I. Identification Presenters: Written by Jen Barnes, training will be presented by Cooking Matters managers Date: TBD Name of Organization: Cooking Matters Spring 2013 Contact: Jessica Caouette jcaouette@strength.org Goal Statement: To increase knowledge of the low FODMAP diet in Cooking Matters staff and volunteers in order to assist participants with irritable bowel syndrome, inflammatory bowel disease, and other gastrointestinal diseases in managing their symptoms Title of Presentation: FODMAPs a PowerPoint presentation to be used as a training for Cooking Matters employees and volunteers in order to educate them about the low FODMAP diet Audience Description: I know: -Some Cooking Matters (CM) employees and volunteers are not formally trained in nutrition -CM employees and volunteers are at least 18 years old -The low FODMAP diet is becoming more popular and being used more often in the clinical setting I assume: -Some CM employees and volunteers with no nutrition background have not heard of FODMAPs -CM employees and volunteers speak and write English, some speak other languages including Spanish. - Literacy levels and education levels vary. - Nutritionists and dietitians may not be well versed on the low FODMAP diet because it is a relatively new topic in nutrition Physical Set-up: -Training (PowerPoint) will be given for a few staff members/volunteers at a time; may be done around a table using a laptop computer -Audience will sit around table Time Allotted: 30 minutes II. Learning Objectives After participating in the FODMAPs training, the audience will: 1. Gain an understanding of what FODMAPs are 2. Recognize common gastrointestinal (GI) diseases that CM participants and/or their families may be struggling with 3. Be able to identify foods high in FODMAPs and suggest low FODMAP food alternatives for high FODMAP ingredients (using CM recipes) III. Performance Objectives 1. After participating in the FODMAPs training and given a choice of 4 types of carbohydrates, all staff/volunteers will be able to correctly identify the carbohydrate that is not a FODMAP. 2. After participating in the FODMAPs training and given a list of ingredients for a recipe, all staff/volunteers will be able to correctly identify 2 ingredients that are considered high FODMAP and be able to list one low FODMAP substitution for a high FODMAP ingredient.
IV. Content, Sequence, and Learning Activities Introduction -Welcome staff/volunteers -This training is meant to introduce them to a newer area of nutrition (first research done in 2005) FODMAPs The CM managers recognized a need for some in-depth trainings on specific nutrition topics Why? CM participants look to us for guidance, and may ask a question related to a GI disease that either they or someone in their family struggles with - State learning objectives/goals for this training (stated above) Pre-assessment Ask if everyone is familiar with what a gastrointestinal (GI) disease is. Clarify that it is a disease of the GI tract that may affect the stomach, small intestine, or large intestine, or a combination of these 3 organs Ask if anyone has ever heard of FODMAPs or the low FODMAP diet If they answer yes, ask what they know about it or have heard about it. Ask if anyone has ever had a CM participant ask them for advice about how to cope with symptoms of irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) such as Crohns, or other gastrointestinal diseases If they answer yes, ask them to provide an example of a question a participant asked. Ask if anyone has had a CM participant ask them about the low FODMAP diet. If they answer yes, ask to what extent the participant asked about it. Learning Activity 1 - What is a FODMAP? Part 1 -Acronym for Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols. -These are long words that may overwhelm someone without a background in science. Break each FODMAP down even further into more recognizable sub categories Oligosaccharides Disaccharides Monosaccharides Polyols Fructans Galactans Lactose Fructose Sugar Alcohols Saccharide means sugar Sugars are carbohydrates Polyols = sugar alcohols Oligo, Di, Monosaccharides are all short chain carbohydrates (1-10 sugars per chain) -FODMAPs have 3 things in common: Poorly absorbed in small intestine
o Molecules that are not absorbed are excreted Rapidly fermented by bacteria o Produce a large amount of gas in a short amount of time o Short chain carbohydrates ferment quickly Osmotically active o Increase liquidity of content inside intestine (laxative effect) o Create distention/expansion in the intestine Abdominal Pain Bloating Abdominal distention Motility changes Slow motility = constipation Fast motility = diarrhea -Reducing FODMAPs in the diet will result in 3 things: Increased absorption when long chain carbohydrates are eaten instead Slower fermentation of carbohydrates and a less gassy feeling Less liquid delivered to intestine and less distention/expansion in the gut RECAP: FODMAPs are poorly absorbed carbohydrates 5 major groups: fructans, galactans, lactose, fructose, sugar alcohols Part 2 Who Benefits from a low FODMAP diet? IBS IBD (Crohn s and Ulcerative colitis) Other functional GI diseases Symptoms IBS and IBD have many symptoms in common: Physical feelings o Abdominal pain o Bloating o Nausea o Fatigue Bowel function o Diarrhea o Constipation
-According to the research, the low FODMAP diet improves some of the symptoms described above Symptom Abdominal pain Bloating Flatulence Diarrhea Constipation Nausea Fatigue Does low FODMAP relieve symptom in IBS and IBD? Mixed, inconclusive for IBS, No for IBD for IBS, No for IBD Learning Activity 2 High FODMAP Foods How much FODMAPs is considered high? One study suggests that high FODMAP is 50 g/day, low FODMAP is 9 g/day For a frame of reference, 1 medium sized apple contains 10.74 g fructose Apples also contain fructans and polyols (so total FODMAP content is higher than 10.74 g) High FODMAP Foods Oligosaccharides Disaccharides Monosaccharides Polyols LL Fructans Galactans Lactose Fructose Sugar Alcohols Peaches Beans Milk Apples Think of fruits Watermelon Chickpeas Yogurt Cherries with a pit and Artichokes Lentils Ice cream Mango artificial sweeteners Brussels Sprouts Custard Pear Garlic Ricotta cheese Sugar Snap Peas Apricots Onion Cottage cheese Agave Avocado Wheat Honey Plums Rye High Fructose Corn Syrup Other stone Barley Pistachios Key points: Comprehensive list Look for patterns and ways to categorize these foods o Dairy foods, fruit with a pit, gluten, legumes, etc Foods not listed as high FODMAP foods may be considered as suitable low FODMAP alternatives. If low FODMAP foods are eaten in large amounts, they are quickly considered to be high FODMAP o Limit low FODMAP fruit to 1 serving per meal (1 medium orange or banana, 1 cup berries or cut up low FODMAP fruit) fruits already listed Cauliflower Mushrooms Mannitol* Maltitol* Xylitol* Isomalt* Sorbitol* *Found in sugar free gum, mints, cough drops
When is a low FODMAP diet recommended? Only for people with known GI diseases because: o Consuming FODMAP rich foods do not cause GI diseases in otherwise healthy people o Eliminating FODMAPS does not prevent the occurrence of GI diseases in otherwise healthy people o Eliminating FODMAPs does help control symptoms in individuals who already have a GI disease Certain foods are known to cause discomfort in many individuals with IBS/IBD o Fatty foods o Greasy foods o Spicy/acidic foods (citrus, tomatoes) o Caffeine o Carbonated beverages o Alcohol Individuals who do not find relief in symptoms from eliminating/limiting these types of foods may benefit from the low FODMAP diet Learning Activity 3: Make the Swap Using this Cooking Matters recipe, identify foods that are high in FODMAPs. What are some substitutions that could be used? Black Bean and Vegetable Quesadillas 8 oz. black beans, no salt added 2 medium zucchini 1 bunch fresh spinach 1 ear fresh corn 4 oz. low-fat cheddar cheese 1 T. canola oil Pinch of ground cayenne pepper 1-2 t. water ½ t. ground black pepper 6 whole wheat flour tortillas Non-stick cooking spray High FODMAP food Black beans Whole wheat tortillas Low FODMAP substitution Chicken or other meat, low FODMAP vegetables only, firm tofu Gluten free tortilla (refined white tortillas still contain wheat) Zucchini, spinach, and corn are low FODMAP vegetables. Cheddar cheese is a hard cheese and is therefore lower in lactose/fodmaps. An individual who is severely lactose intolerance may not tolerate even small amounts of cheddar cheese. Although not a FODMAP, cayenne pepper may be too spicy for some individuals with GI
Conclusion symptoms and can be left out. Firm tofu is better tolerated than soft tofu (similar to hard and soft cheeses) Take away messages regarding high FODMAP foods: Reiterate key points from high FODMAP food list Garlic and onions are two of the most commonly consumed high FODMAP foods Meats and eggs do not contain carbohydrates, therefore they do not contain FODMAPs Suggestions for CM participants Keep a food journal and see how different foods affect symptoms o Everyone is different o May tolerate certain FODMAPs Low FODMAP diet should only be used for someone who already has a GI disease Many high FODMAP foods are also great sources of fiber. It is important for someone on the low FODMAP diet to make sure they get enough fiber (if fiber is tolerated) o May need to supplement VI. Materials and Resources Used Research used for Instructional Plan a. "National Digestive Diseases Information Clearinghouse (NDDIC)." Irritable Bowel Syndrome. N.p., n.d. Web. 22 Apr. 2013. b. FODMAP Label Reading Tips handout. Kate Scarlata. 2012. c. FODMAPs Checklist handout. Kate Scarlata. 2012. d. Ong DK, Mitchell SB, Barrett JS, Shepherd SJ, Irving PM, Biesiekierski JR, Smith S, Gibson PR, Muir JG. Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome. J Gastroenterol Hepatol. 2010;25:1366-1373. e. Food Group."Foods List. Web. 24 Apr. 2013. Materials needed for presentation: a. Laptop Computer b. The Low FODMAP Diet PowerPoint c. Post-training evaluation (one for each person participating in training) d. Pens/Pencils (one for each person participating in training)
The Low FODMAP Diet Evaluation Show us what you ve learned! 1. Which of the following carbohydrates is not considered a FODMAP? a. Fructose b. Glucose c. Lactose d. Fructans 2. a. Using this Cooking Matters recipe for Yogurt Parfaits, circle 2 ingredients that are high in FODMAPs. 4 cups fresh or thawed frozen fruit (bananas, strawberries, peaches, mango) 3 cups nonfat plain yogurt 1 ½ cups granola 2 T. sliced almonds b. Name one low FODMAP substitution that could be used in place of one of your circled items. 3. Did you find this training helpful? Circle one: No Answers: (not to be included on evaluation given to participants) 1. Glucose 2. a. Peaches, mango, yogurt, granola (may contain gluten and have dried high FODMAP fruits and honey) b. any low FODMAP fruit is acceptable, lactose-free yogurt, gluten free granola that does not contain high FODMAP dried fruits or honey, gluten free cereal