Do you have ongoing altered bowel habits such as diarrhoea, constipation or a mixture of both?
Does your stomach bloat or the sides of your belly expand some days?
Do you experience wind, gas, pain or discomfort in your gut?
Do any of the above symptoms impact your daily lives?
If your answer is yes, there is a possibility that you are experiencing a functional gastrointestinal disorder known as Irritable Bowel Syndrome (IBS). While IBS is not detrimental to health it can significantly impact your quality of life.
It is important to speak with a Dietitian who has had experience with IBS management as some of these symptoms are similar in diseases such as inflammatory bowel disease, coeliac disease, diverticular disease, endometriosis, intestinal cancers and many others. Self-diagnosis and or misdiagnosis can delay proper treatment and even be detrimental especially if the symptoms are signs (red flags) of a disease.
Hence before going down the complex IBS pathway ; it is important to first eliminate the possibility of disease by being screened for ‘red flags’. Next a thorough assessment must be carried out to identify if the symptoms are caused by trigger foods or other factors such as lifestyle habits, stress, strenuous exercise and even medication.
Trigger foods like caffeine, fatty foods, alcohol, spicy foods and or excessive fluid intake should be considered prior to the implementation of the ‘Dietitian led’ FODMAPs elimination diet also known as ‘phase 1’ of the Low FODMAP diet.
FODMAPs is the acronym for Fermentable Oligosaccharide, Disaccharide, Monosaccharide, And Polyols. The Low FODMAP diet can become quite restrictive and should not be used long term. It is also not possible to adhere to the diet long term as this would mean not eating some of your favourite foods or only being able to have very small doses of them. It is necessary to identify which of these fermentable carbohydrates is/are causing your symptoms and to find your individual threshold of tolerance (again I iterate) with the help of an experienced Dietitian; otherwise this will impact your quality of life due to ongoing gut symptoms or cause poor gut health as some of these FODMAPs are also required to keep your gut environment healthy or even cause nutrient deficiencies long term due to self-implemented food restrictions leading to inadequate intake of important food groups such as dairy and wheat.
It is therefore crucial to move to phase 2 of the diet which is to slowly re-introduced high FODMAPs into the diet to identify the fermentable carbohydrates (culprits) that are causing your gut symptoms. Once the problem carbohydrates are identified and thresholds are studied, the Dietitian will then be able assist you with diet modification to prevent frequent flare ups and unnecessary food avoidance and restrictions.
An important thing to note is that breath tests to identify malabsorbed fermentable carbohydrates such as, fructose, sorbitol and mannitol naturally found in food is not a reliable method to determine if you have IBS as the test (carbohydrate) dosage used are not a good representation of what an individual’s daily consumption is among other clinical factors. The lactose intolerance breathe test may have some value but your gut microbiota (microorganisms) does change and hence your threshold of tolerance can change.
It must also be considered that sometimes, it could be a case of simply limiting the frequent consumption of some very high FODMAPs foods to improve symptoms or that the elimination diet may not improve gut symptoms and other factors will then have to be investigated in place of the re-challenge phase. For example, chemicals in food may be explored together with the Dietitian (this can get extremely restrictive) or a combination of stress, and FODMAPs may be triggering symptoms or even strenuous exercises which would require a referral to other allied health professionals.
Take home message
If you have gut symptoms that impact your quality of life, make time to schedule an appointment with a Dietitian who practices in gut health and complete the process without quitting halfway.