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What is FODMAP Stacking?

It is not an uncommon scenario where you have been super strict on the Low FODMAP Diet and still see very little change in your symptoms. The answer may be FODMAP stacking. Read on for a brief overview on what it is.

What is FODMAP Stacking?

FODMAP stacking occurs when multiple portions of one or more Low FODMAP foods from the same FODMAP category, e.g. Fructose, are consumed in a single meal or close together. This causes the FODMAPs to “stack” in your digestive system, which can eventually lead to a trigger in symptoms.

The reason for this is because food intolerance is dose dependent, meaning that whatever Low FODMAP food you may be intolerant to, will trigger your symptoms when you have reached your personal threshold. Ripe bananas may trigger a reaction in both Bob and Bobette but Bob can eat 1/2 a serve before triggering symptoms, whereas Bobette can only eat 1/3 of a serve.

Example of FODMAP Stacking

Using the Monash University Low FODMAP Smartphone App, I will explain how to identify if you’re FODMAP stacking:

Let’s look at flax seeds, if you didn’t go into the description of flax seeds, they appear to be relatively safe to consume on a Low FODMAP Diet because of the green light. However, upon reading the description the app states that most individuals with IBS should tolerate 1 tablespoon of flax seeds but 2 tablespoons contains high levels of Oligos – GOS. This means that if you consume more than 1 tablespoon of flax seeds in a single meal or within 2-3 hours from the first serve, the Oligos – GOS content stacks which may lead to a trigger in your symptoms.

Image source: Monash Uni Low FODMAP Diet app

There you have it, a quick overview on FODMAP stacking. Please note that the Monash University Low FODMAP Smartphone App has recently updated so there are changes in portions and descriptions to some of the foods

Need help?

At The Nutrition Space, we can help you understand the Low FODMAP Diet and provide you with a structured plan to help you stay in control. For more information please click on the following link https://www.thenutritionspace.com.au/ibs-low-fodmap-program

Original article post on The Nutrition Space

Replacing Garlic in FODMAP Diet – Blog by Evelyn Vo

Garlic is one of the most commonly used foods for flavouring. It’s a great flavour to have in salad dressings, vinaigrettes, marinades, sauces, gravy, vegetables, and soups. So when you finding out that your body doesn’t tolerate well to garlic it may not be the best news. On the Low FODMAP diet, there seems to be a bit of confusion on how to use garlic safely. This article will look into exactly that.

Why Is Garlic A Problem On A Low FODMAP Diet?

Garlic contains fructo-oligosaccharides which is commonly referred to as fructans. Humans do not have the enzymes to break down fructans which means that foods such as garlic, are malabsorbed in the small intestine and then fermented by the gut bacteria. This can then lead to irritable bowel systems such as, gas, bloating, stomach cramps, diarrhea and constipation. It is recommended that while on the Low FODMAP Diet, you remove garlic in the elimination phase.

How Can I Still Have Garlic On A Low FODMAP Diet?

Just because you’re on the Low FODMAP Diet it doesn’t mean you have to miss out on the garlic flavour. Garlic infused oils are a delicious replacement for garlic in the Low FODMAP Diet. Why? Because the fructans that are present in garlic are only water soluble not oil soluble. This means that the garlic flavour can be transferred to the oil, while the fructans stay trapped in the garlic. In garlic oil, there is no water for the fructans to leech into which should be well tolerated by those who are on the Low FODMAP Diet. This is also the reason why you can’t just take garlic out before you have your meal because the fructans will dissolve in any water that is present.

Where Can I Get Garlic Infused Oil?

The commonly sold brand in major supermarkets is Cobram Estate: Garlic Infused Extra Virgin Olive Oil. This has been lab tested to be low FODMAP. Other ones in the market also include: Boyajian Garlic Oil, Texana Brand Roasted Garlic Infused Olive Oil,  and Garlic Gold Oil.

Remember to read the labels carefully when buying processed foods as garlic are often found in added process foods such as dips, mixes, chips and gravy!

Check out our Low FODMAP program here.

Originally posted on The Nutrition Space.

What is The Low FODMAP Diet: A quick summary on what you need to know about The Low FODMAP Diet – Blog By Evelyn Vo

Do you often experience digestive stress after eating certain foods? Does it feel so uncomfortable that you are unable to continue what you were doing? You’re not alone. Research have reported that around 20 % of the Australian population have IBS (Irritable Bowel Syndrome), and of these, 4 in 5 respond to a low FODMAP diet. What is The Low FODMAP Diet? And how does it work?

What are FODMAPS?

FODMAPS stands for:

  • Fermentable – rapidly broken down by bacteria in the bowel
  • Oligosaccharides – fructans and galacto-oligosaccharides (GOS)
  • Disaccharides –e.g. lactose
  • Monosaccharides –e.g. excess fructose
  • And
  • Polyols – sorbitol, mannitol, xylitol and maltitol

These are different types of fermentable carbohydrates that can aggravate the gut in sensitive people due to poor absorption. When these carbohydrates are not absorbed properly, they are fermented or not digested which can result in symptoms of IBS, including bloating, constipation, flatulence, pain and nausea.

High FODMAP foods and other things that can trigger IBS symptoms

Some of the high FODMAP foods include: wheat based breads, legumes, garlics, onions, cow’s milk, figs, mangoes, watermelons, honey, High Fructose Corn Syrup (HFCS), apples, pears, and sugar-free gum.

Unfortunately the list of IBS triggers can go beyond food. Things like level of stress, anxiety, certain medications, can also trigger your IBS symptoms.

What is The Low FODMAP Diet?

The Low FODMAP Diet was first developed by a team of researchers at Monash University in Australia. Their research reported that reducing the intake of high FODMAP foods could help mange the symptoms of IBS.

How is the diet implemented?

Like with many diets, it is recommended to consult with your Nutritionist so they can guide you through each stage of the plan, while ensuring that you are eating a balanced diet and not over-restricting your diet unnecessarily.

The Low FODMAP Diet consists of 3 stages:

  • The elimination stage: A strict restriction of all high FODMAP foods for 4-6 weeks.
  • The reintroduction stage: Reintroducing high FODMAP foods to identify the foods you can tolerate and your threshold level.
  • The adaptation stage: We establish your ‘modified low FODMAP diet.’ This increases diet variety and flexibility.

Why can’t I just stay on the low FODMAP diet?

Research has reported that staying on the low FODMAP diet long-term can have detrimental affects on your gut health. Foods such as onions and garlic are beneficial for improved digestion, so finding the right balance is recommended rather than removing it entirely. The good news is most people do not need to avoid all types of FODMAPs, even if you’re sensitive to certain FODMAPS, small amounts can be tolerated without sending you to the toilet.

For expert nutritional advice, please book an appointment at The Nutrition Space by sending through an enquiry or contacting us on +61468 463 837.

Evelyn Vo is a university qualified Nutritionist at The Nutrition Space with a passion for helping her patients implement practical dietary changes to improve their health and well-being.

Original article publish on The Nutrition Space.

Avoiding the Guilt trip this holiday season – Blog by Evelyn Vo (Nutritionist)

Admit it, for some of us it’s the same process every year when it comes to the holiday season. We spend the whole year “being good” and when the time comes, we think who cares! We then put ourselves through a guilt trip thinking, “why did I let myself do that?” It’s time to stop that vicious cycle and here are my top 5 tips to start you off:

  1. Plan ahead: If you are hosting a lunch/dinner there is no need to cook enough to feed an army (this tends to be a common trend during this time). Plan the meals accordingly, if there are going to be 5 guest, cook for 5 not 10.
    Going out? Look up the menu before hand and plan what you are going to eat.
  2. Set realistic goals: Goal setting is a great way to manage what you eat but you don’t want to go over board by setting unrealistic goals. An example of an unrealistic goal may be, “I won’t eat anything at the dinner party.” You will be more likely to throw it out the window and more importantly, you won’t enjoy yourself. A more realistic goal may be, “I will moderate my alcohol consumption to 1 standard drink at the dinner party.” This ditches the “all or nothing” approach which is more achievable than removing it completely. To read more about setting personal goals click here.
  3. Listen to your body cues: This is something I cannot emphasise enough, listen to your body cues!!!! Eat till you’re satisfied but not till you’re stuffed. If you’re hungry eat. If you’re bored ask yourself, “Am I hungry enough to eat a full meal?” If not, move on.
  4. Drink a glass of water before the main meal: Research has reported that drinking 500 mls of water 30 minutes before a large meal decreases the likelihood of overconsumption. This does not mean you should only drink water because your body still needs energy and nutrients to function.
  5. Reduce your portions sizes: Serving sizes have grown massively over the last several decades. Whether it is a family value meal for $20 or a all you can eat pizza and pasta deal, for many of us, it’s about bang for our buck. This value-based pricing have taught us to look at large portions as the norm, increasing our risk of obesity. It’s about time we retrain our brains when it comes to portion sizes and a simple way to start is by using a smaller plate. This simple step can lead to a 30% reduction in the amount of food consumed on average.

Remember to have fun and ditch that “all or nothing” attitude to eating. Enjoy good quality tasty food in controlled amounts and balance them with nutritious foods.

If you feel like you’re stuck in a rut when it comes to healthy eating and weight management, reach out to me by clicking on this link.

Originally posted on The Nutrition Space

Why its important to get your Iron up – By Evelyn Vo (Nutritionist)

The 2011-12 National Nutrition and Physical Activity Survey (NNPAS) reported that 1 in 8 people aged 2 years and over are not consuming adequate intakes of iron. This post highlights the importance of iron in the diet with a brief overview on the risk of deficiency, and some tips on achieving an adequate intake.

What is iron and why is it important?

Iron is an important mineral, which is a key component in red blood cells responsible for the transportation of oxygen in the blood tissues throughout the body (haemoglobin). It is also involved in immune function, acts as an oxygen reservoir (myoglobin), and is important for children’s cognitive and physical development. Without sufficient iron, haemoglobin levels will be low and anaemia will result.

How are we tracking with iron intakes?

The recent NNPAS data highlighted that inadequate intakes were more prevalent among females, particularly those aged 14-50 years, compared to males aged 14-50 years (refer to the table below). It has been assumed that females aged 14 years and over menstruate. During this process they need more iron to make up for the amount of iron lost during their menstruation (1 mg for every day of bleeding).

Adapted from “Australian Health Survey: Usual Nutrient Intakes, 2011-12

(No 4364.0)” by the Australian Bureau of Statistics, 2015

What is the recommended dietary intake (RDI) of iron for people aged 14-50 years?

The table below details the RDI for iron people aged 14-50 years of age. Females require more iron compared to males within this age range. During pregnancy, the iron requirement increases to 27 mg/day to compensate for the developing foetus drawing iron from the mother in preparation for the first 5-6 months after birth. The important thing about iron is to make sure you do not run low, this is particularly so for females. Prevention is the best strategy!

Adapted from “Iron/ Nutrient Reference Values” by the National Health and Medical Research Council (NHMRC), 2014

What is Iron-Deficiency Anaemia (IDA)?

IDA is the most common form of anaemia, which is a condition where there is a decrease in levels of haemoglobin and a haematocrit (blood test) displays a decreased production of red blood cells and oxygen capacity. IDA usually develops over time if you consistently have inadequate iron levels which is needed to build healthy red blood cells. As a result, the body starts using stored iron. If it does reach to a point where it uses up all the stored iron, your body makes fewer red blood cells, which contains less hemoglobin than what is required for the body.

Presentation of IDA

Symptoms of IDA can lead to:

  • Breathlessness
  • Dizziness
  • Fatigue
  • Looking very pale

Severe symptoms of IDA, in particular with young children, can lead to:

  • Heart problems
  • Decreased resistance to infection
  • Developmental issues with lifelong effects

Factors that can lead to IDA

Factors that can lead to the development of IDA include:

  • Delayed introduction to iron-rich foods during infancy followed by poor dietary habits in preschool:
  • At at 6 months of age, infants need iron from food sources for cognitive and physical development, and increased resistance to infection.
  • Malabsorption:
    • This occurs when your body cannot absorb iron from foods. If you suspect that you have malabsorption issues please contact your GP or local health professional.
  • When haem iron foods are poorly consumed or not consumed at all:
    • Haem iron (from animal sources) is absorbed more efficiently compared to non-heam iron (plant-based sources). If your diet excludes haem iron foods this does not mean you need to start eating meat. Non-haem sources such as: nuts, beans, whole grains such as brown rice and fortified breakfast cereals can still contribute valuable sources of iron in the diet.
  • High levels of blood loss:
    • This is prevalent amongst females aged 14 years and over due to menstruation.
  • Pregnancy:
    • A mother’s requirements increase significantly due to foetal development. Some mothers need to increase their intake of iron-rich foods and others may require iron supplements. It is recommended to consult your GP or local health professional before making any changes to your diet.
  • Professional athletes:
    • Professional athletes, in particular females, are at high risk of iron deficiency due to poor intake of iron-rich foods and iron loss through sweat, gastrointestinal bleeding, and red blood cell damage. This has been reported to become increasingly common for athletes who self-prescribe iron supplements with a self-belief that this will counter the feelings of fatigue due to heavy training However, it is important to remember that iron supplements should come second to iron-rich foods as iron supplements will only be beneficial when there is iron deficiency. There is also a risk of iron overload or haemochromatosis if an excessive amount of iron supplements are consumed. Haemochromatosis is a genetic disorder where the iron salts are deposited in the tissues of the body which can lead to liver damage, diabetes mellitus, bronze discoloration of the skin.

Groups at risk of IDA

  • Infants
  • Preschoolers
  • Adolescents
  • People with malabsorption issues
  • Vegetarians
  • Pregnant women

If you suspect you may be iron deficient please contact your GP or local health professional.

Which foods give you iron?

  • Red meat ~ 2 mg per 100 g
  • Chicken ~ 0.5 mg per 100 g
  • Fish ~ 0.3 mg per 100 g
  • Weetbix ™ ~ 3 mg per 2 biscuits
  • Cooked spinach ~ 3 mg per ½ cup
  • Tofu ~ 2.96 mg per 100 g
  • Cooked brown rice ~ 0.7 mg per 1 cup

Important things to note:

  • Milk is a poor source of iron
    • This has been reported to be prevalent amongst preschoolers who consume high volumes of milk. Milk is a great source of protein, however, this may displace the preschooler’s appetite for solid (iron containing)foods putting them at risk of iron deficiency.
  • Vitamin C plays a role in enhancing iron absorption, particularly of non-haem sources
  • Choose food first before taking iron supplements. It is recommended that if you’re going to take iron supplements you should do so under the supervision of a GP or local health professional.
    • Absorption of iron taken as ferrous sulfate or as an iron chelate is better than that from iron supplements.
    • The absorption of iron improves when you take the supplement on an empty stomach with liquids such as between meals or at bedtime.
    • As previously mentioned Vitamin C enhances the absorption of iron. There is no benefit in taking a Vitamin C tablet over Vitamin C foods because it does not enhance absorption.

Let’s increase our iron intakes through wholesome iron rich foods!

Originally published on The Nutrition Space. Evelyn works at our Heidelberg Practice on Saturdays 8:30-12:30pm. If you would like to make an appointment please visit here.

Is Sugar Really that Bad For You?

Blog By Evelyn Vo

We have to admit, sugar does not have the best reputation. Despite being delicious, sugar has often been demonised by media personalities who argue that it makes us fat, sick, that it is a poison and is slowly killing us. That said, the majority of us regularly consume sugar. According to the Australian Bureau of Statistics, Australians consume about the equivalent of 14 teaspoons of white sugar per day. Sugar cravings are often responsible for our late night binges and the inevitable sugar crash afterwards. The picture looks very bleak, but is sugar really that bad for us? Are the media personalities right in their crusade against sugar?

The low down on sugar

The first thing we need to realise when we talk about sugar is that there are several different types. Not all sugar is created equal. There are sugars that are bad for us in moderate to high amounts and other sugars that are healthy in higher amounts. For example, there are sugars that occur naturally in fruits, vegetables, milk, and whole grains, and are key to a healthy balanced diet. Cutting down on these types of food deny your body of vital nutrients for health.

Sugar becomes a problem when we regularly add refined sugar to our diets. Refined sugar belongs to a group of sugars called free sugars. These include any sugar that we add to food and includes both refined sugars (e.g., white sugar, raw sugar, brown sugar, etc.) and natural sugars (e.g., honey, maple syrup, fruit juices, etc.) Free sugars are often added to foods we eat by manufacturers to enhance the flavour, texture,colour, and overall shelf life of their products.

Here lies the problem with the media personalities that attack sugar. They argue that we should take sugar completely out of our diet, or, at least, remove all added sugar. They fail to make the distinction between good and bad sugars and often neglect the importance of moderation.

What is moderation?

The term moderation is used a lot in nutritional information. But, what does moderation mean to you? Does it mean the same thing to your best friend? How about your doctor? I think you’ll notice that we all vary in what we consider to be “moderate” use. Moderation can mean different things to different people. When it comes to the consumption of sugar, the World Health Organization provides a good recommendation. They suggest that adults and children aim for an intake of free sugars that equals 5% of their daily energy requirements. In other words, they recommend about 25 grams of added sugar per day, which equates to about 6 teaspoons of honey or white sugar.

This sounds like a lot! But, many of us consume more than this, even if we don’t add sugar to our coffee each day. the Australian Bureau of Statistics reported that many of us consume 105 grams per day. So, where is this extra sugar coming from?

Unfortunately, the awesome convenience of processed or packaged foods carries a significant cost. You guessed it, a large amount of added sugar. It is also tricky to determine the amount of free sugars in processed or packaged goods. This is because the Nutrition Information Panel that is located on all packaged foods in Australia does not differentiate between naturally occurring sugars and added free sugars.

If you’re interested in figuring out how much added sugar would equal 5% of your daily intake, the first place to start is by calculating your average daily energy intake. This can be provided by your Nutritionist or you can get a rough estimate from the Eat For Health website. Once you have got your average daily energy intake, calculate 5% of that intake and then divide it by 17. The resulting number will be the grams of added sugar You should aim to consume.

Be an informed consumer

Have you ever found a name on the ingredient list that sounds like sugar, but you’re not sure? I certainly have and that is because there are lots of different names for added sugar in packaged foods, many of which may be refined or artificial sugars. You can find out what they are by clicking on this >>link.

Also remember that not all foods with the same amount of sugar are equal. You can choose foods that have more nutrients with the same amount of sugar. For example, flavoured yogurts contain sugar, but you also get the benefit of calcium and protein, compared to a snickers bar, which have very few, if any, additional nutrients.

Are there healthier sugars than others?

No, despite the different colours and flavours, the nutritional values of white, brown, raw sugars are very similar. Some sugars have been spruiked, often by media personalities, as containing more vitamins, minerals or antioxidants than others. Often they are true, but the amounts are so miniscule that we’d have to consume tons of sugar to get any benefit from these “healthier” options. I would advise against this.

The bottom line

While the media personalities want to help you, making sugar out to be a demon is not helpful. You don’t need to avoid sugar to be healthy. Here is a more helpful approach: Sugar, like many nutrients, foods, and behaviours, can be harmful if used in excessive amounts. Arm yourself with knowledge, make wise food choices, and, fill your diet with plenty of nutrients to balance your sugar consumption. You can learn how to moderate your intake by reading nutrition labels, understanding your energy intake, and, creating a meal planner.

As a finishing point, you’ll notice that many of the media personalities who are anti-sugar also tend to cook their own food. Unless they are selling a food product, they don’t rely on processed or packaged foods. This isn’t by coincidence. If we chuck out their anti-sugar crusade, there is actually a good and simple message in their actions: make your own food and control your diet to achieve your goals. That’s a message I believe in.

Evelyn Vo is a nutritionist who practices at The Nutrition Space (Heidelberg and Melbourne CBD)
www.thenutritionspace.com.au