Friday, 8 May 2015

The low FODMAP diet and diabetes management

By Dr Jane Varney



Although unrelated in their aetiology, diabetes and IBS have two things in common. 

Firstly, both are highly prevalent in the population, for instance, diabetes affects around 4% of Australians and IBS affects around 15%. Indeed, a crude estimate suggests that around 150,000 Australians are affected by both conditions and many more people with IBS are likely to either have undiagnosed diabetes or be at high risk of developing it.

Secondly, diet plays a key role in the management of both conditions. 

So, how do you adapt your low FODMAP diet to suit diabetes management, or vice versa? 


Let’s start with the carbohydrate foods (breads, cereals, fruit, vegetables, pulses and dairy). People with IBS are familiar with modifying their carbohydrate intake because FODMAPs are found exclusively in carbohydrate foods. 

In people with diabetes, carbohydrates are important too, because they’re broken down to glucose in your blood stream, therefore affecting your blood glucose level.

But all carbohydrate foods are not equal. They differ in:
  •    Fibre content;
  •    Whole grain content
  •    Inclusion of other ingredients like fat, salt and sugar;
  •    The rate at which they’re broken down to glucose in your blood stream (you may have heard about the glycaemic index)
  •    FODMAP content


Needless to say, this is a lot to weigh up as you cruise the supermarket aisles doing your weekly shop. 


Here are our hot tips on choosing the best low FODMAP carbohydrate foods, especially if you have diabetes.

Fruit: All low FODMAP fruits are healthy and fine for diabetes management. The main points to remember are to:         
  • Include 2 serves of low FODMAP fruit each day (most Australians get in only half this amount). One serve is around 150g fruit (e.g. 1 medium orange or banana, ~10 strawberries, 1 cup of grapes or 2 small kiwifruit);
  • Limit fruit juice and dried fruit, most of which are high FODMAP anyway. Fruit juice is high in kilojoules, low in fibre and acidic, causing damage to your teeth, while dried fruit is high in kilojoules and sticky on your teeth, causing tooth decay.
  • Buy fruit in season as it is cheaper. 
  • Include a range of colours and varieties to ensure you get a good mix of vitamins and minerals.

Vegetables: All low FODMAP vegies are fine for people with diabetes. They’re healthy and naturally low in kilojoules, high in fibre, and packed full of vitamins, minerals and antioxidants. The main points to remember are to:
  • Include 5 serves of low FODMAP vegies per day (most Australians get less than half this amount!). One serve is around 75g of cooked vegetables (e.g. ½ cup cooked carrot, corn or zucchini); 1 cup of salad vegetables (e.g. lettuce) or ½ a medium starchy vegetables (e.g. potato, taro or sweet potato). Hot chips don’t count!
  • Go easy on the starchy vegetables such as potato as they contain more kilojoules and have a greater effect on blood glucose levels.


Breads and cereals: Some low FODMAP breads and cereals are better than others. Best choices are higher fibre, whole grain varieties. Main points to remember:
  • Include 4-6 serves of low FODMAP bread and cereal foods each day (have a look at our app to see what we mean by one serve)
  • Look for the words whole grain or wholemeal on the packaging. Whole grain foods are healthier because they are higher in fibre, vitamins, minerals and antioxidants whereas much of this goodness is lost through processing in refined grains (e.g. bread made from gluten free white flour)
  • Healthy, low FODMAP, higher fibre, whole grain foods include brown rice, basmati rice, polenta, spelt sourdough bread, wheat and fruit free muesli, oats, porridge, quinoa flakes, buckwheat kernals, rice cakes, oat bran and rice bran.
Dairy or alternatives: Low fat varieties are best and if you are lactose intolerant, use lactose free varieties. Main points to remember:
  • Include 2-3 serves of low fat dairy per day (1 cup low fat milk, 200g low fat yoghurt and 40g reduced fat cheese)
  • If you are lactose intolerant, use low fat, lactose free, milk and yoghurt (Liddell’s, Zymil) as well as small quantities reduced fat cottage, cream or ricotta cheese.

Legumes: As healthy as legumes are (e.g. cannellini beans, lentils, split peas and borlotti beans), they are also high in FODMAPs. Fortunately, there are lower FODMAP varieties such as canned chickpeas (1/4 cup) and canned lentils (1/2 cup). Best tip is to include low FODMAP legumes, on most days, in small quantities. Add them to soups, salads and casseroles!




14 comments:

  1. Why would it be better, for diabetics, with low fat dairy..?

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    Replies
    1. Hi Patrik,

      It is important to use low fat dairy products, because the type of fat in dairy products is saturated fat. Saturated fat is a ‘bad’ type of fat and can raise your LDL (‘bad’) cholesterol levels. It is important that people with diabetes ensure that they keep their cholesterol levels low. Speak with your Doctor about getting your cholesterol levels checked if you haven’t already and you have diabetes.
      For more information specifically about diabetes, see the Diabetes Australia website: http://www.diabetesaustralia.com.au

      Kind regards,

      The Monash University Low FODMAP team

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    2. The University of Cambridge meta analysis found no link between saturated fat and heart disease.
      More recently a Canadian meta analysis found no link between all cause mortality and saturated fat, so it would seem there is no need to restrict people's natural fat intake.

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    3. Hi Ralph, in diabetes it is best practice to recommend an overall reduced fat and energy consumption for many who have Type 2 diabetes. There is evidence suggesting that reducing saturated fat intake reduces indulin resistance and therefore has a possitive effect on diabetes management. Thank you, Shirley

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    4. Emily, there is increasing evidence that trans fats, not saturated fats, are the problem in heart disease. Past dietary/heart studies that condemned saturated fat intake did not also measure trans fat intake; much of the saturated fat could have been fried or processed in other ways that made it trans fat, but saturated fat got the blame. The low-fat, high-carb trends that followed tthose studies ended up promoting diabetes. Full fat products from butter to bacon to whole milk have helped me to otherwise follow the FODMAP diet.

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  2. Hi! Ok!
    Thanks for your Answer. Even if I dont agree.. :)
    I happen to live with a diabetic, and she has managed her disease with a higher fat, lower carb, diet, for several years. Including higher fat dairy (wich is my choice to..).
    She measures her bloodglucose, ketones, cholesterol, and other health markers regularly (she has t-1 D) and she's doing great for such a Serious disease.
    She was told by her doctor to eat more carbs and less fat, beacause they were afraid of her getting higher cholesterol and during the first 3-4 months of LCHF she did, but then it stabilised, and after a while it dropped to normal levels, and has stayed there.. I'm not talking about a couple of months now, but a couple of years.
    And as I said she has excellent health markers, wich is being measured regularly, she only need minimal doses of insulin, and her doctor is actually somewhat stunned by her health, and claims her bloodglucose is as stable as in a healthy person.
    Just wanted to give you some perspective on these advice about the fat.
    Otherwise I think you guys are doing a great job with the Low Fodmap diet. :)

    ReplyDelete
    Replies
    1. Hi Patrik,

      We appreciate your feedback and it's great to hear your wife is working closely with a doctor to monitor her symptoms. Diet therapies need to be personalised regardless of the condition.It may be that your wife's carbohydrate intake is adequate and her fat intake is predominantly made up of poly- and monounsaturated fats. This of course can only be determined with a proper dietetic assessment. Our advice on low fat dairy varieties is generalised to ensure we cover at risk groups and those at risk of co-morbidities. If you ever require dietetic assistance you can find one closest to you by visiting the Dietitian's Association of Australia website daa.asn.au.

      Kind regards,

      The Monash University Low FODMAP team

      Delete
  3. I need a diet for diabetics, gluten-free, high blood pressure, high chlosterol, high triglycerides, low FODMAP (for my IBS-D). Do you have any suggestions on what I can possibly eat that doesn't overlap with all my many ailments? Thanks.

    ReplyDelete
    Replies
    1. I'm with ya! The recommendations here definitely don't work for me given I have to keep under 30 carbs at any one meal and function best when staying below 75 carbs total a day! Again, all about what your blood sugar/insulin function is actually doing. I've been on this lifestyle restricted diet for a long time now so other health markers have resolved as a result.

      You've got quite a complex case there. Professional help is key especially if you're on meds for any of these conditions.

      For myself, all grains are out. I'll have occasional limited amounts of quinoa and same for hummus/chickpeas, black beans and white beans...as in no more than 2oz...(mixed in salad for example. If I had most of the fruits recommended here I'd be done for sugar wise. Yep, I'm all about veggies (low to no starch), nuts, and mostly fish, some lamb, and occasional chicken. The limited chicken has more to do with access to organic free range good quality. I do enjoy blueberries, goji berries, and 72% plus dark chocolate squares :D.

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  4. My query is about lentils. Are canned lentils better than dried ones that I cook myself? Does the colour matter?
    Thanks,
    Judy

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    Replies
    1. Hi Judy, canned lentils are typically lower in FODMAPs than boiled lentils. This is because most of the FODMAPs contained in the lentils dissolve into the canning water, which is then discarded when you drain and rinse them to use. Soaking your lentils before cooking and thorough draining and rinsing will also help to lower the FODMAP content, but canning seems to be superior at reducing FODMAPs - probably because he soaking time is quite long prior to use. Best wishes, Monash FODMAP

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  5. Are fresh borlotti beans any lower in fodmaps than dried ones?

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  6. Can high FODMAPS create insulin resistence in a person with compromised digestive system due to the dysfunctional breakdown of carbohydrates? I've had T1 diabetes 42 yrs now with IBS

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  7. The main aims of diet control are listed below:
    1. Avoid hyperglycemia
    2. Minimize fluctuations in blood glucose levels and reduce overall blood glucose
    3. Achieve weight reduction in obese patients to reduce insulin resistance, hyperglycemia, and dyslipidemia
    4. Avoid hypoglycemia and weight gains that are commonly associated with drugs such as insulin
    5. Avoid diets that may aggravate diabetic symptoms. For example, diabetic nephropathy diabetic diet
    may become acute in case of a high diabetic diet. These diets are known as atherogenic diets in medical parlance.

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