Food to go

by Jennifer Bowden / 17 July, 2010
How three women with IBS made small changes to their diet to great effect.

'I've had problems with irritable bowel for at least 30 years. It's like a way of life," says Sandra Dent, a busy working Wellington wife and mother. "I'd be dashing to the bathroom halfway through a meal," says Dent, or "it'll hit me in the middle of the night, so I can be up with absolutely griping stomach pains for a couple of hours until I have diarrhoea ... and then I'm washed out the next day."

Dent has visited naturopaths, homeopaths and GPs over the years in her so-far-unsuccessful quest to resolve irritable bowel syndrome (IBS). When her symptoms began to escalate recently, that quest became more urgent. "I thought there was something seriously wrong with me. I was in so much pain, it was throwing me out of bed, doubled over," says Dent, who likens the agony of some IBS attacks to the early stages of childbirth. Dent even carries Imodium tablets in her handbag for fast relief of diarrhoea in emergencies.

A gastroenterologist appointment and colonoscopy earlier this year confirmed Dent's bowel was healthy and normal, but provided no solutions for her chronic IBS symptoms.

However, just before her specialist appointment, Dent's father had shown her a Listener article about how low-Fodmap diets could resolve IBS symptoms. Dent asked her gastroenterologist about trying the low-Fodmap diet. "He pooh-poohed Fodmaps to me," says Dent, who was nonetheless determined to try the low-Fodmap diet, and contacted Wellington-based dietitian Sarah Elliott, from Food Savvy.

Fodmaps is an acronym for Ferment­able Oligosaccharides, Disaccharides, Monosaccharides and Polyols - a group of small carbohydrate molecules that some people don't digest properly. When Fodmaps aren't digested properly they travel into the large intestine where bacteria ferment them, producing gases that cause bloating, abdominal pain, cramps, ­diarrhoea and/or constipation.

In 2008 Australian researchers published, in Clinical Gastroenterology and Hepatology, findings from their randomised clinical trial showing that a low-Fodmap diet significantly reduced symptoms in a large proportion of IBS sufferers. Unfortunately, their landmark research isn't yet widely recognised by the medical fraternity.

Dent trialled a low-Fodmap diet under Elliott's guidance and within weeks was feeling significantly better. The initial diet involves avoiding the five key groups of Fodmaps commonly found in our diet. Examples of foods include (but are not limited to):

excess fructose - apples, pears, mangoes, fructose sweeteners, honey, dried fruit and fruit juices;

lactose - dairy milk and products;

fructans - wheat, onion, garlic, leeks, cabbage and brussels sprouts;

galactans - legumes such as chickpeas, kidney beans, baked beans; and

polyols - apples, pears, stonefruit, watermelon, avocado, mushrooms and sugar-alcohol sweeteners such as sorbitol and xylitol.

After a four- to six-week low-Fodmap diet trial (to check whether the IBS symptoms improve), different groups of Fodmap-containing foods are gradually reintroduced to determine whether patients can tolerate small or larger amounts or none at all, as not everyone has a problem with all five groups. The dietitian's goal is to create a nutritionally balanced diet that isn't too restrictive.

Dent has now learnt which foods ­trigger her IBS symptoms. "There are certain things that I completely avoid now, like apples, pears and stonefruits", and other foods, like wheat, are simply limited to avoid triggering IBS symptoms.

Auckland businesswoman Rachel Jones (not her real name) struggled with IBS for over 15 years. "It's really difficult because you tend to plan your life around it, because when you've got to go, you've got to go."

Doctors recommended Jones trial a low-dose antidepressant to resolve her IBS symptoms, an option that didn't appeal to her and left her feeling increasingly annoyed. "I thought I was eating the right foods so I didn't think it could be that, and I was getting really frustrated."

Earlier this year Jones was excited to read about the low-Fodmap diet, "I was reading [the Listener] one morning and was like 'oh, my God, I've got to try this!" Jones emailed dietitian Elliott immediately and completed a number of tele­phone consultations with her.

Jones's IBS symptoms started to improve within weeks of commencing the low-Fodmap diet. "It was really exciting", but she was surprised to learn that many so-called healthy foods in her diet were triggering her IBS symptoms. "I always had a black tea with a teaspoon of honey in it ... three or four times a day. I'd read somewhere in the past that manuka honey was really good for the digestive system." Unfortunately, honey is also a source of excess fructose, and for those people sensitive to fructose-rich foods it can trigger IBS symptoms.

Jones also discovered that sorbitol, the artificial sweetener commonly found in many sugar-free gums, was triggering her IBS. "I used to chew gum while I went for a run in the morning, and I wondered why I was sort of sick all the time after running." With the benefit of hindsight, and her new Fodmap education, she quickly realised the chewing gum was the cause.

Indeed, being shown lists of Fodmap-containing foods is often a revelation for IBS sufferers. "I could look at the list and tell you what was going to make me feel bad," says Jones, who consequently declined to even try reintroducing certain Fodmap-containing foods like artificially sweetened gum.

Christchurch grandmother Lesley Evans already had a fair inkling that her IBS symptoms were food-related. So after reading about the low-Fodmap diet, she contacted Christ­church-based dietitian Julie Leeper, from Dietary Specialists, and started a six-week low-Fodmap diet trial.

"After a few days I saw some improvement in the symptoms very clearly and it got better and better," says Evans, who by the six-week mark was stable and "felt normal again". She is now gradually reintroducing Fodmap-containing foods to determine the culprits. An avid milk drinker, she was thrilled to discover that dairy products caused her no problems. Unfortunately her favourite stonefruit, peaches, didn't make the cut.

But although she misses peaches, she doesn't miss her early morning sprints to the toilet. And if she follows her low-Fodmap diet correctly, her gastrointestinal health is "very good". What's more, Fodmap-experienced dietitians can find tasty, nutritious food alternatives for Fodmap-containing foods that must be avoided.

Evans, Jones and Dent all wholeheartedly recommend that fellow IBS sufferers trial the low-Fodmap diet. Evans says it's "definitely worth looking at seriously". Says Jones, who is relieved to not feel tired and sick all the time, and to finally be able to eat foods that make her feel good: "I'd really encourage people to try it, because I have experienced some pretty good results from it - you can't do any harm by trying."

Dent's husband has a different view on the topic. "My husband said to me, 'We should have discovered this 30 years ago - it would have saved an awful lot of money on meals!" Still, at least she can sit through an entire restaurant meal with her husband now. And hopefully one day soon she'll feel confident enough to leave the Imodium tablets at home.

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