IBS is a common condition and it affects approximately four million people in the UK. It is a chronic, relapsing and often life-long condition and people suffer from significant symptoms including abdominal pain, bloating and an overwhelming sense of lethargy.
As a dietitian, IBS has been a tricky condition to treat in the past due to lifestyle factors and a lack of robust evidence. This has now changed with the development of the low FODMAP diet. This diet targets short chain fermentable carbohydrates (oligo-saccharides, di-saccharides, mono-saccharides and polyols, FODMAPs) and is revolutionising the world of IBS. Supported by science and advised by dietitians, it's been shown to significantly improve symptoms by 75%. It entails avoiding foods high in these fermentable carbohydrates for up to eight weeks and introducing them systematically after this exclusion period. After this time, you begin the re-introduction phase, to identify foods that trigger symptoms. Whilst these foods will not damage the gut, they will trigger symptoms in people.
As a specialist dietitian with extensive clinical experience, I successfully treat numerous people with this approach and I am fully aware of the challenges it holds. Sharing a successful client story highlights this for many.
Working and living in London, Tanya presented to her doctors with stomach pain, bloating and a change in bowel habit. She underwent myriad investigations, all of which were unremarkable and was given a diagnosis of IBS. Before starting the FODMAP diet, Tanya said that she 'experienced several episodes of burning in my bowels, very irritable bowels and a general discomfort including headaches and lack of concentration at work. I was always worried about eating the wrong food and of not being in control of my wellbeing. Every time I experienced some symptoms I tried to avoid alcohol and ate mainly rice, vegetables, fish and chicken but the relief was never immediate and I always had the feeling I was eating something wrong and that anything could cause the symptoms. Sometimes my bowels burnt even after drinking tea or water.'
After being recommended by a friend, she made an appointment to see me in clinic. After a full assessment I identified a high intake of high FODMAP foods. We discussed following a low FODMAP diet, what it involved, the challenges it held and the science behind the treatment. I provided Tanya with detailed dietary advice and meal ideas to ensure nutritional adequacy during the eight weeks. She reported a considerable reduction in symptoms and improvement in her quality of life: 'I am now able to considerably reduce my symptoms by avoiding the food that can trigger them. My feeling of wellbeing has improved as well as my general level of energy and concentration'.
The treatment isn't without its challenges and meal repetition and flavour fatigue is common. This coupled with limited cookery skills and lack of time can make the diet challenging to follow, although we know compliance rates are high. The development of recipes and cookery books are on the increase and designed to support clients with this. When asked if Tanya thought it was worthwhile despite its challenges, she replied: 'Absolutely, the first part of the diet was very manageable and I was able to follow it properly. It requires a lot of discipline and I had to considerably adjust my social life which includes regular meals and drinks out.'
Whilst, the FODMAP approach provides relief in symptoms for 75%, it's important to note is has little effect for some and people shouldn't be given expectations of a 'cure' as intermittent symptoms will remain. It also affects our gut bacteria so it's essential that the second phase of treatment is followed for long term gut health.
A final word from Tanya: 'Overall, I think it's challenging, but worth it to find the various intolerances. In my case after having understood what food can trigger my symptoms I feel more in control and able to avoid any recurrence.'
For more information about IBS, visit www.myprivatediet.com
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