Alex Gazzola and Julie Thompson RD are guest-blogging for us during IBS Awareness Month! The co-authors of IBS: Dietary Advice to Calm Your Gut will be writing each week with tips and advice for management of IBS.
IBS Part Three: Diet and Food
Symptoms of IBS are without doubt affected by what we eat and drink, and most patients would like dietary solutions to their problems, in preference to medication or other interventions, that we covered in last week’s blog.
Occasionally, changing your diet according to healthy eating guidelines can help with mild forms of IBS, and certainly not everyone needs to make drastic changes. Your doctor may have given you some simple suggestions when you were diagnosed.
First, it’s important to consider what we mean by healthy eating in practice.
The first principle of good nutrition is variety. Research shows many of us rely on just a few foods which we eat regularly, but we should eat a broad selection of grains, protein sources, vegetables and fruits to ensure we receive a wide collection of nutrients.
Freshly prepared meals, from whole ingredients, can be better for your IBS – but if you struggle to find time to prepare your own lunches and dinners, the stress of trying to do so may negatively impact your IBS, so compromises may have to be considered. Enlist the help of family members, if you can.
But so-called healthy eating may not always be helpful in IBS, and it’s important to discuss with a dietitian.
For a balanced diet, these are good targets to aim for:
Bread, rice, potatoes, pasta – at least a third of our daily diet should be complex, wholegrain starchy carbohydrates.
Fruit and vegetables – a third of our daily dietary intake.
Milk and dairy foods – a fifth of your intake: three portions a day.
Meat, fish, eggs, beans – also a fifth of your intake.
Foods high in fat and/or sugar – no more than 5% of your daily calories should come from sugar.
The Low FODMAP diet
The word FODMAP is an acronym. It stands for ‘Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols’.
These represent four groups of simple sugars or carbohydrates, all of which occur naturally in plant and dairy foods to varying degrees, and which in some people can cause gut symptoms.
The low FODMAP diet plan was developed by a team of researchers from Monash University in Australia. Research shows the diet offers benefits for around 70% of those with IBS, but only in patients supported throughout by a FODMAP-trained dietitian.
The diet is complex, and should not be undertaken lightly. The temptation to go it alone may be strong – especially if you are impatient for a solution – but failure is far more likely if you attempt it without professional support, which may put you off trying again in future, and may also have longer-term consequences.
The diet itself begins with an elimination (or restriction) of all high FODMAP foods for 4-8 weeks.
This must be followed by a re-introduction in stages – where foods are individually reincorporated, each over the course of three days, in increasing quantities – to identify intolerances and personal threshold tolerance levels to various foods.
This is where specially-trained dietitians are needed. It is important to consume FODMAP-containing foods to the point of tolerance, for the importance of the health of the gut bacteria. Dietitians also have access to up-to-date FODMAP contents of foods; many of the resources online are unreliable.
If you have IBS and believe a FODMAP-moderated plan could help, speak with your GP. Referrals can be difficult, in which case you may like to work with a dietitian privately. The British Dietetic Association can also advise. See freelancedietitians.org and bda.uk.com.
Next week, we’ll look at The Future of IBS.
Alex Gazzola is a journalist and author who has been specialising in gut health and food sensitivities for over a decade. He writes widely for the national and international press, and is author of several books, including Coeliac Disease: What you need to know, and Living with Food Intolerance, both for Sheldon Press. Julie Thompson is a registered dietitian with a specialism in inflammatory and functional gut disorders and ‘free from’ diets for food intolerances and allergies. She is an adviser to the IBS Network and runs the Calm Gut Clinic.