Friday, 30 September 2016

Low FODMAP Vegetarian Frittata

By Monica Rundle (Student Dietitian) & Lyndal McNamara (Dietitian)

National Nutrition Week is almost here and this year's theme is 'Try for 5'- which challenges all Australians to look for new ways to incorporate 5 serves of vegetables into their everyday diet. This simple vegetarian frittata recipe provides 3 or your 5 daily serves of vegetables per portion and is a quick, healthy lunch or dinner option that the whole family will enjoy!

Top tip- Use leftover cooked/roasted low FODMAP vegetables from a meal earlier in the week to make your frittata! This will make dinner preparation even faster and is a great way to reduce food wastage.

Serves 4


 

Ingredients

·         ½ medium sweet potato, cubed

·         2 tbsp. olive oil

·         1 tsp. paprika

·         3 spring onions (green tops only), chopped

·         1 bunch of broccoli, chopped

·         1 medium zucchini, grated

·         5 eggs

·         Dash of lactose-free milk (or other low FODMAP milk alternative)

·         ½ cup mixed herbs (basil/parsley)

·         4 tbsp. chives 

·         ¼ cup Danish feta

·         Salt and pepper to taste




Method
 


Step 1

Pre heat oven to 180 degrees Celsius. Toss sweet potato in half of the oil and paprika, place on lined baking tray. Roast in oven for 45 minutes of until tender

Step 2

Heat the remaining oil in a large 22cm ovenproof frying pan over medium heat.  Sauté spring onion and once softened, add the broccoli stirring occasionally until charred. Add zucchini; cook for 2 minutes or until softened. Remove from heat.

Step 3

Combine eggs, milk and mixed herbs in a food processor. Process until herbs are finely chopped and egg mixture is fluffy.

Step 4

Once cooked, add the roasted sweet potato to the broccoli mixture within the frying pan, and turn heat back to medium.  Add the egg mixture to the frying pan and stir until well combined. Sprinkle with feta and chives and season with salt and pepper. Reduce heat to low and cook for 8 minutes of until the egg mixture has mostly set.

Step 5

In the meantime, preheat the grill on high. Place the frying pan under the grill and grill until golden brown and egg mixture is set. Top with rocket salad (see below for recipe).

Rocket Salad
 
Serves 4
 
Ingredients

·         2 cups rocket

·         1 cup baby spinach leaves

·         ½ medium avocado

·         ¼ cup black pitted olives

·         3 tbsp. olive oil

·         1 tbsp. apple cider vinegar

·         Pinch of salt and pepper

Method



Step 1

Add salad ingredients to a bowl. To make dressing, add oil, vinegar, salt and pepper to a jar. Shake well. Taste and adjust seasoning if necessary. Add to salad, toss and serve with frittata.

Nutrition Information/serve:



Energy

1791kJ

Protein

13.6g

Fat

35.0g

Saturated fat

6.3g

Carbohydrates

11.8g

Dietary fibre

6.6g

Sodium

266mg

 

Tuesday, 27 September 2016

Have you seen what’s new in the Monash Low FODMAP Diet App?


By Shirley Webber, Research Dietitian 

Food Guide

You may have noticed that we have re-ordered categories in the Food Guide section and added two new categories: Nutritional Drinks and Snacks, Bars and Cookies. Foods listed in the new, Snacks, Bars and Cookies category were previously listed in the Breads and Cereals category, but we separated these to make it easier to find specific foods.


New Flags

We are now testing food products sourced from all over the world. Have a look in this section to see if foods from your country have been tested or alternatively, consult this section when you travel to find country specific information about the FODMAP content of local food. Providing users with country specific information about FODMAP food composition is important because of international differences in food supply and in food processing techniques that may affect FODMAP content. Filters in the food guide enable app users to only display foods relevant in their country. 

More Detail about Serving Sizes
We are now giving app users more information about the serving size at which green serves of fruit and vegetables become amber serves. This allows users to determine the upper limit serving size that would still be considered low in FODMAPs. Examples of fruit and vegetables with more serving size information include aubergine, red cabbage, cherry tomatoes, pineapple, cumquats and green kiwi fruit.

Nutritional Guidelines:
Consistent with our goal to encourage app users to follow a healthy, well balanced diet that is consistent with the Australian Guide to Healthy Eating, we have updated the guide section with reminders to eat 2 serves of fruit and 5 serves of vegetables each day. When you click into a food in the fruit and vegetable categories you will see a reminder that you can eat multiple serves of ‘green’ foods in one sitting and that you should eat at least 2 serves of fruit and 5 serves of vegetables each day.


A dietitian can provide advice on how to incorporate these recommendations into your low FODMAP diet. Our blog also includes many healthy, low FODMAP recipe ideas and the following pages may give you ideas on how to incorporate more fruit and vegetables in your diet: https://www.eatforhealth.gov.au/ and http://gofor2and5.com.au/.

The Monash FODMAP Team welcomes feedback on your experiences using the app and where possible, we take this into consideration when planning app updates.

           


Friday, 23 September 2016

Low FODMAP Chicken and Gnocchi Pasta Bake

Recipe by Lyndal McNamara (Dietitian)
Serves 5-6
Ingredients:
  • 1 large zucchini, diced
  • 1 large red capsicum, diced
  • 200g Jap pumpkin, diced
  • 2 tsp. garlic infused olive oil
  • 1x 500g packet gluten-free gnocchi*
  • 1x 500g jar tomato passata (tomato puree)
  • 100g baby spinach leaves
  • 1 large handful fresh basil leaves
  • 400g cooked chicken breast, shredded
  • 2 tsp. cracked black pepper
  • ½ cup grated parmesan cheese
Method:
  1. Preheat oven to 220°C. Spray a large baking dish with olive oil spray.
  2. Add chopped zucchini, capsicum and pumpkin to baking dish and toss with garlic-infused olive oil to coat. 
  3. Roast vegetables in oven for 20-25 minutes or until beginning to soften.
  4. Meanwhile, cook gnocchi according to packet instructions; drain and set aside. 
  5. Heat tomato passata in a large pot and stir through baby spinach leaves and basil leaves until wilted slightly. Add cooked chicken, black pepper, gnocchi and roasted vegetables and stir to coat in sauce.
  6. Pour gnocchi and sauce mixture back into the baking dish and top with grated Parmesan. Bake for a further 10-15 minutes or until golden.
Tips:


  • *Gluten-free gnocchi is typically made from Low FODMAP ingredients including potato, potato flour/rice flour/corn flour and egg. Be sure to check the packet first for any added high FODMAP ingredients.
  • Consider including one or more serves of 'moderate' FODMAP vegetables during the rechallenge phase or as tolerated for a prebiotic boost (e.g. substitute Jap pumpkin for butternut pumpkin or sweet potato, add a small amount of green peas etc.) - use the app to guide you.


Nutrition Information/serve:

Energy

1721kJ

Protein

31.8g

Fat

9.2g

Saturated fat

3.6g

Carbohydrates

50.6g

Fibre

8g

Sodium

802mg



Tuesday, 20 September 2016

#FODMAPchat Twitter Forum- Summary of Responses

Thank you to all who participated in our September 2016 Twitter chat. For all those that wanted to participate but couldn’t make it for the chat, here is a summary of the conversation:

Q1. Is there a standard re-challenge protocol to use with all patients on a low FODMAP diet?
We wish it was that simple, but unfortunately there is no standard protocol for re-challenging FODMAPs. It is so important to seek the assistance of an experienced dietitian to individualise the FODMAP challenge process to the needs and symptoms of each patient. The length of the re-challenge, foods chosen and the portion sizes used may also vary between each individual. Dietitians may find it useful to ask their patient which foods they miss the most from their regular diet and consider introducing those foods first when getting them started on re-challenging.
The re-challenge phase is an important part of the low FODMAP diet, but research studies on this specific area are lacking. Unfortunately, a rechallenge research trial is very difficult to design and conduct.



Q2. Should all FODMAP subtypes be challenged in every patient?
It is important that all FODMAP subtypes that have been restricted are re-challenged. For some patients lactose may remain in the diet, even during the initial elimination phase, if lactose intolerance is not evident. We always recommend re-challenging fructose due to unreliability with the fructose breath testing.  
A key point to note is that often just because an individual didn’t tolerate one particular food within a subtype of FODMAPs doesn’t mean that this person won’t tolerate any other foods within that subtype. The portion sizes of these foods may need to be adjusted. Seeking the assistance of a dietitian to tailor the diet to an individual is essential.
As each person’s FODMAP tolerance and their FODMAP threshold varies, a dietitian may need to be more cautious with one person who is extremely sensitive compared to another person who may have reasonable FODMAP tolerance. No two patients are alike and personalising the diet will assist patients with expanding the diet long term, which is very important.
Starting with a subtype of FODMAPs that the patient may tolerate better can ease the patient into the rechallenge process.



Q3. How long should each FODMAP challenge go for?
The answer varies depending on the patient and their symptoms and their level of anxiety about doing the re-challenge. For those who need a cautious approach, slowing down the challenge to testing a food every second day over the course of a week may be appropriate. For others, a typical challenge of a new food is to introduce a small portion and increase the amount every day for 3-4 days.

Q4. What sort of doses of foods should be used for FODMAP challenges?
There are no set portion sizes that suits each person. How much should be used depends on the individual, their symptom severity and tolerance level. As a general rule, half of a normal serving of a particular FODMAP containing food would be consumed on day 1, then increase the serving size on the second and third day.



Q5. What do you do with a patient who has severe reactions to all challenges?
For highly sensitive patients it may be necessary to slow down the re-challenges to small serves of a particular food consumed every second day. Alternatively try using different foods to the previous challenges in small amounts. If the patient continues to react to even small amounts, alternative therapies may need to be considered or they should be referred back to their GP for further investigations.
Small intestinal bacterial overgrowth (SIBO) may be a contributing factor in those with ongoing symptoms, however SIBO is very difficult to diagnose. A glucose breath test can be undertaken, but this is not a perfect science and will not diagnose SIBO in all cases.
Assess the patient’s stress levels as stress is one factor that can further exacerbate symptoms with challenges increasing stress and anxiety.  Continue to provide support and encouragement during the re-challenge phase.



Q6. What are some helpful tips to increase fibre intake on low FODMAP diet?
Some handy hints for increasing fiber while on a low FODMAP diet:

·         Try and include a vegetable with breakfast, such as tomato or spinach,

·         Add small amounts of low FODMAP legumes or pulses to soups, stews and salads - You may want to start by adding canned legumes and pulses as they tend to be lower in FODMAPs than fresh options

·         Aim to include fiber at each meal and snack, this may include oats, baked potatoes with the skin, oranges, quinoa and chia seeds

·         Also making food swaps such as using brown rice rather than white rice will help increase fiber
Q7. What are some of the key hidden FODMAPs that can be found in US commercial products?
Hidden ingredients aren’t always so hidden so do encourage your patients to check the ingredient label for foods and supplements high in FODMAPs particularly looking at sweeteners and added fibres such as inulin, fructose, high fructose corn syrup, crystalline fructose, lactose, and apple/pear juice concentrate. Also check liquid medications, chewable vitamins, powdered protein supplements or shakes for sweeteners that are often high in polyols or fructose.

Please remember to check the Monash University low FODMAP app for more information on US products that we have tested for FODMAP levels that includes sauces, gluten free breads and jams containing fructans and HFCS.

 Q8. Are fermented foods suitable on a low FODMAP diet?
There is a huge interest in this area and yes there are some fermentable foods that are low in FODMAPs, however not all low FODMAP foods remain low in FODMAPs when fermented.  Tempeh is low in FODMAPs and a good vegan option for a low FODMAP fermented option. We have also found spelt sourdough bread to be low in FODMAPs.

Sauerkraut has recently been tested and found an interesting result. 1 Tablespoon of Sauerkraut is low in FODMAPs however becomes moderate to high in the Polyol (mannitol) in a larger serve despite common cabbage being low in FODMAPs. We also tested fermented red cabbage and found that when red cabbage was fermented it was low in FODMAPs when consuming only ½ a cup but contained moderate Oligosaccharides (Fructans) at 1 cup, whereas fresh is still low in FODMAPs at these portion sizes.
Kefir is only high in lactose so another suitable option for those who are not lactose intolerant.
We can’t always predict what is going to happen to low FODMAP foods once they have been processed in some way or another and therefore these foods need to be tested. We will share this knowledge via our Monash University low FODMAP app as the foods are tested.



Q9. What next if the low FODMAP diet does not improve symptoms?
When the low FODMAP diet is unsuccessful for a particular patient then look further into their diet history to see if excess fats, sugar and caffeine, or an inadequate intake of fibre are contributing to their symptoms. Further investigate if other dietary factors may be relevant for each individual patient such as histamine, Type IV hypersensitivity or IgE- mediated food allergy.

The low FODMAP diet doesn’t always work for everyone. If it does not work it is very important that FODMAPs are reintroduced into the diet. A dietitian can continue to provide support and assistance to a patient in achieving a healthy balanced diet, consider other dietary factors that may be playing a role, as well as working with other health professionals to investigate other factors contributing to symptoms.



Q10. What are some handy hints for travelling on a low FODMAP diet?
Travelling while trying to follow a low FODMAP diet can be difficult. Monash University are testing more international foods and will continue to add these to the Monash University low FODMAP diet app under specific country flags.

Plan ahead. Pack low FODMAP snacks to avoid getting hungry and therefore grabbing something that may flare up symptoms. If lactose is an issue then carrying Lactaid / Lacteeze and/or Beano + Dairy defence could assist with managing symptoms if you are limited with food choice. For the very organised traveler, take a soft side lunch bag or cooler in your luggage to carry low FODMAP snacks purchased at your destination. Request a hotel room with a mini fridge to store low FODMAP options.

For domestic trips you may want to take your own fruit, cheese, nuts, snack bars or nutritional drinks.

Note that patients may actually tolerate foods better whilst travelling due to having less stress and anxiety to contribute to symptoms and being in a relaxing state may help relieve some symptoms.




Thank you to all who participated in the fodmapchat and for those who missed this twitter chat feel free to check out the hashtag #fodmapchat for the discussion and follow us on Facebook and twitter to stay in the loop for when the next one will be happening.

Remember to encourage patients to download the Monash University low FODMAP diet app to further fund research and food testing as well as to get all the latest food testing information.