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The Low FODMAP diet – the scoop on advances in treating irritable bowel syndrome

Emma Stirling APD

It wasn’t that long ago that sufferers of a regular ‘upset tummy’ or ‘grinding guts’ were told simply to learn to live with it or ‘stress, less’. Today however, irritable bowel syndrome (IBS) is a recognised condition with some highly technical diagnostic and therapeutic approaches including the Low FODMAP diet.

It’s estimated that as many as one in seven adults have IBS with common symptoms including abdominal bloating, wind, abdominal pain and changes in bowel habits such as diarrhoea, constipation or a combination of both. Symptoms of IBS can be caused by physical problems like altered gastric motility or the muscle contractions that occur in your gut. However, there are now clearly identified dietary triggers in many, but not all people with IBS.

Food culprits Dietary triggers that may induce symptoms of IBS can include naturally occuring food chemicals (eg. salicylates, amines, glutamates), gluten, caffeine, excess fat and excess alcohol. Attention has recently been drawn to new scientific research showing that poorly absorbed, small, carbohydrate molecules (sugars) in foods can also be a major cause of symptoms. These are given the technical term of FODMAPs, which stands for Fermentable Oligo-saccharides, Di-saccharides, Mono-saccharides And Polyols. So you can see why an acronym was needed.

FODMAPS can trigger a number of unwanted symptoms in people with IBS. Firstly they can increase the amount of water in the bowel and lead to diarrhoea. They also can be poorly absorbed in the small intestine and then fermented by bacteria in the large bowel, which releases gas. These gases can build up in people with IBS and cause bloating, abdominal pain, wind and changes to bowel habits.

Testing times The good news is that with all this new dietary research, comes a whole new set of diagnostic tests including breath testing. Like a glucose tolerance test, you swallow a measured amount of sugars. But instead of blood samples, you breathe into a breathalyser like bag after an assigned time. The gases produced from malabsorption of FODMAPS are absorbed across the intestine, carried through the bloodstream to the lungs and can be measured in exhaled breath. You can read more about breath testing here.

Where to find FODMAPS:

• Excess fructose – fruits, honey, juices
• Lactose – milk and milk products
• Sugar polyols – such as sorbitol and mannitol
• Fructans – found in foods like wheat, rye, onions and garlic
• Galacto-oligosaccharides – found in foods like legumes

Wait just a minute though. Before you go skipping off to cut down on fruit or dairy, you need to see an expert. And if you are on the FODMAP diet it’s even more important to make sure the starchy foods you eat are low GI ones like grainy breads, muesli and low GI starchy veg like carrots, butternut pumpkin (winter squash), parsnips and Carisma potatoes.

Where to get help? It’s important to talk to your doctor if you experience gastrointestinal symptoms and not self-diagnose. There are many other gastrointestinal conditions and diseases including coeliac disease, inflammatory bowel disease and bowel cancer that need proper investigation.

It’s essential to see an Accredited Practising or Registered Dietitian in order to correctly follow the low FODMAP diet and still achieve nutrition balance for well-being, especially if you have other considerations like type 2 diabetes. In Australia, many dietitians work with a handy booklet developed by the expert team, at Monash University. The Low FODMAP Diet – reducing poorly absorbed sugars to control gastrointestinal symptoms is available to order using this form. And we’ve got a low FODMAP recipe from the book this month, suitable for all to enjoy, even if you swear you’re not irritable.

Emma Stirling is an Accredited Practising Dietitian and health writer with over ten years experience writing for major publications. She is editor of The Scoop on Nutrition – a blog by expert dietitians. Check it out for hot news bites.