Irritable Bowel Syndrome (IBS) is a condition of the gastrointestinal system, which typically presents with symptoms of:1,2
IBS affects approximately 1 in 7 adults.1 The cause is unknown, however triggers such as stress, infection, change to routine and diet are known to contribute to symptoms.2 The triggers that affect each person is different and therefore the treatment plan varies for each individual.
It is critical that you do not self-diagnose IBS. Medical investigations are required to rule out any other causes of symptoms such as coeliac disease or inflammatory bowel disease, BEFORE any dietary changes are made. If you think that you may have IBS, make an appointment to see your GP.
The Role of FODMAPS in IBS
The acronym FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols.1 This is just the technical term for ‘fermentable sugars’. These sugars are ingested in food, and normally digested and absorbed in the small intestine. In people with IBS however, these sugars are malabsorbed in the small intestine, and travel into the large intestine. Here they are fermented by bacteria in the gut, producing gas which contributes to symptoms of bloating, abdominal distension, cramping and excessive wind.1 These small molecules of sugar also exert an osmotic effect on the gut, where they cause a large influx of water into the gut, causing diarrhoea.1
There are several different classes of FODMAPS:1
Some FODMAPS are malabsorbed by everyone, while others only affect some. Fructans and GOS for example are malabsorbed by everyone, as humans do not have the enzymes to break these sugars down.1 Baked beans fall under this category for example, which is why they have the reputation of causing excessive wind!
Breath testing can help determine if Lactose, Fructose and Sorbitol contribute to your symptoms, however breath testing is not absolutely essential. With the help of a dietitian, you should be able to determine through a process of elimination and food challenge, which FODMAPs affect you.
The Low FODMAP Diet
So we know that FODMAPs may be contributing to IBS symptoms, but what do we do about it? The Low FODMAP Diet is the only evidence-based dietary therapy for the management of IBS, and is effective for approximately 70% of people with IBS.1 It is important to note that the aim is for symptom improvement, not complete resolution as this is very rare.
The Low FODMAP Diet consists of 3 phases.1
1. Elimination Phase:
2. Reintroduction and Challenge
3. Determining Tolerance Level
At present, there are no studies to suggest that ‘cheating’ on the Low FODMAP Diet causes any damage to the body. Symptoms may be triggered but that’s it.3
The role of a Dietitian
It is recommended that you undertake the Low FODMAP Diet under the guidance of an Accredited Practising Dietitian. Your dietitian can guide you through each stage of the plan, while ensuring that you are eating a balanced diet and not over-restricting your diet unnecessarily.
Low FODMAP Resources
There is lots of information available on the Low FODMAP Diet – some reliable and some not so. The following resources will help you ensure you are gathering reputable information. Your dietitian is also a critical resource and can answer any questions and help explain all aspects of the diet.