Claire Wylde is a Dietitian based in Surrey running clinics at the BMI Runnymede Hospital in Chertsey, The BMI Syon Clinic in Middlesex and The Priory Hospital in North London. A lot of her work includes patients with allergies, coeliac disease, weight management issues, irritable bowel syndrome (IBS) and eating disorders. Here she explains IBS and its popular treatment – FODMAP diets…
We still don’t fully understand what causes IBS –practicalities wise it’s quite a difficult one to research. Whilst stress, alcohol and caffeine have all been shown to have an effect on gut function, it’s almost impossible to pinpoint exactly how or when these will manifest. Positively though, whilst still much more work is needed, we are much better informed than we used to be about foods that trigger symptoms.
15% of the UK population that is affected by IBS. That means there are a lot of people suffering every day with diarrhoea, constipation, bloating, abdominal pain and wind. Those of you experiencing them will know only too well how debilitating and difficult they make your life. However, it is also important to remember that these symptoms can be caused by other gastrointestinal disorders too. Try not to self-diagnose – it’s always essential to rule out inflammatory bowel disease, coeliac disease or even bowel cancer. To do that you need to see your GP who should refer you onto a gastroenterologist.
However, if you are diagnosed with IBS, the fantastic news is that changing your diet can significantly improve your symptoms. From the patients I see, the majority of them say that following the FODMAP exclusion diet for four to eight weeks, completely changed their life.
FODMAPS: Fermentable, Oligo-saccharides, Di-saccharides, Mono-saccharides And Polyols. They sound tricky, but basically they are all just carbohydrates, which is much easier to get your head around. Most FODMAPs aren’t well absorbed by anyone, whether you have IBS or not. However they only become an issue if you are experiencing symptoms.
When we eat carbohydrates, our gut breaks it down into their smaller components (sugars) in order for us to attempt absorption. However, some carbohydrates – namely the above FODMAPs don’t get absorbed as they should. It leaves them free to travel from your small intestine (where the absorption of nutrients should occur) and pass into your large intestine. Here, bacteria feasts on them and osmotic changes can occur which means the amount of water in the large intestine can increase. Et Voila! You now feel bloated and gassy, which is usually painful, and probably have some looser stools to top things off.
So, now we know the names of the potential culprits, what foods contain FODMAPs? FODMAPs are found in a wide variety of foods, most of which are considered healthy. It’s a very detailed and specific list but as a general overview:
Fructans (oligo-saccharide): found in wheat and rye. Various fruits and vegetables.
Galacto-oligosaccharides: found mainly in beans and pulses.
Lactose (Di-saccharide): found in milk and yogurts
Fructose (Mono-saccharide): found in various fruits, fruit juices, honey and agave nectar
Polyols: found in various fruits and vegetables, sugar-free chewing gum/mints
You’ll notice that meat, poultry, fish and eggs are naturally FODMAP free foods. Be warned: it’s really very easy to get the diet wrong and to therefore potentially not see the positive desired effects you are expecting. This is why it is so important to see a dietitian to help you through both the exclusion and reintroduction period, so it’s done safely and still ensures that your diet is nutritionally adequate in spite of restrictions.
Once you’ve done the exclusion diet for four to eight weeks (results determines how long after the 4 weeks you continue), you would embark on the re-introduction phase. Again a dietitian should help you through this so you achieve the best and most accurate results. This stage allows for a systematic and logical re-introduction of each FODMAP. The aim being that you end up with a colour-light system of foods; ones you can’t have at all without triggering symptoms (red list).
Foods you can have in moderation or expect some mild symptoms (amber list). And foods which for you are ‘safe’ (green list). Everyone’s lists are different and the amount of FODMAP foods each individual can tolerate differs too. Hopefully though, it will mean that you are left with a revised version of your diet that still helps control IBS symptoms but allows for normality and variety to return.
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