Free From Heaven 

Results have shown that in around 70% of people with IBS, a low FODMAP diet has resulted in a reduction in symptoms. The British Dietetic Association (BDA) recommends that low FODMAP dietary advice can be considered as second line advice which should be Dietitian led. However, there are a whole host of other considerations to be aware of before turning to this diet alone for effective relief and self-management of IBS.

Understanding IBS

With IBS affecting between 10-20% of people living in the UK (around 12 million people) at any one time, better understanding of the condition and ways to manage the symptoms is needed.

IBS is a long-standing illness consisting of frequent abdominal discomfort and bowel symptoms which cannot be explained by any other disease. Symptoms can be complex and conflicting and can include one or a combination of constipation, diarrhoea, abdominal cramps and pain, bloating, changes in bowel movement and frustrated defaecation. It can lead to feelings of isolation and major problems in people’s working and personal lives.

With wide variations in symptoms experienced, diagnosis is often a difficult and lengthy process. However, IBS should be diagnosed by a qualified practitioner. Doctors will carry out a medical history to identify any ‘Red Flag’ indicators (see www.theibsnetwork.org/have-i-got-ibs/could-it-be-anything-else/) and screen other conditions, such as cancer.

Overcoming IBS…

IBS is a debilitating illness that has no specific cause, no distinctive pathology and no single effective treatment. People with IBS tend to have a sensitive gut, with symptoms triggered by diet and/or lifestyle.

…through diet

People with IBS usually find that eating can trigger their symptoms, but it’s often difficult to identify what component, if any, of the meal may be responsible. In many cases, it may be the act of eating, what it represents or just eating in a rush that is upsetting the gut.

For others, certain food and drink may exacerbate their symptoms, such as fizzy drinks, dairy, gluten, fatty foods, onions, garlic, and some fruits. The national charity which supports people with IBS, The IBS Network offers comprehensive diet advice on its website as well as simple, recipes that are low in fat, low in FODMAPs, low in insoluble fibre and do not contain hot spice or other food substances known to upset a sensitive gut. 

Making the right dietary changes can often help IBS symptoms – and these can be quite simple. Before doing so, it’s important that IBS is diagnosed by a doctor and any diet changes discussed with a Registered Dietitian to ensure that other conditions, such as coeliac disease don’t go undetected.

Encouraging the use of a food diary will help show any patterns where symptoms may be worse. If you are struggling to make changes or are losing weight as a result of dietary restrictions, you should speak to your doctor or dietitian.

…through lifestyle

For people diagnosed with IBS, it’s worth considering physical activity levels and psychological well-being. Many people with IBS discover that their bowels seem to function like an ‘emotional barometer’, indicating how they feel about what is going on in their lives. Emotional tension always makes IBS worse. Anxiety, frustration, despair can all tie the guts in knots. Being aware of this is an important starting point.

Seeking advice on how to manage stress and anxiety, whether through adapting work/life balance, counselling and psychotherapy services, or complementary therapies, can be useful. This may be partly due to the alleviation of an underlying depression and partly because of a direct effect on pain pathways in the gut. Anxiety and depression can make people more sensitive to pain and can upset the bowels.

Tips from The IBS Network to help manage IBS symptoms:

• Try to understand what situations bring on your symptoms and how you feel at those times.
•  Make time for meals. Sit down, relax, and enjoy eating with others, if possible. Avoid eating on the go!
•  Keep a food diary. Know which foods are most likely to worsen your symptoms and reduce your intake of these.
•  Eat three regular meals a day at the same times and roughly the same portions.
•  Always leave enough time to relax on the toilet. The bowel never works well under pressure. Make sure your toilet is warm and comfortable.
•  Try to keep active and get enough exercise. This will make you feel better and also help your bowels.
•  Avoid meals rich in fat and restrict your intake of poorly absorbed carbohydrates.
•  Lead a balanced life and aim to reduce stress as much as possible. Take time out for yourself to relax and do things you enjoy. 
•  Go and see your doctor if you notice any blood in your stool or if you have unplanned weight loss.
•  Ask The IBS Network for advice, support and information on any aspect of your condition and consider becoming a member of the national charity which helps people living with IBS.

What is a FODMAP diet?

FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) are a collection of poorly absorbed simple and complex sugars found in a variety of fruits and vegetables, milk and wheat. Restricting foods that contain significant amounts of fermentable carbohydrates can make a big difference to IBS symptoms. FODMAPs don’t cause IBS, but they can trigger symptoms of the condition in a sensitive gut such as bloating, abdominal pain
and diarrhoea.

The diet has three stages:

1. Restriction
2. Reintroduction
3. Personalisation.

Stage 1 should only be followed for 4-8 weeks. Continuing longer may have a negative effect on your gut bacteria and may unnecessarily reduce the variety of foods you are consuming. It is recommended that anyone following this diet, does so under the guidance of a Registered Dietitian.

Key points

IBS is a complex, long-standing illness which is often difficult to diagnose and debilitating to live with. Through a better understanding of the potential triggers, whether linked to diet, lifestyle, stress or other factors, and knowing therapies and changes to make, people can live well with the condition.

For more information and support on managing IBS symptoms, visitwww.theibsnetwork.org