The FODMAP Diet in Aged Care

Researchers are discovering more about the way food influences health and wellbeing. For the vast majority of Australians, a healthy diet is the best medicine for a healthy life. However, many people find certain foods can give them terrible symptoms of irritable bowel syndrome (IBS). Researchers discovered these symptoms were not linked to an allergic reaction or Coeliac disease, but rather to sugars which weren’t digested properly in the gut. This discovery led Australian researchers at Monash University to develop the FODMAP diet.   

What is the FODMAP Diet?

Aged Care Consulting Dietitian Jenny Houlston explains FODMAP is an acronym that stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. FODMAPs are found in a wide range of foods (they are present in all food groups except meats and oils), contributing to the discomfort of many individuals with IBS.

“FODMAPS are types of sugars present in a variety of foods which some people have trouble absorbing in the small intestine. Some of the sugars end up in the large bowel where the bacteria use it as a food source and they create gas that leads to bloating, wind etc.  Reactions to FODMAPs is not an ‘allergy’ as the immune system is not involved, but rather an intolerance due to malabsorption of these sugars.”

“If the body doesn’t absorb FODMAPS, they ferment in the gut causing gas to be produced. This leads to a range of unpleasant IBS symptoms including abdominal pain, discomfort, bloating, excessive wind and abnormal bowel movements.”

People affected by IBS often find relief from their symptoms by following a low FODMAP diet. “The FODMAP diet generally involves eliminating foods high in these specific sugars, and then when symptoms have improved, gradually reintroducing the foods to test tolerance in the long term,” Houlston explained.

How many Aged Care residents are affected?

In most residential aged care settings, Houlston estimates numbers of residents on a low FODMAP diet are currently low, as many residents suffering from IBS symptoms are given medication to manage persistent diarrhoea or constipation, bloating and excessive wind.

“While 1 in 100 people are diagnosed with Coeliac disease, one in seven people suffer from severe, distressing gastrointestinal discomfort and other symptoms (according to Monash University). Many residents are managed by medications but would also benefit from this diet,” Houlston said.

“If other causes for digestive issues cannot be controlled by medication, a doctor may suggest a trial of a low FODMAP diet, but a Dietitian would be best to determine the details of the particular diet for a resident.”

While many older people know from experience which foods upset them (onions are commonly avoided for this reason), Houlston cautions against self-diagnosis, as the symptoms are also common to many other serious conditions such as coeliac disease, Crohns disease or Bowel cancer. A doctor can test and eliminate these as the cause of symptoms before the diet is started.

What do Aged Care Chefs need to know?

Every individual has a different tolerance to high FODMAP foods, so an individually-tailored approach is needed. One person may tolerate small quantities of one high FODMAP food but another person may not tolerate any at all. Determining which foods to avoid and in what quantities can be a difficult and slow process, requiring an elimination phase where certain foods group are avoided.

Houlston advises Aged Care kitchen and care staff avoid eliminating all High FODMAP foods at once and focus on one or two food groups. If this doesn’t control symptoms, then introduce further restrictions. In her experience, changing fruits to low FODMAP alternatives (avoiding tinned fruit) and dairy to lactose-free milk or almond milk can be a good place to start (note that soy.

“Once foods are reintroduced a person may be able to tolerate small amounts of a particular food but not larger serves. For example, they may tolerate onion salt from a stock powder, but not chunks of onion in a soup.”

Houlston’s advice to Aged Care chefs is to avoid unnecessary restrictions which create extra pressure for the kitchen and anxiety for the resident. The diet can be very restrictive, especially in the elimination phase, so understanding the precise foods and quantities the individual can tolerate is invaluable information. 

“Find out as much as possible from the resident or family if they have been following the diet beforehand, as they will know what they avoid or prefer to save everyone from unnecessary restrictions.”

“Education and reassurance are key. The more compliant the person can be especially in the elimination phase, the better the improvement of symptoms,” she said.

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