Bloating, abdominal pain, diarrhoea, constipation and excess gas are common gut problems that many of us suffer from occasionally. But when these symptoms occur regularly and persist it can hugely affect one’s quality of life and enjoyment of eating. The gut is complex and emotional and physical factors, as well as the food we eat, influences how our gut feels and functions.

I am sure you will have heard of the low FODMAP diet! The low FODMAP diet is a well-researched and accepted treatment option for the above gut symptoms. A short term trial of the low FODMAP diet, with support from a FODMAP trained dietitian, improves gut symptoms (e.g. diarrhoea and bloating) in 70 - 80% of people with irritable bowel syndrome (IBS). FODMAP is an acronym for fermentable oligosaccharides, disaccharides and polyols. These are all types of carbohydrates that occur naturally in food. The type and amount of a FODMAP carbohydrate in a particular food varies with ripeness, growing conditions and manufacturing (e.g. whole grain, dried, juice etc). You may not be aware that the low FODMAP diet actually has three phases. The strict elimination stage should only be followed for a short period to time and then the FODMAP food groups should be re-challenged to identify your which of the FODMAP carbohydrates or foods cause your individual symptoms. The length of each phase depends on an individual’s symptoms and history.

The reintroduction and individualisation phases of the low FODMAP diet are very important. Following an overly restrictive diet long term can reduce the diversity of your gut microbiome, which is not ideal, because much research links a diverse gut microbiome with better long term physical and mental health, including greater happiness! One of the best best ways to promote a greater range of gut microbes is by eating a varied diet. The aim of phase 3 of the low FODMAP diet is to understand how you can eat a varied diet long term while minimising uncomfortable gut symptoms and ultimately improving your enjoyment of food and quality of life.

how can the low fodmap diet help manage inflammatory bowel disease symptoms?

Your IBD is in remission, great! But you are still getting tummy pain and multiple loose bowel motions, and maybe quite a lot of gas and/or bloating too. You are not alone, at least 30% of people with IBD report ongoing gut symptoms when their IBD is in remission. It can be difficult to figure out whether these symptoms are IBD symptoms of a flare or a symptom related to food or something else. You have probably noticed many life factors affect your gut symptoms too, including stress, anxiety, exercise, alcohol, travel, changes in routine etc as well as diet. You may have also noticed that your tolerance of particular foods likely changes depending on these life factors. For example, many people notice their gut symptoms are less intense when they are on holiday.

Randomised controlled trials (the best scientific evidence available) show that the low FODMAP diet can help improve gut symptoms when IBD is in remission. It is very important that phase 2 and 3 of the low FODMAP diet are done. The best way to do this is with support from a low FODMAP trained dietitian. Research shows that in IBD gut microbiome diversity is further reduced on the low FODMAP diet, therefore staying on a restrictive low FODMAP diet long term is not advised. Staying on a strict low FODMAP diet can also reduce your intake of vital nutrients needed to support a healthy immune system and optimise your gut health. Figuring out your individual tolerance of high FODMAP foods, is an essential part of gaining more confidence and knowledge around how your body reacts to certain foods. At Gut Nutrition, I can guide you through this process.

low fodmap christmas cake

I love Christmas cake. But if you find that some groups of fermentable carbohydrates (FODMAPs) cause you gut symptoms then a chunk of Christmas cake may not be your friend. This is variation of my favourite fruit and nut cake that is low in oligassacharides (fructans and GOS) and polyols (sorbitol and mannitol). These are two groups of fermentable carbohydrates that many people find problematic. The recipe does include cherries (one of my favourite fruits!) but one slice of cake (1/10th of the recipe) should be well tolerated by most people. You can substitute cherries for another red fruit if you are not a cherry fan.

Ingredients

2 cups of nuts - 1 cup macadamia & 1 cup walnuts

150g mixed peel

1/2 cup red dried fruit - 1/4 cup freeze dried cherries & 1/4 cup dried blueberries

75g crystallised ginger

75g green or red glacé cherries

1/4 cup Grand Marnier (orange liquor) or whiskey

1 Tbsp chia seeds 

4 sticks of rhubarb roasted 

1/2 cup strawberries roasted

50g butter

1/2 cup firmly packed brown sugar

1 egg

1/4 cup hazelnuts ground

1/2 cup gluten free flour

1/2 tsp baking powder

1 tsp ground cinnamon 

1/4 tsp ground cloves

zest of one orange

1 tsp vanilla essence

Method

1. Preheat oven to 200º fan bake. Cut rhubarb into thumb length pieces and remove green tops of strawberries. Place rhubarb and strawberries on a lined baking tray and bake in oven for 15-20 minutes. Bake until rhubarb is soft to touch. This can be done ahead of time and kept in fridge until needed.

2. Place nuts, dried fruit, ginger, cherries and liquor in a bowl to soak.

3. Mash 1/2 cup of roasted rhubarb, removing any outer stringy bits, and 1/2 cup strawberries. Mash only the fruit and leave behind any juice. Add chia seeds to mashed fruit, mix well and set aside for 15 minutes for chia seeds to swell. 

4. Preheat oven to 150º fan bake. Grease a large loaf tin and sprinkle sides and bottom of tin with a little flour. Tip out excess flour.

5. Cream butter and sugar until light and creamy. Add egg and mix well. Add ground hazelnuts and mix well.

6. Sieve flour, baking powder and spices into creamed mixture. Fold to combine. 

7. Mix soaked nuts and fruit with roasted fruit. Ensure the rhubarb and strawberry mixture is well distributed. This will help ensure the cake is evenly moist. Add fruit to the flour mixture along with orange zest and vanilla essence. Mix well.

8. Spoon the cake mixture into loaf tin. Bake for 75 - 90 minutes. Cake is cooked once the top is cracked and it has slightly pulled away from the edges. If the top of the cake becomes very brown cover with tin foil.

9. Remove from oven and leave to cool in tin for at least 30 minutes. Use a knife to loosen around the edges before tipping cake out of the tin. Slice cake into finger width pieces using a serrated bread knife. Cake stores well in an airtight container in fridge.