Even imagining the symptoms is enough – diarrhoea and/or constipation, abdominal pain or discomfort, nausea, bloating and/or distension, flatulence, not to mention always worrying that you’re near a toilet. It’s enough to sap the joy out of anyone’s day.
“IBS can be very debilitating,” says dietitian, Paula Mee. “Many people avoid social situations because of embarrassment around symptoms, so it does have a big impact on their lives.”
Irritable Bowel Syndrome is a functional gastrointestinal disorder and the symptoms vary from person to person. It mostly affects women in their 20s and 30s, but the cause of IBS is not known, she says.
“We do know, however, that IBS can develop after a gut infection or after the use of antibiotics. Certain types of bacteria being present in the gut are thought to play a role. We also know that stress can exacerbate it.”
75% found it effective
Taking a good medical and diet history is vital when a person with IBS visits a dietitian seeking this treatment.
“It’s important to determine what the most prevalent symptom is for each patient, because that’s how your treatment outcomes will be designed in relation to the new FODMAPS approach.”
The low FODMAP diet originated in Australia at Monash University in Melbourne. Irish dietitians are now being trained in this approach in King’s College, London.
The success rate of the diet is high, Paula Mee says.
“75% of IBS sufferers who have followed the diet under the supervision of a dietitian have found it effective in alleviating symptoms,” Paula says. “Before FODMAPS, we had limited success in treating patients with IBS, but now we have this evidence-based programme. It is really a management programme. You can’t cure the condition, but being symptom-free can change people’s lives.”
FODMAPS
FODMAPS refer to carbohydrates that are not absorbed well by the small intestine.
The term stands for Fermentable Oligosaccharides (fructans and galactans), Disaccharide (lactose) and Monosaccharides (fructose) and Polyols – the group of molecules in foods that are poorly absorbed.
Instead, these carbohydrates are fermented by bacteria in the colon (the large intestine). This fermentation process generates the gas that causes the symptoms of pain, distention and bloating.
FODMAPS are found in common, healthy foods like wheat, apples, rye, pears, peas, mushrooms, onions, milk and yoghurt, as well as in some stone fruits.
What the diet involves
“The diet involves an elimination phase and a food re-introduction phase.”
“This is why it is important that you’re supervised when on this diet,” Paula Mee adds.
“It involves a reduction in peas, beans and lentils, which really are very nutritious foods and we’d like people to be eating them if they could.
“Obviously, there is a reduction in things like dairy initially too, but these foods contain a myriad of nutrients like calcium and micro nutrients that are important for bone health, so in the long-term, we don’t want people excluding such foods.
“The elimination period lasts for six to eight weeks. Then the person comes back and over the next few weeks the FODMAP foods are re-introduced in a very systematic way – one at a time, with a space of three days afterwards to see whether symptoms have come back because that food has been reintroduced.
“If they are symptom-free three days after reintroducing a new food, they move on to the next fodmap and see whether they can reintroduce that food again.”
Dangers of not being supervised
Following this diet based on just random information from the internet is not a good idea, she says.
“We don’t know what success people will have by pulling random information off the internet because there are many problems.
“One of them is that they might be following a list of foods that are not really relevant to them.
“It’s important that they get the right type of list to follow, based on their dominant symptoms.
“Also, the systematic way of reintroducing foods back into your diet isn’t fully explained on the internet. Neither is the importance of challenging yourself with the foods and reintroducing them to see if they cause symptoms.
“If people feel good after the elimination phase, they often don’t want to reintroduce the foods – but that’s where we see potentially big problems with poorly-balanced diets down the line.
“Three visits are usually necessary, the first time for a medical history and the explanation of the elimination phase, the second consultation to be shown how to reintroduce the foods one by one in a systematic manner, and the last consultation to help you identify the triggers and then make sure that your diet is balanced by ensuring that there are replacement foods substituting the ones that are removed from the diet.”
Stress
“They don’t know exactly why, but stress can make IBS worse,” she says.
“People are living such busy lives now that we may not listen to signals from our bodies. One of the important things in terms of the treatment would be to manage stress effectively.”
Managing IBS
Diet and lifestyle changes can help reduce IBS symptoms, that’s according to the INDI (Irish Nutrition and Dietetics Institute). The following general tips can help:
• Eat regular meals: Include breakfast, lunch, evening meal and snacks, if desired, every day. • Avoid missing meals or leaving long gaps between meals. • Try to take time to sit down and relax at mealtimes. • Eat smaller meals and chew food well. • If symptoms are worse at night, avoid eating late.• Eat fruit and vegetables. Aim to have at least five portions of a variety of fruit and vegetables everyday.• Cut down on high-fat foods. Foods like butter, cream and creamy sauces, cheese, pizza, chips, cakes, biscuits, chocolate, pies, pastries and crisps can make symptoms worse in certain individuals. They are also high in saturated fat and should be limited to help you stay healthy and manage your weight.• Get enough fluid: Drink 1.5 to 3 litres of fluid every day.• Limit tea or coffee to three cups per day. • Limit other sources of caffeine such as energy drinks, cola drinks and chocolate. • Avoid fizzy drinks. • As a general guideline, your urine should be a pale yellow/straw colour if you are properly hydrated.• Reduce alcohol and keep to recommended limits. Avoid binge drinking.• Take a probiotic – these friendly or good bacteria may help IBS symptoms. You can choose probiotics in yoghurts, fermented milk drinks or tablet form. If you choose to try one of these products, include it daily for one month. If no improvements are noted, it may be worth considering an alternative brand.• Be more active and maintain a healthy weight. Do whatever exercise you enjoy, and do it most days of the week. • Make time to relax. Try reading, music, meditation tapes or yoga.• Paula Mee is author of Dietary Management of Irritable Bowel Syndrome – where does the evidence stand? A copy of the report is available on www.paulamee.com. The report was supported by Flahavan’s. Porridge is a low-FODMAP food. Paula Mee is a member of the INDI.More Info
To find our more, see www.indi.ie, the website of the Irish Nutrition and Dietetics Institute.
Even imagining the symptoms is enough – diarrhoea and/or constipation, abdominal pain or discomfort, nausea, bloating and/or distension, flatulence, not to mention always worrying that you’re near a toilet. It’s enough to sap the joy out of anyone’s day.
“IBS can be very debilitating,” says dietitian, Paula Mee. “Many people avoid social situations because of embarrassment around symptoms, so it does have a big impact on their lives.”
Irritable Bowel Syndrome is a functional gastrointestinal disorder and the symptoms vary from person to person. It mostly affects women in their 20s and 30s, but the cause of IBS is not known, she says.
“We do know, however, that IBS can develop after a gut infection or after the use of antibiotics. Certain types of bacteria being present in the gut are thought to play a role. We also know that stress can exacerbate it.”
75% found it effective
Taking a good medical and diet history is vital when a person with IBS visits a dietitian seeking this treatment.
“It’s important to determine what the most prevalent symptom is for each patient, because that’s how your treatment outcomes will be designed in relation to the new FODMAPS approach.”
The low FODMAP diet originated in Australia at Monash University in Melbourne. Irish dietitians are now being trained in this approach in King’s College, London.
The success rate of the diet is high, Paula Mee says.
“75% of IBS sufferers who have followed the diet under the supervision of a dietitian have found it effective in alleviating symptoms,” Paula says. “Before FODMAPS, we had limited success in treating patients with IBS, but now we have this evidence-based programme. It is really a management programme. You can’t cure the condition, but being symptom-free can change people’s lives.”
FODMAPS
FODMAPS refer to carbohydrates that are not absorbed well by the small intestine.
The term stands for Fermentable Oligosaccharides (fructans and galactans), Disaccharide (lactose) and Monosaccharides (fructose) and Polyols – the group of molecules in foods that are poorly absorbed.
Instead, these carbohydrates are fermented by bacteria in the colon (the large intestine). This fermentation process generates the gas that causes the symptoms of pain, distention and bloating.
FODMAPS are found in common, healthy foods like wheat, apples, rye, pears, peas, mushrooms, onions, milk and yoghurt, as well as in some stone fruits.
What the diet involves
“The diet involves an elimination phase and a food re-introduction phase.”
“This is why it is important that you’re supervised when on this diet,” Paula Mee adds.
“It involves a reduction in peas, beans and lentils, which really are very nutritious foods and we’d like people to be eating them if they could.
“Obviously, there is a reduction in things like dairy initially too, but these foods contain a myriad of nutrients like calcium and micro nutrients that are important for bone health, so in the long-term, we don’t want people excluding such foods.
“The elimination period lasts for six to eight weeks. Then the person comes back and over the next few weeks the FODMAP foods are re-introduced in a very systematic way – one at a time, with a space of three days afterwards to see whether symptoms have come back because that food has been reintroduced.
“If they are symptom-free three days after reintroducing a new food, they move on to the next fodmap and see whether they can reintroduce that food again.”
Dangers of not being supervised
Following this diet based on just random information from the internet is not a good idea, she says.
“We don’t know what success people will have by pulling random information off the internet because there are many problems.
“One of them is that they might be following a list of foods that are not really relevant to them.
“It’s important that they get the right type of list to follow, based on their dominant symptoms.
“Also, the systematic way of reintroducing foods back into your diet isn’t fully explained on the internet. Neither is the importance of challenging yourself with the foods and reintroducing them to see if they cause symptoms.
“If people feel good after the elimination phase, they often don’t want to reintroduce the foods – but that’s where we see potentially big problems with poorly-balanced diets down the line.
“Three visits are usually necessary, the first time for a medical history and the explanation of the elimination phase, the second consultation to be shown how to reintroduce the foods one by one in a systematic manner, and the last consultation to help you identify the triggers and then make sure that your diet is balanced by ensuring that there are replacement foods substituting the ones that are removed from the diet.”
Stress
“They don’t know exactly why, but stress can make IBS worse,” she says.
“People are living such busy lives now that we may not listen to signals from our bodies. One of the important things in terms of the treatment would be to manage stress effectively.”
Managing IBS
Diet and lifestyle changes can help reduce IBS symptoms, that’s according to the INDI (Irish Nutrition and Dietetics Institute). The following general tips can help:
• Eat regular meals: Include breakfast, lunch, evening meal and snacks, if desired, every day. • Avoid missing meals or leaving long gaps between meals. • Try to take time to sit down and relax at mealtimes. • Eat smaller meals and chew food well. • If symptoms are worse at night, avoid eating late.• Eat fruit and vegetables. Aim to have at least five portions of a variety of fruit and vegetables everyday.• Cut down on high-fat foods. Foods like butter, cream and creamy sauces, cheese, pizza, chips, cakes, biscuits, chocolate, pies, pastries and crisps can make symptoms worse in certain individuals. They are also high in saturated fat and should be limited to help you stay healthy and manage your weight.• Get enough fluid: Drink 1.5 to 3 litres of fluid every day.• Limit tea or coffee to three cups per day. • Limit other sources of caffeine such as energy drinks, cola drinks and chocolate. • Avoid fizzy drinks. • As a general guideline, your urine should be a pale yellow/straw colour if you are properly hydrated.• Reduce alcohol and keep to recommended limits. Avoid binge drinking.• Take a probiotic – these friendly or good bacteria may help IBS symptoms. You can choose probiotics in yoghurts, fermented milk drinks or tablet form. If you choose to try one of these products, include it daily for one month. If no improvements are noted, it may be worth considering an alternative brand.• Be more active and maintain a healthy weight. Do whatever exercise you enjoy, and do it most days of the week. • Make time to relax. Try reading, music, meditation tapes or yoga.• Paula Mee is author of Dietary Management of Irritable Bowel Syndrome – where does the evidence stand? A copy of the report is available on www.paulamee.com. The report was supported by Flahavan’s. Porridge is a low-FODMAP food. Paula Mee is a member of the INDI.More Info
To find our more, see www.indi.ie, the website of the Irish Nutrition and Dietetics Institute.
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