Saturday, August 17, 2013

What are FODMAPS?


What are FODMAPS?

The term FODMAPS, is essentially an acronym for a group of fermentable, poorly broken down short-chain carbohydrates (sugars). Simply put, they are undigested sugars that are ‘fast food’ for or ‘feed’ the bacteria in our bowels. Yes we all do have bacteria in our bowels and in fact, they are essential for good health! It is these particular food components (FODMAPS) that can cause bloating, gas and diarrhoea in individuals who have Irritable bowel syndrome (IBS). Dietitians use a Low-FODMAP diet to help identify food triggers in those individual’s with IBS. We are all different, so react differently to different foods. A Low-FODMAPS diet is not a long term eating plan and if not planned correctly, can be nutritional inadequate. Please remember that FODMAPS are often found in healthy foods and are actually beneficial for our health – as long as we do not react to them – so like always, don’t cut out foods unnecessary. Before starting the Low-FODMAP diet, please see an Accredited Practising dietitian (APD).

FODMAPS stands for:
Fermentable – rapidly broken down by bacteria in the bowel
Oligosaccharides – fructans and galacto-oligosaccharides (GOS) e.g. legumes, wheat based products, watermelon, cabbage, Brussels sprouts, onion, garlic, inulin…
Disaccharides – such as lactose e.g. milk, milk products, yoghurt…
Monosaccharides – fructose e.g. HFCS, honey, apples, mangos, pears, sugar snap peas…
And
Polyols – sorbitol, mannitol, xylitol and maltitol e.g. apples, stone fruit, avocado, cauliflower, diet-foods, chewy, mints…

Keep smiling and experimenting with your food! G xx

By Georgie Rist. Accredited Practising Dietitian (APD), Accredited Nutritionist, and Sports Dietitian

What is hereditary fructose intolerance (HFI)?


What is hereditary fructose intolerance (HFI)?

We get asked this question a lot – so I though I would write a special post for you all…

HFI is an inherited (genetic) condition where a person is born unable to digest the sugar fructose.  Unlike fructose malabsorption, where symptoms occur because the cells of the bowel cannot absorb fructose; HFI is a deficiency and inability to produce the liver enzyme (fructose 1-aldolase, to be technical!) needed to breakdown fructose. Symptoms of HFI are only seen when the child eats fructose for the first time and if left untreated can cause severe health problems for the child.
How common is HFI?
About 1 in every 25,000 people are reported to have HFI
How common is Fructose malabsorption?
About 1 in 3 people have fructose malabsorption.
Treatment of HFI
Elimination of fructose, sucrose and sorbitol under the guidance of Paediatrician and dietitian.
This differs from fructose malabsorption, where small to moderate amounts of fructose can still be consumed without symptoms when balanced out with a higher proportion of glucose.
There are often lots of terms thrown around these days and some incorrectly used interchangeably. In this case, I hope this clarifies the difference between HFI and fructose malabsorption for you.
G xx

By Georgie Rist. Accredited Practising Dietitian (APD), Accredited Nutritionist, and Sports Dietitian

Sunday, July 28, 2013

Hazelnut Goji Berry Cookies


Gluten Free / Low Fructose


These cookies are really simple to make in under 30 minutes

Dough:
1 cup hazelnuts
1 1/2 cups of almond flour/meal
1/2 teaspoon baking soda
2 tablespoons coconut butter (or regular butter if you prefer), melted
2 1/2 tablespoons of water
2 tablespoons of dried goji berries

Glaze:
1 tablespoon coconut butter (or regular)
1 tablespoon of rice malt syrup (if not making for fructose intolerance you can use honey here)
1/2 teaspoon cinnamon


Pre heat oven to 180 degrees
To make the dough, finely grind the hazelnuts in a food processor
In a bowl, combine the hazelnuts and the rest of the dough ingredients
The dough should be firm and a little crumbly due to the hazelnuts
Take small handfuls of mixture, roll into balls and press down flat on a baking tray covered with baking paper
Bake for 10-15 or until golden brown on the edges
To make the glaze, in a small saucepan heat the butter, rice syrup & cinnamon until it lightly bubbles.
Remove from heat and brush the glaze over each individual cookie
Return the cookies to the oven for another 1-3 minutes until the glaze is melted into the cookies
Let cool before serving
:)

Tuesday, July 16, 2013

The SCD Diet - can it help us sufferers of Fructose Malabsorption?




http://scdlifestyle.com/2010/09/why-fructose-malabsorption-causes-gas-cramping-and-diarrhea-and-how-to-bea-it/


I came across this interesting article on line written by Jordan Reasoner discussing how he ended his symptoms of Fructose Malabsorption. It caught my eye because he followed the SCD diet - The Specific Carbohydrate Diet - that was originally developed for sufferers of Chrohns disease and Ulcerative Colitis. My brother suffers from UC and followed this diet religiously for years and basically healed his stomach ulcers so I am very familiar with how incredible it is. The foods used in the diet are described by it's creator Elaine Gottschall as 'healing foods'. The diet cuts out complex carbohydrates such as sugar, starches and grains. I'm surprised I never though to follow it myself! With a few simple modifications (like replacing the honey that is often used in SCD recipes with Rice Malt Syrup) this diet could possibly be quite suitable for suffers of Fructose Malabsorption.

http://www.breakingtheviciouscycle.info/


Below is the foreword to Elaine's book 'Breaking The Vicious Cycle'...very interesting reading.

FOREWORD
Foreword by Ronald L. Hoffman, M.D.
Upon discovering Food and the Gut Reaction, the first edition of Breaking the Vicious Cycle: Intestinal Health Through Diet, I realized that it contained a useful solution for the dietary treatment of many gastrointestinal disorders. By introducing the approach of the “Specific Carbohydrate Diet™,” it enables patients to thrive on a varied diet that very often reduces symptoms and allows healing of an inflamed intestinal tract. Simply presented, yet sophisticated in its conception, the “Specific Carbohydrate Diet™” transcends several oversimplifications to which patients with gastrointestinal problems and their physicians often fall prey.
Four years ago my book, Seven Weeks to a Settled Stomach (Simon and Schuster), was published. Since that time, I have earned a reputation as a trouble-shooter for gastrointestinal problems. Patients from many parts of the country have consulted me. Many complain of symptoms consistent with irritable bowel syndrome. Others have been diagnosed formally with classic inflammatory bowel disease. And though some patients have responded well to the usual arsenal of natural digestive aids, intestinal flora replacement, elimination diets, conventional antifungal drugs and antibiotics, still others found no relief.
Food and the Gut Reaction, the first edition of this book, was introduced to me by a colleague and friend, Dr. Leo Galland. He mentioned the book after one of his patients brought the book to his attention. I immediately recognized Elaine Gottschall’s book as a potential godsend to my patients. Its value lay in providing a palatable but potent alternative to those dietary approaches commonly in use for management of gastrointestinal problems: the high-fiber diet; the low-fat diet; the low-residue diet; the anti-yeast diet; the gluten-free diet; and other elimination diets.
Based on my experience with patients, I already had reason to question the complex carbohydrate plan as the most healthy eating program, especially for patients with gastrointestinal complaints. Many gastroenterologists, like most North American physicians, propound this “low-cholesterol” diet plan. Fat, it is reasoned, is the bane not only of arteries but also of the intestinal tract: in combination with excess animal protein, so it is said, fat sets the stage for a host of Western ills from diverticulosis to appendicitis and colon cancer.
Unquestionably, some patients are excellent fiber-responders, but others do poorly with common sources of roughage. The radical alternative, a meat and salad diet that eliminates all sugars and starches, is unpalatable and unenforceable for all but the most dedicated patients. In fact, this strict vegetable and protein diet, sometimes referred to as the “caveman diet,” is dangerous for marginally-nourished, underweight patients with Crohn’s disease or ulcerative colitis.
One oversimplification Elaine Gottschall’s book avoids is the notion that food allergy is the source of many gastrointestinal complaints. Since dietary manipulation can produce results, it is, perhaps, natural to assume this. But over-reliance on the ambiguous results of allergy testing leaves many patients incompletely treated. The more sophisticated belief that it is not individual foods themselves but the byproducts of ingestion of certain foods that cause intestinal problems is fast replacing the concept of food allergy.
This theory was first set forth by Dr. J. O. Hunter in a landmark Lancet article underscores the frequency of intolerances to corn, wheat, milk, potatoes, and rye. This may be the reason why patients who derive inconsistent benefits from the gluten-free and lactose-free diets respond so completely to the regimen set forth in Elaine Gottschall’s book. This diet addresses carbohydrate intolerance more broadly than other approaches. The second edition of Food and the Gut Reaction, Breaking the Vicious Cycle: Intestinal Health Through Diet, should be among the vital resources of every gastroenterologist.
Other corrective strategies amount to a preoccupation with eradicating intestinal pathogens. Those who take this approach believe in the “find a bug, use a drug” philosophy. Elaine Gottschall substitutes the more holistic goal of reestablishing the healthy balance of intestinal flora.
As I began placing patients on the “Specific Carbohydrate Diet™,” using Food and the Gut Reaction as a comprehensive guide, I became impressed with the results. Many patients with Crohn’s disease, ulcerative colitis, irritable bowel syndrome and even refractory constipation, found relief although their progress had been stymied previously with elaborate but unsuccessful elimination schemes. The clinical value of the “Specific Carbohydrate Diet™” was unquestionable, but, interestingly, I began to notice other unanticipated benefits. Patients with muscle aches, stiff joints and, even full-blown arthritis, registered a distinct diminution of symptoms. Headaches, chronic skin rashes, psoriasis, generalized fatigue and “spaciness” were alleviated. Elaine Gottschall’s diet had probably reduced intestinal toxicity.
Unfortunately, the chances of wider acceptance of dietary approaches like this one are small. While many of my innovative, nutritionally-oriented colleagues have availed themselves of Food and the Gut Reaction and introduced patients to this approach, most gastroenterologists are, sadly, not even curious. They scarcely acknowledge the role diet can play. For example, a recent Lancet article demonstrating the efficacy of the exclusion diet in the treatment of Crohn’s disease has not prompted a single gastroenterologist in my large metropolitan community to administer a facsimile of the successful diet to patients - even when their diseases do not respond to the most skillfully administered drug treatment.
Fortunately, increasing numbers of patients are recognizing the need to break away from total dependency on drugs and symptom-oriented medical care. Many have endured years of suffering, coupled with economic and mental stress, and they are willing to try a wholesome diet, grounded in medical research, which makes sense. The reception given to Food and the Gut Reaction (the first edition of this book) by patients has the makings of a true grassroots uprising. Patients, en masse, are willing to try the diet and many are finding that it works.
Elaine Gottschall is a tireless crusader on behalf of her natural approach to digestive problems. She selflessly gives of her time, love, compassion, attention, and concern to patients and clinicians alike. She has become an energetic cheerleader for many of my patients and has provided invaluable direction when progress has faltered. Her reward is surely the secure knowledge that she has made a difference in the lives of thousands of patients with gastrointestinal disorders.
Ronald L. Hoffman, M.D.
Hoffman Center
40 East 30th St.
New York, New York 10016
June, 1994
 

Tuesday, June 11, 2013

Introducing Dietician Georgie Rist...



We are so excited to introduce dietician Georgie Rist to the Fabulously Fructose Friendly team. We get so many questions about fructose intolerance and although we aim to give the best advice possible, it is only based on our own experiences. Georgie joins us with a wealth of knowledge on food intolerances and will share with us on a regular basis via our page her knowledge and advice.

Georgie is an Accredited Practising Dietitian (APD), Accredited Nutritionist, and Sports Dietitian. Her enthusiasm to help others share her love of good food and optimal health is infectious.  Georgie’s passion for health, fitness and whole foods began at an early age. Some would even say it is in her genes! With her own experience of food allergies and intolerances it was only natural to develop an interest in this area to help others navigate through the detective work and demystify the nutrition misinformation.

Georgie has an extensive and diverse background in the health industry, from launching and managing Australia’s first dedicated Nutritional Genomics dietetic clinic, running her own successful health and nutrition consulting business, leading and publishing nutritional research in malnutrition, presenting at National and International conferences, launching health retreats in Bali, personalising diets based on individuals’ genetic make-up, managing medical nutrition therapy for ICU, cancer and surgical patients; through to product development, sales and marketing, business management, strategic alliance and media communications. Georgie is also Media Spokesperson for Dietitian’s Association of Australia.

Georgie has a passion to share her enthusiasm and integrative approach to achieve good health and wellbeing to help people be the best they can be. “You have the power to change tomorrow, right now.”

 “We have one mind, one body, one life; so make the most of it, strengthen it, stretch it and nourish it.” Georgie believes we all need to be active, eat good food and laugh everyday.

My child has just been diagnosed with fructose intolerance – what do I do, what do I avoid?”

 

Georgie Rist. Accredited Practising Dietitian (APD), Accredited Nutritionist, and Sports Dietitian

QUESTION:
“My child has just been diagnosed with fructose intolerance – what do I do, what do I avoid?”
…Anyone questioning whether or not they have fructose malabsorption (also known as fructose intolerance), should ensure a correct diagnosis is made by a qualified healthcare professional, however this is particularly important for children. The last thing we want to do is cut foods out of their diet unnecessarily or create food aversions or anxiety around one of the best, most natural and essential elements of life…food and eating.
So your doctor or dietitian has told you that your child has fructose malabsorption; first things first, don’t panic. Apart from becoming familiar with high and low fructose containing food, it is important to remember that symptoms are often dose related and everyone has their own unique threshold of what they can tolerate. This means Alana might tolerate a quarter of an apple, Oscar might be able to eat half an apple but Lenny feels unwell after one bite! We are all different! I can’t emphasise enough about the relationship between stress, anxiety and gastrointestinal health, so creating a calm, peaceful and happy environment at meal times is crucial for your child’s relationship with food but also for their health.
Remember fructose malabsorption is not an illness or a condition, it is just a part of a person’s physiology – some people can tolerate excess fructose and some people cannot.
Top 10 foods to limit or avoid for those with fructose intolerance:
1.    Onion
2.    Garlic
3.    Honey
4.    Apples and pears
5.    Watermelon
6.    Select vegetables such as beetroot, asparagus, brussel sprouts, cabbage, peas and leeks
7.    Sweeteners in processed foods such as High fructose corn syrup (HFCS), fruit juice concentrate
8.    Wheat
9.    Rye
10. Legumes
Top 10 alternatives to include and substitute for problematic foods to minimise symptoms of fructose intolerance:
1.    Ginger
2.    Spring onions (green part)
3.    Maple Syrup
4.    Bananas and berries
5.    Tomatoes
6.    Oranges
7.    Avocado
8.    Vegetables such as green leafy ones, carrots, celery, green beans, zucchini, capsicum, mushrooms, sweet potatoes, potato, pumpkin…and the list goes on!
9.    Grains such as oats, spelt, quinoa, rice and buckwheat
10. Nuts and seeds (given there is no allergy of course)
Top tips to get started:
1.    Be prepared – and become familiar with substitutions
2.    Just because you or your child has fructose malabsorption doesn’t mean you must avoid fructose-containing foods completely.
3.    Remember because something is fructose free or low fructose doesn’t always mean it is ‘healthy’
4.    Fruit is an essential part of the diet for children and provides important nutrients such as fibre, vitamin and minerals – just limit intake to one low fructose fruit serve at a time or add yoghurt to reduce total fructose load.
5.    When baking, use maple syrup or rice syrup as honey, fruit juice or agave alternatives.
6.    Try wheat free bread such as spelt or oat bread and wheat free pasta’s such as quinoa gluten free or spelt
7.    Breakfast is the most important meal of the day – try unsweetened cereal such as untoasted muesli, porridge, kiwi based bircher muesli, banana and cinnamon smoothie; buckwheat pancakes; eggs on spelt toast or peanut butter/favourite nut paste on oat bread.
8.    See an Accredited Practising Dietitian for personalised and tailored advice to suit your child’s needs – you don’t need to do this on your own!
9.    Keep smiling and have fun getting creative in the kitchen
Stay tuned for some lunch box ideas…
 
G xx

Wednesday, May 8, 2013

Salmon, Potato and Spinach Patties

Low fructose / gluten free


Makes approx 8

1 cup cooked mashed potato
1 cup roasted pumpkin pieces
1 cup chopped spinach (we used frozen chopped spinach, thawed)
2 eggs whisked lightly
100gms of fresh or smoked salmon, thinly sliced chopped into small pieces
1/4 cup of goats cheese, crumbled
1/4 cup rice flour
handful of dill
olive oil 
sea salt and pepper to taste
lemon to serve

Mix the rice flour thoroughly through the lightly beaten eggs
Add all other ingredients and combine well
If the mixture is too runny add some more potato then shape the mixture into 8-10 patties
Heat the olive oil in a pan and cook each pattie for a few minutes each side until golden brown.
These can be used as burgers in gluten free bread or served alone with a salad. They are also delicious topped with greek yoghurt or cold as a snack.




Monday, April 29, 2013

Sample Menu Plan for Low FODMAP Diet


Breakfast
  • Fructose free Breakfast Crunch (see recipe post) or a wheat free fruit free cereal from the health food section in your local supermarket
  • Porridge with chopped banana (add rice malt syrup for something sweet instead of honey)
  • Fresh Spelt or Gluten Free toast with cheese (cottage cheese is great), peanut butter (natural) or avocado (no more than 1/4 at a time with avocado due to sorbitol content)
  • Eggs - boiled eggs are great as they are easy to eat without needing toast
  • Banana Chia Smoothie (see recipe post)
  • Rice porridge with banana
  • Buckwheat pancakes with rice malt syrup and banana
  • Omlette with spinach, goats cheese and ham


Snacks
  • Rice cake topped with goats cheese, avocado & sea salt
  • Natural yoghurt (no added sweeteners) with chopped banana or blueberries (approx 8 is tolerable for most people)
  • Choc Banana muffins (see recipe post)
  • Orange Almond Balls (see recipe post)
  • Dry roasted almonds
  • Banana (one per sitting)
  • Carrot/Celery sticks
  • 1 serve of 'safe' fruit. It is not necessary to avoid fruit altogether when you have fructose malabsorption, when a fruit is balanced with fructose and glucose, moderate amounts can be absorbed without symptoms. Fructose is generally only a problem when the fruit contains more fructose than glucose (i.e mango, apple, pear, watermelon, cherries) or too much fructose is eaten at once (for example 2-3 pieces of any fruit in one sitting). Some safe fruits include 1 medium banana or orange or a small slice of melon or pineapple. A small handful of grapes or berries (fit inside palm of your hand) are generally ok for most.

Lunch
  • Baked potato with cheese, sour cream, chopped capsicum & corn (very small amount of corn only)
  • Fresh Spelt or Gluten Free bread with tuna or chicken, lettuce, cucumber, carrot, alfalfa, spinach, tomato (small amounts) boiled egg, cheese, cold roast meats or peanut butter (natural)
  • Roast Pumpkin Brown Rice Salad (see recipe post)
  • Sushi or Sashimi
  • Rice paper rolls with safe ingredients
  • Frittata - include ingredients such as zucchini, spinach, chicken, goats cheese, olives
  • Thai Chicken Burger (see recipe post)
  • Quiche with gluten free pastry and safe veges/chicken
  • Brown rice with Tuna and Yoghurt (This is a great very simple lunch for when you don't have much time - use the sun rice brown rice cups that heat in the microwave, mix through a can of tuna and a couple of spoonfuls of plain greek yoghurt and some lemon or lime juice to taste. Yum!)
Dinner
  • Meat, fish, eggs or tofu 
  • With rice, gluten free pasta, rice noodles, potato or polenta
  • Mixed veges - most veges are safe in moderate portions but steer clear of mushrooms & cauliflower (high levels of mannitol), asparagus, artichokes & sugar snap peas (excess fructose) and garlic, onion, legumes/lentils, leek, shallots, chicory and spring onion (fructans) as they may cause symptoms


This list has been put together from a sample menu plan from Sue Shepherd @ Shepherd Works and some suggestions from us on what we eat. Please remember everyone is different, and what is tolerable for one person with fructose intolerance is not for another.