyme required to break lactose down.  Several factors can influence lactase production such as genetics, ethnicity (Asian, African American, Hispanic, Native American, Alaska Native, and Pacific Islander), and other gut disorders. Common foods are milk, yogurt, ice cream, custard, and soft cheeses.

Fructose is a monosaccharide, a simple sugar and requires no digestion, however when fructose levels are greater than glucose, an alternative absorption method is used. This alternative method of absorption is impaired in some individuals, leading to fructose malabsorption. Common foods are apples, cherries, mangoes, pears, watermelon, asparagus, artichokes, sugar snap peas, honey, and high fructose corn syrup.

Fructans: Globe and Jerusalem artichokes, garlic (in large amounts), leek, onion (brown, white, Spanish, spring and onion powder), shallots, wheat (in large amounts), rye (in large amounts), barley (in large amounts), inulin, Fructo-oligosaccharides.

 

Polyols are a type of sugar alcohol that absorbs one third of what is consumed, and absorption is slow, fermenting in the intestinal tract. Common foods in this group are apples, apricots, cherries, pears, nectarines, peaches, plums, prunes, watermelon, avocado, cauliflower, mushrooms, snow peas, and the artificial sweeteners sorbitol, mannitol, maltitol, and xylitol.

 

Phase 1
The first phase of the Low FODMAP Diet generally involves the strict restriction of all high FODMAP foods for 4-6 weeks. Identify these foods and seek alternatives to ensure your diet is still nutritionally adequate, preferably with the supervision of a naturopath or nutritionist. The symptom response over this period should be noted, and a review appointment will then provide guidance on the second phase.

Phase 2
The second phase is where foods that were restricted in the first phase are reintroduced gradually and the diet is liberalised to suit the individual’s threshold. This is where the type and amount of FODMAPs that can be tolerated by the individual are identified so that their long-term diet can be established. It is very important to determine the level of FODMAPs that can be comfortably tolerated, so that the prebiotic effects of FODMAPs can be enjoyed and the diet is not overly restricted. The professional guidance during the reintroduction process can help to minimise symptoms and to ensure maximum variety is achieved in the diet.

Outcome

The result should be a long-term diet that is lower in the problematic FODMAPs for the individual than were originally consumed, but is not as FODMAP-restricted as the first phase of the diet. This easier to manage dietary plan is tailored to the individual’s tolerance and continually increasing research has shown this approach decreases the occurrence and severity of gas, abdominal discomfort, bloating, craping and diarrhoea in IBS patients
Note: This is a LOW FODMAP Diet, not a NO FODMAP Diet. Eliminating all FODMAP foods from the diet over the long term is not desirable or recommended. I strongly recommend you consult a healthcare professional when making such changes to your diet

 

**Not a complete list of FODMAP containing foods

Recipe: Lactation Cookies

Lactation Cookies Recipe

Have you started to find that your breast milk isn’t flowing like it used to? Give them a natural (and delicious!) boost with these Lactation Cookies! You’ll have liquid gold flowing freely in no time

Ingredients Prep time: approx. 15 minutes

Oven temp: preheat to 170C

Makes approx. 14-16 cookies, using a dessert spoon per cookie (double the recipe for more)

When making these lactation cookies, please try to source organic, local ingredients wherever possible. They’re so much better for you. Wherever possible, healthy alternatives are used, however the lactation cookies need to be sweet enough to hide the very bitter taste of one of the most powerful ingredients.

If you’re already breastfeeding, try eating the dough as well as the cookies, as it seems to be even more effective at increasing supply. Do not eat uncooked dough if you are pregnant. There is a risk of bacterial infection from eating raw egg.

1 cup self raising wholemeal flour (if you have plain flour, add 1/2 teaspoon baking powder) 

1/2 cup organic, virgin coconut oil

3/4 cup brown sugar (if you want to reduce sugar, you could try just 1/2 cup, but try this first time)

2 tablespoons flaxseed meal

1 egg

2-3 tablespoons of water (depends on how moist you prefer the cookies to be)

1 tablespoon vanilla extract (optional, for flavour)

1 teaspoon cinnamon (optional, for flavour)

1-2 tablespoons of brewers yeast – do not substitute with bakers yeast or any other yeast. This is a KEY ingredient. Nutritional yeast and bakers yeast are different

1/2 teaspoon Himalayan salt

1 & 1/2 cups steel cut oats, but rolled oats are fine

OPTIONAL: 1/2 cup of your favourite biscuit ingredients (see suggested list below)

Method

In a large mixing bowl, cream the butter and sugar, then add the egg and vanilla. Mix well. In a separate bowl, combine the flaxseed and water, let them sit for a few minutes before adding to mix.

Add the dry ingredients (apart from the oats and your additional ingredients) and mix well again. Finally, stir in the oats and your additional ingredients.

Make the biscuits (A dessert spoon is a rough size guide) and place them onto a lightly greased or lined baking tray. Flatten them a little with your fingers or a spatula – if you like a soft centre, don’t squash them down too much. If you like you can just make them into balls.

Bake the lactation cookies for around 10-12 minutes, depending on how well cooked or crunchy you like your biscuits.

Boosting Your Lactation Cookies For Better Results Try the above lactation cookies recipe first, but if you don’t notice much of an increase in supply, add more brewers yeast. If you like, add more flaxseed meal too, but don’t forget to increase the water when you add more dry ingredients. Add a tablespoon of water for each tablespoon of flaxseed meal.

 

Lactation Cookies – Ingredient and Variation Ideas

There are so many delicious ingredients you can add to your lactation cookies to flavour them up. You might like to add coconut, banana, grated apple, chic chips, sultanas, almonds, macadamia nuts, walnuts, chopped dried apricots, chopped prunes, dates

Coconut and banana

Choc chip and cranberry

White choc chips and macadamias

Dried apricot and white chocolate

Apple cinnamon: 1 teaspoon of cinnamon instead of vanilla, 1/2 cup stewed apple and 1/2 cup sultanas

“I have only used them for about 24 hours and the milk is flowing! So happy and excited that they are working so well!” — Rika-Marie

“I was eating 1-2 each feed and had only just cooked them so they were still quite soft. I noticed a huge difference when I had them, and I soaked through everything. When my son is feeding I hold a cup under my other breast and collect about 40mls just from leakage!” — Ryatha

“I made a particularly potent batch this week. I haven’t needed to use breast pads for a couple of months, but after this batch, my friends call me ‘Wet Patches’. I doubled the flaxseed meal, added cocoa and hazelnut meal – they taste like Nutella.” — Audax

“I love these things!! Made a heap yesterday, and ate some dough as well, oh yum! First time in a week I’ve been full, and bubs got boobie drunk!” — Sarah

“I started eating cooked lactation cookies at a rate of approximately 2 per feed. Average 24 hour yield over 5 days was: Before: 372ml. After: 412ml. Increase of 40ml, or 11%. Stopped eating cookies for 2 days. Average 24 hour yield: 397ml. Decrease of 4%. Started eating raw lactation cookie dough which, is supposed to be even more effective than cooked dough, also at a rate of the equivalent of 2 per feed. Average 24 hour yield over 4 days: 449ml. Increase (from cooked dough average) of 37ml, or 8%. Increase (from no dough in the previous 2 days) of 52ml, or 13%. Increase (from before eating any cookies or dough) of 77ml, or 20%. Conclusion: When I ate the cookies, raw or cooked, it made a positive, measurable difference to my supply, but the raw dough made a bigger difference.”