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How to ease symptoms of IBS and endometriosis with the right diet

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Diets low in fodmaps are a saviour for people with irritable bowel syndrome and endometriosis, helping to manage the gastrointestinal symptoms of both conditions.

Fodmaps – the word stands for fermentable oligo-, di- and mono-saccharides and polyols – are a group of short-chain carbohydrates that share a number of properties. First, they draw water from the body into the gut, and second, they’re rapidly fermented by the bacteria in the colon that produce gases. Eating a lot of them can lead to bloating, pain, discomfort, wind and diarrhoea or constipation in susceptible people.

It’s long been recognised that bowel symptoms are a common feature of endometriosis and irritable bowel syndrome. That led New Zealand researchers to test a low-fodmap diet on women who had both conditions. Nearly three-quarters reported that the diet eased their symptoms.

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But low-fodmap foods can be hard to identify. A dietician can guide you through the initial restrictive period of eliminating high-fodmap items. They can then help with the process of reintroducing foods to find your tolerance level for the various fodmap groups.

Melbourne’s Monash University has developed an excellent smartphone app for checking food’s fodmap status. Its traffic-light system shows a green, orange or red light depending on whether a particular food contains little, some or a lot of fodmaps.

Not all products on shop shelves have been tested for fodmap content, so it’s a matter of extrapolating the results from one product to other similar items. That means you’ll have to experiment to some extent with new products to see how well you tolerate them.

As expected, a quick check of wheat breads sets off an array of red lights, thanks to the oligosaccharides (fructans) in the wheat. However, as you’ve pointed out, sourdough bread gets a green light as it is lower in oligo-fructans since they are broken down during fermentation.

Interestingly, both white and wholemeal wheat sourdough are green-lit for low-fodmap content. So, if you’re wanting to boost your fibre intake, higher-fibre wholemeal sourdough is fine. Spelt sourdough also has more fibre than the white variety, although some loaves may be unsuitable. For example, the Monash app detected a high level of fructose in one US brand of spelt sourdough, which triggered a red light.

From a health perspective, the normal daily fibre intake recommendation is 25-30g. As a general guide, two slices of gluten-free white bread provide about 4g of fibre, two slices of gluten-free multigrain bread have about 6g and two slices of spelt have 5g.

Other sources of dietary fibre in the cereals food group that should be fine on a low-fodmap diet include brown rice (2g per cup), white rice (2g per cup), quinoa flakes (5g per ½ cup), porridge (3g per cup) and gluten-free pasta (2g per cup).

Add to that the recommended five-plus daily servings of fruit and vegetables and you should make a good dent in your daily fibre goal. You’ll get 5g and 3g of fibre from two small kiwifruit and two small mandarins, respectively. And remember, you can boost the fibre provided by fruit and vegetables by leaving skins on. A potato with its skin on supplies 3.5g of fibre, for example, whereas the same potato peeled has just 2.5g.

This article was first published in the September 8, 2018 issue of the New Zealand Listener.