Easy app for FODMAPs
Monash University has launched an app for the iPad and iPhone that helps patients with irritable bowel syndrome (IBS) to accurately judge foods that are high in certain nutrients known to be poorly absorbed by the digestive tract.
Monash University's Department of Gastroenterology has led the world in research into a family of carbohydrates called FODMAPs – fermentable, oligosaccharides, disaccharides, monosaccharides and polyols – that seem to trigger IBS symptoms.
The university has over the years created a formidable database of knowledge on FODMAP content of foods and has also created a special diet for patients with IBS to help them reduce or avoid foods high in these sugars, called the Monash University Low FODMAP Diet.
While the database is a wonderful resource for researchers, consumers and health professionals don't have easy access to the information. Now, the FODMAP research team – led by Monash's director of gastroenterology, Professor Peter Gibson, and Dr Jane Muir, head of translational nutrition science – has developed an easy to use app to help consumers and healthcare professionals to monitor food intake.
Monash dietitian Dr Jaci Barrett said the team had published medical papers over the years listing the levels of FODMAPs, but they aren't very accessible to the general public.
“Health professionals also don't know where to look for them,” Dr Barrett said. “We were looking for another way to get the information out there and share it in a user friendly manner.”
“That's when we started thinking about some sort of electronic way of sharing the information, leading to the iPhone app.”
FODMAPs are predominantly found in certain fruits and some vegetables, particularly onions and garlic, and in wheat and rye products. Monash University has its own laboratory to test different foods for their FODMAP levels, which Dr Barrett said was not undertaken elsewhere.
“There are international researchers and dietitians who have been interested in our work who send us food from their country to analyse, so there is a lot of interest out there,” she said. “We are gradually expanding our understanding of the levels of these carbohydrates in foods around the world.”
The app uses a traffic light system to show which foods – and how much of it – are high in FODMAPs. Health professionals can also use it if they are caring for an IBS patient on the diet.
“Instead of giving people the actual quantity of FODMAPs in foods we've adapted it into a low (green), moderate (orange) and high (red) traffic light system so people can easily glance at the foods on the list and know whether they are suitable or not,” Dr Barrett said.
“We've given a bit more detail because previous food lists have said 'these foods are high and must be avoided', but we've incorporated a lot more detail into the app. A certain food might be high in FODMAPs, but if they actually eat a small serve of it, they may get away with it without significant IBS symptoms.
“For example, a food may be labelled red if you eat a whole serve, but it's actually orange if you only have a third. Therefore if you love that food, you can try a small amount and it may not cause you symptoms. We don't like overly restricting people's diets so any extra information that helps people expand their diet will help.”
The app also includes a number of recipes and menus, created by a research chef who works with the university.
Dr Barrett said an extra feature had been added for consumers who have a particularly good understanding of what their level of tolerance is with their diet. “If they have worked with a dietitian and know what their sensitivities are, they can filter the settings on the food list,” she said.
“There are five different types of FODMAP sugars and some people might have a major symptom to one of them and tolerate the rest, so they can go into the filter options and adapt it, which adapts the food list for their specific individual needs.
“When it comes to the food lists the patients will be able to use it on their own, but we don't want people being on this diet strictly for a long time. A lot of these foods are really good for us, so I think that encouragement and guidance through a health professional that also understands the app and can use it with them is a really important part of the whole system.”
The app was created by James Eunson, a Monash computer science graduate who is currently working on an Android version.
Dr Barrett has also recently launched an online tool for researchers and dietitians to measure food frequency and adequacy. Devised as part of her PhD, the Food Frequency Questionnaire was developed and validated in 2009, and has just been launched online at www.cnaq.com.au.
Renamed the Comprehensive Nutrition Assessment Questionnaire (CNAQ), the tool is a series of questions that can be given to patients or research participants to fill out.
“We can analyse it and it gives us a snapshot of their normal dietary habits and their adequacy – whether they get enough energy, proteins and vitamins etc – and we obviously put FODMAPs into it, because that was our particular interest,” she said.
“We had a lot of people interested in knowing how to use it and in paper form it was a nightmare. We had an external IT group produce it as an online tool. Users can be researchers or health professionals or the general public who wants to fill out one copy of it; it can be used by anybody.
“We set each new user up with an account with a secure username and password that is emailed to them and they can go in and set up their participation, whether it is for research or just fill in the questionnaire themselves.”
The team has built in the database of FODMAPs and all other nutrients so it automatically calculates the nutrient profile from the answers to the questionnaire, and then exports the results immediately into Excel.
“For researchers who do a lot of dietary analysis this is going to save a lot of time. It's a nice easy way of doing dietary research and hopefully we can use it on a worldwide scale, use it for thousands of people and get really interesting information about dietary habits.”
Dietitians can use it when they are unsure of a patient's nutritional adequacies, she said. “Dietitians can order 10 of them through us and set up their patients on the system. That would then give them a nice easy way of snapshotting the nutritional profile of their diet.
“We could also even use it for compliance, so if you were potentially educating them on dietary change – it doesn't even have to be for IBS, it might be diabetes – you can get them to complete the CNAQ, educate them on dietary change and then in six months get them to repeat the questionnaire to see if their intake of certain nutritional components has changed; for example saturated fat, sugar, carbohydrate or glycaemic index.”The FODMAP app is available from the iTunes store.
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