About The Course
Are you a Registered Dietitian Nutritionist (RDN) or other health professional with aspirations to specialize in the low FODMAP diet? Late last year Monash University launched their online training course for health professionals: The Low FODMAP Diet for Irritable Bowel Syndrome. For those not familiar, Monash University is the birthplace and the most respected primary source for information about the low FODMAP diet.
The research team at Monash University in Melbourne, Australia led by gastroenterologist Professor Peter Gibson and nutrition scientist and dietitian Associate Professor Jane Muir developed the low FODMAP concept in 2005. The diet has proven to be the most effective approach to managing IBS symptoms providing symptom relief for approximately 75% of IBS sufferers. This far surpasses other conventional therapies including the National Institute for Health and Care Excellence (NICE) guidelines and pharmacology.
Monash at The Forefront
Aside from ongoing IBS research studies Monash operates two FODMAP certification programs. Their product certification tests prepared food products for FODMAP levels and provides the stamp of approval to be low FODMAP certified if total FODMAP content is below established cut off values. Their new recipe certification provides validation and certification for recipes; FODMAP Everyday® is the first north American entity to have Monash certified recipes and the only ones in the world offering them free to the user. Monash remains cutting edge with their strong social media presence, frequent blogs, patient education materials and clinical training. As a RDN specializing in gastrointestinal nutrition, IBS sufferer and dedicated FODMAPer myself I signed up for the dietitian course immediately.
Why I Took The Course
I strive to practice evidenced based nutrition, which can sometimes be challenging with new approaches such as the low FODMAP diet since it is an evolving science. My previous training has included two low FODMAP webinars with Dietitian Central, utilizing various low FODMAP books, and the Microbiome and SIBO Summits. I have followed Kate Scarlata RDN, Patsy Catsos MS, RDN, LD, Monash, and other low FODMAP websites. I have also dabbled with the integrative and functional aspects of IBS and SIBO and sought opinion from naturopaths.
These self-taught opportunities provided me with the confidence to expand my outpatient practice and market both myself and this diet to the doctors and gastroenterologists at the multidisciplinary clinic where I practice. Despite this previous training, it has been a challenge to keep up to date, especially with the differences of opinion and outdated resources found online and elsewhere. Nonetheless, teaching the low FODMAP diet has been the most rewarding experience on a personal and professional level. Helping others feel good is addictive, thus began my love affair with the low FODMAP diet.
How the Monash University Low FODMAP Dietitian Course Works
The Monash Training consists of 10 modules and provides 25 CEUs, which are accredited by the Academy of Nutrition and Dietetics and the British Dietetics Association. This training will take 20 to 25 hours to complete. Completion of this training, plus a passing grade on the final exam, awards one with the Monash University Certification of Completion, which increases visibility by listing contact information on their app plus the trust and confidence for those seeking a qualified clinician.
The 10 Modules Explained
Below is a breakdown of the ten modules and the main highlights. Before moving on to the next module one must past a quiz. The module exams are challenging and make certain you are well versed before moving on. There are many short video clips of counseling sessions demonstrating how the RDN handles difficult patients over consecutive visits. The final exam is comprehensive and tests your knowledge on every FODMAP concept including clinical assessment skills. I passed on my first attempt, however you are given three opportunities to take the exam. Also included are handouts available for download, which can be used in your practice, plus numerous research studies to further your reading.
Module 1: Introduction to Functional Bowel Disorders and Irritable Bowel Syndrome.
A clear definition of IBS and the Rome IV criteria diagnosis are discussed, which is necessary to establish before implementing the low FODMAP diet. I learned how to identify high-risk patients, red flag symptoms and when to refer to a gastroenterologist or doctor before dietary modification to ensure safe and effective care. Also discussed are other applications of the low FODMAP diet. More recent studies show the benefit of adding the low FODMAP diet concept to other gastrointestinal related diagnoses.
Quite often my patients have trialed alternative therapies for their IBS. This module provided me with practical advice on how to tactfully challenge non-evidence based approaches, such as breath tests and food allergy testing.
Module 2: Dietary Management of IBS and an Introduction to FODMAPs
I had a flashback of a college nutrition science class with this updated explanation of carbohydrate metabolism. Pass the chalk and let me explain or maybe I’ll just play this descriptive little video for you.
Taking a detailed food recall or reviewing a food log is common practice when counseling IBS patients. Identification of high FODMAP foods is important, however other dietary factors such as quantity and frequency of other nutrients such as fat, protein, and types of fiber intake may contribute to symptoms and should also be considered when developing a personalized nutrition approach. A review of the current gaps in low FODMAP literature and areas where more research is needed helps clinicians know when to use their best judgement.
Module 3: FODMAP Composition of Food
An overview of their lab testing process which determines FODMAP content and cut off values. This module breaks down the science behind the establishment of these levels helping the dietitian better explain the importance of portion control and the concept of FODMAP stacking.
Did you ever hear about boiling a potato to reduce the potassium content? Similarly, how one prepares a food can affect the FODMAP content such as pickling, pressing, straining, fermenting and more.
Module 4: Dietetic Assessment
As a RDN specializing in the low FODMAP diet I want to teach this diet to EVERYONE. Well, this is not always the best approach. Here I learned how to determine if a patient is an ideal candidate for the low FODMAP diet plus practical skills for completing a nutrition care plan and follow up visits.
This includes looking at your patient from a more global viewpoint with attention to frequency and duration of specific symptoms, previous diets trialed, known food triggers, hydration, current dietary habits, fermentable fiber intake and lifestyle habits before determining the best course of action.
Module 5: Implementing a low FODMAP Diet – Practical Skills
Several variations of the low FODMAP diet are reviewed aside from the strict low FODMAP diet, which is most discussed. This is not a one size fits all diet approach.
The Monash app is reviewed with an emphasis on how to use it to its best advantage when teaching the elimination and re-challenge phase.
This module also includes information on how to test for tolerance foods with unknown FODMAP levels
Module 6: Re-challenge Phase
As with the elimination phase there are several different re-challenge methods described plus tips. Basically there are 3 different elimination approaches and 3 different re-challenge methods.
Module 7: Troubleshooting
Here a clinician can learn how to best help patients that “fail” the low FODMAP diet with modifications to the low FODMAP plan to better meet individual needs and lifestyle habits. There are many factors to take into consideration when evaluating a patient with inadequate symptom relief and they are reviewed in this module.
Module 8: Adjunct Therapies – Psychological and Pharmacological Approaches
As many of us know stress management plays a huge factor with IBS; there are now evidenced based guidelines on the psychological treatment for IBS which may be used solo or in combination with diet modification. Probiotics are a hot topic in the world of IBS. This module brings clarity to the most recent to probiotic recommendations for IBS including strain specificity, timing and attention to the shortfalls with current research.
Module 9: Adjunct Therapies – Other Dietary Approaches
It is well known that fiber is important for bowel regularity. Specific recommendations on how to modify specific fibers via diet or supplements can be recommended based on IBS subtype and current eating habits to better address diarrhea and constipation management. Before the low FODMAP diet those with IBS were encouraged to eat smaller, more frequent meals, limit gastrointestinal irritants, exercise regularly, increase fiber, reduce high fat foods, and ensure adequate hydration.
These recommendations still have value and should be considered at baseline. For example, establishing healthy habits such as eating regular meals, reducing intake of fatty meals, and avoiding excessive caffeine and alcohol may be initial steps before implementing the low FODMAP diet. Adding glucose to fructose is reviewed since this is sometimes recommended to improve fructose malabsorption.
Module 10: Other Applications of a Low FODMAP Diet
I was excited to learn about other population groups that may benefit from the low FODMAP diet such as breastfeeding mothers with colicky babies and women with endometriosis and IBS related symptoms. I also feel prepared to teach the low FODMAP concept to pediatric patients and their parents when appropriate, something I would not have considered prior to this training.
I often see patients with SIBO (small intestinal bacteria overgrowth) alone or in combination with IBS diagnosis. The lack of evidence based guidelines around SIBO makes it challenging to provide nutrition therapy. Practical guidelines on when to utilize low FODMAP with SIBO were also provided plus adjunct therapies to consider if diet alone does not improve symptoms.
With 18 years of experience as a RDN and proficiency in the low FODMAP diet this training reaffirmed much I already knew, and yet also provided me new skills of how to integrate evidence based practices, such as recommending a specific fiber supplements or probiotics, or to consider referring patients to a gut related hypnotherapist. This course taught me concepts that I cannot find in a book.
As a clinician we often rely on our best judgments and naturally we let personal and patient experiences influence how we practice. After this training I have a more neutral stance and big-picture mentality of IBS and other functional gut disorders, which helps me be a better listener and RDN.
This has been one of the most practical and enjoyable trainings I have ever taken and as a result I feel so much more confident with all my IBS patients. For example, common dietary restrictions are gluten and dairy, which in some cases are not necessary. Now I encourage my patients to be less restrictive while remaining well versed in the strategies to challenge these possible food triggers when appropriate.
This is not an easy diet to teach or a specialty where a RDN can be complacent. This training can be a great place to start for anyone new to this diet and an important update, for expansion of skills and knowledge for those already practicing. Monash University has set the standards with the most up to date, evidence based recommendations so we as clinicians can be providing a consistent universal message.
If you have taken the Monash online training course – The Low FODMAP Diet for IBS – Let us know what you thought were the most important takeways for you as a practitioner- comment below.
If you would like more information on this course you may go directly to the Monash University course description page here.