Irritable Bowel Syndrome (IBS) affects about one in five of us, so if you suffer from any of its symptoms – stomach pain, bloating, gas, diarrhoea or constipation – don’t feel alone.
The exact cause of IBS is not known, but research has found that it is likely to be a combination of different factors, including hypersensitivity to the amount of gas or food in the gut, strong bowel contractions and, simply, your genetic make-up. Stress has also been associated with IBS.
What is not so widely known, however, is that by eliminating a group of foods called Fodmaps, you can tackle IBS quite effectively.
New research from Monash University in Australia shows that following a low Fodmap diet can improve intestinal comfort and function in 75 percent of all those who follow the diet.
So what are Fodmaps?
The acronym stands for “fermentable oligo-, di-, and monosaccharides and polyols” which are the short chain carbohydrates and sugars that are poorly absorbed in the small intestine.
They include fructose (fruit sugar), lactose (sugar in milk), fructans and galactans (groups of carbohydrates in some fruits and vegetables), and sugar alcohols (artificial sweeteners).
They travel down to the large intestine or colon, where they are fermented – releasing gas. Thus the flatulence and feeling of being bloated.
High levels of Fodmaps are found in foods which would ordinarily be considered healthy – fruits such as pears, apples, peaches, plums and other stone fruit as well as vegetables such as onions, broccoli, sprouts, cabbage and spring onions.
“In IBS sufferers, the increased volume of gas, bacteria or food exerts pressure on the intestines, causing the pain, bloating and altered bowel habits in sensitive individuals,” explains registered dietitian Jane Bentley from the Health & Lifestyle Consultancy.
The tricky part of this is that every IBS sufferer is different, with some more intolerant of some Fodmap foods than other Fodmap foods.
“Fructose (found mainly in fruits and fruit products, honey and sweeteners) may or may not be well absorbed in IBS sufferers. Between 45 and 80 percent of IBS sufferers have been found to mal-absorb fructose. And absorption varies for the sugar alcohols,” says Bentley.
The same applies to lactose (found in milk, yoghurt, and soft cheese).
“Tolerance of lactose is variable, depending on ethnicity and environmental factors. Most people can tolerate up to the equivalent of half a cup of milk at one sitting,” says Bentley.
Cheeses such as cheddar, feta, mozzarella, brie and camembert as well as butter have only traces of lactose in them, and are generally well tolerated.
Lentils, chickpeas, red kidney beans and wheat are also problematic for IBS sufferers, because they are oligosaccharides (the O in Fodmaps), which are not broken down by the body at all, but rather fermented by bacteria in the intestines.
“These are nature’s prebiotics, which promote the growth of ‘good bacteria’ by providing a food source.
“They have been found to reduce colon cancer, and improve colon function, but the fermentation aggravates symptoms in people suffering with IBS,” says Bentley.
The P in Fodmaps, is for polyols (sugar-free sweeteners), which are present in stone fruit, apples, watermelon and mushrooms, but are mostly used as artificial sweeteners in both sweets, and medications.
Unfortunately, the cooking process doesn’t significantly reduce the Fodmap content in vegetables, so by now you’ll be wondering what there is left to eat.
Plenty, it turns out, as long as you stick to the rules of thumb – avoid rich, saucy food, and think soft fibre, which is found in porridges, grains and gluten-free pasta as well as a range of fruits and vegetables.
It’s also important to understand that each IBS sufferer is different and therefore not all Fodmaps foods should be excluded in every case. For a start, you need to be diagnosed an IBS sufferer – either by a GP or a gastroenterologist – as occasional bloatedness or excess flatus doesn’t mean you have IBS, and, in fact, is more likely to be related to the unhealthy meal you just ate.
Ria Catsicas, a dietitian at Nutritional Solutions, helps IBS sufferers to find which foods they tolerate better than others by trial and error, but cautions that a low Fodmap diet “is just one factor in a multifactorial condition that is very much lifestyle-based”.
She adds: “A common problem is a lack of fibre intake. Fibre is critical for good gut health, but a lot of people tend to live on poor fibre diets, including a lot of junk food, and not enough water. Stress and a lack of exercise exacerbate the problem.”
Catsicas explains that there is a difference between soft fibre (that expands in water) and roughage (that feels gritty in the mouth), which is best avoided if you’re an IBS sufferer. “The fibre to include is soft fibre,” she says.
This would include porridges, especially oats. Then there’s potatoes, sweet potatoes (without skins), rice, quinoa, buckwheat, fruits like banana, pawpaw, kiwifruit, strawberries, orange and grapefruit, and vegetables such as butternut, pumpkin, gem squash, carrots, beetroot, baby marrow and spinach (stewed).
A salad made from butter lettuce, peeled cucumber and tomato, carrots and avocado would be a meal with plenty of soft fibre.
Foods made from refined wheat flour often cause indigestion and aggravate IBS symptoms.
“Try to avoid all foods and products made from white flour, like white bread, brown bread and rolls, focaccia, tramezzinis, pizzas, pies, pastries, cakes, biscuits, muffins and croissants,” Catsicas suggests.
Wheat and rye-free bread, such as spelt or mielie bread, is the better option, and toasted bread is better to tolerate than fresh bread.
If you have a coffee habit, that also needs to be stopped or limited, in favour of water, ideally 4-8 glasses a day.
“Water is essential to ensure the contents of the colon are soft and high in volume,” explains Catsicas.
Coffee also acts like a laxative, increasing contraction of intestinal muscles, which can cause predigested food to travel into the intestine, triggering stomach cramps.
Lastly, don’t eat on the run, a habit of many stressed people.
“Optimal digestion starts with the secretion of enzymes in the mouth due to the smell and sight of food. It is important to relax while you eat. Try to eat slowly, at the table, and chew all your food well,” she says.
Bentley adds that while a low Fodmap diet is not a cure for IBS, “good relief is experienced by 75 percent of people with IBS”.
When working with clients, Bentley works out a strict diet plan for six to eight weeks, then she slowly increases the Fodmap content “to see where the tolerance levels are for various Fodmaps”.
Either way, you need Fodmaps to maintain your health.
“A strict low Fodmaps diet can result in nutritional deficiencies if followed too rigidly. It’s best to consult with a dietitian to help you achieve a healthy, nutritionally balanced plan,” she says.
IBS COMMON SYMPTOMS
Symptoms are individual and vary in severity.
* Abdominal pain, often relieved by passing wind or by bowel action (most common).
* Constipation (common)
* Diarrhoea (varies in severity).
* Stools are often small and “pellet like” and are passed only with straining.
* Mucus is often noted in the stools.
* A sense of incomplete evacuation is sometimes present.
SUITABLE ON A LOW FOODMAP DIET
* Fruit: Bananas, grapefruit, blueberries, grapes, honeydew melons, kiwifruit, lemons, limes, mandarin, oranges, pawpaw, naartjie, raspberries, spanspek, strawberries.
* Vegetables: Bamboo shoots, aubergine, carrots, celery, capsicums, corn, eggplant, green beans, lettuce, chives, parsnips, pumpkins, Swiss chard, spring onions (green part only), tomatoes.
* Lactose: Lactose-free milk, rice milk, “hard” cheeses, Brie and Camembert, lactose-free yoghurt, milk-free butter spread.
* Grain foods: Gluten-free bread/cereal products, 100 percent spelt bread, rice, corn, oats and polenta.
FOODS CONTAINING FOODMAPS
* Fruit: Apples, pears, plums, peaches, apricots, lychees, cherries, prunes, mangoes, tinned fruit in natural juice, watermelon, large portions of dried fruit.
* Vegetables: Artichokes, beetroot, asparagus, brussels sprouts, cabbage, fennel, garlic, leeks, okra, onions, spring onions (white part), shallots, mushrooms, avocado.
* Lactose: Milk (cow’s, goat’s and sheep’s milk), yoghurt, ice cream, cheeses (soft and fresh, such as ricotta, cottage).
* Grain foods: Cereals, wheat and rye when eaten in large amounts (bread, pasta, couscous, crackers, biscuits).
* Legumes: Chickpeas, lentils, red kidney beans, baked beans.
* The Health & Lifestyle Consultancy: See http://healthlifestyleconsultancy.co.za, from where you can post e-mail.
* Nutritional Solutions: Call 011 023 8051 or visit www.nutritionalsolutions.co.za site.