FODMAPs

Education courses for Health Professionals

To date, King's College London has trained over 1,700 dietitians from across the world on the latest evidence and dietetic practice in the low FODMAP diet.

All King's courses are based on the research evidence and delivered by world-leading experts in dietetic and medical management of IBS, IBD and other gut disorders, including:

• Prof Kevin Whelan PhD RD FBDA
  Professor of Dietetics at King’s College London.
• Dr Peter Irving MD MRCP
  Consultant Gastroenterologist at Guy’s and St Thomas’ NHS Foundation Trust.
• Prof Miranda Lomer MBE PhD RD
  Senior Consultant Dietitian at Guy’s and St Thomas’ NHS Foundation Trust and Professor of Dietetics in Gastroenterology at King’s College London.

Advanced Dietary Management and the Low FODMAP Diet in IBS (2024)

Online (recorded lectures)

Course dates:

The course runs twice a year, in autumn and spring.

Spring 2024: 12 March 2024 to 23 July 2024

Autumn 2024: dates to be released in March 2024.

For more information and to apply please click here.

Course duration: 38 hours to be completed within 19 weeks

Please note that you must complete the application form to secure your place on this course. We do not book places via purchase order numbers emailed to us.

If your place of work e.g. NHS Trust or other hospital is paying for your place on the course, please make sure you have a purchase order number ready before starting the application form. Without a purchase order number your application will be rejected. However, if you are self-funded and pay by credit card you do not need a purchase order number.

Also, please make sure you provide all details in full, including your home address: any inaccuracies or missing information will delay the processing of your application.

Introduction to Dietary Management and the Low FODMAP Diet in IBS (2023/2024)

Online (recorded lectures)

Course dates: start anytime and complete in your own time (the course closes on 31 July 2024).

Course duration: equivalent to one day (8 CPD Continuing Professional Development hours)

For more information and to apply please click here.

Please note that you must complete the application form to secure your place on this course. We do not book places via purchase order numbers emailed to us.

If your place of work e.g. NHS Trust or other hospital is paying for your place on the course, please make sure you have a purchase order number ready before starting the application form. Without a purchase order number your application will be rejected. However, if you are self-funded and pay by credit card you do not need a purchase order number.

Also, please make sure you provide all details in full, including your home address: any inaccuracies or missing information will delay the processing of your application.

The Low FODMAP Diet - Update course (2023/2024)

Online (recorded lectures)

Course dates: start anytime and complete in your own time (the course closes on 31 July 2024).

Course duration: equivalent to one day (8 CPD Continuing Professional Development hours)

For more information and to apply please click here.

Please note that you must complete the application form to secure your place on this course. We do not book places via purchase order numbers emailed to us.

If your place of work e.g. NHS Trust or other hospital is paying for your place on the course, please make sure you have a purchase order number ready before starting the application form. Without a purchase order number your application will be rejected. However, if you are self-funded and pay by credit card you do not need a purchase order number.

Also, please make sure you provide all details in full, including your home address: any inaccuracies or missing information will delay the processing of your application.

An Update on Dietary Management and Integrated Care for IBS

In-person

Course date: 16 April 2024

Course duration: 8 CPD (Continuing Professional Development) hours

Location: King's College London, Waterloo campus, 150 Stamford Street, London, SE1 9NH

Course fees: £200 (including electronic copy of lectures, refreshments and lunch)

Course outline:

The course aims to provide updated information on clinical pathways in relation to the dietary management of irritable bowel syndrome (IBS).

It will include lectures on:

• the diagnosis and holistic approach to the management of IBS, including digital technology in referral and triage pathways
• recent evidence for dietary management of IBS, namely first-line and second-line advice
• the use of probiotics as part of the first-line advice
• the gut-brain axis
• the management of IBS following a holistic approach as part of an integrated care pathway

The lectures will be interactive and accompanied by group workshops and self-guided learning tasks.

Please email fodmaps@kcl.ac.uk to express your interest.

For a summary of each course's learning outcomes and benefits, please read the PDF document below.

If you are not sure which course is suitable for you, please read the PDF document below.

If you have any questions please email: fodmaps@kcl.ac.uk

 Nutrient intake, diet quality, and diet diversity in irritable bowel syndrome and the impact of the low FODMAP diet

Research question: What is the habitual nutrient intake, diet quality, and diet diversity in individuals with IBS without constipation and does the low FODMAP diet impact on these parameters compared with control diets?

Key findings: In this secondary analysis of two randomized controlled trials in IBS, many individuals failed to meet national recommendations for a number of nutrients, including fat, fibre, iodine, and selenium. A low FODMAP diet, when delivered by a specialist dietitian, did not significantly impact the intake of most nutrients or diet diversity, however, it led to lower diet quality compared with controls.

Staudacher HM, Ralph FSE, Irving PM, Whelan K, Lomer MCE. Nutrient Intake, Diet Quality, and Diet Diversity in Irritable Bowel Syndrome and the Impact of the Low FODMAP Diet. 2019

The full paper can be accessed at:

https://www.ncbi.nlm.nih.gov/pubmed/31029650

 Prebiotics in IBS

In patients with irritable bowel syndrome there are conflicting messages about dietary fibre for improving symptoms. On one hand the low FODMAP diet restricts the type of dietary fibres that may be fermented by gut microbes, however specific types of fibre that are fermented by a select few types of gut microbes, called prebiotics, have been shown in some studies to improve symptoms and increase some types of probiotic bacteria (bifidobacteria) in IBS.

We recently performed a systematic review and meta-analysis that showed that while in general prebiotics did not improve symptoms in IBS they did increase bifidobacteria, sub-analysis revealed that some types of prebiotics may actually improve symptoms in IBS whereas others may make symptoms worse, we also found that prebiotic doses lower than 6 g/d could improve symptoms.

We concluded that if a prebiotic isn’t a type of FODMAP fibre (fructan, FOS, OF, inulin) then it may improve IBS symptoms when taken at a dose of less than 6 g/d.

Wilson B, Rossi M, Dimidi E, Whelan K. Prebiotics in irritable bowel syndrome and other functional bowel disorders in adults: a systematic review and meta-analysis of randomized controlled trials. 2019

The full paper can be accessed at:

https://academic.oup.com/ajcn/article/109/4/1098/5428039

Diet low in FODMAPs reduces symptoms in patients with irritable bowel syndrome and probiotic restores bifidobacterium species: a randomized controlled trial.

We have recently published a large ground breaking trial undertaken in 104 patients with irritable bowel syndrome. We wanted to determine if the low FODMAP diet is better than a placebo diet. We wanted to use this trial design as it provides the highest quality evidence for the effectiveness of treatments in medical research.

Patients were allocated to either receive low FODMAP dietary advice or sham (fake) dietary advice from a dietitian.

Other studies have shown that a low FODMAP diet can lead to changes in the gut microbiome (bacterial community in the gut), so at the same time we also allocated patients to receive a probiotic or a placebo supplement to see if the probiotic could prevent these changes in gut microbiome.

We found that after 4 weeks, the low FODMAP diet improved gut symptoms and aspects of quality of life in around 60%-70% of patients. When analysed individually, the probiotic was not as effective as the low FODMAP diet in improving IBS symptoms, but we need bigger studies to confirm this. Interestingly, the probiotic did help to preserve one type of beneficial bacteria, Bifidobacteria.

What does all this mean? This is strong evidence that a low FODMAP diet will help improve symptoms in most people with IBS. We don’t have enough information at this stage to routinely ask patients to add in a probiotic when they follow a low FODMAP diet.

The next step is to find out whether reintroducing FODMAPs back into the diet (which is a key stage in the low FODMAP diet process) is able to increase the Bifidobacteria back to the usual level.

Staudacher HM, Lomer MCE, Farquharson FM, Louis P, Fava F, Franciosi E, Scholz M, Tuohy KM, Lindsay JO, Irving PM, Whelan K. Diet low in FODMAPs reduces symptoms in patients with irritable bowel syndrome and probiotic restores bifidobacterium species: a randomized controlled trial. Gastroenterology. 2017

The full paper can be accessed at:

http://www.sciencedirect.com/science/article/pii/S001650851735744X

FODMAP composition data now available for foods eaten by ethnic minority groups

The King’s College London FODMAP group recently identified and measured the FODMAP content of foods commonly consumed by ethnic minority groups.¹ Over 350 dietitians were invited to complete a survey to identify foods commonly consumed by ethnic minority groups based on how important they believed measuring their FODMAP content would be. Consultation with focus groups, including members of ethnic minority groups and experts in the low FODMAP diet, were also undertaken to ensure appropriate foods were selected for analysis. The top 20 ranked foods underwent FODMAP analysis using validated analytical techniques in conjunction with our collaborators at Monash University. Of the 20 foods analysed, five were identified as significant sources of at least one FODMAP (see table below). Although more foods still need to be analysed this study has made a positive step forward in broadening the potential reach, acceptability and equality of access to the low FODMAP diet across different groups.

nd, not detected

Reference:

Prichard, R, et al.: Fermentable oligosaccharide, disaccharide, monosaccharide and polyol content of foods commonly consumed by ethnic minority groups in the United Kingdom. Int J Food Sci Nutr, 67: 383-90, 2016.

 Dr Miranda Lomer awarded an MBE in the Queen’s Birthday Honours 2016

Dr Miranda Lomer, Reader in Dietetics, was awarded an MBE for services to dietetics and gastroenterology.

Dr Lomer is a Senior Consultant Dietitian in Gastroenterology at Guy’s and St Thomas’ NHS Foundation Trust. She is a leader in the dietary management of functional bowel disorders and inflammatory bowel disease and has published British Dietetic Association guidelines for these conditions.

Dr Lomer leads an educational course for dietitians on the low FODMAP diet and has trained over 1,000 dietitians in this successful dietary treatment for irritable bowel syndrome.

How can I follow the low FODMAP diet?

There are 3 stages to the low FODMAP diet:

• Stage 1 Restriction: In this stage, you reduce your FODMAP intake by avoiding foods that are high in FODMAPs for 4 to 8 weeks as this period is considered long enough to identify if symptoms will respond to a low FODMAP diet.
• Stage 2 Reintroduction: If your symptoms have improved following FODMAP restriction, it is important to reintroduce some high FODMAP foods. This will enable you to identify which FODMAPs you are most sensitive to, as well as how much of a high FODMAP food triggers your symptoms.
• Stage 3 Personalisation : The long term aim of a low FODMAP diet is to personalise your diet so you only avoid foods that trigger your symptoms and you return to as normal a diet as possible.

How successful is the low FODMAP diet?

The low FODMAP diet is effective for about 70% of people with IBS who try it. It works by improving the gut symptoms associated with IBS. There is no evidence that it works for non-gut symptoms that are sometimes associated with IBS, such as headaches and skin or joint problems.

I want to try the low FODMAP diet. What should I do?

The low FODMAP diet is quite a complex approach and so it is important that you receive good quality advice about how to follow the different stages. A registered dietitian, preferably one with experience of educating people on the low FODMAP diet, will help you to follow it carefully. He/she will ensure you follow a healthy balanced diet by providing you with ideas for suitable low FODMAP alternatives. Ask your GP or gastroenterologist (gut specialist) to refer you to a registered dietitian who is trained in the low FODMAP approach. A list of King's College London FODMAP-trained dietitians is available here.

Do I need to see a dietitian to follow the low FODMAP diet?

The diet is effective when FODMAP-trained dietitians provide the dietary advice. A recent evaluation has shown that 76% of patients that had seen a FODMAP-trained dietitian reported improvement in symptoms after being on the diet.

As this is a complex and restrictive diet, it is very important that you follow a well-balanced diet and meet your nutritional requirements. The diet should be individualised to each patient taking into consideration your usual dietary intake and symptom profile. Therefore, it is strongly recommended that you see a dietitian to follow the low FODMAP diet. A list of King's College London FODMAP-trained dietitians is available here.

Do I have to see an NHS dietitian?

There are FODMAP trained dietitians working in the NHS and privately. If you want to see an NHS dietitian ask your GP or consultant to refer you. Some private dietitians may also require a referral. Please note there are an increasing number of registered dietitians who are skilled in the delivery of the low FODMAP diet without having had formal training at KCL. A list of King's College London FODMAP-trained dietitians is available here.

There is a lot of information on the internet about the low FODMAP diet. Can I try the diet myself?

The diet is not recommended to be used without specialist dietary advice from a registered dietitian. This is for a number of reasons:

Firstly, it is not as simple as following a list of ‘foods to eat’ and ‘foods not to eat’. High FODMAP ingredients are often hidden in packaged foods. You will need to learn about how to read food labels and how to make sensible decisions when eating out.

Secondly, as the low FODMAP diet is relatively new, much of the information available on the internet, and from other sources, may be out of date and create confusion regarding which foods to include and which foods not to include. This makes it difficult to work out how to follow the diet.

Thirdly, if you follow a low FODMAP diet without professional support from a registered dietitian, you may miss out certain foods from your diet that are essential to good health.

Finally, if you do not follow the low FODMAP diet properly, it is unlikely to be effective. Therefore, it is best to get advice from a registered dietitian in the first instance.

I have spoken to my GP or gastroenterologist and he/she has never heard of the low FODMAP diet

The low FODMAP diet is still a relatively new concept in the UK. It is recognised by national guidelines produced by NICE as an effective diet for managing IBS symptoms. Gradually more GPs and gastroenterologists in the UK are referring patients for advice from a registered dietitian who has experience in advising on a low FODMAP diet.