1. Introduction & Overview of IBS | Physiology & Diagnosis

Professor William D Chey, MD, AGAF, FACG, FACP, RFF

  • Define functional gastrointestinal disorders.
  • Identify symptoms associated with IBS.
  • Summarise the aetiology, pathophysiology and prevalence of IBS.
  • Identify how IBS is diagnosed using the ROME IV Criteria and other diagnostic tests such as breath testing.
  • Identify red flags associated with diagnosis of IBS and their relevance such as cancer, Coeliac Disease and IBD.
  • Define small intestinal bacterial overgrowth (SIBO) and identify how the symptoms differ.
  • Demonstrate the relevance of the low FODMAP diet in management of IBS in the absence of a cure.

2. Dietary Management of IBS | Low FODMAP Diet Fundamentals

Andrea Hardy, RD

  • Describe the role of nutrients commonly implicated in the onset of IBS symptoms (e.g. fat, proteins, carbohydrates and fibre).
  • Describe chemical structure, absorption patterns and food sources of short chain carbohydrate such as fructose, fructans and lactose.
  • Describe the process by which FODMAPs contribute to IBS symptoms.
  • Discuss the evidence supporting the role of diets that excluded one of more short chain carbohydrates to control IBS symptoms (e.g. the low lactose diet).
  • Discuss concepts of FODMAPs their mechanism of action and evidence supporting the use of this diet in people with IBS.
  • What to do if the low FODMAP diet does not work? Discuss dietary management practices for IBS that are not FODMAP related – the low FODMAP diet may help 70-85% of those with IBS, leaving 15-30% that may need other solutions.

3. FODMAPS in Food | Distinguishing High & Low FODMAP Foods

Beth Rosen, RD

  • Identify the methods used to measure the FODMAP content of foods.
  • Describe the rationale for and application of cut-off values used to classify foods as low in FODMAPs.
  • Recognize the main food sources of each FODMAP subgroup and foods particularly rich in one or more FODMAP subgroups.
  • Identify the foods where gluten and fructans co-exist and discuss the role of the gluten free, wheat free and low FODMAP diets in people reporting IBS and/or IBS-like symptoms.
  • Discuss external factors that impact on the FODMAP composition of fresh and processed foods, such as climate and growing conditions; country of origin; ripeness; crop variety; the part of the plant sampled; ingredients used in processed foods.

4. Assessing indications & Contraindications for the low FODMAP diet

Dr Stine Störsrud, RD, PhD

  • Identify patients who are suitable candidates for the low FODMAP diet.
  • Examine medical assessment has eliminated conditions with overlapping symptoms with IBS such as cancers, IBD or Coeliac disease.
  • Identify “red flags” which contraindicate management through the low FODMAP diet, such as those with a history of eating disorders.
  • Conduct adequate symptom and diet assessment including types of food, quantity and timing of meals and symptoms.
  • Discuss alternate therapies if the low FODMAP diet is contraindicated including gut directed hypnotherapy, mindfulness & meditation to ease anxiety and stress and exercise and its effect on the gastrointestinal tract.

5. Implementing Phase 1 - Elimination Phase (Initial Low FODMAP Phase)

Emily Haller, RD

  • Implementing Phase 1 – Elimination Phase (Initial Low FODMAP Phase)
  • Identify the goal of the elimination phase to assess the efficacy of the low FODMAP diet on IBS symptom management.
  • Construct realistic expectations with patients embarking on the low FODMAP diet.
  • Demonstrate the basics of FODMAP education to patients including high and low FODMAP food lists, label reading, recipe modification and recommending resources such as apps, books and websites.

Describe the importance of maintaining a thorough food & symptom journal with serving sizes and timing of symptoms.

6. Reviewing Your Patient | Implementing phase 2 - Challenge/Reintroduction Phase

Kirsten Jackson, RD

  • Troubleshoot the low FODMAP diet if your patient is not experiencing symptom relief.
  • Demonstrate understanding of “FODMAP stacking”, the combination of FODMAP containing foods.
  • Identify the non FODMAP triggers – stress, fat, fibre, caffeine, capsaicin, carbonated drinks, meal size.
  • Identify when is appropriate for a patient to stop the low FODMAP diet.
  • Discuss rationale behind challenging FODMAPs including identifying triggers, nutritional adequacy, maintaining a diverse gut microbiome and social reasons.
  • Implement different challenge schedules and approaches to the challenge phase.
  • Identify appropriate challenge foods for each FODMAP group.

Demonstrate understanding of the “wash out” period.

7. Liberalising Your Patient's Diet | Implementing Phase 3- Maintenance Phase

Rebecca Ponsford, APD

  • Translate the challenge phase results into practical suggestions: adding back in the high FODMAP groups tolerated and strategies when first doing this to figure our thresholds. i.e. Combining high FODMAP groups that were tolerated during the re-introduction phase.
  • Implement long-term nutrition outcomes based on the results of each FODMAP subgroup challenge.
  • Discuss changing tolerances over the lifespan and re-challenging failed FODMAP groups.
  • Discuss the role of prebiotic and probiotic supplementation in IBS patients.
  • Review the use of trialing specific digestive enzymes for discovered triggers: Lactase for lactose intolerance, Alpha-galactosidas for GOS group – based on challenge results

8. Nutrients at Risk When Following the Low FODMAP Diet

Tamara Duker Freuman, MS, RD, CDN

  • Identify the key nutrients at risk of inadequate consumption when following the low FODMAP diet: Fibre, Calcium, Iron
  • Identify know FODMAP substitute foods rich in fibre, calcium & iron.
  • Identify the signs of nutritional inadequacy.
  • Identify sources of low FODMAP prebiotic foods.
  • Discuss methods of implementing the low FODMAP diet for vegans & vegetarians.
  • Demonstrate understanding that low FODMAP diet is not a long-term diet.
  • Discuss potential risks and contraindications for the low FODMAP diet (including macro/micro nutrient deficiencies, the effect on microbiome diversity, disordered eating, food fears etc.

9. The Low FODMAP Diet for Other Conditions

Laura Manning, MPH, RDN, CDN

  • Discuss the emerging evidence related to the low FODMAP diet and the management of SIBO, inflammatory bowel disease, colic babies, PCOS & endometriosis.

10. Case Study Assessment MCQ

Presented by: Dr Stine Störsrud, RD, PhD, Andrea Hardy, RD, Beth Rosen, RD, Laura Manning, RD

Four clinic case studies and final assessment to be completed using the knowledge you have gained to apply in a practical sense