Trying to beat IBS Cut out cabbage and honey: It may have an indigestible name… but the FODMAP food plan stops symptoms in 75 per cent of cases
21:11 GMT, 14 July 2012
Sufferer: Actress Kirsten Dunst has IBS
Lenin is thought to have been a lifelong sufferer due to stress, and Hollywood legend Elizabeth Taylor was plagued by the condition. More recently, Spider-Man star Kirsten Dunst and supermodel Tyra Banks have admitted to having irritable bowel syndrome (IBS).
An estimated one in five Britons suffer from the embarrassing digestive problem, which carries a raft of distressing symptoms, including abdominal pain, wind and bloating, along with diarrhoea and constipation.
The precise cause of IBS is unclear, but stress and problems with the immune system or how gut muscles squeeze food through the bowel may play a part.
Now a new food plan being pioneered by UK dieticians is having life-changing effects in up to three-quarters of sufferers.
It’s not a catchy name but FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols, which – for the uninitiated – are types of carbohydrates that are not successfully broken down and absorbed by the small intestine.
Passing through to the bowel undigested, they are rapidly fermented by colonic bacteria, which draw in fluid and produce gas, significantly exacerbating IBS symptoms in susceptible individuals.
The new diet is low in FODMAPs.
FINDING THE TRIGGERS
Established treatments centre on trying to calm symptoms, with anti-spasmodic medications, adjustments in fibre intake, stress management or taking small, regular meals.
National Institute for Health and Clinical Excellence guidelines suggest that sufferers may also benefit from limiting gas-producing food ingredients, such as resistant starch (found in some processed and reheated food) and sorbitol (a sweetener found commonly in sugar-free chewing gums).
But as Sasha Watkins, a spokeswoman for the British Dietetic Association, explains: ‘Treatment for IBS sufferers is often limited, which is why the emerging success of the low-FODMAP diet – an approach that helps patients discover the precise foods that trigger their symptoms – is excellent news.’
TRIAL AND ERROR
Developed by a team at Monash University in Melbourne, Australia, the low-FODMAP diet has been shown to work in a placebo-controlled trial, and is more effective than all other previous dietary treatments for IBS.
It has also been successfully adapted in the UK by researchers at King’s College, London, and implemented at Guy’s and St Thomas’ NHS Foundation Trust in London.
Peter Irving, consultant gastroenterologist at Guys and St Thomas’, says: ‘I can now refer IBS patients for dietetic advice with a greater degree of confidence that their quality of life will improve.’
The precise cause of IBS is unclear, but stress and problems with the immune system or how gut muscles squeeze food through the bowel may play a part
Patients on the diet go for eight weeks without consuming any FODMAP-rich foods – which include honey, wheat, apples, pears and stone fruits (such as plums and peaches), along with the onion family and artichokes.
Traditionally ‘windy’ foods such as cabbage and beans must also be given up, as must polyol sweeteners (such as sorbitol, mannitol and xylitol), which are often added to sugar-free varieties of mint, chocolate and chewing gum.
EASY DOES IT
After the eight weeks are up – during which time the gut is rested and it is expected that symptoms will subside – the period of reintroducing the offending FODMAPs, group by group, begins.
The aim is for sufferers to discover which fermentable carbohydrates they are most sensitive to, and to identify their individual tolerance level so that they can plan a diet that suits them.
‘For example, to check tolerance to the “m”, or monosaccharide in the acronym FODMAP, people would start with a teaspoon of honey, which is very rich in the monosaccharide fructose, and build up gradually,’ says Sasha Watkins.
ASK THE EXPERTS
Heidi Staudacher, who delivers FODMAPs training to dieticians, says IBS sufferers should not try the plan without medical supervision. ‘Information on the internet or in books is often conflicting or out of date,’ she says.
‘Advice from a registered dietician – with whom patients are likely to need up to three one-hour sessions – is crucial for good results, and should be obtained after appropriate assessment by a GP or gastroenterologist.
An increasing number of privately registered dieticians are now offering FODMAPs advice costing 55 to 80 for an hour-long session.
Traditionally 'windy' foods such as cabbage (left) must be given up, along with honey, which is rich in FODMAP
GETTING OVER YOUR FEAR
Emma Carder, a FODMAPs-trained freelance dietician based in the North West, says: ‘In my experience, people require the most help after the elimination stage, when they can feel so much better that they are reluctant to start reintroducing foods.
‘But pinpointing any FODMAPs that can be tolerated and in what quantities is important because if people go on avoiding foods they don’t need to, nutritional deficiencies and food intolerances that weren’t previously a problem could worsen or develop.’
BEAT THE BLOATING
One patient to have benefited is teacher Sara Martinez, 28. Her symptoms began after a bout of acute gastroenteritis – sometimes a trigger for bowel irritability – during a volunteer trip to Kathmandu in Nepal.
She was referred to gastroenterologists, who confirmed a diagnosis of IBS and suggested she follow a low FODMAP diet.
Most primary care trusts do not fund dietician consultations for IBS, so Sara tried to do the diet on her own by researching the plan on the internet.
‘I stuck to eating chicken, rice and vegetables, and I noticed more regular bowel habits and a reduction in bloating and nausea,’ she says.
A SMALL PRICE TO PAY
‘I didn’t have my food list right – for example, I had still been eating watermelon, which I shouldn’t have done,’ adds Sara. ‘And I had been avoiding milk, which in my case I didn’t have to as previous medical tests had shown I wasn’t lactose-intolerant.
‘Now I’m doing the elimination phase in a more intelligent way and symptoms have lessened significantly. It’s been tough but worth it.’
Sara says she feels well-equipped to start reintroducing foods in a couple of weeks, when she will discover which trigger her symptoms. ‘Even if my diet ends up quite restricted, it’s a small price to pay to feel as well as I do now.’