Do you have ‘tummy trouble’? About 15 per cent of the world’s population suffer from Irritable Bowel Syndrome (IBS), and it is much more common in women.
It’s not fun to talk about, and it’s easy to dismiss IBS as a trivial disorder. It’s not life-threatening, after all, but it has wide-ranging effects. It’s estimated about 30 per cent of IBS sufferers take sick leave because of it, and 50 per cent of those are absent from work for more than two weeks a year.
Symptoms of IBS include abdominal pain, altered bowel habits, bloating, constipation, diarrhoea and excess wind. As these symptoms can indicate other serious problems, it’s really important to get properly diagnosed if you think you may have IBS. Diagnosis can be a long road, as other causes are eliminated, and may involve not only your GP but also gastroenterology specialists. If there is no other cause found for your symptoms, it’s likely you have IBS. The question then becomes: what do I do about it? Is food a cause?
There is some really interesting emerging research on IBS, led by Australian dietitian and IBS expert Dr Sue Shepherd. It centres on substances known as FODMAPs. Many of the common (and healthy) foods we eat contain a variety of small, naturally occurring carbohydrate molecules. These molecules don't cause problems for most people, but some of us don't digest them well – leading to IBS symptoms. Collectively, these molecules are known as FODMAPs – Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. Catchy, isn’t it?
FODMAPs include fructose, a sugar which naturally occurs in fruits, honey and some vegetables. It’s thought that 30-40 per cent of IBS sufferers have trouble absorbing fructose. Lactose, the sugar found in dairy products, is another. Fructans, which naturally occur in wheat, onions and garlic, and polyols, which are in some artificial sweeteners and occur naturally in some fruits and vegetables, can also cause problems. Galactans are found in legumes, baked beans, kidney beans, chickpeas and lentils.
Identifying the particular FODMAP-containing foods that are problematic can be life-changing for IBS sufferers. Dr Shepherd has published several books on the topic, and has written an article on IBS for the June issue of Healthy Food Guide. She says “Research has found a low-FODMAP diet is very effective. But there's no need to restrict all FODMAP foods – just those which give you symptoms. In other words, if you're diagnosed with fructose intolerance, there may be no need to avoid lactose.”
Dr Shepherd says many people with FODMAP intolerances also find that symptoms are 'dose dependent', so you don't need to be as strict as someone with an allergy. “Rye and garlic, for example, contain fructans, but many people find they don't cause severe symptoms when consumed in small amounts. Similarly, people with fructose intolerance don't necessarily need to cut out all fructose from their diet – they simply need to avoid foods which contain more fructose than glucose.”
The web is a surprisingly good source of information on FODMAPs. We’ve published several articles in Healthy Food Guide on the topic, as well as recipes (search FODMAP on our website for articles). In our latest issue there’s a step-by-step guide to addressing IBS symptoms. If you’re serious about trying a low-FODMAP diet, it is a fantastic idea to get professional guidance from a nutritionist or dietitian, who will be able to guide you through the necessary elimination diet. You may find this cumbersome acronym is the key to solving your tummy trouble.