Research investigating the various subtypes of FODMAPs, their mechanisms of action, absorptive capacity and food composition has lead to the refinement of the Monash University low FODMAP diet. As with any medical nutrition therapy, implementation under dietitian guidance is paramount. Food lists are a useful way to start, but individualised dietetic counselling will aide nutritional adequacy and compliance throughout the trial.
The initial consultation must include a thorough assessment of the patient’s history to ensure relevant tests have been completed and other possible diagnoses have been excluded. Living situation, age and cooking skills of the patient, as well as the type and severity of gastrointestinal symptoms need to be considered to determine the level of restriction likely to be required. A lactose breath test may be helpful to determine the requirement for lactose restriction. The Monash University low FODMAP diet SmartPhone app is first choice for use as an education tool. Alternatively, the Monash University low FODMAP diet booklets can be used, or an individualised list of potential FODMAP triggers can be constructed for those when assessment suggests a less restrictive diet is appropriate. All FODMAP subtypes should be explained and high FODMAP foods highlighted, with considerable time spent discussing low FODMAP alternatives that fit within the patients’ current food preferences and patterns to ensure compliance and nutritional adequacy. Additional limitations need to be given attention including other restrictions such as a vegetarian diet.
At the closure of the initial consultation emphasis should be on long term management. The Monash University low FODMAP diet is not a diet for everyone, nor is it for life. Follow up by a dietitian is essential to ensure symptoms have improved. The importance of reintroduction to optimise long term gut health should be highlighted with patients encouraged to expand the diet over the coming months.